Enamel defects and dental caries in 9-year-old children living in fluoridated and nonfluoridated areas of Auckland, New Zealand

Kanagaratnam, S., Schluter, P., Durward, C., Mahood, R. and Mackay, T. (2009) Enamel defects and dental caries in 9-year-old children living in fluoridated and nonfluoridated areas of Auckland, New Zealand. Community Dentistry And Oral Epidemiology, 37 3: 250-259. doi:10.1111/j.1600-0528.2009.00465.x

Author Kanagaratnam, S.
Schluter, P.
Durward, C.
Mahood, R.
Mackay, T.
Title Enamel defects and dental caries in 9-year-old children living in fluoridated and nonfluoridated areas of Auckland, New Zealand
Formatted title
Enamel defects and dental caries in 9-year-old children living in
fluoridated and nonfluoridated areas of Auckland, New Zealand
Journal name Community Dentistry And Oral Epidemiology   Check publisher's open access policy
ISSN 0301-5661
Publication date 2009-06
Year available 2009
Sub-type Article (original research)
DOI 10.1111/j.1600-0528.2009.00465.x
Volume 37
Issue 3
Start page 250
End page 259
Total pages 10
Editor A. John Spencer
Place of publication Denmark
Publisher Wiley-Blackwell Munksgaard
Collection year 2010
Language eng
Subject C1
110599 Dentistry not elsewhere classified
111706 Epidemiology
920402 Dental Health
Formatted abstract
Objectives: This epidemiological study aims to investigate the
developmental enamel defects and dental caries among 9-year-old children resident in fluoridated and nonfluoridated regions in Auckland, New Zealand.
A stratified, two-stage random selection design where strata were defined by fluoridation status, school size, and school decile. After
informed consent was obtained, parents completed oral health questionnaires and children underwent dental examinations at school clinics.

612 children from 38 schools participated in the study. Overall, 175 (29%) children had lived continuously in fluoridated areas, 149 (24%) had lived continuously in nonfluoridated areas, and 288 (47%) had resided intermittently in fluoridated areas. Diffuse opacities were present in 117 (19%) children and deciduous teeth dental caries was seen in 370 (60%) children. After adjustment for covariates, a strong dose–response relationship between diffuse opacity and fluoridation status was found, with children who lived continuously in fluoridated areas being 4.17 times as likely to have diffuse opacities as children who lived continuously in nonfluoridated areas (P < 0.001). Conversely, a strong protective dose–response relationship between caries experience and fluoridation status was seen, with children who lived continuously in fluoridated areas being 0.42 times as likely to have dental caries as children who lived continuously in nonfluoridated areas (P < 0.001).

