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The multidisciplinary nature and long duration of birth cohort studies allow investigation of the relationship between general and oral health and indicate the most appropriate stages in life to intervene. To date, the worldwide distribution of oral health-related birth cohort studies (OHRBCSs) has not been mapped, and a synthesis of information on methodological characteristics and outcomes is not available. We mapped published literature on OHRBCSs, describing their oral health-related data and methodological aspects. A 3-step search strategy was adopted to identify published studies using PubMed, Embase, Web of Science, and OVID databases. Studies with baseline data collection during pregnancy or within the first year of life or linked future oral health data to exposures during either of these 2 life stages were included. Studies examining only mothers' oral health and specific populations were excluded. In total, 1,721 articles were suitable for initial screening of titles and abstracts, and 528 articles were included in the review, identifying 120 unique OHRBCSs from 34 countries in all continents. The review comprised literature from the mid-1940s to the 21st century. Fifty-four percent of the OHRBCSs started from 2000 onward, and 75% of the cohorts were from high-income and only 2 from low-income countries. The participation rate between the baseline and the last oral health follow-up varied between 7% and 93%. Ten cohorts that included interventions were mostly from 2000 and with fewer than 1,000 participants. Seven data-linkage cohorts focused mostly on upstream characteristics and biological aspects. The most frequent clinical assessment was dental caries, widely presented as decayed, missing, and filled teeth (DMFT/dmft). Periodontal conditions were primarily applied as isolated outcomes or as part of a classification system. Socioeconomic classification, ethnicity, and country- or language-specific assessment tools varied across countries. Harmonizing definitions will allow combining data from different studies, adding considerable strength to data analyses; this will be facilitated by forming a global consortium.

Birth cohorts are those among observational studies that provide understanding of the natural history and causality of diseases since early in life. Discussions during an International Association for Dental Research symposium in London, United Kingdom, in 2018, followed by a workshop in Bangkok, Thailand, in 2019, concluded that there are few birth cohort studies that consider oral health and that a broader discussion on similarities and differences among those studies would be valuable. This article aims to 1) bring together available long-term data of oral health birth cohort studies from the low, middle, and high-income countries worldwide and 2) describe similarities and differences among these studies. This work comprises 15 studies from all 5 continents. The most studied dental conditions and exposures are identified; findings are summarized; and methodological differences and similarities among studies are presented. Methodological strengths and weaknesses are also highlighted. Findings are summarized in 1) the negative impact of detrimental socioeconomic status on oral health changes over time, 2) the role of unfavorable patterns of dental visiting on oral health, 3) associations between general and oral health, 4) nutritional and dietary effects on oral health, and 5) intergenerational influences on oral health. Dental caries and dental visiting patterns have been recorded in all studies. Sources of fluoride exposure have been documented in most of the more recent studies. Despite some methodological differences in the way that the exposures and outcomes were measured, some findings are consistent. Predictive models have been used with caries risk tools, periodontitis occurrence, and permanent dentition orthodontic treatment need. The next steps of the group's work are as follows: 1) establishing a consortium of oral health birth cohort studies, 2) conducting a scoping review, 3) exploring opportunities for pooled data analyses to answer pressing research questions, and 4) promoting and enabling the development of the next generation of oral health researchers.

Epidemiological studies over 70 y ago provided the basis for the use of fluoride in caries prevention. They revealed the clear relation between water fluoride concentration, and therefore fluoride exposure, and prevalence and severity of dental fluorosis and dental caries. After successful trials, programs for water fluoridation were introduced, and industry developed effective fluoride-containing toothpastes and other fluoride vehicles. Reductions in caries experience were recorded in many countries, attributable to the widespread use of fluoride. This is a considerable success story; oral health for many was radically improved. While previously, water had been the only significant source of fluoride, now there are many, and this led to an increase in the occurrence of dental fluorosis. Risks identified for dental fluorosis were ingestion of fluoride-containing toothpaste, water fluoridation, fluoride tablets (which were sometimes ingested in areas with water fluoridation), and infant formula feeds. Policies were introduced to reduce excessive fluoride exposure during the period of tooth development, and these were successful in reducing dental fluorosis without compromising caries prevention. There is now a much better understanding of the public perception of dental fluorosis, with mild fluorosis being of no aesthetic concern. The advantages of water fluoridation are that it provides substantial lifelong caries prevention, is economic, and reduces health inequalities: it reaches a substantial number of people worldwide. Fluoride-containing toothpastes are by far the most important way of delivering the beneficial effect of fluoride worldwide. The preventive effects of conjoint exposure (e.g., use of fluoride toothpaste in a fluoridated area) are additive. The World Health Organization has informed member states of the benefits of the appropriate use of fluoride. Many countries have policies to maximize the benefits of fluoride, but many have yet to do so.

