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Many states and localities do not have the resources to conduct oral health surveys of their whole populations, but the demands for data collection continue to increase for both program administration and for Maternal and Child Health Block Grant funding. As one response to this problem, the Oral Health Program of the Michigan Department of Public Health developed an oral health surveillance system as a low-cost method of collecting usable data from the service populations of local health agencies providing direct patient care in Michigan. A record form, to be completed by dentists or hygienists in those agencies at initial or recall examinations, was developed and pilot-tested for all patients of target age groups who presented over a specified four-week period. This paper gives the results from 19 agencies that participated in the pilot test in Michigan. Results showed that 40.5 percent of 2–5-year-olds (n/341) had some caries experience, their d/dft was 78.2 percent, and mean dft was 4.8 (SD±3.5). Among the 6–19-year-olds (n/710), 61.4 percent had experienced caries, the D/DFT was 41.8 percent, and the mean DFT was 4.2 (SD±3.2). Among the adults examined, 45.1 percent of 20–64-year-olds (n = 820) and 38.1 percent of those 65 years or older (n = 105) had two or more teeth with untreated decay. These data suggest a high level of untreated disease among the service populations of the local dental health agencies. The method of data collection was well accepted by the staff of the agencies concerned and proved to be simple and inexpensive to conduct. While the population examined is not representative of the state population, it reflects a good cross-section of the population seeking clinical dental services through public health agencies. The data will be used in program development and to address the Maternal and Child Health reporting requirements of the Omnibus Budget Reconciliation Act of 1989. We intend to conduct this oral health surveillance survey periodically in Michigan to demonstrate trends in oral disease.

This study examined endosseous cylinder implant survival, defined as the unqualified presence of the implant in the mouth at the end of the observation period, in 598 consecutive VA patients, with a total of 2098 implants. Data were taken from the Department of Veterans Affairs (VA) Dental Implant Registry, which has maintained longitudinal data on the survival of individual dental implants in VA patients since 1987. The maximum time of observation in any one patient was 2040 days (5.6 yr). Survival analysis by use of life-table methods was carried out on both an implant- and a patient-specific basis. Implant cases were accrued randomly, and therefore a random censoring model was used. A correlated binomial model was used for assessment of the degree of within-patient clustering of implant removals. Results showed that the implant-specific survival rate during the longest time interval (5.6 yr) was 89.9%; the patient-specific implant survival rate during the same time was 78.2%. Among implants which were removed, the mean time to removal was 292 days. The hazard function, which describes the probability of implant loss as a function of time, decreased steadily throughout the observation period. The correlated binomial model suggested a clustering of removals within patients with multiple implants (p = 0.11, p = 0.0001). The odds of having a second implant removed were 1.3 times greater if the patient had already had one implant removed. This study suggests that when implants fail, they do so soon after placement, and the likelihood of failure decreases steadily from implantation through the first five years post-surgery. These findings also suggest the existence of systemic factors which affect the survival of all implants within a given patient and may lead to multiple implant failures. Identification of these systemic factors may lead to improvements in patient selection and increases in the success rates for oral implants. Finally, results show that pure titanium implants had better short-term survival rates, but worse long-term survival rates, when compared with implants that had some other form of surface coating.

Risk-related terms such as risk factor, modifiable risk factor, demographic risk factor, risk indicator, determinant, and risk marker are often not well defined in the literature. This short report supports the use of a 1996 definition of risk factor, as probably the most commonly used term related to risk, for the Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life, March 26-28, 2001.

Recent epidemiologic and related evidence suggests the following trends: 1. the prevalence of caries continues to decline in children of the US and several other developed countries; 2. the prevalence of mild dental fluorosis is increasing; 3. the majority of the cariostatic effects of fluoride are topical; and 4. dietary fluoride supplements are a risk factor for dental fluorosis. These trends, and the scientific evidence on fluoride and fluorosis, suggest that it is time to re-evaluate the use of dietary fluoride supplements. This paper examines the evidence for each of the four trends and the use of fluoride supplements in caries prevention today.