Reticulated water fluoridation in Auckland reduces the risk of dental caries but increases the risk of diffuse opacities in 9-year-old
children. Guidelines and health-promotion strategies that enable children to
minimize their risk to diffuse opacities yet reduce their risk of dental caries
should be reviewed.
Keyword caries
diffuse opacities
public health
References 1. Cheng KK, Chalmers I, Sheldon TA. Adding fluoride to water supplies. Br Med J 2007;335:699–702. 2. Centers for Disease Control and Prevention. Community water fluoridation. Atlanta, GA: CDC; 2007. http://www.cdc.gov/fluoridation; last accessed on 29 November 2007. 3. World Health Organization. Fluorides and oral health report of a WHO Expert Committee on Oral Health Status and Fluoride Use. Technical Report Series 846. Geneva: WHO; 1994. 4. Colquhoun J. Why I changed my mind about water fluoridation. Perspect Biol Med 1997;41:29–44. 5. Fluoride Action Network. Broadening public awareness about fluoride. Canton, NY: Fluoride Action Network; 2007. http://www.fluoridealert.org; last accessed on 27 November 2007. 6. McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J et al. Systematic review of water fluoridation. Br Med J 2000;321:855–9. 7. Medical Research Council. Water Fluoridation and Health. London: MRC; 2002. 8. Riorden PJ, Banks JA. Dental fluorosis and fluoride exposure in Western Australia. J Dent Res 1991;70:1022–8. 9. National Health and Medical Research Council. Health Department of Western Australia and the University of Western Australia Consensus Conference on Appropriate Fluoride Exposure for Infants and Children. Perth: NHMRC; 1993. 10. Australian Research Centre for Population Oral Health. The use of fluorides in Australia; guidelines. Aust Dent J 2006;51:195–9. 11. Public Health Commission. Fluoride and Oral Health. The Public Health Commission’s Advice to the Minister of Health. Wellington: PHC; 1995. 12. Hagre K, Kiro C, Stewart L, Logan R, Forgere G, Pearce N. Improving Child Oral Health and Reducing Child Oral Health Inequalities. Wellington: Public Health Advisory Committee, National Advisory Committee on Health and Disability; 2003. 13. Mackay TD, Thomson WM. Enamel defects and dental caries among Southland children. N Z Dent J 2005;101:35–43. 14. Cutress TW, Suckling GW, Pearce EIF, Ball ME. Defects of tooth enamel in children in fluoridated and non-fluoridated water areas of the Auckland region. N Z Dent J 1985;81:12–9. 15. Suckling GW, Brown RH, Herbison GP. The prevalence of developmental defects of enamel in 696 nineyear- old New Zealand children participating in a health and development study. Community Dent Health 1985;2:303–13. 16. de Liefde B, Herbison GP. The prevalence of developmental defects of enamel and dental caries in New Zealand children receiving differing fluoride supplementation, in 1982 and 1985. N Z Dent J 1989;85:2–7. 17. Ministry of Education. Deciles information. Wellington: MOE; http://www.minedu.govt.nz; last accessed on 9 January 2008. 18. Pitts NB, Evans DJ, Pine CM. British Association for the Study of Community Dentistry (BASCD) diagnostic criteria for caries prevalence surveys – 1996 ⁄ 97. Community Dent Health 1997;14:S6–9. 19. FDI Working Group. A review of the developmental defects of enamel index (DDE Index). Commission on Oral Health, Research & Epidemiology. Int Dent J 1992;42:411–6. 20. Twisk J. Applied longitudinal data analysis for epidemiology. Cambridge: Cambridge University Press; 2003. 21. Dupont WD. Statistical modelling for biomedical researchers. Cambridge: Cambridge University Press; 2002. 22. Public HealthCommission. Fluoridation of water supplies: draft policy statement. Wellington: Public Health Commission; 1993. 23. Do LG, Spencer AJ. Decline in the prevalence of dental fluorosis among South Australian children. Community Dent Oral Epidemiol 2007;35:282–91. 24. Suckling GW, Pearce EI. Developmental defects of enamel in a group of New Zealand children: their prevalence and some associated etiological factors. Community Dent Oral Epidemiol 1984;12:177–84. 25. Wong HM, McGrath C, Lo EC, King NM. Association between developmental defects of enamel and different concentrations of fluoride in the public water supply. Caries Res 2006;40:481–6. 26. Milsom K, Mitropoulos CM. Enamel defects in 8-year-old children in fluoridated and non-fluoridated parts of Cheshire. Caries Res 1990;24:286–9. 27. Cochran JA, Ketley CE, Arnado´ ttir IB et al. A comparison of the prevalence of fluorosis in 8-yearold children from seven European study sites using a standardized methodology. Community Dent Oral Epidemiol 2004;32:S28–33. 28. Nik-Hlissein NN, Majid ZA, Mutalib KA, Abdullah F, Abang A, Wan MN. Prevalence of developmental defects of enamel among 16-year-old children in Malaysia. Ann Dent, Univ Malaya 1999;6:11–6. 29. Kanagaratnam S. Dental caries patterns and the utilisation of dental services among 15-year-old adolescents in the Southern Regional Health Authority region. N Z Dent J 1997;93:44–6. 30. Hill AB. The environment and disease: associations or causation? Pro R Soc Med 1965;58:295–300. 31. Clarkson JJ, O’Mullane DM. Prevalence of enamel defects ⁄ fluorosis in fluoridated and non-fluoridated areas in Ireland. Community Dent Oral Epidemiol 1992;20:196–9. 32. Ellwood R, O’Mullane D, Clarkson J, Driscoll W. A comparison of information recorded using the Thylstrup Fejerskov Index, Tooth Surface Index of Fluorosis and Developmental Defects of Enamel Index. Int Dent J 1994;44:628–36.
Q-Index Code C1
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Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Nursing, Midwifery and Social Work Publications
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