Breastfeeding is important for health and development. Yet, the interaction between breastfeeding duration and usage of fluoridated water on caries experience has not been investigated. This study examined exposure to fluoridation as an effect modifier of the association between breastfeeding duration and caries. The 2012 to 2014 national population-based study of Australian children involved parental questionnaires and oral epidemiological assessment. Children were grouped by parent-reported breastfeeding duration into minimal (none or <1 mo), breastfed for 1 to <6 mo, breastfed for 6 to 24 mo, and sustained (>24 mo). Residential history and main water source used for the first 2 y of life were collected to group children into exposed (WF) and nonexposed (NF) to fluoridation. Socioeconomic status, infant formula feeding, and sugar-sweetened beverage (SSB) consumption data were collected. The prevalence and severity of caries in children aged 5 to 6 y were primary outcomes. Multivariable regression models with robust error estimation were generated to compute prevalence ratios (PRs) and mean ratios (MRs) for 3 breastfeeding groups against the reference (breastfed for 6-24 mo). Of the 5- to 6-y-old children, 2,721 were in the WF and 1,737 were in the NF groups. The groups had comparable distributions of socioeconomic factors, infant formula feeding, and SSB consumption. There were U-shape distributions of caries experience among breastfeeding groups, being more pronounced among NF children. Among NF children, the minimal and sustained breastfeeding groups had significantly higher PR (1.4 [1.1-1.9] and 1.8 [1.4-2.4]) and MR (2.1 [1.4-3.3] and 2.4 [1.4-4.1]) than the reference group. However, among the WF children, this association between breastfeeding duration and caries attenuated after adjustment for other factors. The study contributes evidence of a nonlinear (U-shape) association between breastfeeding duration and dental caries. Early life exposure to fluoridated drinking water attenuated the potential cariogenic effect of both lack of and sustained breastfeeding.

The discovery during the first half of the 20th century of the link between natural fluoride, adjusted fluoride levels in drinking water and reduced dental caries prevalence proved to be a stimulus for worldwide on-going research into the role of fluoride in improving oral health. Epidemiological studies of fluoridation programmes have confirmed their safety and their effectiveness in controlling dental caries. Major advances in our knowledge of how fluoride impacts the caries process have led to the development, assessment of effectiveness and promotion of other fluoride vehicles including salt, milk, tablets, toothpaste, gels and varnishes. In 1993, the World Health Organization convened an Expert Committee to provide authoritative information on the role of fluorides in the promotion of oral health throughout the world (WHO TRS 846, 1994). This present publication is a revision of the original 1994 document, again using the expertise of researchers from the extensive fields of knowledge required to successfully implement complex interventions such as the use of fluorides to improve dental and oral health. Financial support for research into the development of these new fluoride strategies has come from many sources including government health departments as well as international and national grant agencies. In addition, the unique role which industry has played in the development, formulation, assessment of effectiveness and promotion of the various fluoride vehicles and strategies is noteworthy. This updated version of 'Fluoride and Oral Health' has adopted an evidence-based approach to its commentary on the different fluoride vehicles and strategies and also to its recommendations. In this regard, full account is taken of the many recent systematic reviews published in peer reviewed literature.

