Posted on 07/05/2002 12:16:10 AM PDT by JameRetief
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July 1, 2002 The "Fuzzy Math" of Fluoride Promotion By Paul Connett, PhD (ggvideo@northnet.org)
Many of you may have probably heard the term "fuzzy math" before. It is a term used to describe a somewhat controversial method of teaching math where the answers do not have to be EXACTLY right. But at the very least, they are supposed to be close. Unfortunately, many of those promoting the practice of water fluoridation would fail to meet even these basic "fuzzy math" guidelines, with methods better described as "hairy" than "fuzzy". And "fuzzy math" is supposed to be a temporary teaching tool for young children, NOT a permanent way of doing business or a method used to change the data to whatever suits your agenda.
While I was in New Zealand recently, I was sent some literature, better described as a propaganda package, from the Australian Dental Association entitled "Fluoridation: Nature Thought of it First". My response to that title was that I completely agree. "Nature" did indeed think of it first, and wisely spotted that fluoride was very toxic. That is why "Nature" limits the level of fluoride in mother's milk to 0.01 ppm (parts per million), which is 100 times less than most of the levels at which water is fluoridated in the few "not so bright" countries which continue this foolish practice. Some of these "not so bright" countries have produced some remarkably clever people: Shakespeare, Newton, Ernest Rutherford and Mark Twain to name a few. However, those in government in these countries and those who write the propaganda for their Dental Associations, seem to have a great deal of trouble performing simple arithmetic. Measuring Dental Caries (Cavities) For example, the first paper cited in the Australian Dental Association's package promoting fluoridation is an article entitled "Water Fluoridation in Australia" (Community Dental Health (1996) 13, Supplement 2, 27-37). In the abstract of this article, the authors tell us that "Results from Australian oral epidemiological studies constantly support the accumulated evidence on the effectiveness of water fluoridation. This includes recent evidence that lifetime exposure to fluoridation is associated with average reductions of 2 dmfs and between 0.12 and 0.30 DMFS per child compared with non-exposed children".
Do these authors really believe that these numbers are strong evidence in support of fluoridation's effectiveness? Let's look at exactly what these numbers actually mean. Let's begin with an explanation of the terms used: dmfs - decayed, missing and filled surfaces of the primary (baby) teeth DMFS - decayed missing and filled surfaces of the secondary (adult) teeth.
Thus a savings of 2 dmfs is the saving of two tooth surfaces in the primary teeth, which amounts to less than half a tooth. However, even this moderate savings is problematic, because of the complicating factor that fluoride delays the eruption of teeth. As Dr. Hardy Limeback, Head of Preventive Dentistry at the University of Toronto, has noted: Fluoride ingestion delays tooth eruption and this may account for some of the differences seen in the past between fluoridated and non-fluoridated areas (i.e. dental decay is simply postponed). No fluoridation study has ever separated out the systemic (eruption delaying) effects of fluoride.
But it is with the secondary teeth where the claims of "effectiveness" become truly preposterous. A saving of between 0.12 and 0.30 of the tooth surfaces (DMFS) out of a total of 128 tooth surfaces in a child's mouth, is a saving of between 0.09% and 0.23%! It is highly unlikely that such savings have any statistical, let alone clinical, significance. Making these claims of "safety and effectiveness" even more bizarre is that these same authors report dental fluorosis rates in fluoridated communities ranging from 40% (in Western Australia) to 56% (in South Australia).
How can any one in their right mind promote a practice that saves at most 0.23% of the tooth surfaces in a child's mouth, while contributing to permanent damage of the enamel in about half the population? Some of this damage is very mild, but 5-11% are affected in more severe categories, which can often require expensive cosmetic surgery to repair. This level of damage to the tooth enamel (dental fluorosis) is 4 -5 times higher than the original goal of those who launched the fluoridation program who thought at 1 ppm fluoride, they could limit dental fluorosis to 10% of the population in its mildest category. Fluoridation proponents like to claim that dental fluorosis (which they love to call a "cosmetic effect") is the only possible adverse effect of fluoridation. However, we know that 50% of the fluoride we ingest each day accumulates in our bones and a recent study from Mexico indicates that the severity of dental fluorosis correlates well with the frequency of bone fractures in children (Fluoride 2001; 34: 2, 139-149). Moreover, there are numerous studies in the literature which have found an association between increased hip fracture and life long exposure to fluoridated water (see http://www.fluoridealert.org/abstracts.htm) . There are also studies which haven't found this association, but, with an outcome as serious as hip fracture (25% of the elderly who suffer a hip fracture die within a year, 50% never regain an independent existence) how many red flags are you willing to risk for less than one third of a tooth surface? But, let’s give fluoride promoters the benefit of the doubt. Rather than assume that these people are out of their minds, let’s just assume that they are not too good at arithmetic! Either way, it is troubling that they are allowed to influence a public health policy that puts a substance - known to be highly toxic - into the drinking water of their citizens.
How Many Nations Fluoridate Their Water?Lending further evidence to the notion that those promoting fluoridation cannot perform (or at least comprehend) even the simplest arithmetic, is the way they cannot work out either accurately - or even approximately - how many countries in the world actually fluoridate their water. One would have thought with a large work force at its disposal that this would not be a difficult exercise for agencies like the American Dental Association. But apparently this is not the case. In its Fluoridation Facts brochure (accessed online on August 2000), the American Dental Association stated that "Water Fluoridation is practiced in approximately 60 countries benefiting over 360,000,000 (three hundred sixty million people" (Fluoridation Facts, Question 39). The reference given for these statistics was the British Fluoridation Society. (BFS. Optimal water fluoridation: status worldwide. Liverpool; May 1998).
However, when Doug Cragoe (Fluoride Action Network) and Jane Jones (National Pure Water Association) asked the British Fluoridation Society in August and October of 2000 for this list of 60 countries, they were told that the list does not exist! This was a bit odd considering that the ADA was citing a 1998 paper from the BFS, which supposedly documented the "60 countries." But never fear, the BFS assured both Cragoe and Jones that the list would soon be forthcoming. In October 2000, they wrote:
"We will be submitting a paper on fluoridation status worldwide to a journal in the near future" However, it's now some two years later, and the BFS has yet to furnish the list. On June 26, 2002, Jane Jones again requested the list from the BFS and they again responded that: "This work is still in progress, and will be published in due course."
