title: Dental caries in school-age children residing in five Guatemalan communities.
abstract: OBJECTIVE
  The caries epidemiology within the country of Guatemala is poorly understood. This work reports the cross-sectional prevalence of caries in the permanent teeth of children between the ages of 6 and 12 years in five different communities within Guatemala, and relates the caries experience to the fluoride levels in the communal drinking water in each of these cities.
  
  
  METHODS
  These cities were selected because they represent geographically distinct regions of Guatemala, where there is no fluoridation of public drinking water. A total of 1,145 children were enrolled and examined in this study, with 227, 230, 231, 228 and 229 enrolled at Coban, Solola, Guatemala City, Chiquimula, and Estanzuela, respectively. Caries examinations were performed by a calibrated examiner using a visual tactile examination method performed with the aid of an artificial light, mouth mirror, compressed air, and a dental explorer employing a modified Radike criteria. Fluoride concentrations from drinking water, collected from the primary drinking water spigot at each elementary school in each city, were determined using ion chromatography.
  
  
  RESULTS
  The cross-sectional mean DMFS in children 6-8 years old was 4.61, 4.34, 3.75, 3.52 and 2.71 for Coban, Solola, Guatemala City, Chiquimula, and Estanzuela, respectively. The cross-sectional mean DMFS in children 9-12 years old was 10.96, 10.09, 8.67, 8.71 and 6.02 for Coban, Solola, Guatemala City, Chiquimula, and Estanzuela, respectively. The prevalence of caries in children between the ages of 9 and 12 years was greater than 90% in all five cities. The natural fluoride concentration in water was 0.05 ppm, 0.23 ppm, 0.14 ppm, 0.50 ppm, and 0.60 ppm for Coban, Solola, Guatemala City, Chiquimula, and Estanzuela, respectively.
  
  
  CONCLUSIONS
  Collectively, these data demonstrate that the high prevalence of caries in Guatemala appears to be directly correlated to levels of fluoride in the community drinking water.
authors.affiliation: University of Texas Health Science Center Dental School at San Antonio, San Antonio, TX, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Archila
authors.forename: Robert D
authors.initials: RD
authors.lastname: Bartizek
authors.forename: Robert W
authors.initials: RW
authors.lastname: Gerlach
authors.forename: Steven A
authors.initials: SA
authors.lastname: Jacobs
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Biesbrock
mesh_terms: D000531:Altitude; D002327:Cariostatic Agents / Q000032:analysis; D002648:Child; D003430:Cross-Sectional Studies; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D005260:Female; D005459:Fluorides / Q000032:analysis; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D016014:Linear Models; D008297:Male; D015995:Prevalence; D014505:Urban Population; D014881:Water Supply / Q000032:analysis
chemical_list: D002327:Cariostatic Agents; D005459:Fluorides