Tooth-surface progression and reversal changes in fluoridated and no-longer-fluoridated communities over a 3-year period.
OBJECTIVE
To compare permanent tooth surface-specific progression/reversal changes between fluoridation-ended (F-E) and still-fluoridated (S-F) communities in British Columbia, Canada, over a 3-year period.


METHODS
D1D2MFS examinations were contrasted for 2,964 schoolchildren in 1993/94 (grades 2, 3, 8 and 9) and 1996/97 (grades 5, 6, 11 and 12). Generalized Estimating Equation (GEE) models explored the relation between progression/reversal changes and fluoridation status, age, gender, socioeconomic status, and dietary/fluoride histories.


RESULTS
Within a scenario of low levels of caries overall, few children had multiple surfaces progressing. At least one smooth surface progressed in 31.4% of subjects; at least one pit-and-fissure (PF) surface progressed in 43.1% of subjects. At least one smooth surface reverted in 89% of subjects who had reversible stages; at least one PF surface reverted in 23.8% of subjects who had reversible stages. GEE (smooth) indicated that odds ratios of progression were twice as large in the F-E site compared to the S-F site, and slightly increased in older participants and in participants exposed to more fluoride technologies. GEE (PF) also indicated that progression was slightly more common in the F-E site; more frequent snacking and lower parental educational attainment had modest associations with increased progression in PF surfaces. For the two types of surfaces, GEE models demonstrated that unerupted surfaces were less likely to progress than sound surfaces. No associations were found between reversals and independent variables.


CONCLUSIONS
Progressions were found to be weakly linked to socio-demographic factors; baseline surface statuses were better predictors of progression. Using the current definitions for disease transitions, F-E communities had more frequent progressions than a S-F community.
Maupomé
G
G
Center For Health Research, Portland, OR 97227-1110, USA. gerardo.maupome@kpchr.org
Shulman
J D
JD
Clark
D C
DC
Levy
S M
SM
Berkowitz
J
J
D000293:Adolescent; D000367:Age Factors; D001955:British Columbia / Q000453:epidemiology; D002327:Cariostatic Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002648:Child; D003430:Cross-Sectional Studies; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D004522:Educational Status; D005247:Feeding Behavior; D005260:Female; D005457:Fluoridation / Q000706:statistics & numerical data*; D005459:Fluorides / Q000627:therapeutic use; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D015588:Observer Variation; D016017:Odds Ratio; D010290:Parents / Q000193:education; D012044:Regression Analysis; D015203:Reproducibility of Results; D012737:Sex Factors; D012923:Social Class; D014089:Tooth Remineralization / Q000706:statistics & numerical data*; D014097:Tooth, Unerupted / Q000503:physiopathology
D002327:Cariostatic Agents; D005459:Fluorides