The Cochrane Review on water fluoridation for the prevention of dental caries was published in 2015 and attracted considerable interest and comment, especially in countries with extensive water fluoridation programmes. The Review had two objectives: (i) to evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries, and (ii) to evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis. The authors concluded, inter alia, that there was very little contemporary evidence, meeting the Review's inclusion criteria, that evaluated the effectiveness of water fluoridation for the prevention of dental caries. The purpose of this critique is to examine the conduct of the above Review, and to put it into context in the wider body of evidence regarding the effectiveness of water fluoridation. While the overall conclusion that water fluoridation is effective in caries prevention agrees with previous reviews, many important public health questions could not be answered by the Review because of the restrictive criteria used to judge adequacy of study design and risk of bias. The potential benefits of using wider criteria in order to achieve a fuller understanding of the effectiveness of water fluoridation are discussed.

In 1994, the dental health of 327 5-year-old children who had lived in continuously fluoridated (at 1.0 mg/IF-) Newcastle was compared with the dental health of 335 children of the same age in non-fluoridated (less than 0.1 mg/IF-) south east Northumberland. The caries prevalance in social class groups I + II, III, IV + V children was compared both within and between the two areas. The prevalence of dental caries in the three social groupings I + II, III, and IV + V (and the mean dmft) respectively, was 23 percent (0.59), 39 percent (1.21) and 31 percent (1.17) in the fluoridated area, and 38 percent (1.46), 47 percent (2.04) and 62 percent (2.74) in the non-fluoridated area. Differences between the fluoridated and non-fluoridated areas were observed in all social class groupings but the greatest difference in the percentage of children with decay experience occurred in social groups IV + V. There has been a fall in caries experience in all social groups in both the fluoridated and non-fluoridated areas since a previous survey in 1987. However, this reduction was not enough to obviate the disadvantage of social background. Reduction in caries experience especially amongst social classes I and II has meant that the power of water fluoridation to reduce caries experience has diminished. Refinement of the instruments for classifying socio-economic position has the potential to demonstrate greater degrees of inequality than the crude measures such as occupational class as used in this study.

A large number of liquid oral medicines contain sugars and there is concern for the dental health of children requiring this medication long-term for chronic medical problems. Ninety-four chronically sick children aged 2-17 years taking sugar-based or sugar-free liquid oral medication for 1 year or more, and their 92 siblings were dentally examined. The medical problems of the sick children included epilepsy, cystic fibrosis, chronic renal failure, asthma, recurrent urinary tract infections, cardiac disease and chronic constipation. Ordinal logistic regression analysis compared differences between sick children and their healthy siblings and showed the only significant confounding factors related to dental health to be age (for dmfs p = 0.013, DMFS p < 0.001) and exposure to fluoridation (for DMFS p = 0.0097, DFS (approximal) p = 0.013). Children taking long-term liquid oral medicines had significantly more caries of deciduous anterior teeth than their siblings (p = 0.046).

In 1994, the dental health of 496 5-year-old children who had lived in continuously fluoridated (at 1.0 mg F/litre) Newcastle was compared with the dental health of 436 children of the same age in non-fluoridated (less than 0.1 mg F/litre) south east Northumberland. The study also reported changes in the dental health of 5-year-old children in four surveys in these areas during the period 1976 to 1994. The mean dmft of children in the fluoridated area was 1.33 compared with 2.41 in the non-fluoridated area--a difference of 1.08 per child (45%). The corresponding dmfs scores were 2.80 in the fluoridated area and 5.77 in the non-fluoridated area--a difference of 2.97 tooth surfaces per child (52%). Thirty-nine per cent of children in the fluoridated area had experienced dental caries, compared with 55% in the non-fluoridated area. Only 10% of children in the fluoridated area had experienced dental caries in more than four teeth, compared with 22% in the non-fluoridated area. The prevalences of lifetime experience of toothache, extractions and general anaesthesia for dental extractions were greater in the non-fluoridated area than in the fluoridated area. When the results of this survey were compared with the results of similar surveys in the same areas in 1976, 1981 and 1987, it appeared that there has been a further reduction in dental caries levels following the levelling off observed between 1976 and 1981.

