DOI: 10.3290/j.qi.b5136857, PubMed ID (PMID): 3852642325. Mar 2024,Pages 1-22, Language: EnglishSuárez-Fernández, Carlota / García-Pola, María
Objective: The goal was to identify the lifestyle risk factors associated with benign and potentially malignant oral disorders.
Method and Materials: The study enrolled first-time patients from the Oral Pathology Section, volunteers from Oviedo, and first-time patients from University of Oviedo dental clinic. Patients underwent a survey that included sociodemographic information, lifestyle habits, and medical history. Then, a comprehensive examination of the oral mucosa was conducted. Univariate and multivariate logistic regression were conducted using R software.
Results: Among the 183 participants, the most prevalent lesions were varicose veins (43.2%), cheek/lip biting (34.97%) and coated tongue (33.3%). Among the OPMDs (16.4%), oral lichen planus (OLP, 12.64%) and leukoplakia (3.3%). Tobacco was associated with melanotic pigmentation (OR 3.87, p= 0.001) and coated tongue (OR 5.90, p= 0.001). Longer intervals since last check-up were associated with traumatic keratosis (OR 2.05, p=035). Age and heavy smoking were found to have higher risk of developing an OPMD (OR 1.04, p=0.035 and OR 7.35, p=0.028 respectively).
Conclusions: Our data should be considered when organizing public health programs focused on the detection and screening of heavy smokers. It is also important to strengthen the oral pathology units in universities as reference centres for students to acquire the necessary knowledge for their diagnosis and treatment, while simultaneously promoting awareness of this risk factor for oral precancer among the general population.
Keywords: Leukoplakia, Mouth neoplasms, Oral lichen planus, Oral potentially malignant disorders, Prevention and control, Risk factors
DOI: 10.3290/j.qi.b5104947, PubMed ID (PMID): 3850215519. Mar 2024,Pages 1-44, Language: EnglishNagy, Pal / Ghanaati, Shahram / Heselich, Anja / Windisch, Peter
Objectives: This case series aimed to assess the efficacy of a novel horizontal ridge augmentation modality using histology. Combinations of “sticky bone” and tenting screws without autologous bone were used as augmentative materials.
Methods and Materials: Five individuals presenting healed, atrophic, partially edentulous sites that required horizontal bone augmentation before implant placement were enrolled. Patients underwent the same augmentation type and five months of postoperative reentry procedures. The first surgery served as implant site development, while the biopsy and corresponding implant placement were performed during reentry. The bone was qualitatively analyzed using histology and histomorphometry and quantitatively evaluated using cone-beam computed tomography (CBCT).
Results: Four individuals healed uneventfully. Early wound dehiscence occurred in one case. Histology showed favorable bone substitute incorporation into the newly formed bone and intimate contact between de novo bone and graft material in most cases. Histomorphometry revealed an average of 48 + 28% newly formed bone, 19 + 13% graft material, and 33 + 26% soft tissue components. The CBCT-based mean alveolar ridge horizontal increase was 3.9 + 0.6 mm at five months postoperatively.
Conclusions: The described augmentation method appears suitable for implant site development resulting in favorable bone quality according to histology. However, clinicians must accommodate 1–2 mm resorption in augmentative material width at the buccal aspect.
Keywords: autologous platelet concentrates, histology, histomorphometry, horizontal augmentation, sticky bone, tenting screw
DOI: 10.3290/j.qi.b5104925, PubMed ID (PMID): 3850215419. Mar 2024,Pages 1-24, Language: EnglishSubba, Priyambadha H. / Khanna, Richa / Singh, Rajeev Kumar / Ansaari, Afroz Alam / Singhal, Rameshwari / Mahour, Pooja
Objective: To compare effect of planning interventions on self-reported changes in parents supervised oral health related behaviours (OHRBs) and associated clinical oral health parameters for ‘primary school age’ children.
Methods: 110 parent-child pairs (children aged 3-8 years) were randomly assigned to either of the two groups. In ‘Action planning’ group (AP), parent participants of the pair were asked to make ‘action plan’ within “how, when, where” format for their child OHRBs. In ‘Implementation Intention’ (IMI) group, parents were asked to form an ‘if-then plan’ to improve OHRBs for their child. Self-reported changes on target OHRBs, change in plaque scores, change in plaque stagnation areas and change in caries status of tooth surfaces were observed at 2, 8, 12 weeks.
