A comparison of the anticaries effectiveness of daily and weekly rinsing with sodium fluoride solutions: findings after two years.
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Biomedical subjects
Publications and source records attributed to S B Heifetz.
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In 1972, a self-administered fluoride program was initiated in Nelson County, VA, a fluoride-deficient area. Children in elementary school (grades K-6) ingest daily a 1-mg fluoride tablet, rinse weekly with 0.2% NaF solution and receive fluoride dentifrice for home use. In 1978, dental examinations of elementary schoolchildren (ages 6-12) who had continuously participated in the program for 1 to 6 years showed a prevalence of 2.70 DMFS, 45% lower than the score of 4.89 DMFS for their cohorts at the baseline. The preventive program inhibited dental caries effectively in all types of surfaces, but the reduction in proximal surfaces of 85% is particularly striking. Findings of high school children (ages 13-17) in 1978, who had not participated in the elementary school program for 1-5 years, showed evidence of strong post-treatment effects. At each succeeding follow-up survey, benefits have continued to improve. For elementary school participants, benefits were 17.7% after 2 years, 35.3% after 4 years and 44.8% after 6 years. Weekly fluoride mouthrinsing and daily ingestion of a fluoride tablet are feasible school-based procedures for the prevention of dental caries. Combined with the use of a fluoride dentifrice at home, these procedures have a pronounced cariostatic effect.
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The data from the Wayne County study indicate that administration of fluoride tablets in school should be recommended in nonfluoridated areas as an effective public health measure for the prevention of dental caries. The finding that benefits persist for at least 1 1/2 years after treatment is discontinued further accentuates the public health appeal of the procedure. As the data show no clear-cut superiority in posttreatment benefits for two fluoride tablets a day, a single tablet daily can be recommended as more suitable for school programs because of lower cost and greater feasibility.
Nearly all children who attend elementary school (grades K through 6) in a rural community have participated since 1972 in a school-based caries preventive program consisting of daily ingestion of a 1-mg fluoride tablet and weekly rinsing with a 0.2% sodium fluoride solution. 3they also regularly receive toothbrushes and a fluoride dentifrice for use at home. Examinations conducted after four years showed that the prevalence of dental caries among continuous participants, 7 through 12 years of age, was reduced by 35% compared with baseline findings; mean DMFS scores in 1972 and 1976 were 5.39 and 3.49, respectively. The preventive program inhibited decay in all three types of surfaces: approximal surfaces received about twice the relative protection against decay (70%) as buccolingual surfaces (34%) and more than three times as much as occlusal surfaces (22%). A comparison of estimates of four-year increments of decay taken from cross-sectional data at the baseline and actual increments from the 1972 and 1976 examinations showed that, for children ages 6 through 15, the incremental DMFS score was 41% lower during the period of the program than before its initiation. Findings in older children (ages 13 through 15) in 1976 who had stopped participation when they left elementary school at about age 12 showed evidence of strong posttreatment effects--as great as 31% fewer DMFS for 14-year-old children.
Before public finance is committed to a particular public health measure it is essential that the project should be analytically evaluated. Cost-benefit analysis is one method of choosing between alternative programmes. It suffers from the disadvantage that, while costs can be accurately assessed, the benefit to an individual of freedom from pain, discomfort or inconvenience cannot be simply expressed in monetary terms. Such benefits may therefore be omitted from calculations of cost-benefit and a programme with valuable indirect or intangible benefits may not receive adequate consideration in competition with other alternatives. Futhermore, since benefits may only accrue some time after expenditure has been incurred, inflation distorts the significance of cost-benefit calculations. Cost-effectiveness analysis is an alternative method which enables one to determine the least expensive of several alternative methods of achieving a stated objective. The application of these concepts to preventive programmes against dental caries is described. Distinction must be made between the effectiveness of preventive measures during controlled clinical trials on limited numbers of subjects and their value when applied under field conditions to the whole community. Detailed comparisons are made between various methods of the application of fluorides caries prevention by community fluoridation water supply, school water fluoridation and topical application of fluorides. It is concluded that while completely accurate and valid analyses of cost-effectiveness are not possible, they do enable dentistry to view its activities more objectively and to indentify the real issues which should affect future decisions.
In 1968 at Seagrove, NC, fluoride was added to the water supply of a rural school (grades 1 through 12) at a level of 6.3 ppm, seven times the optimum level recommended for community water fluoridation in the area. Findings after eight years showed that children in grades 1 through 8 had approximately 40% fewer DMF surfaces than did their counterparts on the baseline. A comparison of these findings with those of another school fluoridation study, in which a level of 4.5 times the optimum concentration had been tested, showed only a slight advantage to the children at Seagrove. However, the full potential of school water fluoridation at seven times the optimum level cannot be determined until children in all grades will have been exposed since entering the first grade.
Two groups of children, initially in the first and second grades, chewed, rinsed with, and swallowed an acidulated phosphate-fluoride tablet containing 1 mg of fluoride either once or twice a day in school. A control group of children followed the procedure once a day using a placebo tablet. An evaluation after six years of treatments showed that both the once-a-day and the twice-a-day procedures with fluoride tablets effectively reduced the incidence of dental caries.
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Two groups of children initially in the first and second grades chewed, rinsed with, and swallowed an acidulated phosphate-fluoride tablet containing 1 mg of fluoride either once or twice a day in school. A control group of children followed the procedure once a day using a placebo tablet. An interim evaluation after 55 months showed that the children receiving two fluoride tablets daily had a significant reduction in incremental caries on early erupting teeth, which received primarily topical exposure to the fluoride, as well as on late erupting teeth, which received mainly preeruptive, systemic exposure. The findings also suggested that the use of a single fluoride table daily may reduce dental caries, although the presence of a benefit was less definitive than it was for the two-tablet procedure.
The single application of a BIS-GMA adhesive sealant in Kalispell on a paired half-moouth basis and the annual monitoring of the sealed sites for five years is not a recommended preventive regimen. The study does proved information on the potential long-term in vivo retention of the sealant and its ability to prevent dental caries. The findings of this study clearly show that when this pit and fissure sealant is retained, its is effective in preventing caries in sealed tooth surfaces. Moreover, on occlusal surfaces, the usual susceptibility to decay is not altered by having been treated with a sealant that is not retained.
Until a few years ago, the results of most surveys of the prevalence of dental caries among school-age children in the United States, particularly those done in the south, showed that black children had a lower prevalence of dental caries than did white children who lived in the same community.4-6,11,16,19,20-23,25 However, in several recent surveys, the formerly observed race-caries relation has not been detected.2,8,17,18,26 In connection with a study initiated in 1972 in Nelson County, Virginia to determine the effectiveness of a combination of self-applied procedures for the administration of fluoride, baseline data on dental caries experience were collected for 1,374 white and 761 black children attending the County's public schools. The availability of data for large numbers of white and black children prompted a cross-racial comparison of prevalence of dental caries. Findings of the comparative analysis are contained in this report.
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