But why could a question so seemingly basic, take an institution with deep coffers so long to answer? The obvious answer: Because nowhere near 60 countries fluoridate their water. And no one seems to know this better than the BFS and the ADA.
Changing the Definition of "Water Fluoridation"At some point following Craoge's and Jone's exchanges with the BFS in 2000, the ADA made a little-noticed change to their Fluoridation "Facts" page. They changed the wording of their statement from " Water Fluoridation is practiced in approximately 60 countries" to "Water fluoridation (natural and/or adjusted) is practiced in approximately 60 countries..." (change bolded) In other words, the ADA - no doubt hoping it would go unnoticed - had made a rather large change, not to its own figures, but to the very definition of what constitutes water fluoridation.
According to Websters Dictionary, water fluoridation means "the addition of a fluoride to the water supply (to prevent dental decay)." But, the ADA is now telling us that a country doesn't have to actually add fluoride to its water to be listed as 'practicing water fluoridation.' Instead, it simply has to have some area of its nation-state with elevated levels of naturally occurring fluoride in the water. It also puts a very peculiar connotation on the word "practice". How do you "practice" something that happens to you naturally? By this definition, the US could ban the practice of adding fluoride to water supplies, and still be listed by the ADA as "practicing water fluoridation" because, indeed, some water supplies in the US have elevated levels of naturally occurring fluoride. If this weren't bad enough, the ADA and BFS still can't produce a list of 60 countries under this expanded definition of water fluoridation. Even though the ADA still supports its 60 country claim by citing the British Fluoridation Society, the BFS maintains that it doesn't know yet whether this 60 country figure is correct. To quote from their website: "The British Fluoridation Society is in the process of validating these data which have been collected in an ad hoc manner over several years. A detailed up-to-date table will be published in due course."
As the BFS attempts to put together this list, they will face some rather awkward questions. Will they cite India or China, or the dozens of other countries where naturally occurring fluoride is causing a host of severe human health problems (see http://www.fluoridealert.org/fluorosis-india.htm), and where money is being actively sought to REMOVE fluoride from the water? Indeed, it would be rather ironic if the BFS listed India, China, and other countries where defluoridation is being actively implemented - and in which not one artificial fluoridation program exists - as examples of countries "practicing water fluoridation." Enter the New Zealand AuthoritiesWhile I was in New Zealand recently, I read with interest two additional papers in which fluoridation proponents tackle this question of water fluoridation's international status - one by the Bay of Plenty District Health Board (New Zealand) and the other by the Public Health Commission of New Zealand (PHC).
In the former paper (dated June 2002) 41 countries are cited as artificially adding fluoride to the water. But of these 41 countries, the authors are only able to cite 11. And of the 11 countries they cite, one (Finland) stopped its fluoridation program back in 1991, and another (Switzerland) only fluoridates one community - Basle. So what about the other 31 countries? Fortunately, the PHC report (dated 1994) provides a little bit more information on the matter. According to the PHC: "…water fluoridation has been adopted by an estimated 39 countries (1984 data) with approximately 155 million people being supplied with fluoridated water in 1978 (Rozier, 1992)."
To their credit, the PHC - unlike the ADA or BFS - provides a list of the 39 countries which supposedly fluoridate their water. However, a quick examination of the list reveals a number of errors. The PHC's list counts Greece and Romania as part of the 39. Neither of these countries, however, practice fluoridation (Martin 1991). The PHC list also counts the Phillipines as one of the 39, despite the fact that the only areas in the Phillipines with fluoridated water are US military bases which comprise just 0.014% of the population (Martin 1991). In addition, the PHC lists Bulgaria, Hungary, and Italy - 3 countries which the World Health Organization, in 1987, listed as having no existing water fluoridation programs. Thus, unless fluoridation programs were implemented in these 3 countries between the years 1987 and 1994 (the year in which the PHC report was issued), these 3 countries should also be stricken from the list. Of these 32 countries, it should be noted that 21 of them are listed as having "unknown legal status" in regards to fluoridation. What does this mean?
That makes the grand total anywhere from 14 to 32, which in any case, is a far cry from the ADA's claim of 60. To state the obvious, if these "authorities" cannot count up to 60, what credence should we give their other "research" claims? Let me end with something we do know. In the democracies of Western Europe, water fluoridation has been almost unanimously rejected. Countries there that have rejected fluoridation include Austria, Belgium, Denmark, Finland, France, Germany, Iceland, Italy, Luxembourg, Netherlands, Norway, and Sweden. For explanations of why these countries chose not to fluoridate, visit www.fluoridealert.org/govt-statements.htm. Of particular interest in this respect is that according to World Health Organization figures (see http://www.fluoridealert.org/WHO-DMFT.htm) their children’s’ teeth are just as good, if not better, than the teeth of children in fluoridated countries. And that isn't fuzzy math!
Paul Connett, PhD, is a co- founder of the Fluoride Action Network and a Professor of Chemistry at St. Lawrence University, Canton, NY. (email - ggvideo@northnet.org) |
However, the reason the anti-fluoridationists have been ridiculed so much in the past is because of the silly arguments they use. It seems any fluoride thread brings the hypochondriacs out of the woodwork, and they complain about every malady under the sun being due to fluoride.
Check out the website, www.udoerasmus.com. It has alot of good information about both the good oils(unprocessed and protected oils, like fresh Omega 3 aand Omega 6 containing oils and virgin olive oil) and the bad oils (any processed or refined oils).
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We've got a live one here ;-)
Basically, fluoride was added to water supplies because it was believed to incorporate into developing teeth to make them resist decay. Science has proven this theory wrong. Fluoride's beneficial effects, are topical only. So there's no good reason to add fluoride to water except if you want an expensive mouthwash. The CDC says the amounts that emerge from saliva are too low to be therapeutic
You are either very confused or deliberately misleading here, bad start. While early theory may have held that fluoride could affect developing teeth prior to eruption, there is no current thought that that is the case. Fluoride is effective as a topical agent, whether in water, toothpaste, or as a treatment at the dentist's office. Nobody claims otherwise.