Results: Overall OHRBs scores changed significantly from baseline to 12 weeks for both interventions. But the scores were significantly better with ‘if-then’ planning than ‘action planning’ (z=4 p=<0.001) at 12 weeks. Plaque scores also changed significantly from baseline to 12 weeks for both interventions but improved significantly with ‘if-then’ planning (16.20±5.24) than ‘action planning’ (50.655±11.24) at 12 weeks. Number of plaque stagnation areas also changed significantly from baseline to 12 weeks for both interventions but improved significantly with if-then’ planning at 12 weeks (12.80±5.33) than ‘action planning’ (42.76±10.34) (t=-11.55 p=<0.001). There was significant change in caries status of sound tooth surfaces with ‘action planning’ at 12 weeks (z=116.5 p=0.023). There were no new carious lesions reported with ‘ifthen’ planning at 12 weeks.
Conclusion: The study observed significant improvement in OHRBs and associated oral health parameters with planning interventions preferring 'if-then' planning over 'action planning'. It also elicited significant barriers to behaviours in action.
Keywords: oral health-related behavior, health-related behavior, volitional intervention, planning intervention, action planning, implementation intention
DOI: 10.3290/j.qi.b5031815, PubMed ID (PMID): 3841599528. Feb 2024,Pages 1-24, Language: EnglishChen, Jui Yen / Takizawa, Keita / Ozasa, Kana / Otani, Naoki / Young, Andrew / Noma, Noboru
Background: Glossopharyngeal neuralgia due to vertebrobasilar dolichoectasia is a rare form of neuropathic pain and presents with diagnostic and therapeutic challenges.
Clinical Presentation: A 67-year-old man presented with severe burning pain in the left oral cavity, with no explanatory findings during dental and ENT evaluations. TMJ examination revealed tenderness, and panoramic radiographs showed a non-contributory periapical radiolucency. MRI/MRA revealed abnormally tortuous vertebral arteries compressing the glossopharyngeal nerves and the brainstem. Topical lidocaine reduced pain, confirming glossopharyngeal neuralgia (GPN). Carbamazepine was initially ineffective, but at 200 mg pain reduced from 90 to 20 on the visual analog scale. The patient requested and underwent microvascular decompression (MVD) surgery, which eliminated his pain.
Conclusion: When the vertebral artery compresses the glossopharyngeal nerve, the pain is more intense, attributed to its thicker vascular structure. Local anesthetic testing aids in identifying GPN. Dentists must be skilled in diagnostics and possess anatomical knowledge for accurate evaluation and referral of throat and ear pain.
Keywords: temporomandibular disorder, Glossopharyngeal neuralgia, orofacial pain, Pain, Vertebrobasilar Dolichoectasia
DOI: 10.3290/j.qi.b5031811, PubMed ID (PMID): 3841599428. Feb 2024,Pages 1-45, Language: EnglishFitzpatrick, Sarah G / Cha, Seunghee / Katz, Joseph / Migliorati, Cesar A
Objectives: Autoimmune activation by COVID-19 infection/vaccination has been postulated to be responsible for initiating or reactivating multiple types of oral mucosal immune disorders. These include oral lichen planus (OLP); oral pemphigoid, either bullous pemphigoid (BP) or mucous membrane pemphigoid (MMP) with oral involvement; pemphigus vulgaris (PV) with oral involvement; or Sjögren’s disease. In addition, chronic conditions such as oral burning, xerostomia or changes in taste and/or smell have also been linked to COVID-19 infection/vaccination.
Data Sources: Part 1 (mucosal conditions): an English-language literature review of Pubmed, Web of Science, Scopus, and Embase was performed searching cases of OLP, oral BP, MMP, PV and COVID-19 infection/vaccination, with additional cases from the authors’ clinical practice presented. Part 2 (non-mucosal conditions): Cases of initiated or flared Sjögren’s disease, chronic oral burning, or xerostomia after COVID-19 infection/vaccination from the authors’ clinical practice were aggregated. Our literature review discovered 29 cases of OLP following COVID-19 infection/vaccination. For BP, 10 cases were identified after infection/vaccination. The number of PV cases following infection/vaccination were 28. The majority of mucosal cases were reported after vaccination. Most reported initial disease, but a substantial amount included recurrences of existing diseases.
