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Objective: To assess the evidence presented in a set of articles that use the Canadian Maternal–Infant Research on Environmental Chemicals (MIREC) study database to claim that community water fluoridation (CWF) is associated with harm to foetal and infant cognitive development. Methods: Critical appraisal of measurements and processes in the MIREC database, and articles derived therefrom. MIREC's cohort is approximately 2000 pregnant women recruited in 10 centres across Canada, 2008–2011, leading to measuring 512 children aged 3–6 years in six cities. Fluoride exposure was measured by city fluoridation status, self‐reports and maternal spot urine samples. Intelligence Quotient (IQ) was measured using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI‐III) by different assessors in each city. Results: MIREC's fluoride and IQ measurements are invalid and therefore cannot support the claim that CWF is associated with IQ decline in children. Conclusions: The MIREC fluoride‐IQ articles' results should be considered unacceptable for legal and policy purposes; other water fluoridation studies and systematic reviews show no effect of fluoridation on cognition. [ABSTRACT FROM AUTHOR]

Abstract: Early Childhood Caries (ECC) is prevalent around the world, but in particular the disease is growing rapidly in low‐ and middle‐income countries in parallel with changing diet and lifestyles. In many countries, ECC is often left untreated, a condition which leads to pain and adversely affects general health, growth and development, and quality of life of children, their families and their communities. Importantly, ECC is also a global public health burden, medically, socially and economically. In many countries, a substantial number of children require general anaesthesia for the treatment of caries in their primary teeth (usually extractions), and this has considerable cost and social implications. A WHO Global Consultation with oral health experts on “Public Health Intervention against Early Childhood Caries” was held on 26‐28 January 2016 in Bangkok (Thailand) to identify public health solutions and to highlight their applicability to low‐ and middle‐income countries. After a 3‐day consultation, participants agreed on specific recommendations for further action. National health authorities should develop strategies and implement interventions aimed at preventing and controlling ECC. These should align with existing international initiatives such as the Sixtieth World Health Assembly Resolution WHA 60.17 Oral health: action plan for promotion and integrated disease prevention, WHO Guideline on Sugars and WHO breastfeeding recommendation. ECC prevention and control interventions should be integrated into existing primary healthcare systems. WHO public health principles must be considered when tackling the effect of social determinants in ECC. Initiatives aimed at modifying behaviour should focus on families and communities. The involvement of communities in health promotion, and population‐directed and individual fluoride administration for the prevention and control of ECC is essential. Surveillance and research, including cost‐effectiveness studies, should be conducted to evaluate interventions aimed at preventing ECC in different population groups. [ABSTRACT FROM AUTHOR]

Objectives To review the effectiveness of adjusted fluoridation of public water supplies in the prevention of dental caries, with emphasis on results of studies published worldwide since 1990 and to discuss aspects of the design and reporting of these studies compared with those published before 1990. Method Studies published worldwide, in any language, reporting the effect of water fluoridation in terms of the dmf/ DMF caries index between 1990 and 2010 were examined. The literature search was by professional Internet search, back-tracking from references given in publications, hand-searching all issues of four journals and by contacting colleagues in relevant countries. For the dmf index, age 5 year was preferred, and for the DMF index, age 12 year or older was preferred. The results were compared with results obtained from worldwide literature search prior to 1990 by the same author. Results Fifty-nine studies of adjusted water fluoridation were identified, yielding 83 evaluations (30 recording dmft/s and 53 recording DMFT/ S) from 10 countries. These numbers are lower than pre-1990 results of 113 studies (66 for primary and 86 for permanent teeth) from 23 countries. For the USA, for example, four studies were indentified since 1990 compared with 61 studies before 1990. The most number of recent reports came from Brazil and Australia. There were fewer reports of per cent caries reductions (% CR) above 50% in the recent studies. 86% of the post-1990 investigations were concurrent control cross-sectional studies and, of these, 52% used multivariate statistical analysis to adjust for confounding factors. In the eight studies that provided dmf/ DMF data before and after adjustment for confounders, the % CR were little affected by these adjustments. Conclusions Fewer studies have been published recently. More of these have investigated effect at the multi-community, state or even national level. The dmf/ DMF index remains the most widely used measure of effect. % CR were lower in recent studies, and the 'halo' effect was discussed frequently. Nevertheless, reductions were still substantial. Statistical control for confounding factors is now routine, although the effect on per cent reductions tended to be small. Further thought is needed about the purpose of evaluation and whether measures of effect and study design are appropriate for that purpose. [ABSTRACT FROM AUTHOR]