They neglected the calcium, magnesium and other bone and teeth building components of the water supply.
Of course they didn't. "Colorado Brown Stain" was noted in the 19th century in the southwest and mountain states, and concurrent with that was high levels of fluoride (many times higher than what is added to water supplies). There was a direct relationship between fluoride levels in the water and caries suseptability. Because they didn't know which substance present in the water was causing the stain, they had to eliminate everything that wasn't, including the minerals mentioned above.
Now that over 62% of the USA is fluoridated, tooth decay rates have not been leveled out. The same disparities according to region exist today as it did back in the early 1900's.
Obviously, because the diets of present day children differ so radically from those of the early 1900's, you are comparing apples to oranges. Although I'd appreciate a link to your information on decay rates, since they seem out of step with mine.
Tooth decay, like most other diseases, is caused by poor nutrition in the womb.....
What?! Care to rephrase that?
Without going off on a tangent, fluoridation has failed to eliminate tooth decay like it promised.
Could you show where present day researchers have "promised" that fluoride would eliminate tooth decay? While I can't say that someone has never made that claim, I've never heard it. And it would be silly to do so. There are too many other factors involved.
However, dental fluorosis rates are skyrocketing in the US while the Surgeon General reports an epidemic of tooth decay in certain segments of the US population.
Links to those studies, please.
And anecdotal evidence from dentists tell us that their "fluoride protected" patients are also suffering more tooth decay - usually because they drink too much soda.
Who is "us"? And why would you think that fluoride can protect you from abusing your teeth? Could you point me to dental literature which says "Put fluoride in the water, and you can eat and drink anything you want, and never get decay!"
That's a mighty big strawman you're beating up.
Dental researchers now tell us that fluoride in doses above "optimal" can actually cause tooth decay (like any drug causes what it can cure)
Once again, please post a link to support this. In cases of extereme fluoride exposure the teeth can be deformed, and maybe then decay easier, I'm not aware of very many cases. In over 10 years of practice, I have never seen one severe case of fluorosis, and very few cases of anything but mild white spotting. As a matter of fact, I've only had to cosmetically repair 4 or 5 cases in over a decade of looking.
And how wise is it these days to have this unnecessary, odorless, tasteless chemical sitting next to most water plants in the US.
I guess it was only a matter of time before the anti-fluoridationists would exploit 9-11 for their own purposes. That's really low. If a terrorist is going to poison the water supply, they're going to use something more potent that fluoride.
Here is what the CDC says:
"This manuscript is poorly written and provides insufficient detail on study method to allow a full evaluation. Based on the information presented, this study used a flawed analytic approach, which undermines the validity of its conclusions. ....Much of the authors' contentions regarding the relation between fluoridation chemicals (or lead, for that matter) and crime rates is weakly supported, and is likely to highly confounded by complex social factors including, for example, unemployment rates, occupational chemical exposures, and socioeconomic factors not captured in this simplistic analysis." Also, they said, "This is a very poor conceived and developed piece of research. The review of the literature is highly selective and one of the key documents to support the author's point of view is authored by one of the authors."
There is also a new paper to be published in the International Journal of Environmental Studies. This paper, authored by Urbansky and Schock, examines Master and Coplan and their various studies. Anyine inclined to take the Master study seriously should look at their other work, it is, to say the least, unusual.
From the paper:
"Recent reports have attempted to show that fluoridated potable water is linked to increased levels of lead (II) in blood. ...Overall, we conclude that no credible evidence exists to show that water fluoridation has any quantitatable effects on the solubility, bioavailability, bioaccumulation, or reactivity of lead (0) or lead (II) compounds". "Masters and Coplan's conclusions are unsupported even by their own limited data and are inconsistent with established scientific literature. The paper will not stand up to rigorous review by expert scientists experienced in the relevant disciplines. There are no credible data in any report or letter they have written thus far to suggest any link between fluoridation and anything else."
So this leaves us with the unanswerable question, at least to the anti-fluoridationists. Since fluoride is a naturally occurring substance, and many areas of the country have it in concentrations many times higher than what is added to water supplies, and communities have been drinking that water for hundreds of years, why don't we see pockets of illness in all these areas?
You claim that we don't know the action of fluoride, yet I gave you the correct answer. A quick look at the ADA, CDC and other websites all have it correct, so I'm not sure what your complaint is. I question those links becasue I know of NOBODY who thinks fluoride works systemically. And given the anti-fluoridationists history of "stretching" the truth, I doubt you assertions have any basis in fact.
?In April 1947, a research team head by Dean Conrad Elvehjem put out a release claiming that in a series of experiments at the University, 1 ppm fluorine had ?absolutely no effect on rats? and that additions of raw, whole milk produced more positive reslts than fluorine in preventing decay.
And I have over 800 studies (the last I checked) that show fluoride is effective. The fact you have to go back to a study from 1947 shows the weakness of your case.
Dental decay is rising rapidly in the 1990's in children in the United States. Recent study's results were published in the American Academy of Dentistry for children in its November-December 1998 issue. This journal is only received by dentists, and it showed that dental decay in children under the age of five years has doubled in the past ten years. The average child in the study had seven cavities prior to their sixth birthday, and the same population of children in 1987 had three and one half cavities.
You didn't discuss my point, which is that diet has a large impact on caries. Obviously rates would be much higher without fluoride.
CHICAGO - Pregnant women can help ensure their children get a good start on their oral health by focusing on staying healthy, including a proper diet, because teeth begin developing between the third and sixth month of pregnancy, says the American Dental Association (ADA).
You made the statement that "Tooth decay, like most other diseases, is caused by poor nutrition in the womb..... ". That is a patently FALSE statement and is an example of your inablility to understand the subject. Illness and malnutrition during fetal development can cause tooth malformation and other developmental problems in some cases, NOT DECAY. If you don' understand the difference, you have no business passing yourself off as some kind of expert.
NYSCOF says: I didn?t say *present* day researchers promised anything. Early researchers thought fluoride deficiency caused tooth decay just like vitamin deficiency caused disease. Just like Vitamin C cured scurvy dentists believed fluoride would cure tooth decay.