Fluorosis prevalence has increased in North America since the 1930's-1940's. It may also have increased since 1970, though the evidence for that is less clear. Continued monitoring will help determine whether increased fluorosis prevalence in children in the United States is a cohort effect from the 1970's. This review considers the evidence for an increase in fluoride ingestion from all sources since the 1970's. If an increase has occurred, the most likely sources are fluoride dietary supplements, inadvertent swallowing of fluoride toothpastes, and increased fluoride in food and beverages. For adults, there is no evidence from dietary surveys to show that fluoride intake has increased over the last generation. Dietary surveys for children aged six months to two years are similarly inconclusive, though the great variation in fluoride content of various infant foods might be obscuring real effects. The data on fluoride intake by children from food and beverages, infant foods included, are not strong enough to conclude that an increase in fluoride ingestion has occurred since the 1970's. However, the suggested upper limit of fluoride intake is substantially being reached in many children by ingestion of fluoride from food and drink (0.2-0.3 mg per day) and from fluoride toothpaste (0.2-0.3 mg per day). Two public health issues that arise from this review are: (a) the need for a downward revision in the schedule for fluoride supplementation, and (b) education on the potential for high fluoride concentration of soft drinks and processed fruit juices.

Recent trends in the prevalence of dental caries in children, as well as a possible increase in the prevalence of dental fluorosis, have prompted some researchers to suggest the reassessment of water fluoride concentration standards. Instead of reducing water fluoride concentrations, an alternative approach would be to limit the use of, or reduce the fluoride concentration of, dentifrices, mouthrinses, and supplements. Information about the use of these other sources of fluoride, however, is scarce. Using data from a 1987 survey of Michigan schoolchildren, exposure to selected fluoride sources as well as tooth brushing habits are described. Responses from questionnaires revealed that, overall, 98.5 percent of the children have used fluoride dentifrices, 27 percent have used topical fluoride rinses, 72.5 percent have had at least one exposure to professionally applied topical fluoride, and 27percent have used dietary fluoride supplements. Although the use of fluoride dietary supplements was appropriate for most children residing in fluoride-deficient Cadillac, the percentages of children in the other communities who have ingested these supplements suggest that these products are being prescribed improperly. Given the almost universal use of fluoride dentifrices at an early age, it may be time to investigate the use of reduced fluoride dentifrices for children. In addition, continuing efforts to decrease inappropriate dietary fluoride supplementation are required.

January 25, 1995, is the 50th anniversary of the first controlled addition of fluoride to a public water supply. Those 50 years have seen extraordinary advances in oral health and consequent quality of life, for which fluoride use is generally considered the primary reason. More extensive exposure to fluoride in the modern era, however, has led to both a continuing decline in caries experience and an increased prevalence of dental fluorosis in children. At the other end of life, fluoride's role in bone strength among older people is not well defined. This symposium examines several aspects of fluoride use in the United States today, and has the purpose of helping to define the balance between maximizing the benefits of fluoride while minimizing its undesirable side effects.

The Southwestern portion of the Hispanic Health and Nutrition Examination Survey (HHANES) was conducted by the National Center for Health Statistics (NCHS) in 1982 and 1983. The survey population was Mexican-Americans residing in five Southwestern states. This report presents data on the prevalence of total tooth loss, dental caries, and periodontal diseases in 3860 Mexican-American adults aged from 18 to 74. Results show that 4.3% of this group was edentulous. Among the dentate, Mexican-Americans had lower overall DMF scores but higher numbers of untreated decayed teeth than did residents of the same region seen in the NHANES I survey in 1971-1974. Caries of the smooth surfaces in both posterior and anterior teeth was more pronounced in the older than in the younger age groups. Mexican-Americans had more gingivitis but fewer periodontal pockets than did the general population in the Western states during NHANES 1. The caries pattern in the Mexican-Americans suggests that caries among adults may remain a problem in the future, with the possibility of increased involvement with the aging, although modest, of smooth tooth surfaces.

Recent research has suggested that susceptibility to destructive periodontal disease may not be as universal as was previously thought. This report analyzes data from a representative national sample of 11 338 American adults aged 25-74, examined in a national survey in 1971-74. Results showed that 46.1% of those aged 65-74 were edentulous, but half of the dentate persons in that age group were diagnosed as free of destructive periodontal disease. Periodontal (PI) and oral hygiene (OHI-S) index scores in this group were significantly better in those persons who had lost fewest teeth. When persons aged 65-74 who retained 25 or more teeth were compared with younger adults who also had 25 or more teeth, OHI-S and CI scores were similar. It is hypothesized that maintenance of oral hygiene levels corresponding to OHI-S scores of 0.3-0.6, and calculus levels corresponding to CI scores of 0.1-0.2, is sufficient to maintain a dentition free of periodontal disease throughout life. Slightly higher OHI-S levels (0.7-1.3) and CI levels (0.3-0.6) might be compatible with acceptably low levels of periodontal disease.