Children aged 2, 4 and 5 years were examined for dental caries using WHO criteria, m the Emirate of Abu Dhabi, UAE, in 1996, The children were from the three administrative regions of Abu Dhabi, Al Ain and Western Region. Sampling of health centres and kindergartens was stratified by urban or rural location. Parents completed a questionnaire, and children were classified into high, middle or low groups on the basis of their parents' education and income. All 20 kindergartens and 22 health centres sampled agreed to participate. The participation rate of sampled children was high and complete data were available for 640 children -217 aged 2 years, 204 aged 4 years, and 219 aged 5 years. Similar numbers of boys and girls were included. The prevalence of dental caries was very high -36% to 47% at age 2 years, 71% to 86% at age 4 years and 82% to 94% at age 5 years. The mean dmft at age 5 years was 8.4 in Abu Dhabi, 8.6 in Al Ain and 5.7 in Western Region. Few teeth had been filled. Apart from age, the parents' education and income were found to be statistically significantly related to caries experience (P<0.05) while gender, ethnicity (UAE or non-UAE), region, and urban or rural living, were not related to dental caries experience (P>0.3). While high parental educational attainment was related to lower caries experience, conversely, high parental income was related to higher caries experience. Caries experience was higher than that recorded approximately 6 years previously and is a cause of concern. [ABSTRACT FROM AUTHOR]

The reliability of caries data obtained during three clinical trials is presented. Each of the three trials, conducted by different examiners, lasted 3 years and involved children aged 12 to 15 years. Reliability was quantified in terms of reliability coefficient and error variance, which allowed the effect of error upon the efficiency of each study to be measured. Reliability tended to be reduced when precavitation (initial) lesions were included in the DMFS count, but there was little difference between the reliability coefficients for each of four different surface-types. Error was more important in 3-year incremental rather than prevalence data, but nevertheless had a rather small influence upon sample size estimation or confidence limits of percent caries reductions. [ABSTRACT FROM AUTHOR]

A partial recording system, suitable for use in caries incremental studies, was developed from first principles using data from 330 11- to 14-year-old English schoolchildren. This system was shown to be rapid, accurate and highly efficient when the results were compared with full-mouth statistics. Comparisons were also made with five published caries partial recording methods, using 2- and 3-year incremental data from a recent clinical trial. The results have been calculated both excluding and including precavitation lesions, as well as for three separate surface types (fissure, free smooth surface and approximal). Three methods of expressing "relative efficiency" are compared. The need for partial recording systems to be maximally efficient is discussed. The results confirm that many partial recording techniques are accurate, efficient and capable of considerably reducing examination time. [ABSTRACT FROM AUTHOR]

The purpose of undertaking repeat examinations in oral epidemiology has been discussed. Since many of the published methods of demonstrating repeatability do not allow the influence of error to be quantified, the value of estimating reliability was investigated. This is based of the assumption that the coefficient of reliability is the ratio or true to total variance, where total variance is the sum of true and error variance. It was suggested that the reliability coefficient together with error variance should be used to express repeatability in oral epidemiology since reliability is closely related to the efficiency of the study and allows the relative importance of error to be assessed. Five methods for determining the reliability of dental caries data have been investigated and compared; all but one required the reexamination of subjects. The fifth method, although not requiring a reexamination, was considered unsuitable for use in caries studies. The two methods recommended for use in prevalence surveys were simple to use and provided data from which the reliability of incremental scores might be calculated. [ABSTRACT FROM AUTHOR]

Since 1968, six caries clinical trials have been conducted in the North-West of England by different examiners using the same diagnostic system, and a steady reduction in caries prevalence in 11-12-yr-old schoolchildren has been recorded. In the present study, five of the examiners revisited some of tile schools which participated in their original trials and each examined between 196 and 296 children. The time intervals between die original and repeat examinations were 12. 10, 8,5 and 3 yr. Percent caries reductions (PCRs) ranged from 19 to 33 for DMF'T and from 24 to 35 for DMFS but the PCRs did not relate to the time intervals between examinations. The PCRs were greater on free smooth and approximal surfaces than on fissure surfaces and for the anterior teeth titan for the mouth as a whole, suggesting that fluoride may have played a role in the reductions. [ABSTRACT FROM AUTHOR]