Then you don't have a point, it's just whining.
NYSCOF says: Cavities increase in people with severe fluorosis according to the dental textbook, ?Dentistry, Dental Practice and the Community,? by Burt and Eklund. But few practicing dentists seem to know this. Burt and Eklund explain that fluoride concentrations in drinking water, form a J-shaped curve. With increasing fluoride levels, cavity experience diminishes to a certain point and then starts to rise again. The true relationship between water fluoride levels and dental decay is the J-shaped curve, with the turning point in the J being something between 3 and 4 times the optimal level, they write. Studies show this level is already exceeded by many American children Burt (also editor of Community Dentistry and Oral Epidemiology) & Eklund use published scientific studies as the basis for this book.
At what concentrations does this occur? What percentage of the population has this problem? I say again that I have NEVER seen a case of severe fluorosis. Reading from a textbook shows that the probelm exists in theory, but where is it in the real world?
NYSCOF says: Water Fluoride Poisons 23 Californians http://www.enn.com/direct/display-release.asp?id=7099
Here's more fluoride accidents and poisonings: http://www.fluoridealert.org/accidents.htm
New York State Coalition Opposed to Fluoridation http://www.orgsites.com/ny/nyscof
Doesn't seem like a great terror weapon, does it? If terrorists attack our water supply, it will be to kill people, and fluoride is a poor choice of poison. And please answer the question I asked, I realize there are probably no cut-and-paste answers, but do your best:
So this leaves us with the unanswerable question, at least to the anti-fluoridationists. Since fluoride is a naturally occurring substance, and many areas of the country have it in concentrations many times higher than what is added to water supplies, and communities have been drinking that water for hundreds of years, why don't we see pockets of illness in all these areas?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=PubMed
A cogent comment, my friend. But let's examine the matter a little closer. Take for example our paranoid friend's comment:
NYSCOF: Tooth decay, like most other diseases, is caused by poor nutrition in the womb.....
I incredulously ask what he means by that, and, as proof, he posts this, from the ADA:
CHICAGO - Pregnant women can help ensure their children get a good start on their oral health by focusing on staying healthy, including a proper diet, because teeth begin developing between the third and sixth month of pregnancy, says the American Dental Association (ADA).
Obviously, to any rational person reading that blurb, the meaning is that one of the reasons pregnant women should maintain a proper diet is to help with the proper DEVELOPMENT of the teeth. Nowhere does it say anything about tooth decay.
Unfortunately, this is how these people read medical journals, if at all. The see one small portion of a study and make sweeping generalizations from them, failing to understand the limitations and purposes of the study.
Par for the course, I guess.
BUT, if you want to play "who can cut-and-paste more", I'll play along.
Studies showing the effectiveness and safety of fluoridation in all forms:
1. Bratthall D, Hänsel Petersson G, Sundberg H. Reasons for the caries decline: what do the experts believe? Eur J Oral Sci 1996;104:416--22.
2. Blaney JR, Tucker WH. The Evanston Dental Caries Study. II. Purpose and mechanism of the study. J Dent Res 1948;27:279--86.
3. Ast DB, Finn SB, McCaffrey I. The Newburgh-Kingston Caries Fluorine Study. I. Dental findings after three years of water fluoridation. Am J Public Health 1950;40:716--24.
4. Dean HT, Arnold FA, Jay P, Knutson JW. Studies on mass control of dental caries through fluoridation of the public water supply. Public Health Rep 1950;65:1403--8.
5. Hutton WL, Linscott BW, Williams DB. The Brantford fluorine experiment: interim report after five years of water fluoridation. Can J Public Health 1951;42:81--7.
6. Pao EM. Changes in American food consumption patterns and their nutritional significance. Food Technol 1981;35:43--53.
7. Heller KE, Sohn W, Burt BA, Eklund SA. Water consumption the United States in 1994--1996 and implications for water fluoridation policy. J Public Health Dent 1999;59:3--11.
8. Public Health Service Committee to Coordinate Environmental Health and Related Programs. Review of fluoride: benefits and risk. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991.
9. National Research Council Committee on Toxicology. Health effects of ingested fluoride. Washington, DC: National Academy Press, 1993.
10. World Health Organization. Environmental health criteria 36: fluorine and fluorides. Geneva: World Health Organization, 1984.
11. Institute of Medicine. Fluoride. In: Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: National Academy Press, 1997:288--313.
12. Featherstone JDB. Prevention and reversal of dental caries: role of low level fluoride. Community Dent Oral Epidemiol 1999;27:31--40.
13. Koulourides T. Summary of session II: fluoride and the caries process. J Dent Res 1990;69(special issue):558.
14. Tatevossian A. Fluoride in dental plaque and its effects. J Dent Res 1990;69(special issue):645--52.
15. Chow LC. Tooth-bound fluoride and dental caries. J Dent Res 1990;69(special issue):595--600.
16. Ericsson SY. Cariostasis mechanisms of fluorides: clinical observations. Caries Res 1977;11(suppl 1):2--23.
17. Kidd EAM, Thylstrup A, Fejerskov O, Bruun C. Influence of fluoride in surface enamel and degree of dental fluorosis on caries development in vitro. Caries Res 1980;14:196--202.
18. Thylstrup A. Clinical evidence of the role of pre-eruptive fluoride in caries prevention. J Dent Res 1990;69(special issue):742--50.
19. Thylstrup A, Fejerskov O, Bruun C, Kann J. Enamel changes and dental caries in 7-year-old children given fluoride tablets from shortly after birth. Caries Res 1979;13:265--76.
20. White DJ, Nancollas GH. Physical and chemical considerations of the role of firmly and loosely bound fluoride in caries prevention. J Dent Res 1990;69(special issue):587--94.
21. Hamilton IR. Biochemical effects of fluoride on oral bacteria. J Dent Res 1990;69(special issue):660--7.
22. Bowden GHW. Effects of fluoride on the microbial ecology of dental plaque. J Dent Res 1990;69(special issue):653--9.
23. Bowden GHW, Odlum O, Nolette N, Hamilton IR. Microbial populations growing in the presence of fluoride at low pH isolated from dental plaque of children living in an area with fluoridated water. Infect Immun 1982;36:247--54.
