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This randomized, double-blind study tested the caries-preventive efficacy of prenatal fluoride supplementation in 798 children followed until age 5. Initially, 1,400 women in the first trimester of pregnancy residing in communities served by fluoride-deficient drinking water were randomly assigned to one of two groups. During the last 6 months of pregnancy the treatment group received 1 mg fluoride daily in the form of a tablet and the control group received a placebo. Both treatment and control subjects were encouraged to use postnatal dietary fluoride supplements. Caries was measured in children at age 3 and 5 while fluorosis was assessed at age 5. Caries activity was very low in both study groups: 92% of children remained caries-free in the treatment group and 91% remained caries-free in the placebo group. Fluorosis was observed in 26 subjects, all classified as very mild. Overall, there were no statistically significant differences in the study groups with respect to caries and fluorosis in deciduous teeth. The study had sufficient power to detect an absolute risk reduction of 5.1% while only a 1.5% reduction was observed. These findings do not support the hypothesis that prenatal fluoride has a strong caries-preventive effect.

This study reports the interexaminer agreement of three pairs of evaluators of salivary dip slide tests for mutans streptococci and lactobacilli. 717 Cariescreen SM and Bactotest LB dip slides were available for assessment by 2 dentists and 1 dental hygienist. A single calibration session was held prior to the onset of the study. Each dip slide was read once by each examiner independently. Among the three pairs of examiners, Pearson R values ranged from 0.84 to 0.90 for Cariescreen and from 0.78 to 0.87 for Bactotest. Kappa statistic values ranged from 0.56 to 0.61 for Cariescreen and from 0.70 to 0.74 for Bactotest. The range of agreement was from 72.2 to 76.9% for Cariescreen and from 86.4 to 88.3% for Bactotest. The majority of disagreements were of one category in magnitude, though there were a few disagreements of greater magnitude. This study found moderately strong agreement among the three examiners; it suggests that multiple examiners of dip slide tests carefully calibrated initially and periodically to ensure a high level of agreement.

Although the prevalence of dental caries is continuing to decline, it still affects a majority of the US population and can be a serious problem for those afflicted. The objective of this project was to develop and perfect a model for assessment of risk of dental caries onset in children. In the first study, reported herein, a set of clinical, microbiological, biochemical, and socio-demographic variables was identified that distinguished, with an acceptable level of sensitivity and specificity, between children who had no previous caries experience and children who had high caries levels. A total of 313 children--age 12-15 years, 140 from a fluoridated community and 173 from a fluoride-deficient community--was selected on the basis of previous caries experience, either zero DMFS or high DMFS (> or = 6 in the fluoridated or > or = 8 in the fluoride-deficient community). Clinical exams for DMFS, dental fluorosis, and plaque were conducted. Stimulated whole saliva was collected for analysis of mutans streptococci, lactobacilli, total viable flora, and fluoride concentration. A questionnaire was used for collection of demographic data as well as information on prior fluoride exposure, dietary habits, and oral hygiene practices. By means of discriminant analyses, with use of seven key clinical and laboratory variables, it was possible for zero-DMFS subjects to e classified correctly (specificity) in 77.6% of cases in the fluoridated community and in 86.1% of cases in the fluoride-deficient community. High-caries subjects were classified as such (sensitivity) in 79.3% and 88.1% of cases, respectively.

Our objective was to develop and perfect a model for the assessment of risk of dental caries onset in children. Even though dental caries prevalence in children is continuing to decline, there is still a significant minority for whom it is a problem. In this study, we sought to ascertain whether a set of variables selected in a previous cross-sectional study could be used to differentiate between caries-free six-year-olds who would or would not subsequently present with clinically-detectable caries. A total of 472 caries-free six-year-olds--286 from a fluoridated community and 186 from a fluoride-deficient community--was selected. Clinical examinations for DMFS, dental fluorosis, and plaque were conducted. Stimulated whole saliva was collected for analysis of mutants streptococci, lactobacilli, total viable flora, and fluoride, calcium, and phosphate concentrations. A questionnaire was used for collection of demographic data as well as information on prior fluoride exposure, dietary habits, and oral hygiene practices. By means of linear discriminant analyses, it was possible to predict correctly which children would develop caries within six to 12 months (sensitivity) in 82.8% of cases and which children would not develop caries during that period (specificity) in 82.4% of cases.