Non-mucosal disease: Sjögren’s disease, chronic oral burning, or xerostomia after COVID-19 infection/vaccination cases totaled 12 cases identified from the authors’ clinical practice, with the majority occurring after infection.
Conclusions: Chronic conditions after infection with COVID-19 or vaccination remain relatively rare and self-limited, yet reinforce the importance of comprehensive history taking involving COVID-19 to differentiate potential etiologic factors for these conditions.
Keywords: COVID-19, oral burning, Oral Lesions, oral lichen planus, Oral medicine, oral pemphigoid, oral pemphigus, Review (narrative), Sjogren disease, xerostomia
DOI: 10.3290/j.qi.b5013287, PubMed ID (PMID): 3839119223. Feb 2024,Pages 1-22, Language: EnglishFrench, David / Clark-Perry, Danielle / Ofec, Ronen / Levin, Liran
Background: This retrospective study analyzed radiographic bone levels of 10871 dental implants in a cohort of 4247 patients over a 22-year period. The objectives of the study were to assess and explore risk factors associate with the radiographic bone level of dental implants.
Methods: A longitudinal observational cohort study based on data collected from 1995 to 2019 was conducted on implants placed by a single periodontist. Inclusion criteria included both partially and fully edentulous sites. Exclusion criteria were patients who were considered ASA 3 or greater. Information on medical and dental status prior to implant placement such as diabetes and smoking were included in the analysis. Implant factors such as the implant characteristics (length and diameter), and surgical site, were recorded. The outcome assessed was the prevalence of bone loss around implants and any associative factors related to the bone loss.
Results: Overall, dental implants lost an average of 0.05±0.38mm of bone 2-3 years after placement and 0.21±0.64mm 8 years after placement. The soft tissue condition was evaluated using the Implant Mucosal Index (IMI) and bone loss around dental implants was significantly higher when bleeding on probing was multi-point and moderate, multi-point and profuse, and when infection with suppuration was recorded. The mean difference in bone level between smokers and non-smokers was 0.26mm (P<0.01) over a 4-year period. A mean difference of 0.10 mm (P=0.04) in bone loss over 4 years was found between those with an auto immune disease compared to those without. The diameter of the implant and immediate loading of the dental implant did not influence the radiographic bone levels over time.
Conclusions: This large data set of dental implants highlights predictive risk factors for bone loss around dental implants and the impact these risk factors have on the implant bone level. Consideration of these risk factors by both the dental team and the patient prior to dental implant placement will promote success of the treatment.
Keywords: Bone graft, Bone substitute, Dental implants, implant, Implantology
DOI: 10.3290/j.qi.b5013159, PubMed ID (PMID): 3839119123. Feb 2024,Pages 1-28, Language: EnglishSinghal, Ridhima / Tewari, Shikha / Sharma, Rajinder Kumar / Singhal, Savita Rani / Tanwar, Nishi / Sangwan, Aditi
DOI: 10.3290/j.qi.b4994315, PubMed ID (PMID): 3837472320. Feb 2024,Pages 1-21, Language: EnglishOlcay, Vania / Atria, Pablo / Hirata, Ronaldo / Sampaio, Camila S.
Objective: This clinical case outlines a comprehensive digital workflow for a minimally invasive multidisciplinary treatment. The process utilizes one open-source software for digital wax-up and one low-cost software to address esthetic concerns related to teeth misalignment. The patient's function is stabilized with a digitally made occlusal splint.
Clinical considerations: The case report illustrated the achievement of immediate and highly esthetic restoration, ensuring proper teeth alignment through a complete digital workflow.
Conclusion: The application of the described digital workflow technique, incorporating open-source, low-cost, and closed software, played a pivotal role in attaining a straightforward and predictable outcome with minimally invasive treatment. Furthermore, the continual evolution of technology contributes to the growing precision of dental procedures.
Clinical Significance: The presented digital workflow helped formulate a predictable treatment plan, replicate a diagnostic digital wax-up, and achieve precise teeth alignment. This approach satisfactorily addressed the patient's aesthetic concerns, providing an outstanding approximation of the definitive result.