24. Marquis RE. Diminished acid tolerance of plaque bacteria caused by fluoride. J Dent Res 1990;69(special issue):672--5.
25. Rosen S, Frea JI, Hsu SM. Effect of fluoride-resistant microorganisms on dental caries. J Dent Res 1978;57:180.
26. Van Loveren C. The antimicrobial action of fluoride and its role in caries inhibition. J Dent Res 1990;69(special issue):676--81.
27. Oliveby A, Twetman S, Ekstrand J. Diurnal fluoride concentration in whole saliva in children living in a high- and a low-fluoride area. Caries Res 1990;24:44--7.
28. Rölla G, Ekstrand J. Fluoride in oral fluids and dental plaque. In: Fejerskov O, Ekstrand J, Burt BA, eds. Fluoride in dentistry. 2nd ed. Copenhagen: Munksgaard, 1996:215--29.
29. LeGeros RZ. Chemical and crystallographic events in the caries process. J Dent Res 1990;69(special issue):567--74.
30. Dean HT, Dixon RM, Cohen C. Mottled enamel in Texas. Public Health Rep 1935;50:424--42.
31. McClure FJ, Likins RC. Fluorine in human teeth studied in relation to fluorine in the drinking water. J Dent Res 1951;30:172--6.
32. Marthaler TM. Fluoride supplements for systemic effects in caries prevention. In: Johansen E, Taves DR, Olsen TO, eds. Continuing evaluation of the use of fluorides. Boulder, CO: Westview, 1979:33--59. (American Assocation for the Advancement of Science selected symposium no. 11).
33. Murray JJ. Efficacy of preventive agents for dental caries. Systemic fluorides: water fluoridation. Caries Res 1993;27(suppl 1):2--8.
34. Groeneveld A, Van Eck AAMJ, Backer Dirks O. Fluoride in caries prevention: is the effect pre- or post-eruptive? J Dent Res 1990;69(special issue):751--5.
35. Levine RS. The action of fluoride in caries prevention: a review of current concepts. Br Dent J 1976;140:9--14.
36. Margolis HC, Moreno EC. Physicochemical perspectives on the cariostatic mechanisms of systemic and topical fluorides. J Dent Res 1990;69(special issue):606--13.
37. Clarkson BH, Fejerskov O, Ekstrand J, Burt BA. Rational use of fluorides in caries control. In: Fejerskov O, Ekstrand J, Burt BA, eds. Fluorides in dentistry. 2nd ed. Copenhagen: Munksgaard, 1996:347--57.
38. Arends J, Christoffersen J. Nature and role of loosely bound fluoride in dental caries. J Dent Res 1990;69(special issue):601--5.
39. Burt BA, Eklund SA. Dentistry, dental practice, and the community. 5th ed. Philadelphia, PA: W.B. Saunders, 1999. 40. National Institute of Dental Research. The prevalence of dental caries in United States children, 1979--1980. Bethesda, MD: U.S. Public Health Service, Department of Health and Human Services, National Institutes of Health, 1981; NIH publication no. 82-2245.
41. Kelly JE, Harvey CR. Basic dental examination findings of persons 1--74 years. In: Basic data on dental examination findings of persons 1--74 years, United States, 1971--1974. Hyattsville, MD: US Department of Health, Education, and Welfare, Public Health Service, Office of Health Research, Statistics, and Technology, National Center for Health Statistics, 1979; DHEW publication no. (PHS) 79-1662. (Vital and health statistics data from the National Health Interview Survey; series 11, no. 214).
42. National Institute of Dental Research. Oral health of United States children. The National Survey of Dental Caries in U.S. School Children: 1986--1987. National and regional findings. Bethesda, MD: US Department of Health and Human Services, Public Health Service, National National Institutes of Health, National Institute of Dental Research, 1989; NIH publication no. 89-2247.
43. Kaste LM, Selwitz RH, Oldakowski RJ, Brunelle JA, Winn DM, Brown LJ. Coronal caries in the primary and permanent dentition of children and adolescents 1--17 years of age: United States, 1988--1991. J Dent Res 1996;75(special issue):631--41.
44. Meskin LH, ed. Caries diagnosis and risk assessment: a review of preventive strategies and management. J Am Dent Assoc 1995;126(suppl):15--245.
45. Pitts NB. Risk assessment and caries prediction. J Dent Educ 1998;62:762--70.
46. Vargas CM, Crall JJ, Schneider DA. Sociodemographic distribution of pediatric dental caries: NHANES III, 1988--1994. J Am Dent Assoc 1998;129:1229--38.
47. Edelstein BL. The medical management of dental caries. J Am Dent Assoc 1994;125(suppl):31--9.
48. US Department of Health and Human Services. Oral health in America: a report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000:63, 74--94, 245--74.
49. Fejerskov O, Manji F, Baelum V. The nature and mechanisms of dental fluorosis in man. J Dent Res 1990;69(special issue):692--700.
50. Avery JK. Agents affecting tooth and bone development. In: Avery JK, ed. Oral development and histology. 2nd ed. New York, NY: Theime Medical Publishers, 1994:130--41.
51. DenBesten PK, Thariani H. Biological mechanisms of fluorosis and level and timing of systemic exposure to fluoride with respect to fluorosis. J Dent Res 1992;71:1238--43.
52. Evans RW, Stamm JW. Dental fluorosis following downward adjustment of fluoride in drinking water. J Public Health Dent 1991;51:91--8.
53. Dean HT. The investigation of physiological effects by the epidemiological method. In: Moulton FR, ed. Fluorine and dental health. Washington, DC: American Association for the Advancement of Science, 1942;19:23--31.
54. Fejerskov O, Manji F, Baelum V, Møller IJ. Dental fluorosis---a handbook for health workers. Copenhagen: Munksgaard, 1988.
55. Kaminsky LS, Mahoney MC, Leach J, Melius J, Miller MJ. Fluoride: benefits and risks of exposure. Crit Rev Oral Biol Med 1990;1:261--81.