Nutrition and diet can affect teeth in three ways: by affecting the structure of teeth (and thus appearance), by causing dental caries and by eroding teeth. The importance of dietary sugars in causing dental caries is clearly established and a reduction in consumption of non-milk extrinsic sugars recommended by government. The Health Education Authority has played a major role in promoting this aspect of dietary advice. The structure of teeth is influenced by nutrition; much of the evidence for this being published by Mellanby and colleagues in this country. Interest in this topic has increased recently and it seems probable that malnutrition enhances susceptibility to dental caries, and possible that it increases susceptibility to enamel defects especially in areas with moderate to high levels of fluoride ingestion. The prevalence and severity of dental erosion is likely to be increasing in Britain. Preliminary studies indicated that fluoride helps to protect teeth against erosion, but more research is needed.

The use of fluorides has benefited greatly the dental health of preschool children. Water fluoridation cuts caries by half in the deciduous dentition as it does in the permanent dentition. In the absence of water fluoridation, fluoride dietary supplements can be used and are effective. For practical reasons it may be useful to limit their use to those at risk from caries and those seen to be prone to caries. There has been some concern over links between early use of fluoride toothpastes and the occurrence of very mild fluorosis. Although this is not perceived as a problem by parents or the community, it is prudent to recommend that parents clean their children's teeth with a pea-size amount of toothpaste. Fluoride varnishes are effective and are useful for preventing caries in young children.

Diet can affect teeth both during their formation (pre-eruptively) and locally in the mouth (post-eruptively). Several dietary factors have been considered to act pre-eruptively, affecting the caries-susceptibility of the forming tooth, but only fluoride has been shown to have any distinct effect. The post-eruptive influence of diet is very much more important than any pre-eruptive effect, and sugar is by far the most cariogenic dietary item. The aim should be to reduce the frequency of consumption and the amount of sugar consumed. Important sources of added sugars are confectionery, table sugar and soft drinks. Starchy foods and fresh fruit as eaten by man cause little caries. Non-sugar sweeteners are non-cariogenic and useful substitutes for sugars in many foods and drinks.

The most commonly discussed methods of caries control are use of fluoride, fissure sealing and toothbrushing. In fact, dietary control can be more effective than any of these. Studies have shown that if there is no sugar in the diet, then caries can be virtually eliminated. This article reviews the evidence, and offers guidance for the GDP giving dietary advice.

Britain, along with many other developed countries, has experienced a dramatic decline in prevalence of dental caries. This has been attributed to the widespread use of fluoride toothpastes, which has done much to improve children's dental health. Studies indicate that fluoridation of water supplies would confer an additional benefit to dental public health, while other fluoride vehicles (mouthrinses, topical gels and varnishes, tablets and drops) are valuable in preventing caries in high-risk patients. The authors review the issues involved.

The study was conducted in seven schools on children initially aged 11.5 years. They recorded their diet on five occasions, each of three days, and received an annual dental examination, including radiography. Caries increments were low, mostly (58 per cent) in fissure surfaces. Correlations between caries increment and dietary factors were low due to the low caries increments observed and the large error associated with dietary data where analyses attempt to discriminate between individuals. The highest correlation was between caries increment and weight of daily intake of sugars (+0.143, p less than 0.01). Multivariate analyses revealed that this relationship could not be explained by differences in sex, social class, tooth-brushing habits or level of plaque as measured by gingival inflammation. Weight of sugar intake appeared to be more strongly correlated to caries than frequency of intake; concentration of sugars in foods was positively related, and sugars in snacks were more strongly related to caries than total dietary sugars. The 31 children who consumed most sugar (greater than 163 g/day) developed 5.0 DMFS during the 2 years, 0.9 DMFS per year more than the 31 children (3.2 DMFS during 2 years) who had the lowest sugar intake (less than 78 g/day).

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 precaviation (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.

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 the schools which participated in their original trials and each examined between 196 and 296 children. The time intervals between the original and repeat examinations were 12, 10, 8, 5 and 3 yr. Percent caries reductions (PCRs) ranged from 19 to 33 for DMFT 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 than for the mouth as a whole, suggesting that fluoride may have played a role in the reductions.