Keywords: close software, Diagnostic procedure, digital workflow, lowcost software, open-source software, Orthodontics, Restorative Dentistry, wax-up
DOI: 10.3290/j.qi.b4984249, PubMed ID (PMID): 3836270316. Feb 2024,Pages 1-16, Language: EnglishAbdin, Maria / Ahmed, Eilaf E. A. / Hamad, Rakan / Splieth, Christian H. / Schmoeckel, Julian
The evidence base for the use of space maintainers (SMs) is relatively sparce despite being used for decades after the premature loss of primary molars. Thus, this study aims to increase the dental evidence base via investigating retrospectively the success rates of prefabricated fixed and removable space maintainers inserted from 2019 to 2021 and followed up until 02/2023 at a specialized university clinic and to identify reasons of any reported minor and major failure. Authors hypothesized that there is no significant difference in failure rates between fixed and removable SMs inserted after the premature loss of a single primary molar per quadrant. Patient’s digital records were searched yielding 645 space maintainers. After the application of inclusion criteria, 157 (67%) fixed prefabricated SMs in 112 children and 77 (33%) removable SMs in 61 children were analyzed for an average of 18.4 months (±9.5). Kaplan-Meier survival analysis with Mantel- Cox statistics showed an overall cumulative survival time of 31.6 months (SE=1.15, 95% CI=29.4-33.9). Major failure occurred significantly more in removable maintainers (n=40/67, 59.7%) mostly due to loss of the appliance compared to fixed space maintainers (n=27/67, 40.3%; P<0.001). The present study indicates that space maintainers were mainly placed in young children with high caries experience, where treatment was mostly possible using advanced behavior management. Fixed Space maintainers had a significantly lower failure rate than their removable counterpart. However, both require continual repairs, preservation or even replacement till the eruption of the permanent tooth.
Keywords: band & loop, failure rate, removable appliance, space maintainer, survival rate
DOI: 10.3290/j.qi.b4984231, PubMed ID (PMID): 3836270216. Feb 2024,Pages 1-31, Language: EnglishElsharawy, Rahma Mohamed / Elawsya, Mohamed Elshirbeny / AbdAllah, Asmaa Mohamed / ElEmbaby, Abeer ElSayed
Objectives: To evaluate polymerization efficiency of different bulk-fill resin-based composites (BFRBCs) cured by monowave and polywave light curing units (LCUs), by assessment the degree of conversion (DC) and Vickers microhardness (VMH) at different depths.
Method and Materials: Two commercially available BFRBCs were used; Filtek One Bulk Fill Restorative (3M ESPE) (FOBF) and Tetric N-Ceram Bulk Fill (Ivoclar Vivadent) (TNBF). LCUs utilized were two light-emitting diodes (LEDs) LCUs; a monowave LED LCU (BlueLEX LD-105, Monitex) and a polywave LED LCU (Twin Wave GT-2000, Monitex). For each test, twenty cylindrical specimens (4 mm diameter, 4 mm thickness) were prepared from each BFRBC using a split Teflon mold. Ten specimens were light cured by monowave LCU and the other ten were light cured by polywave LCU according manufacturer's recommendations. Attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) was used to assess DC. VMH tester was used to assess VMH. Statistical analysis was performed using three-way ANOVA and Tukey’s post-hoc tests (P <.05).
Results: DC and VMH in BFRBC containing only camphorquinone as photo-initiator were similar when cured with either monowave or polywave LCU. However, BFRBC containing a combination of photo-initiators exhibited significantly higher DC and VMH when cured with polywave LCU. Although all groups showed statistically significant differences between top and bottom surfaces regarding DC and VMH, all of them showed bottom/top ratios >80% regarding DC and VMH.
Conclusion: Polywave LCU enhances polymerization efficiency of BFRBCs especially when the later containing a combination of photo-initiators, but does not prevent the use of monowave LCU.
Keywords: Bulk-fill resin-based composites, Degree of conversion, Light curing units, Photo-initiators, Vickers microhardness
DOI: 10.3290/j.qi.b4955867, PubMed ID (PMID): 383297178. Feb 2024,Pages 1-18, Language: EnglishTheodoro, Leticia Helena / Campista, Christian Cézane Cardoso / Bury, Luiz Lordêlo / de Souza, Ricardo Guanaes Barbosa / Muniz, Yuri Santos / Longo, Mariéllen / Mulinari-Santos, Gabriel / Ervolino, Edilson / Levin, Liran / Garcia, Valdir Gouveia
Background: This study aimed to evaluate the effectiveness of biomaterials in bone healing of critical bone defects created by piezoelectric surgery in rats calvaria.