Out of 6694 recruits who joined the Royal Navy between September 1979 and February 1981, 1983 (30%) had lived all their lives in one locality. Information on the fluoride level, between 1963 and 1980, in the water supply to each of the recruits' homes was obtained. The examiner recording the dental status of each recruit did not know where the recruit had lived. Some of the information on fluoride levels was imprecise or of variable quality so the final analyses were restricted to 1332 16-17-year-old subjects. The overall mean DMFT for the 1332 recruits was 9.72. There was a consistent fall in caries experience with increasing water fluoride level although the differences between the caries experience of recruits from low and high fluoride areas (about 20% for mean DMFT) was smaller than that observed in other studies. A possible explanation for this smaller difference is that some of the subjects did not receive fluoridated water early in life. [ABSTRACT FROM AUTHOR]

Eighteen dentists working in the same School Dental Service participated in a calibration trial with the Purpose of reducing interexaminer disagreement on radiographic diagnosis of approximal caries. The calibration program was in two stages: firstly, discussion in small groups and, secondly, the use of a reference standard. The effect of the training programs on interexaminer disagreement was limited, but a statistically significant decrease in the number of D-surfaces recorded per child was observed. The finding that the major part of the error variance was due to random error, rather than systematic error, may explain why the calibration program was unsuccessful at reducing error. [ABSTRACT FROM AUTHOR]

Due to very high levels of caries experience in Saudi Arabia's 6-year-olds living in a city with a near-optimal water fluoride level, a study of younger children was undertaken in Riyadh, the country's capital, which has a similar, near-optimum water fluoride level. A total of 390 boys were dentally examined, in the age groups of 2, 4 and 6. More children from the high socio-economic group were included than from the low or rural socio-economic group. For all three age groups, caries prevalence was the highest in the low socio-economic group.

Video recordings were obtained of 90 adults aged 18-22 yr brushing their teeth. Thirty subjects were unaware they were being filmed and 60 subjects had been informed that they would be filmed while they brushed their teeth. From repeated viewing of the tapes the areas of the mouth that were brushed, the total brushing time and the proportion of time spent brushing each of 16 areas of the mouth were obtained for each subject. Subjects who knew they were being filmed brushed significantly more mandibular occlusal surfaces, and lingual areas in both arches than subjects who were unaware they were being filmed. There was no significant difference in the mean toothbrushing time between the two groups. The informed group spent proportionally less time brushing posterior buccal areas and more time on occlusal and lingual areas than the group who were unaware they were being filmed, the difference being statistically significant for the mandibular arch areas. It was concluded that knowledge of filming alters toothbrushing behaviour to a small extent so that care should be taken when interpreting behavioural changes in future intervention studies. [ABSTRACT FROM AUTHOR]

Video recordings were obtained of 50 men aged 18- 20 yr (25 smokers, 25 non-smokers) brushing (heir teeth. From repeated viewing of the films the total brushing time and the number of strokes used in each of 16 areas of the mouth were obtained for each subject. Comparisons between smokers and non-smokers of time spent brushing, and number of brushing strokes used overall and in each area of the mouth, showed no significant differences. However, the distribution of brushing strokes around the mouth was more uniform in the non-smokers than in the smokers, which may indicate a tendency towards less favourable toothbrushing performance in smokers. [ABSTRACT FROM AUTHOR]

85 uninstructed children aged 11-13 years brushed their teeth and were unaware that they were recorded on video tape. By viewing the films, the time spent brushing in each of 16 areas of the dentition and the number of strokes used in each area were obtained. The mean overall brushing time was 60.3 s (± 23.8); the mean number of strokes used by each subject was 397 ( ± 224). More time was spent and more strokes employed brushing mandibular than maxillary arches, labial and buccal than occlusal areas, and occlusal than lingual areas. The percentages of time spent and number of strokes used brushing lingual areas were low. [ABSTRACT FROM AUTHOR]