56. Clark DC, Hann HJ, Williamson MF, Berkowitz J. Aesthetic concerns of children and parents in relation to different classifications of the Tooth Surface Index of Fluorosis. Community Dent Oral Epidemiol 1993;21:360--4.
57. Dean HT. Endemic fluorosis and its relation to dental caries. Public Health Rep 1938;53:1443--52.
58. Clark DC. Trends in prevalence of dental fluorosis in North America. Community Dent Oral Epidemiol 1994;22:148--52.
59. Szpunar SM, Burt BA. Trends in the prevalence of dental fluorosis in the United States: a review. J Public Health Dent 1987;47:71--9.
60. Brunelle JA. The prevalence of dental fluorosis in U.S. children, 1987. J Dent Res 1989;68(special issue):995.
61. Heller KE, Eklund SA, Burt BA. Dental caries and dental fluorosis at varying water fluoride concentrations. J Public Health Dent 1997;57:136--43.
62. Pendrys DG, Katz RV, Morse DR. Risk factors for enamel fluorosis in a fluoridated population. Am J Epidemiol 1994;140:461--71.
63. Osuji OO, Leake JL, Chipman ML, Nikiforuk G, Locker D, Levine N. Risk factors for dental fluorosis in a fluoridated community. J Dent Res 1988;67:1488--92.
64. Pendrys DG, Katz RV. Risk for enamel fluorosis associated with fluoride supplementation, infant formula, and fluoride dentifrice use. Am J Epidemiol 1989;130:1199--208.
65. Pendrys DG. Risk for fluorosis in a fluoridated population: implications for the dentist and hygienist. J Am Dent Assoc 1995;126:1617--24.
66. US Department of Health, Education, and Welfare. Public Health Service drinking water standards, revised 1962. Washington, DC: US Public Health Service, Department of Health, Education, and Welfare, 1962; PHS publication no. 956.
67. Galagan DJ, Vermillion JR. Determining optimum fluoride concentrations. Public Health Rep 1957;72:491--3.
68. CDC. Engineering and administrative recommendations for water fluoridation, 1995. MMWR 1995;44(No. RR-13):1--40.
69. US Environmental Protection Agency. 40 CFR Part 141.62. Maximum contaminant levels for inorganic contaminants. Code of Federal Regulations 1998:402.
70. US Environmental Protection Agency. 40 CFR Part 143. National secondary drinking water regulations. Code of Federal Regulations 1998;514--7.
71. US Department of Health and Human Services, Food and Drug Administration. 21 CFR Part 165.110. Bottled water. Federal Register 1995;60:57124--30.
72. US Food and Drug Administration. 21 CFR Part 355. Anticaries drug products for over-the-counter human use. Code of Federal Regulations 1999:280--5.
73. American Dental Association. ADA guide to dental therapeutics. 1st ed. Chicago, IL: American Dental Association, 1998.
74. American Academy of Pediatric Dentistry. Special issue: reference manual 1995. Pediatr Dent 1994--95;16(special issue):1--96.
75. American Academy of Pediatrics Committee on Nutrition. Fluoride supplementation for children: interim policy recommendations. Pediatrics 1995;95:777.
76. Singer L, Jarvey BA, Venkateswarlu P, Armstrong WD. Fluoride in plaque. J Dent Res 1970;49:455.
77. Dabeka RW, McKenzie AD, Lacroix GMA. Dietary intakes of lead, cadmium, arsenic and fluoride by Canadian adults: a 24-hour duplicate diet study. Food Addit Contam 1987;4:89--102.
78. Kramer L, Osis D, Wiatrowski E, Spencer H. Dietary fluoride in different areas of the United States. Am J Clin Nutr 1974;27:590--4.
79. Osis D, Kramer L, Wiatrowski E, Spencer H. Dietary fluoride intake in man. J Nutr 1974;104:1313--8.
80. Singer L, Ophaug RH, Harland BF. Fluoride intake of young adult males in the United States. Am J Clin Nutr 1980;33:328--32.
81. Ophaug RH, Singer L, Harland BF. Estimated fluoride intake of average two-year-old children in four dietary regions of the United States. J Dent Res 1980;59:777--81.
82. Ophaug RH, Singer L, Harland BF. Estimated fluoride intake of 6-month-old infants in four dietary regions of the United States. Am J Clin Nutr 1980;33:324--7.
83. Singer L, Ophaug RH, Harland BF. Dietary fluoride intake of 15-19-year-old male adults residing in the United States. J Dent Res 1985;64:1302--5.
84. Pang DTY, Phillips CL, Bawden JW. Fluoride intake from beverage consumption in a sample of North Carolina children. J Dent Res 1992;71:1382--8.
85. Levy SM, Kohout FJ, Guha-Chowdhury N, Kiritsy MC, Heilman JR, Wefel JS. Infants' fluoride intake from drinking water alone, and from water added to formula, beverages, and food. J Dent Res 1995;74:1399--407.
86. Levy SM, Kiritsy MC, Warren JJ. Sources of fluoride intake in children. J Public Health Dent 1995;55:39--52.
87. Johnson J Jr, Bawden JW. The fluoride content of infant formulas available in 1985. Pediatr Dent 1987;9:33--7.
88. Dean HT, Jay P, Arnold FA Jr, Elvove E. Domestic water and dental caries. II. A study of 2,832 white children, aged 12--14 years, of 8 suburban Chicago communities, including Lactobacillus acidophilus studies of 1,761 children. Public Health Rep 1941;56:761--92.
89. Dean HT, Arnold FA Jr, Elvove E. Domestic water and dental caries. V. Additional studies of the relation of fluoride domestic water to dental caries experience in 4,425 white children, aged 12 to 14 years, of 13 cities in 4 states. Public Health Rep 1942;57:1155--79.
90. Galagan DJ. Climate and controlled fluoridation. J Am Dent Assoc 1953;47:159--70.
91. Galagan DJ, Lamson GG Jr. Climate and endemic dental fluorosis. Public Health Rep 1953;68:497--508. 92. Galagan DJ, Vermillion JR, Nevitt GA, Stadt ZM, Dart RE. Climate and fluid intake. Public Health Rep 1957;72:484--90.