Material and Methods: Histomorphological analysis was performed to assess bone regeneration and tissue response. Fifty animals were randomized into 5 groups with one of the following treatments: Control group (CO, n=10), spontaneous blood clot formation with no bone fill; BO group (Bio-Oss®, n=10), defects were filled with bovine medullary bone substitute; BF group (Bonefill®, n=10), defects were filled with bovine cortical bone substitute; hydroxyapatite group (HA, n=10), defects were filled with HA; calcium sulfate group (CS , n=10), defects were filled with CS. Five animals from each group were euthanized at 30 and 45 days. The histomorphometry calculated the percentage of the new bone formation in the bone defect.
Results: All data obtained were evaluated statistically considering P<0.05 as statistically significant. The results demonstrate the potential of all biomaterials for enhancing bone regeneration. The findings showed no statistical differences between all the biomaterials at 30 and 45 days including the control group without bone grafting.
Conclusion: In conclusion, the tested biomaterials presented an estimated capacity of osteoconduction, statistically non-significant between them. In addition, the selection of biomaterial should consider the specific clinical aspect, resorption rates, size of the particle and desired bone healing responses. It is important to emphasize that in some cases, using no bone filler might provide comparable results with reduced cost and possible complications questioning the very frequent use of ridge presentation procedures.
Keywords: alveolar ridge, bone, Dental implants, extraction, implant
DOI: 10.3290/j.qi.b4938419, PubMed ID (PMID): 383148515. Feb 2024,Pages 1-21, Language: EnglishChandrashekhar, Hemamalini / Shah, Bijal / Mangal, Jaya / Stitik, Todd / Heir, Gary
Orofacial pain is a worldwide pain problem with many patients unable to find appropriate diagnosis and treatment. Orofacial pain includes pain arising from the odontogenic and nonodontogenic structures in the head and neck region. Dental clinicians need to have a thorough knowledge and skill to diagnose, manage and treat patients with odontogenic pain or refer patients for treatment of non-odontogenic pain to specialists such as Orofacial pain specialist, neurologist, otolaryngologist, rheumatologist, etc. More often, dentists diagnose patients with a temporomandibular disorder and when treatment is ineffective, term it “atypical facial pain”. The first requirement for effective treatment is an accurate diagnosis. Dental clinicians must be aware of Giant Cell Arteritis (GCA), a chronic large-vessel vasculitis, primarily affecting adults over the age of 50 years, as it frequently mimics and is misdiagnosed as “temporomandibular disorders”. GCA is associated with loss of vision, and stroke and can be a life-threatening disorder. Therefore, diagnostic testing for GCA and differential diagnosis should be common knowledge in the armamentarium of all dental clinicians.
Historically, Temporal artery biopsy was considered the definitive diagnostic test for GCA. Temporal artery ultrasound (TAUSG), a safe and non-invasive imaging modality has replaced the previous diagnostic gold standard for GCA, the temporal artery biopsy, owing to its enhanced diagnostic capabilities and safety profile. This case report describes a patient with GCA and the role TAUSG played in the diagnosis.
A 72-year-old female, presented with left-sided facial pain, jaw claudication, dysesthesia of the tongue, and episodic loss of vision of two years duration. She was diagnosed with, and treated for a myriad of dental conditions including endodontia and TMJ therapy with no benefit. A thorough history and physical examination, combined with serological analysis led to the diagnosis of GCA and TAUSG, which confirmed the diagnosis. This paper underscores the responsibility of differential diagnosis and early recognition of GCA facilitated by TAUSG in optimizing treatment outcomes as a viable, non-invasive diagnostic tool.
Keywords: Diagnostic procedure, Giant Cell Arteritis, Headache, Misdiagnosis, Temporomandibular disorders
DOI: 10.3290/j.qi.b4925761, PubMed ID (PMID): 382995991. Feb 2024,Pages 1-19, Language: EnglishSubramanian, Gayathri / Yeung, Vincent / Baredes, Soly / Kim, Sung / Bergsbaken, Tessa / Quek, Samuel Y. P.
