Griffith research aims to combat tooth decay problems in Australian children

Tooth decay in children is a major problem across Australia, especially so in rural, remote and Indigenous communities. Children in the Northern Peninsula Area (NPA) have a particular problem partly because the plant to add fluoride to the water system is no longer in use.

The good news is that these children will be able to access a special annual dental treatment and preventative program as part of an innovative research project from August this year.

The research, led by Griffith University and funded by the National Health and Medical Research Council, will investigate the cost-effectiveness of a single annual dental visit to apply known preventative measures to all children.

This involves application of an antiseptic, filling grooves in susceptible teeth with resin or dental cement, and painting fluoride varnish onto tooth surfaces.

"It is necessary to treat all existing decay before application of the preventative measures," says Emeritus Professor Newell Johnson from the Menzies Health Institute Queensland and the leader of the project.

"The research team will supplement Queensland Health resources and treat all children enrolled in NPA schools by the end of the year. There will be follow-up by the research team once a year for the next few years.

"The team believes that the model can apply to remote communities across Australia, especially where it is difficult to have permanent dentists or dental therapists in such places."

Torres and Cape Hospital and Health Service are supporting the research by providing access to a dental surgery at Bamaga Hospital and to the health service mobile dental van which will be located at Bamaga Primary School.

"We are very pleased to be able to support this research," says Dr Jill Newland, Health Service Chief Executive, "as it could potentially have a big impact on the oral health of young people in our region".

The researchers have conducted extensive community consultation with stakeholders and received permission from relevant authorities. These include the Community Elders, Queensland Health Chief Dental Officer, Cape York Health Council (Apunipima), Torres and Cape Health and Hospital Service, Northern Peninsula Area Regional Council (NPARC) and the Northern Peninsula Area State College (NPASC).

Dr Newland says she is impressed with the researchers’ strong community focus.

"We are always ready to assist researchers who follow the due process and whose work can lead to an improvement in health for our communities."

Comments

  1. Dan Germouse Dan Germouse Australia says:

    Here's some quotes from the 2015 Cochrane review.
    p 2 "A total of 155 studies met the inclusion criteria; 107 studies provided sufficient data for quantitative synthesis."
    p 2 "There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries across socioeconomic status (SES) levels.
    There is insufficient information to determine the effect of stopping water fluoridation programmes on caries levels.
    No studies that aimed to determine the effectiveness of water fluoridation for preventing caries in adults met the review's inclusion criteria."
    p 3 "Researchers from the Cochrane Oral Health Group reviewed the evidence - up to 19 February 2015 - for the effect of water fluoridation. They identified 155 studies in which children receiving fluoridated water (either natural or artificial) were compared with those receiving water with very low or no fluoride. Twenty studies examined tooth decay, most of which (71%) were conducted prior to 1975. A further 135 studies examined dental fluorosis."
    p 14 "Five studies were funded by research grants from research organisations, health authorities and government organisations, one study was funded in collaboration with members of the committee pro-fluoridation, while the other studies [on caries] did not state their funding sources."
    p 17 "We judged that all the 20 studies included for the caries outcome (including disparities in caries) were at high risk of bias overall."
    p 17 "We found all studies to be at high risk of bias for confounding. We considered confounding factors for this outcome to be sugar consumption/dietary habits, SES, ethnicity and the use of other fluoride sources."
    p 28 "Whilst these [fluoridated] areas tend to have low to very low DMFT, there are many other parts of the world where fluoridated water is not widespread that also have low caries levels. Equally, there are areas with relatively high distribution of water fluoridation and moderate caries levels (e.g. Brazil)."
    p 30 "The quality of the evidence, when GRADE criteria are applied, is judged to be low."

    • Philip Robertson Philip Robertson Australia says:

      Yes Dan, the idea that  water fluoridation is having much effect in reducing dental decay is fading. As you pointed out, the evidence just isn't there. Unfortunately, Australian health departments and dental clinics desperately deny these facts - understandably of course - nobody likes to admit mistakes too quickly. But most important is how good this will be for the health of many residents in the northern peninsular that the  plant to add their  fluoride treatment into drinking water is no longer in use.  I work in Geelong, Victoria and many people became ill from excessive fluoride when the fluoride went into the water in 2009. So now local dental fluoride varnish is going to be used practitioners taking charge of the treatments can check if patients become sick from the fluoride. The most common symptom in Geelong after the water was fluoridated was dermatitis and itching after drinking or washing in the fluoridated water. So it is good advice for anyone noticing reactions after the fluoride varnish to be careful. Some people doing intense training in Geelong also noticed another symptom from fluoride of muscle weakness developing. Important for all affected athletes or sportspeople to avoid fluoride, as endurance can drop away until the person experiencing side-effects stops exposure to fluoride.

      • Steve Slott Steve Slott United States says:

        Philip

        1.  The mind is a wonderful thing.  It can convince the body to have all kinds of reactions in order to further its agenda.  In all likelihood, all that had to be done was to tell your "many people" that fluoride was being added to the water, and they would have reported the reactions, even if the fluoride had not been added.

        The actuality is that there is no valid, peer-reviewed scientific evidence of any "dermatitis, itching, people becoming ill" or any other adverse effect of optimal level fluoride.  If you disagree, then please produce such evidence, properly cited.