Recently there have been several reports from the USA and UK which suggest that under certain rare conditions breast feeding may cause rampant (severe) dental caries. This paper provides a critical review of the available information and gives some experimental evidence suggesting that human milk possesses a greater cariogenic potential than bovine milk. It is concluded that, although it is possible for human and bovine milk to cause dental caries, the prevalence would appear to be very low and is associated with breast or bottle feeding which has continued until at least two years of age on many occasions during the day and night.

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.

The dental health of 457 5-year-old children who have lived continuously in fluoridated (at 1.0 mg F/litre) Newcastle and 370 children of the same age in non-fluoridated (less than 0.1 mg F/litre) South Northumberland has been reported. This paper examines in detail the caries prevalence in social class groups I + II, III, IV + V, and the social class/fluoridation relationship in 1987. The prevalence of dental caries in the three social class groupings I + II, III, and IV + V (and the mean dmft), respectively, was 35% (1.1), 46% (1.7) and 67% (2.4) in the fluoridated area, and 59% (2.2), 67% (3.7) and 77% (5.0) in the non-fluoridated area. Fluoridation was effective in all social class groupings and, because caries levels were higher in social classes IV + V, fluoridation brought about greater savings for these children than for those in social classes I + II. Fluoridation reduces but does not eliminate social inequalities, leaving social disadvantage/social background/social class as the major factors in caries prevalence for this age group. Further research into the fluoridation/social class relationship is required, particularly since the understanding of occupational class, now considered an imperfect representation of social class, is being superseded by other criteria which have stronger associations with measures of poor health.

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 difference 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.

Background Dental caries remains the most prevalent chronic condition in children and a major contributor to poor general health. There is ample evidence of a skewed distribution of oral health, with a small proportion of children in the population bearing the majority of the burden of the disease. This minority group is comprised disproportionately of socioeconomically disadvantaged children. An in-depth longitudinal study is needed to better understand the determinants of child oral health, in order to support effective evidence-based policies and interventions in improving child oral health. The aim of the Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) project is to identify and evaluate the relative importance and timing of critical factors that shape the oral health of young children and then to seek to evaluate those factors in their inter-relationship with socioeconomic influences. Methods/Design This investigation will apply an observational prospective study design to a cohort of socioeconomically-diverse South Australian newborns and their mothers, intensively following these dyads as the children grow to toddler age. Mothers of newborn children will be invited to participate in the study in the early post-partum period. At enrolment, data will be collected on parental socioeconomic status, mothers' general and dental health conditions, details of the pregnancy, infant feeding practice and parental health behaviours and practices. Data on diet and feeding practices, oral health behaviours and practices, and dental visiting patterns will be collected at 3, 6, 12 and 24 months of age. When children turn 24-30 months, the children and their mothers/primary care givers will be invited to an oral examination to record oral health status. Anthropometric assessment will also be conducted. Discussion This prospective cohort study will examine a wide range of determinants influencing child oral health and related general conditions such as overweight. It will lead to the evaluation of the inter-relationship among main influences and their relative effect on child oral health. The study findings will provide high level evidence of pathways through which socioenvironmental factors impact child oral health. It will also provide an opportunity to examine the relationship between oral health and childhood overweight. [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]

As part of a longitudinal study of diet and dental caries, 405 Northumberland children initially aged 11–12 years recorded the time of going to bed on 3 consecutive days on 5 occasions over a 23-month period. The bedtimes were recorded in a personal diary and checked at private interview. Mean bedtime for the 212 females changed from 21 hr 44 min at age 11 years 7 months to 22 hr 11 min at age 13 years 3 months. Bedtime for the 193 males was, on average, 9 min later than that for the females. There was a consistent relation between bedtime and social class, with social class IV + V children going to bed, on average, 14 min later than social class I + II children. When the average age of the children was 13 years 3 months, 13% of them went to bed at or after 23.00 hr, and they were latest to bed on Saturday when their average bedtime was 22 hr 59 min. [ABSTRACT FROM PUBLISHER]