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Background Acidogenic, acid-tolerant bacteria induce dental caries and require D-alanyl glycerol lipoteichoic acid (D-alanyl LTA) on their cell surface. Because fluoride inhibits acid-mediated enamel demineralization, an elevated antibody response to D-alanyl LTA may indicate subjects with more acidogenic bacteria and, therefore, an association of DMFT with fluoride exposure and gingival health not apparent in low responders. Methods Cluster analysis was used to identify low antibody content. Within low and high responders (control and test subjects), the number of teeth that were decayed missing and filled (DMFT), or decayed only (DT) were regressed against fluoride exposure in the water supply and from dentrifice use. The latter was determined from gingival health: prevalences of plaque (PL) and bleeding on probing (BOP), and mean pocket depth (PD). Age was measured as a possible confounding cofactor. Results In 35 high responders, DMFT associated with length of exposure to fluoridated water (F score), PL and BOP (R2 = 0.51, p < 0.001), whereas in 67 low D-ala-IgG responders, DMFT associated with PL, age, and PD (R2 = 0.26, p < 0.001). BOP correlated strongly with number of 7 7 decayed teeth (DT) in 54 high responders (R2 = 0.57, p < 0.001), but poorly in 97 low responders (R2 = 0.12, p < 0.001). The strength of the PD association with DMFT, or of BOP with DT, in high responders significantly differed from that in low responders (p < 0.05). Conclusion Caries associates with gingival health and fluoridated water exposure in high D-alanyl LTA antibody responders.

Although the data presented by Dr. Conti and his group may be typical for one region of Florida, only, they have added to the scarce information on caries-experience of preschool black children who are consuming fluoridated water.

The oral health status of 454 children and 115 adults from a population of migrant and seasonal farm workers in Florida was assessed. The prevalence of disease among the children was consistent with that reported for other black children of this age. The migrants had received more dental treatment than the children of seasonal farm workers; however, the level of care for both groups was strikingly low. The results of this neglect were clearly reflected in the mouths of the adults, most of which were found to be in a very deteriorated state of dental health. A program to cope with these long unmet needs is unrealistic. Efforts should be made to eliminate pain and infection until the cycle of poverty can be broken.

In areas lacking public water supplies and where fluoride is not naturally present in the well water, school fluoridation programs have been shown to be effective and safe. Reductions of up to 38.9% in the rate of dental decay have been reported. Higher levels of fluoride are used in the school water than in public water because of the limited time the children are in school. The relatively low cost of the necessary equipment and chemicals can easily be justified by taking into account the amount of dental decay that can be prevented. Interested parents, teachers, or administrators should contact their state health department for technical assistance.

The Job Corps is a program for disadvantaged youths between the ages of 16 and 22 in need of general education and vocational training. During fiscal 1978, 61 residential centers had a total enrollment of 33,732. Despite differences in size, location, and organizational structure of the centers, uniform requirements for health services have been established. The administration at each center must ensure emergency dental care, arrange for examination of all corps members, and make routine treatment available on a priority basis. Because of uniqueness of local situations, various mechanisms are used to accomplish these goals. The most fundamental difference is the provision of care by means of onsite clinics with salaried dentists as opposed to offsite arrangements with fee-for-service in private dental offices. An analysis of cost and utilization data for the 1978 FY indicated that onsite care ($96.19/CMY) was significantly more expensive than offsite care ($72.24/CMY). The difference in the mean number of visits, however, was also statistically significant. Onsite care resulted in 4.78 visits/CMY; corps members made 2.24 visits/CMY when offsite care was provided. Furthermore, even taking into consideration the initial expenses involved in establishing clinical facilities, the cost of an onsite visit, $22.30, was less than an offsite visit, $33.62. The cost and utilization patterns were the same at small centers as large centers.