93. CDC. Fluoridation census 1992 summary. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 1993.
94. Arnold FA Jr, Likins RC, Russell AL, Scott DB. Fifteenth year of the Grand Rapids Fluoridation Study. J Am Dent Assoc 1962;65:780--5.
95. Ast DB, Fitzgerald B. Effectiveness of water fluoridation. J Am Dent Assoc 1962;65:581--7.
96. Blayney JR, Hill IN. Fluorine and dental caries. J Am Dent Assoc 1967;74(special issue):225--302.
97. Hutton WL, Linscott BW, Williams DB. Final report of local studies on water fluoridation in Brantford. Can J Public Health 1956;47:89--92.
98. Brunelle JA, Carlos JP. Recent trends in dental caries in U.S. children and the effect of water fluoridation. J Dent Res 1990;69(special issue):723--7.
99. Newbrun E. Effectiveness of water fluoridation. J Public Health Dent 1989;49(special issue):279--89.
100. Ripa LW. A half-century of community water fluoridation in the United States: review and commentary. J Public Health Dent 1993;53:17--44.
101. Grembowski D, Fiset L, Spadafora A. How fluoridation affects adult dental caries: systemic and topical effects are explored. J Am Dent Assoc 1992;123:49--54.
102. Wiktorsson A-M, Martinsson T, Zimmerman M. Salivary levels of lactobacilli, buffer capacity and salivary flow rate related to caries activity among adults in communities with optimal and low water fluoride concentrations. Swed Dent J 1992;16:231--7.
103. Eklund SA, Burt BA, Ismail AI, Calderone JJ. Highfluoride drinking water, fluorosis, and dental caries in adults. J Am Dent Assoc 1987;114:324--8.
104. Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth---2nd ed. Gerodontology 1997;14:33--47.
105. Burt BA, Ismail AI, Eklund SA. Root caries in an optimally fluoridated and a high-fluoride community. J Dent Res 1986;65:1154--8.
106. Stamm JS, Banting DW, Imrey PB. Adult root caries survey of two similar communities with contrasting natural water fluoride levels. J Am Dent Assoc 1990;120:143--9.
107. Brustman B. Impact of exposure to fluorideadequate water on root surface caries in elderly. Gerodontics 1986;2:203--7.
108. Jones CM, Taylor GO, Whittle JG, Evans D, Trotter DP. Water fluoridation, tooth decay in 5 year olds, and social deprivation measured by the Jarman score: analysis of data from British dental surveys. BMJ 1997;315:514--7.
109. Provart SJ, Carmichael CL. The relationship between caries, fluoridation, and material deprivation in five-year-old children in County Durham. Community Dent Health 1995;12:200--3.
110. Slade GD, Spencer AJ, Davies MJ, Stewart JF. Influence of exposure to fluoridated water on socioeconomic inequalities in children's caries experience. Community Dent Oral Epidemiol 1996;24:89--100.
111. Kumar JV, Swango PA, Lininger LL, Leske GS, Green EL, Haley VB. Changes in dental fluorosis and dental caries in Newburgh and Kingston, New York. Am J Public Health 1998;88:1866--70.
112. Graves RC, Bohannan HM, Disney JA, Stamm JW, Bader JD, Abernathy JR. Recent dental caries and treatment patterns in US children. J Public Health Dent 1986;46:23--9.
113. Ast DB, Smith DJ, Wachs B, Cantwell KT. Newburgh-Kingston caries-fluorine study. XIV. Combined clinical and roentgenographic dental findings after ten years of fluoride experience. J Am Dent Assoc 1956;52:314--25.
114. Russell AL. Dental fluorosis in Grand Rapids during the seventeenth year of fluoridation. J Am Dent Assoc 1962;65:608--12.
115. Lewis DW, Banting DW. Water fluoridation: current effectiveness and dental fluorosis. Community Dent Oral Epidemiol 1994;22:153--8.
116. Kumar JV, Swango PA. Fluoride exposure and dental fluorosis in Newburgh and Kingston, New York: policy implications. Community Dent Oral Epidemiol 1999;27:171--80.
117. Szpunar SM, Burt BA. Dental caries, fluorosis, and fluoride exposure in Michigan schoolchildren. J Dent Res 1988;67:802--6.
118. Horowitz HS. School fluoridation for the prevention of dental caries. Int Dent J 1973;23:346--53.
119. Horowitz HS, Law FE, Pritzker T. Effect of school water fluoridation on dental caries, St. Thomas, V.I. Public Health Rep 1965;80:381--8.
120. Horowitz HS, Heifetz SB, Law FE, Driscoll WS. School fluoridation studies in Elk Lake, Pennsylvania, and Pike County, Kentucky---results after eight years. Am J Public Health 1968;58:2240--50.
121. Horowitz HS, Heifetz SB, Law FE. Effect of school water fluoridation on dental caries: final results in Elk Lake, PA, after 12 years. J Am Dent Assoc 1972;84:832--8.
122. Heifetz SB, Horowitz HS, Brunelle JA. Effect of school water fluoridation on dental caries: results in Seagrove, NC, after 12 years. J Am Dent Assoc 1983;106:334--7.
123. King RS, Iafolla TJ, Rozier RG, Satterfield WC, Spratt CJ. Effectiveness of school water fluoridation and fluoride mouthrinses. J Dent Res 1995;74(special issue):192. 124. CDC. Acute fluoride poisoning---North Carolina. MMWR 1974;23:199.
125. Hoffman R, Mann J, Calderone J, Trumbull J, Burkhart M. Acute fluoride poisoning in a New Mexico elementary school. Pediatrics 1980;65:897--900.
126. Vogt RL, Witherell L, LaRue D, Klaucke DN. Acute fluoride poisoning associated with an on-site fluoridator in a Vermont elementary school. Am J Public Health 1982;72:1168--9.
127. Stannard J, Rovero J, Tsamtsouris A, Gavris V. Fluoride content of some bottled waters and recommendations for fluoride supplementation. J Pedod 1990;14:103--7.
128. Weinberger SJ. Bottled drinking waters: are the fluoride concentrations shown on the label accurate? Int J Paediatr Dent 1991;1:143--6.