A three-year longitudinal study was carried out with a group of children, initially aged 11-15, residing in non-fluoridated rural communities in south-central Michigan. This report analyzes the relation between caries increment and consumption of sugars from all sources to see if accepted relationships have changed with the caries decline in the United States. There were 499 children who provided three or more 24-hour dietary recall interviews, and who received dental examinations at baseline and after three years.Caries increment averaged 2.91 DMFS over the three years, with 81 % of new lesions on pit-and-fissure surfaces. Consumption of sugars from all sources averaged 156 g per day for males and 127 g per day for females, an average of 52 kg per person per year. Sugars constituted one-quarter of total caloric intake for both boys and girls, and the average number of eating occasions per day was 4.3.Children who consumed a higher proportion of their total energy intake as sugars had a higher increment of approximal caries, though there was little relation to pit-and-fissure caries. The average number of daily eating occasions was not related to caries increment, nor was the average number of sugary snacks (defined as foods with 15% or more of sugars) consumed between meals, but the average consumption of between-meal sugars was related to the approximal caries increment. When children were categorized by high caries increment compared with no caries increment, a tendency toward more frequent snacks was seen in the high-caries children.In an age of generally declining caries, it was concluded that higher average daily consumption of sugars, and higher between-meal consumption of sugars, was still a risk factor for children susceptible to approximal caries. Overall frequency of eating and frequency of ingestion of sugary foods between meals, however, were both poorly related to approximal caries increment. Pit-and-fissure caries could not be related to any aspect of sugars consumption.

Knowledge of the epidemiology, natural history, and bacterial etiology of the periodontal diseases has advanced considerably as a result of research conducted through the 1980s. Prevention and control of these conditions, however, remains mechanical, cumbersome, and often impractical, based as it is on bacterially nonspecific plaque removal for an indeterminate period. This research has not yet changed the content of public health programs, but it does affect the way the programs are applied. Because severe, generalized disease seems to be less prevalent than previously thought, the need of regular, routine professional care for everybody is questioned. Professional care in a public health context is likely to be more efficient when targeted toward those with severe disease. Dental health education for personal oral hygiene is still supported by scientific studies, though a targeted approach and careful assessment of educational content is needed. Until predictive screening methods for identifying susceptible individuals are developed, selection of priority groups for education and treatment should be guided by epidemiologic data.

Existing data on the economics of sealant use are insufficient to permit firm conclusions; an additional handicap is that both data and attitudes are based principally on results with first-generation sealants when it is clear that greatly improved materials are now available. The limited data plus the preceding discussion of issues, however, do allow the following statements by way of conclusions. In public programs, few would argue that the cost-effectiveness of sealants would be enhanced by: (a) Using trained auxiliaries to apply sealant to the fullest extent allowed by law. (b) Applying the most recently developed sealants in which retention rates appear to be most favorable. (c) Their application in areas where proximal caries is low. This means many communities in the United States at present, especially fluoridated areas. Although marginal benefits have not been determined, sealants would appear to complement the use of fluoride. There is less clarity on other areas where some tradeoffs would be required, for the nature of the tradeoffs cannot be specified. These areas include: (d) Whether the program should be based on a single application or whether there should be annual checks and reapplications. Reapplications will push effectiveness closer to 100 percent, but will incur greater costs. The ideal situation would be virtual 100 percent retention of sealant over a long time following a single application, but that outcome is unlikely in a public program. (e) Whether all molars and premolars should be sealed. There is general agreement that first and second molars should be sealed as soon as possible after eruption because of their susceptibility to occlusal caries.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper assesses, by comparing recent published evidence with Dean's pioneering work, whether an increase in the milder forms of dental fluorosis may have occurred since Dean's time. To the extent that the crude comparisons of recent research with historic studies are valid, the data indicate a slight trend toward more fluorosis today than would be expected based upon findings in the late 1930s and early 1940s. This suggested increase in fluorosis is not as clear-cut nor as widely accepted as the recent decline in the prevalence of dental caries. Thus, further study of the prevalence of fluorosis and caries in relation to fluoride ingestion will be required to help validate the trend, and to allow dental researchers and decision makers to plan for the future.

