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Biomedical subjects

H S Horowitz

Publications and source records attributed to H S Horowitz.

At least 19 recordsLinked to original sources
PubMed1992

The need for toothpastes with lower than conventional fluoride concentrations for preschool-aged children.

Since 1945, when community water fluoridation was first implemented in the United States, not only has the procedure grown to cover more than half of the US population, but the development and use of other fluoride methods have expanded greatly. A concomitant, dramatic decrease has occurred in the caries prevalence of US school-aged children. Recent studies indicate, however, that the prevalence and, to a lesser extent, the intensity of dental fluorosis have increased in schoolchildren in both fluoridated and fluoride-deficient areas. Several studies show that young children inadvertently ingest sizable proportions of toothpaste during toothbrushing. Although ingestion of fluoride toothpastes by preschool-aged children may not be the major contributor to the increase in fluorosis, the findings of at least four studies suggest that the use of fluoride toothpastes by young children is a risk factor. The direct dose-response relation between effectiveness and fluoride concentration of toothpastes is far from clear-cut and, at best, is weak. Thus, considering today's reduced risk of caries, it is timely to market fluoride toothpastes in the US with 400-500 ppm fluoride for preschool-aged children, who are still at risk for developing fluorosis, as has been done in several other countries. Dental public health authorities must work with toothpaste manufacturers, professional organizations, and regulatory agencies to facilitate the approval and marketing of such pediatric fluoride toothpastes.

Child, Preschool↗
PubMed1992

A researcher's view.

The Food and Drug Administration (FDA), by ensuring that the health care products used by Americans are both safe and effective, provides an essential regulatory function. With respect to the regulation of dental drug products, this researcher perceives that the FDA has not changed or modified its position on a number of issues to reflect new scientific information. Reasons for this inflexibility include the size and ponderousness of the agency, inadequate staff with dental expertise, and a failure to keep current with new dental research findings. The FDA must solve these problems if it wishes to regulate intelligently. The acceptance and certification programs of the American Dental Association ensure that products offered to the profession and the public that bear its seal of acceptance are safe and effective. The ADA's Council on Dental Therapeutics has a long history of staying current on issues in dental research and public health and regularly seeks consultation from eminently qualified experts. Overall, it has done an excellent job over the years in conducting an important voluntary regulatory program. Both the FDA and the ADA benefit and help protect the oral health of the public.

American Dental Association↗
PubMed1990

The future of water fluoridation and other systemic fluorides.

School and community water fluoridation, salt fluoridation, and use of dietary fluoride supplements have abundant scientific support as effective caries-preventive methods. Because caries has declined greatly in many developed countries from use of topical fluorides, the absolute caries reduction will be considerably smaller when systemic fluoride methods are implemented now than it was 20 to 40 years ago. For countries with most of the population living in cities with communal water supplies, community fluoridation is the most logical approach from the standpoints of cost-effectiveness and total caries-preventive impact. In countries with a mostly rural population without central water supplies, salt fluoridation is more practical. Dietary fluoride supplements can be recommended only for regions where neither water fluoridation nor salt fluoridation is possible, or as a temporary measure. Although divergent views exist concerning the relative caries-preventive effects of pre-eruptive and post-eruptive fluoride administration, the effectiveness of systemic fluoride methods for preventing dental caries remains unchallenged. Persuasive scientific and public health arguments exist to justify implementing and sustaining their use. The future of these methods will be influenced by the findings of new clinical and epidemiological research. Social, political, economic, and educational factors will be of equal, if not greater, importance. Perceptions of the current severity of dental caries as a health problem and of risks associated with preventing the problem may affect the future uses of systemic fluorides more than will recommendations of scientists.

Fluoridation↗
PubMed1989

Effectiveness of school water fluoridation and dietary fluoride supplements in school-aged children.

School water fluoridation and school-based fluoride tablet programs both have been shown in many studies to be effective in preventing dental caries. These studies indicate that school water fluoridation reduces dental decay by approximately 40 percent and school-based fluoride tablet programs by about 30 percent. However, nearly all the studies were done when the prevalence of caries among US schoolchildren was greater than it is today, which makes it difficult to assess their current effectiveness. Data from dental surveys of school-aged children conducted during the past 30 years indicate that overall caries prevalence has declined by more than 75 percent and that of approximal tooth surfaces by more than 90 percent. Recent national data indicate the difference in caries prevalence between children with lifetime residence in either fluoridated or nonfluoridated areas has also diminished, which raises questions about the cost effectiveness of initiating school-based fluoride programs for all areas. There are still groups of children, however, seriously affected by dental caries. It is safe to assume that implementation of school water fluoridation or fluoride tablet programs will result in traditionally reported benefits among these children. Ongoing school-based fluoride programs should not be discontinued until it is known what impact their cessation will have on dental disease.