Radiation treatment plays a mainstream role in the management of head and neck cancers (HNSCC). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathological fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCC. Adverse impact on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCC exposed to both radiation treatment to the jaws and ICI therapy.
This manuscript documents adverse jaw outcomes including osteonecrosis and pathological fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC and had received prior radiation treatment.
A potential link between immunotherapy and adverse jaw outcomes is consistent with our growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC.
The general dentist may encounter such patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management.
Keywords: Cancer, Case-report/series, immunotherapy, Oral surgery , Osteonecrosis, Pathology, Radiation Therapy
DOI: 10.3290/j.qi.b4920305, PubMed ID (PMID): 3828900130. Jan 2024,Pages 1-25, Language: EnglishHamadeh, Wiam / Alhabashneh, Rola / Abdelhafez, Reem / Khader, Yousef
Objective: Currently, there is no established treatment protocol to treat Interdental papillary loss. This research aimed to evaluate the outcomes of interdental papillary reconstruction using minimally invasive surgery, with injectable hyaluronic acid (HA) gel.
Materials and Methods: Seventeen patients were included, each with five sites of class 1 papillary recession; (forty sites in the upper jaw and forty-five sites in the lower jaw). Subperiosteal tunneling was performed through a horizontal incision made apical to the base of the papilla without penetrating it. The free gingival sulcus was sealed by 000 retraction cord. After that a total of 0.2-0.6 mL HA was injected gradually. The incision was sutured with polyglycolic sutures. Treated sites underwent clinical and digital evaluation at three follow up time points (1 month, 3 months and 6 months).
Results: The interdental papillary defect height in the upper jaw sites significantly reduced by 60%, 66%, and 42% at 1 month, 3 and 6 months, respectively. Also, in lower jaw sites, the reduction was of about 54%, 55%, and 40% at the same follow up time points. Regarding interdental papillary defect surface area in the upper jaw the reduction was about 65%, 71%, and 45% at 1 month, 3 and 6 months. In the lower jaw, a reduction of about 60%, 64%, and 48% was noticed at the same time points. Regarding patients’ pain level score, during the day of surgery, sixteen patients reported pain, the average pain score out of 10 was 3.94, and eleven patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. Also, at the day of the treatment twelve out of the seventeen patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity or allergy was noted in any patient.
Conclusion: Subperiosteal tunneling with HA injection demonstrates clinical improvements in papilla height and papillary recession surface area reduction after 3 months of follow-up with reduction in improvement after 6 months.
Keywords: black triangle, dental papilla augmentation , hyaluronic acid, minimal invasive surgery, periodontal surgery, Periodontology
DOI: 10.3290/j.qi.b4790573, PubMed ID (PMID): 3812671721. Dec 2023,Pages 1-21, Language: EnglishTobias, Guy / Khaimov, Alexander / Zini, Avi / Sgan-Cohen, Harod D / Mann, Jonathan / Chotiner Bar-Yehuda, Yael / Aflalo, Efrat / Vered, Yuval
Objectives: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5000 individuals was fluoridated. In 2014 CWF in Israel stopped.
Methods: Data on 12-year-old children from all areas in Israel from the national crosssectional epidemiological survey conducted in 2011-2012 were stratified by city water fluoridation and by city and school socio-economic status (SES). Two dependent variables were defined: (1) DMFT index -caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov (TF) classification of fluorosis.
Results: Data from 2181, 12-year-olds was analyzed. the average DMFT was 1.17+1.72 and 49% were caries free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs. 0.98 in fluoridated cities) and there were more caries free children 56.4% in fluoridated cities vs. 40.6% in non-fluoridated. DMFT was higher in cities with lower SES than high SES (1.29 vs. 1.05 respectively, p<0.001) and there were less caries free children in low SES (44.5% vs. 53% in high SES cities, p<0.0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in TF index), had questionable to mild fluorosis (9.3%).
Conclusions: CWF is a cheap, simple method of dental health protection that reaches all socio-economic levels and cessation of water fluoridation reduced the health of Israel's children.
Clinical Significance: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities.
Keywords: Caries detection, DMFT, Epidemiology, Fluoride, Public health