A dental treatment program, for a subnormal group in an institution near London, England, was designed by applying both epidemiologic data and empirically derived data from the Experimental Dental Care Project at The London Hospital Dental School. For the epidemiologic study, a two-examiner system was developed to help overcome the special problems of examining subnormal adults. The data collected in the study had to be flexible enough to allow the analysis of several alternative treatment strategies. Once these alternative treatment strategies were defined, the data from the Experimental Dental Care Project were applied to analyze the effects of using dental teams of varying composition to carry out the treatment. It was found that to meet the dental needs of the group, a team consisting of one dentist, three New Cross auxiliaries and one dental surgery assistant would be 30 % less expensive than a traditional team of one dentist and one assistant. This larger team would also be able to complete the necessary initial treatment in less than half the time that the traditional team would require.

Dental caries declined in prevalence and severity among schoolchildren in the United States during the 1970s, although it still remains a problem in some areas. The decline could have started well before the 1970s, even though it was only recently identified. Caries should continue to decline as long as fluoride use remains around current levels. Use of fluoride toothpaste seems to be increasing. Sugar consumption is stable, although sucrose consumption as a proportion of total sugar consumption is declining. Increased tooth retention is thought to increase the risk of root caries in older persons, but the continued use of fluoride toothpaste should minimize any such increase. The main growth area for fluoride use may be in toothpastes. Monitoring caries trends in the future will require good data on the epidemiology of caries in young and middle-aged adults.

The adverse effect of smoking on periodontal health has been demonstrated in the analysis of the dental and smoking history data collected from a representative sample of the US population. The association between poorer levels of periodontal health and smoking remained even after accounting for age, sex, race, oral hygiene, socioeconomic status, and frequency of daily toothbrushing variables. When the analysis was restricted to smokers only, no clear-cut association was demonstrated between periodontal disease and the duration of smoking or the number of cigarettes smoked per day. The results of this study suggest that dental practitioners should try to discourage their patients from smoking for reasons of periodontal health as well as general preventive care.

The purpose of this study was to measure the prevalence and distribution of root caries in two New Mexico communities. One community, Deming, had a natural fluoride concentration of 0.7 mglL in its drinking water, optimum for its climate. The other, Lordsburg, was naturally fluoridated at 3.5 mg/L, five times the optimum. Dental examinations were carried out on 151 adults in Deming (mean age, 39.8 years) and 164 in Lordsburg (mean age, 43.2 years); only persons born in the communities were included. Prevalence of root caries was 23.8% in Deming and 7.3% in Lordsburg; mean number of lesions was 0.69 in Deming and 0.08 in Lordsburg (p < 0.0001). Although there was more gingival recession in Lordsburg, Root Caries Index scores were five times greater in Deming. Root caries was more prevalent in older age groups, and was correlated with coronal caries experience in both communities. Root caries was correlated with plaque and calculus scores in Deming only. Logistic regression showed that city of residence was the major predictor of root caries, with other significant predictors being age, education, gingival recession, and loss of periodontal attachment. When combined with previous research, these results confirm that root caries experience is directly related to the fluoride concentration in the drinking water.

This paper describes the estimated prevalence of dental caries and periodontal disease in 2,550 children, 5 through 17 years of age, who resided in five southwestern states of the United States and were examined in the Hispanic Health and Nutrition Examination Survey (HHANES) of 1982-84 of the National Center for Health Statistics. Dental caries in the Mexican American children was predominantly a disease of occlusal surfaces of molars; few smooth surfaces of posterior and anterior teeth were affected by caries. This intra-oral distribution of dental caries strongly supports the use of fissure sealants as a preventive procedure. Filled tooth surfaces contributed about 66 per cent of the total DMFS (decayed, missing, filled surfaces) scores. The analysis also shows that about 50 per cent of the 17 year old Mexican Americans had five or more filled or decayed teeth. Mild gingivitis was prevalent (76.9 per cent) in the Mexican American children.