Plaque indices, numbers of mutans streptococci, lactobacilli and total viable flora in plaque and saliva were assessed as part of a large-scale cross-sectional study designed to determine the factors that are associated with high caries activity in children. Subjects, 12 to 15 years old, residing in areas where the water supplies were either fluoridated (n = 140) or fluoride-deficient (n = 173) were studied. Mutans streptococci and lactobacilli numbers in saliva were positively correlated with plaque index. Plaque indices were significantly higher in the high-caries group than in the zero-caries group of the fluoride-deficient community. In the fluoridated community, there was no difference in the plaque index between the zero- or high-caries groups. In each community, pooled dental plaque and saliva harbored fewer mutans streptococci and lactobacilli in the zero-caries than the high-caries group. Greater numbers of mutans streptococci were found in the dental plaque and saliva of the zero-caries subjects in the fluoridated community than in the fluoride-deficient community, suggesting that a greater caries challenge can coexist with zero-caries status in the fluoridated community.

An epidemiologic investigation to reliably identify caries-susceptible subjects by microbiological and chemical assessment of plaque and saliva is currently in progress. As part of that study, the numerical relationships of mutans streptococci, lactobacilli and total viable microflora in plaque and saliva among 12- to 15-year-old children in a fluoridated community were determined. Paraffin-stimulated whole saliva and pooled dental plaque were collected. Each sample was suspended in reduced transport fluid, chilled on ice, and assayed. The bivariate normal distribution was found to be a suitable model for the distribution of the pairs [numbers of bacteria in plaque (log10), numbers of bacteria in saliva (log10)]. Statistically significant positive correlations were found between numbers of mutans streptococci in plaque and saliva, and between lactobacilli in plaque and saliva.

This paper reports on a relatively uncomplicated and inexpensive computerized system for prospective evaluation of clinical dental programs from the point of view of effectiveness and efficiency. Availability of this system does away with some high start-up costs. Three forms of input data, new case information, examination findings and operative procedure information, are regularly collected on data sheets and specially designed Port-a-punch IBM cards. Easily interpreted output tables are generated monthly on such variables as completed cases according to treatment series and clinician, number of various procedures performed by clinicians, etc. Productivity is measured, in part, by application of monetary constants to procedure data. This paper describes the computer programs used, the cost of setting up and operating the system (which is within the budgetary constraints of most small, publicly funded programs) and the benefits that can be derived from the use of such a system. The system provides prompt feedback of relevant administrative data, thus allowing for relatively quick response to problems. Use of the system reduces clerical needs to a minimum and the program can easily be implemented on any except the very smallest digital computer.

The aim of this study was to compare the effects of daily mouthrinsing with aqueous solutions of 0.05% NaF or 0.1% SnF2 on dental caries and tooth staining. The study population consisted of 437 children, aged from 12 to 15 years at baseline, residing in a non-fluoridated community. By stratified random sampling, the subjects were divided into two groups, one group rinsing daily under supervision for 28 months with the NaF solution and the other with the SnF2 solution. The SnF2 group exhibited four to five times as much extrinsic stain as did the NaF group, although the stains were quite mild and not explicitly distinguishable between groups. There were no statistically significant differences between the two groups in terms of total DMFS. However, the increment of pit and fissure caries was 0.9 surfaces fewer for the SnF2 group (p = 0.04), while the increment of smooth surface caries was 0.6 surfaces fewer for the NaF group (p = 0.04). These data suggest that there may be a difference in mechanism of action between SnF2 and NaF rinses.

In the fall of 1975, 1,915 children in grades K through eight began a school-based program of supervised weekly rinsing with 0.2 percent aqueous solution of sodium fluoride in an unfluoridated community in the Finger Lakes area of upstate New York. At baseline and annually thereafter, a random sample of children in grades K through 11 received clinical dental caries examinations. The prevalence of dental caries by grade at each of the follow-up dental examinations was compared to the grade-specific prevalence of dental caries at baseline. Overall, there was a decline of 57.8 percent in prevalence of caries in permanent teeth after seven years of rinsing. Among children in grades K through five, there was a decline of 35.4 percent in the prevalence of caries in primary teeth during the same time period. Tenth and eleventh grade children, after not rinsing for one and two years, respectively, continued to show the same trend toward lower caries prevalence as active rinsers. Caries prevalence among seventh and eighth graders after seven years of rinsing was not significantly different from caries prevalence among seventh and eighth grade lifetime residents of a nearby fluoridated community. A decline in the prevalence of caries in primary teeth among kindergartners prior to rinsing suggests that factors in addition to the mouthrinse program may have contributed to the decline in caries prevalence.

Community water fluoridation and individual use of fluorides have brought about a marked reduction in the prevalence of dental caries in the United States during the past 35 years. There is evidence that the prevalence of caries is declining in communities with unfluoridated water as well as in those with fluoridated water. This phenomenon may be related to an increase of fluoride in the food chain, especially from the use of fluoridated water in food processing, increased use of infant formulas with measurable fluoride content, and even unintentional ingestion of fluoride dentifrices. This trend should encourage reevaluation of research priorities and previously accepted standards for optimal fluoride use.