        2.  In regard to your unsubstantiated claim that "the evidence [of effectiveness of fluoridation] just isn't there"......it's there.  It always has been.  The fact that you deny such evidence is a problem with your own science denial, not with the evidence of effectiveness of fluoridation.  The following are but a few of the volume of peer-reviewed studies clearly demonstrating the effectiveness of fluoridation.  I will gladly provide more if you so desire.

        1)  Results 
        Children from every age group had greater caries prevalence and more caries experience in areas with negligible fluoride concentrations in the water (<0.3 parts per million [ppm]) than in optimally fluoridated areas (≥0.7 ppm). Controlling for child age, residential location, and SES, deciduous and permanent caries experience was 28.7% and 31.6% higher, respectively, in low-fluoride areas compared with optimally fluoridated areas. The odds ratios for higher caries prevalence in areas with negligible fluoride compared with optimal fluoride were 1.34 (95% confidence interval [CI] 1.29, 1.39) and 1.24 (95% CI 1.21, 1.28) in the deciduous and permanent dentitions, respectively. 

        ------Community Effectiveness of Public Water Fluoridation in Reducing Children's Dental Disease
        Jason Mathew Armfield, PhD

        2) CONCLUSIONS: 
        Children with severe dental caries had statistically significantly lower numbers of lesions if they lived in a fluoridated area. The lower treatment need in such high-risk children has important implications for publicly-funded dental care. 

        ------Community Dent Health. 2013 Mar;30(1):15-8.
        Fluoridation and dental caries severity in young children treated under general anaesthesia: an analysis of treatment records in a 10-year case series.
        Kamel MS, Thomson WM, Drummond BK.
        Department of Oral Sciences, Sir John Walsh Research Institute, School of Dentistry, The University of Otago, Dunedin, New Zealand.


        3).  CONCLUSIONS: 
        The survey provides further evidence of the effectiveness in reducing dental caries experience up to 16 years of age. The extra intricacies involved in using the Percentage Lifetime Exposure method did not provide much more information when compared to the simpler Estimated Fluoridation Status method. 

        -----Community Dent Health. 2012 Dec;29(4):293-6.
        Caries status in 16 year-olds with varying exposure to water fluoridation in Ireland.
        Mullen J, McGaffin J, Farvardin N, Brightman S, Haire C, Freeman R.
        Health Service Executive, Sligo, Republic of Ireland. 

        4) Abstract 
        The effectiveness of fluoridation has been documented by observational and interventional studies for over 50 years. Data are available from 113 studies in 23 countries. The modal reduction in DMFT values for primary teeth was 40-49% and 50-59% for permanent teeth. The pattern of caries now occurring in fluoride and low-fluoride areas in 15- to 16-year-old children illustrates the impact of water fluoridation on first and second molars. 

        ----Caries Res. 1993;27 Suppl 1:2-8.
        Efficacy of preventive agents for dental caries. Systemic fluorides: water fluoridation.
        Murray JJ.
        Department of Child Dental Health, Dental School, University of Newcastle upon Tyne, UK.


        5). CONCLUSIONS: 
        Data showed a significant decrease in dental caries across the entire country, with an average reduction of 25% occurring every 5 years. General trends indicated that a reduction in DMFT index values occurred over time, that a further reduction in DMFT index values occurred when a municipality fluoridated its water supply, and mean DMFT index values were lower in larger than in smaller municipalities. 

        ----Int Dent J. 2012 Dec;62(6):308-14. doi: 10.1111/j.1875-595x.2012.00124.x.
        Decline in dental caries among 12-year-old children in Brazil, 1980-2005.
        Lauris JR, da Silva Bastos R, de Magalhaes Bastos JR.q
        Department of Paediatric Dentistry, University of São Paulo, Bauru, São Paulo, Brazil. 


        Steven D.Slott, DDS

  2. Steve Slott Steve Slott United States says:

    Germouse

    Cochrane set strict parameters for fluoridation studies it chose to review.  The Committee members culled 4,677 studies from the literature and found 155 that fit the parameters of what they chose to review.  This excluded from their review thousands of quality fluoridation studies.  The assessments made by Cochrane are simply in regard to the 155 studies it chose to review.

    Now, let's look at further quotes from this Review:

    Page 3:   "Data suggest that the introduction of water fluoridation resulted in a 35% reduction in decayed, missing or filled baby teeth and a 26% reduction in decayed, missing or filled permanent teeth. It also increased the percentage of children with no decay by 15%. Although these results indicate that water fluoridation is effective at reducing levels of tooth decay in children’s baby and permanent teeth, the applicability of the results to current lifestyles is unclear because the majority of the studies were conducted before fluoride toothpastes and the other preventative measures were widely used in many communities around the world."

    Pp 29-30:   "However, there has been much debate around the appropriateness of GRADE when applied to public health interventions, particularly for research questions where evidence from randomised controlled trials is never going to be available due to the unfeasibility of conducting such trials. Community water fluoridation is one such area."

    And:

    "we accept that the terminology of 'low quality' for evidence may appear too judgmental. We acknowledge that studies on water fluoridation, as for many public health interventions, are complex to undertake and that researchers are often constrained in their study design by practical considerations. For many public health interventions, the GRADE framework will always result in a rating of low or very low quality. Decision makers need to recognise that for some areas of research, the quality of the evidence will never be 'high' and that, as for any intervention, the recommendation for its use depends not just upon the quality of the evidence but also on factors such as acceptability and cost-effectiveness (Burford 2012)."


    Steven D. Slott, DDS

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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