Dental health education is part of the curriculum in many school systems around the The rationale is that prevention is the key to controlling dental disease, that caries and periodontal disease are largely preventable through personal behavior, and that the educational environment of the school is the logical place to teach dental health practices which will result in better dental health for today’s children and tomorrow’s adults.e.6 The benefits that materialize from these efforts, however, are difficult to substantiate. In their comprehensive review published in 1971, Rayner and CohenZs described the equivocal nature of results from studies to that time. Since that review, some studies have reported improvements in oral hygiene following an educational program,12,ef1~e1.10.:’~ but there appears to be at least as many which show little or no positive results that can be attributed to the educational program.”il.”~e~~~12.~’~ Other reported studies are difficult to assess because they did not evaluate health outcomes; “success” was determined by the reactions expressed by students, teachers, or parents. 18.’8,22.37 In a recent appraisal of the effectiveness of dental health educational programs, Frazier’O concluded that traditional activities which attempt to motivate individuals to alter their behavior were conceptually faulty, and furthermore were founded upon assumptions that cannot be supported by empirical data. Heifetz and SuomiI3 were equally unenthusiastic, stating that there was no technology known to be effective at achieving voluntary behavioral change on a community basis. Nevertheless, despite the currently prevalent view that traditional dental health educational programs are ineffective, they continue to be a major part of publicly funded school dental care programs in many countries. iw,:3’ It seems that uncertainty about the value of these dental health educational programs might be perpetuated by the inherent difficulties in their evaluation. Such evaluation as has been undertaken, as in the studies cited previously, has been mostly short-term, and usually directed at dental health educational programs that were not part of the dental treatment programs. However, some exceptions have been reported. Results from the World Health Organization, Division of Dentistry

The widespread availability of fluoride from many sources is accepted as a major reason for the caries decline among children in developed countries. There is still controversy, however, about its principal mode of action. This article reviews the evidence on fluoride's preeruptive and posteruptive effects, and suggests reasons for its continuing role in the caries decline. Early fluoridation studies accepted that fluoride acted preruptively through incorporation into developing enamel; but further research could not explain why fluoride levels were not clearly higher in enamel exposed to fluoride, nor why there were no clear correlations between caries experience and enamel fluoride concentration. Instead, considerable evidence suggests that fluoride acts mainly, though not entirely, through posteruptive remineralization of demineralized enamel. Caries experience has declined in nonfluoridated as well as in fluoridated areas, though DMF scores are still consistently lower in fluoridated areas. Posteruptive remineralization effects are seen from fluoridated drinking water as well as with fluoride from other sources. The continuing caries decline, beyond the level suggested by early fluoridation field trials, can be attributed either to more efficient remineralization or to long-term, intraoral ecological change, or to both.

A tentative analysis was made of the efficiency of allocating resources to fissure sealing, rather than to restorative care, in a public dental program. Data for the study were taken from a 2-year clinical trial in London. The analysis is necessarily tentative because the clinical trial employed the half-mouth design, which does not represent a true-life situation. Over the 2 years of the study, it was found that sealing the population of study teeth took from 24.9% to 33.8% more time than treating the lesions which developed in the control teeth would have. Reasons are given why this finding cannot be accepted as conclusive; rather, it is presented to raise questions and to stimulate additional studies into the efficiency of preventive programs. Guidelines for such studies, which should be conducted in different populations with varying caries prevalence, are suggested.

The objective of this study was to assess the relative effects of age and oral hygiene on the progression of periodontitis by estimating incidence from age-specific prevalence. This study analyzed data from a representative national sample of 14,690 dentate Americans, aged from 15 to 74, seen in the first National Health and Nutrition Examination Survey (NHANES 1) in 1971-1974. Results showed that the rate of increase in the estimated incidence of periodontitis with age, throughout all age groups, is much higher among subjects with poor oral hygiene than among those with good oral hygiene. Oral hygiene was confirmed as the most important predictor for periodontitis; in all age groups, more than 95% of those examined with good oral hygiene did not have periodontitis. It was concluded that the effect of age on the progression of periodontitis could therefore be considered negligible when good oral hygiene is maintained.