Adolescent↗
PubMed1989

Fluoride and enamel defects.

The concentration of fluoride in drinking water is the major determinant of the prevalence and severity of dental fluorosis in a community. Fluorosis is more prevalent and discernible in permanent teeth than in primary teeth; the intensity can range from barely perceptible, whitish striations in enamel to confluent pitting and dark staining. The traditional belief is that fluorosis is produced only during the secretory stages of ameloblastic activity. Some recent reports suggest that the maturation stages of enamel development are as important as or even more important than the secretory stages as the time when fluorosis can be produced. The question of timing remains unresolved. Many questions also remain about general and individual physiologic variations in relation to susceptibility to dental fluorosis. Good criteria for differential diagnosis exist to distinguish dental fluorosis from non-fluoride enamel opacities. An increasing number of reports indicates that the prevalence of fluorosis may be increasing among children in fluoridated and non-fluoridated communities. Reasons for the increases may relate to misuse of dietary fluoride supplements, ingestion of fluoride toothpastes, or increasing amounts of fluoride in foods or the atmosphere. The intensity of the increased fluorosis is in the milder categories and is not generally unsightly. It should be recognized that a small amount of fluorosis may be an alternative to a greater prevalence of dental caries, a disease that may produce cosmetic problems and sequelae worse than those produced by fluorosis.

Animals↗
PubMed1986

Indexes for measuring dental fluorosis.

Dental fluorosis, a hypoplasia or hypomineralization of tooth enamel or dentin, ranges in intensity from barely noticeable whitish striations to confluent pitting and staining. Various indexes or classification systems have been used in surveys to measure the presence and severity of enamel fluorosis. Other systems and indexes record all defects in enamel, based on a premise that an etiology for the condition should not be presumed. If all defects are recorded, a retrospective attempt to reconstruct which of them are fluorosis is inappropriate. Dean's classification system has been used most frequently over the years for assessing fluorosis. Therefore, its continued use is sometimes important for historical comparisons. Dean's system, however, has several shortcomings, principally its inability to measure fluorosis in different tooth surfaces. As it has been traditionally used, it also does not permit specifying the cosmetic importance of the most severe fluorosis detected in a dentition. The Tooth Surface Index of Fluorosis (TSIF) eliminates or reduces some of the shortcomings of Dean's method. Use of the TSIF in a survey in Illinois was able to discriminate between the prevalence and severity of fluorosis in four groups of communities with different concentrations of fluoride in their drinking water.

Dental Health Surveys↗
PubMed1986

Combined fluoride, school-based program in a fluoride-deficient area: results of an 11-year study.

In 1972, a school-based fluoride program was initiated in elementary schools in Nelson County, VA, a fluoride-deficient area. For 11 years, participating children ingested daily in school a 1-mgm fluoride tablet and rinsed weekly with a .2% sodium fluoride solution. They also received fluoride dentifrice and toothbrushes for home use. The program was extended into junior high school in 1978 and into high school in 1980. In 1983, dental examinations of children aged 6 to 17 years, who had continuously participated in the program for 1 to 11 years depending on school grade, showed a mean prevalence of 3.12 DMFS, which was 65% lower than the corresponding score of 9.02 DMFS for children of the same ages at the baseline examinations. The preventive program inhibited decay in all types of surfaces: 54% in occlusal surfaces; 59% in buccolingual surfaces; and 90% in mesiodistal surfaces.

Adolescent↗
PubMed1986

Prevalence of dental caries and dental fluorosis in areas with negligible, optimal, and above-optimal fluoride concentrations in drinking water.

The prevalence of dental caries and dental fluorosis was assessed in 1,123 children aged 8 to 16 years who were lifelong residents of areas with negligible, optimal, and above-optimal concentrations of natural fluoride in drinking water. Caries prevalence in the optimal fluoride area was 38.1% lower than it was in the negligible fluoride area, and, in the higher-than-optimal fluoride areas, even greater caries protection was evident. Caries protection was compromised in children with severe fluorosis. Findings do not support the contention that definite increases in the prevalence of fluorosis are occurring in communities with negligible and optimal water-fluoride concentrations because of increased total fluoride consumption from various sources.

Adolescent↗