Bacteriologic and clinical studies suggest that sealants can be used therapeutically on incipient caries of the enamel. The present study was designed to explore this approach further by determining whether there is a difference in retention rates on sound or carious tooth surfaces sealed for the first time as well as resealed surfaces. A total of 1766 teeth were sealed for subjects 12-14 yr of age of which 120 were judged to be carious. Mouths were divided sagittally on a random basis and an ultraviolet light activated resin with a filler or an autopolymerizing resin without a filler was placed on contralateral surfaces of all molar and premolar teeth. The effects of sealant type, caries status, arch and tooth type on retention over a 2-yr period were tested using Mantel-Haenszel statistics. At the end of 1 yr, 88% of the teeth sealed with the autopolymerizing resin were judged to be completely intact compared to 82% of the teeth filled with the ultraviolet light resin. At the end of the second year the retention rates were 84% and 75% respectively. The retention rates for carious and sound teeth at the end of both years were almost identical. Overall, premolars had a 15% more favorable retention rate than molars. There were minimal differences between arches although maxillary premolars had approximately a 5% higher retention rate than mandibular premolars. The reverse was true for molar teeth. Retention of sealants at the end of the second year (resealed after 1 yr) was 4% less than comparable teeth sealed initially.

This paper presents a general approach for simultaneously assessing, from serial data, diagnostic consistency, interrater reliability and incidence of a strictly progressive disease. Observed data are viewed as incomplete: diagnostic errors are not distinguished from true diagnoses. We introduce a broad class of models to separate rater errors from underlying patterns of disease incidence. The analysis can include covariates and risk factors. We provide variance expressions for parameter estimates. Categorical data for estimating the incidence of dental caries serve as an example.

Two groups of children, ages 12 to 15, rinsed daily for 28 mo with aqueous fluoride solutions, one group using 0.05% sodium fluoride (NaF) and the other group using 0.1% stannous fluoride (SnF2). The SnF2 group had less plaque accumulation after four mo, but no difference was apparent at 16 and 28 mo. Gingivitis was less severe in the SnF2 group throughout the study, although the difference did not reach statistical significance. The 0.1% SnF2 solution, used daily as a mouthrinse, inhibits plaque formation, although this inhibitory effect is not apparent after 16 mo of rinsing.

This clinical trial of a daily 0.1% SnF2 mouthrinse involved over 400 children, from 12 to 15 years of age. With 0.05% NaF as the active control, rinsing was conducted daily for four mo after baseline examinations. Four-month examinations showed significantly lower Plaque Index scores for the SnF2 group. Gingival Index scores for the SnF2 group were lower, but did not reach statistical significance.

The results of a 2-year radiographic assessment of 113 carious posterior teeth that were sealed with one of two sealants are presented. Little or no difference was found in radiographic ratings of caries by type of sealant. Sealant loss between annual recall visits had little or no detectable effect on radiographic ratings of caries during the study. Radiographs suggested that caries may regress in sealed teeth with early caries. The results support the safety of sealing incipient caries in pits and fissures to increase the potential uses of sealants.

A study was conducted of family records and claim forms of a company-sponsored dental plan to determine the effects of several demographic variables on utilization of the plan and on patterns of expenditure. The plan was non-contributory on the part of the employees. Individual utilization of the plan (at least once during the study year) closely approximated the average for the entire U.S. population. Salaried employees, and families, were more likely to use the plan than hourly-paid employees and families. High income families were more likely than lower income families to use the plan. Most of the independent variables (income, age, hourly versus salaried) correlated with utilization patterns in a predictable manner. A notable exception was when one looked from one division of the corporation to another, with 25 per cent of families in one division using the plan in the study year, compared to 90 per cent at another division. The reasons for these dramatic differences may be related, at least in part, to institutional factors rather than to patient behavior, and further study is indicated.

Fluoride mouthrinses have been used extensively for the past 15 years to prevent dental caries in children. Their use has been especially widespread in organized school-based programs in the US. Nearly three dozen clinical studies of fluoride mouthrinses, both with and without placebo controls, have been reported in the literature since the early 1960s. The overwhelming majority of those studies report statistically significant caries inhibition from the use of the products. Most of the studies were published prior to the knowledge of a decline in caries prevalence during the past 30 years. Consequently, the results of those studies lacking a placebo control group have been challenged. Even randomized clinical trials with appropriate control groups appear to be reporting declining differences between test and control groups. Using a model based on annual caries increments from published studies, the conclusion is reached that future use of fluoride mouthrinses is unlikely to result in annual savings in DMF increment greater than 0.4 surfaces, regardless of age of rinsers.