Trends over time in the prevalence and severity of oral conditions are best established by periodic epidemiologic surveys of representative samples of the population, conducted at regular intervals by trained examiners using the same criteria and methods. However, few countries or public health jurisdictions have the resources even to attempt to reach this ideal, so simpler and cheaper compromises are frequently sought. The inelegant but inexpensive “pathfinder” surveys, encouraged by the World Health Organization, represent one such compromise which clearly has a place in obtaining epidemiological data for certain purposes.lO As another compromise, attention might be given to the use of treatment statistics as indicators of time trends in oral conditions. After all, many dental public health programs already collect treatment statistics, but all too often these statistics find little use beyond a mention in the agency’s annual report. Perhaps the time has come to see if these data can be better used to discern epidemiological trends. Of course, it is traditionally accepted that dental treatment statistics cannot be used to discern epidemiological trends because of self-selected samples and the variability in the clinical dentists’ approach to treatment plans. However, it may be that specific treatment statistics, when used under certain conditions, could be a valid and inexpensive source for discerning time trends in oral conditions. As an example of the way that treatment statistics have been used to indicate time trends in oral conditions, Brudevold3 pointed to Norway as one of a few countries which has treatment data from large populations reflecting a successful preventive program. Such a casual claim, however, may or may not be valid. The purpose of this paper is to examine treatment statistics from Norway in order to highlight some possible difficulties in the interpretation of treatment statistics for discerning time trends in oral conditions. Some suggestions toward the development of more rigorous methods of collecting and analyzing treatment statistics will then be presented. While Norwegian data are chosen as an example, it is not necessarily suggested that the way the data are collected and presented is typical of all dental public health programs, nor that difficulties in interpretation will be present in all situations.

The cariogenicity of soft drinks was evaluated in 3,194 Americans aged 9 to 29 years who were examined during the NHANES I survey conducted from 1971 to 1974. A significant positive association was found between the frequencies of at- and between-meal consumption of soft drinks and high DMFT scores. These associations remained even after accounting for the reported concurrent consumption of other sugary foods and other confounding variables. The results of this study underscore the need for further evaluation of the relation between adhesiveness of sugary foods and dental caries and more research of the cariogenicity (or lack of it) of diet drinks. "Pure cariogenicity" is suggested as a term to apply to gram-for-gram comparisons, whereas "effective cariogenicity" also considers amount and frequency of consumption. Dentists and auxiliaries, in their dental health education, should not imply that sugary solutions are less cariogenic than sticky snacks, for there may be no difference in effective cariogenicity in modern American society.

Dr. Burt, with a background of Australian education, was asked to take a “tough,” but objective look at the supplementation of the mother's diet with fluoride to prevent dental caries in her offspring.

Public health administrators are forced to consider efficiency as a criterion in their choice of preventive programs because of the numerous programs to choose from, restricted budgets, and declining caries experience in children. Interest in cost effectiveness in dental prevention has risen considerably since the initial conference on this issue at the University of Michigan in 1978. This article introduces the goals of the workshop, the nature of the work groups, and the data they will use.

Interpretation of the guidelines for ethical considerations in epidemiological studies requires defining a position of delicate balance. The goal must be to protect the rights, the health, and the dignity of study participants to the extent possible, while at the same time placing as few inhibitions as possible on the conduct of the research. The end result must therefore be a compromise, because these two requirements are inherently in conflict. The elements of this compromise are not static, for social philosophies change over time. What society considers the ideal balance between protection of the individual

A clinical trial of one application of Nuva-Seal fissure sealant was conducted under School Dental Service conditions in a low-income area of London. The sealant was applied to one of a cariesfree pair of permanent teeth by schools' dentists, the other tooth being left as a control. One examiner, who did not apply the sealant, conducted examinations at baseline, after 6 months, and after 2 years. There were 118 children, initially aged 5-12, who remained in the trial after 2 years. The sealant was fully retained on 27.4 % of the teeth, partially retained on 40.6 %, and missing on 17.9 %. The remaining 14.1 % of teeth had been restored. There was no statistically significant difference between subjects who had less decay in sealed teeth and those who had less decay in control teeth. The sealant was 13.6 % effective (not significant, P less than 0.4) in preventing caries in sealed teeth. These results are less favorable than those in other trials reported. The potential role of fissure sealants in a School Dental Service is discussed.

The effect of limited exposure to fluoridated water in childhood is of potential importance in highly-mobile modern society, but the subject has not been well-studied. This longitudinal study assessed caries experience and S. mutans proportions from fissure plaque in school-children who lived for at least the three years of the study in a non-fluoridated community (0.2 mg/L). Residence histories permitted division of the cohort into those who had lived all their lives in non-fluoridated communities, and those who had lived for some time previously in a fluoridated community. The children were aged 6-7 years at the beginning of the three-year study. Children with previous residence in the fluoridated communities developed 26.8% less caries in their permanent teeth during the study than did the children who had lived in non-fluoridated communities all their lives (p = 0.04), and had 29.8% less caries after three years (p = 0.02). Differences between the groups in S. mutans proportions from fissure plaque, sampled at six-monthly intervals throughout the study, could not be demonstrated. The dental benefits observed could not be attributed to socio-economic differences between the groups. Despite evidence that the benefits of limited ingestion of fluoridated water are topical in nature, the fact that many of the affected teeth in this study were unerupted at the time of the fluoride exposure means that pre-eruptive benefits cannot be ruled out.

Up, and after putting several things in order to my removal, to Woolwich; the plague having a great increase this week, beyond all expectation, of almost 2,000, making the general Bill 7,000, odd 100; and the plague above 6,000. Thus this month ends with great sadness upon the public, through the greatness of the plague everywhere throughout the kingdom almost. Every day sadder and sadder news of its increase. In the city dies this week 7,496, and of them 6,102 of the plague. But is feared that the true number of the dead this week is near 10 000: partly from the poor that cannot be taken notice of, through the greatness of the number, and partly from the Quakers and others that will not have any bell ring for them.

The prevalence and distribution of dental fluorosis and coronal caries are measured in this study of lifelong adult residents of two New Mexico communities. This study measures the prevalence and distribution of dental fluorosis and coronal caries in lifelong adult residents of two New Mexico communities. One community has a natural fluoride concentration of approximately 0.7 mg/L in its drinking water, optimum for the climate, and the water of the other community is naturally fluoridated at approximately 3.5 mg/L, five times optimum. The differences between the communities in amounts of dental fluorosis and any reduced susceptibility to dental caries associated with higher levels of fluorosis, particularly in molars, the teeth most susceptible to decay, are discussed.

This study relates the prevalence of caries and fluorosis among Michigan children, residing in four different areas, to the various concentrations of F in the communities' water supplies. Demographic information, details of F history, and dental attendance data were collected by a questionnaire form filled out by parents. Children ages six to 12 were screened for caries by means of the NIDR criteria and for fluorosis by means of the TSIF index. Results pertain only to continuous residents and the permanent dentition. The prevalence of both caries and fluorosis was significantly associated with the F concentration in the community water supply. Approximately 65% of all children were caries-free, ranging from 55.1 % in fluoride-deficient Cadillac to 73.7% in Redford (1. 0 ppm F). About 36% of all children had dental fluorosis, ranging from 12.2 in Cadillac to 51.2 in Richmond (1.2 ppm). All of the fluorosis was very mild. From logistic regression, the prevalence of caries was significantly associated with age, dental attendance, and the use of a water supply fluoridated at 1.0 ppm. The odds of experiencing fluorosis increased at every F level above the baseline (Cadillac), with the use of topical F rinses, and with age. Results suggest that children in the four communities may be ingesting a similar level of F from sources such as dentifrices, dietary supplements, and professional applications, but the factor that differentiates them with respect to the prevalence of caries and fluorosis is the F concentration in the community water supply.

With standardized plaque sampling techniques, bacterial populations were studied on the fissures of 500 unrestored lower first permanent molars in 279 children 6–7 years old at the beginning of a 2-ye

Epidemiologists often use mortality statistics to examine trends in health and disease,*9 principally because these data are frequently all that are available, and also because they are reasonably reliable.@ A major drawback to their use, however, is that mortality statistics are an extremely crude measure of health status, for they say nothing about the quality or degree of illness and disability in a population. The dental epidemiologist’s equivalent of mortality statistics is data on the loss of teeth. Until recently, these data, too, were frequently the only existing dental statistics. Tooth mortality data are a crude measure of dental health, but they also can probably be compared over time with reasonable confidence. This paper attempts to find reasons for any changes in dental health status over the last 50-100 years. Scarcity of data requires that tooth retention be used as a measure of dental health, despite its inadequacy; it also restricts the assessment of dental disease prevalence in an historical perspective almost totally to dental canes. Another constraint is that most historical data are available only from the United States and Great Britain; it is contended, however, that the conclusions reached from these countries can be more widely applied.