129. Van Winkle S, Levy SM, Kiritsy MC, Heilman JR, Wefel JS, Marshall T. Water and formula fluoride concentrations: significance for infants fed formula. Pediatr Dent 1995;17:305--10.
130. Mark AM. Americans taking to the bottle: loss of important fluoride source may be result. ADA News 1998;29:12. 131. US Environmental Protection Agency. 40 CFR Part 141 Subpart O. Consumer confidence reports. Federal Register 1998;63:44526--36.
132. Duckworth RM, Morgan SN, Burchell CK. Fluoride in plaque following use of dentifrices containing sodium monofluorophosphate. J Dent Res 1989;68:130--3.
133. Duckworth RM, Morgan SN. Oral fluoride retention after use of fluoride dentifrices. Caries Res 1991;25:123--9.
134. Sidi AD. Effect of brushing with fluoride toothpastes on the fluoride, calcium, and inorganic phosphorus concentrations in approximal plaque of young adults. Caries Res 1989;23:268--71.
135. Reintsema H, Schuthof J, Arends J. An in vivo investigation of the fluoride uptake in partially demineralized human enamel from several different dentifrices. J Dent Res 1985;64:19--23.
136. Stookey GK, Schemehorn BR, Cheetham BL, Wood GD, Walton GV. In situ fluoride uptake from fluoride dentifrices by carious enamel. J Dent Res 1985;64:900--3.
137. Bruun C, Givskov H, Thylstrup A. Whole saliva fluoride after toothbrushing with NaF and MFP dentifrices with different F concentrations. Caries Res 1984;18:282--8.
138. Levy SM. Review of fluoride exposures and ingestion. Community Dent Oral Epidemiol 1994;22:173--80.
139. Horowitz HS, Law FE, Thompson MB, Chamberlin SR. Evaluation of a stannous fluoride dentifrice for use in dental public health programs. I. Basic findings. J Am Dent Assoc 1966;72:408--22.
140. James PMC, Anderson RJ. Clinical testing of a stannous fluoride-calcium pyrophosphate dentifrice in Buckinghamshire school children. Br Dent J 1967;123:33--9.
141. Jordan WA, Peterson JK. Caries-inhibiting value of a dentifrice containing stannous fluoride: final report of a two year study. J Am Dent Assoc 1959;58:42--4.
142. Muhler JC. Effect of a stannous fluoride dentifrice on caries reduction in children during a three-year study period. J Am Dent Asoc 1962;64:216--24.
143. Stookey GK. Are all fluoride dentifrices the same? In: Wei SHY, ed. Clinical uses of fluorides: a state of the art conference on the uses of fluorides in clinical dentistry: May 11 and 12, 1984, Holiday Inn, Union Square, San Francisco, California. Philadelphia, PA: Lea & Febiger, 1985:105--31.
144. Clarkson JE, Ellwood RP, Chandler RE. A comprehensive summary of fluoride dentifrice caries clinical trials. Am J Dent 1993;6(special issue):59--106.
145. Stamm JW. The value of dentifrices and mouthrinses in caries prevention. Int Dent J 1993;43:517--27.
146. Mellberg JR, Ripa LW. Fluoride dentifrices. In: Mellberg JR, Ripa LW. Fluoride in preventive dentistry: theory and clinical applications. Chicago, IL: Quintessence Publishing Co., 1983:215--41.
147. Mellberg JR. Fluoride dentifrices: current status and prospects. Int Dent J 1991;41:9--16.
148. Richards A, Banting DW. Fluoride toothpastes. In: Fejerskov O, Ekstrand J, Burt BA, eds. Fluoride in dentistry. 2nd ed. Copenhagen: Munksgaard, 1996:328--46.
149. Lind OP, von der Fehr FR, Joost Larsen M, Möller IJ. Anti-caries effect of a 2% Na2PO3F-dentifrice in a Danish fluoride area. Community Dent Oral Epidemiol 1976;4:7--14.
150. O'Mullane DM, Clarkson J, Holland T, O'Hickey S, Whelton H. Effectiveness of water fluoridation in the prevention of dental caries in Irish children. Community Dent Health 1988;5:331--44.
151. Stookey GK, Beiswanger BB. Topical fluoride therapy. In: Harris NO, Christen AG, eds. Primary preventive dentistry. 4th ed. Stamford, CT: Appleton & Lang, 1995:193--233.
152. Horowitz HS, Ismail AI. Topical fluorides in caries prevention. In: Fejerskov O, Ekstrand J, Burt BA, eds. Fluorides in dentistry. 2nd ed. Copenhagen: Munksgaard, 1996:311--27.
153. Ronis DL, Land WP, Passow E. Tooth brushing, flossing, and preventive dental visits by Detroitarea residents in relation to demographic and socioeconomic factors. J Public Health Dent 1993;53:138--45.
154. Wagener DK, Nourjah P, Horowitz AM. Trends in childhood use of dental care products containing fluoride: United States, 1983--89. Hyattsville, MD: U.S. Department of Health and Human Services, Public Health Service, CDC, 1992. (Advanced data from vital health statistics; no. 219).
155. Peffley GE, Muhler JC. The effect of a commercially available stannous fluoride dentifrice under controlled brushing habits on dental caries incidence in children: preliminary report. J Dent Res 1960;39:871--5.
156. Bixler D, Muhler JC. Experimental clinical human caries test design and interpretation. J Am Dent Assoc 1962;65:482--90.
157. Chesters RK, Huntington E, Burchell CK, Stephen KW. Effect of oral care habits on caries in adolescents. Caries Res 1992;26:299--304.
158. Chesnutt IG, Schafer F, Jacobson APM, Stephen KW. The influence of toothbrushing frequency and post-brushing rinsing on caries experience in a caries clinical trial. Community Dent Oral Epidemiol 1998;26:406--11.
159. Duckworth RM, Knoop DTM, Stephen KW. Effect of mouthrinsing after toothbrushing with a fluoride dentifrice on human salivary fluoride levels. Caries Res 1991;25:287--91.
160. Sjögren K, Birkhed D, Ruben J, Arends J. Effect of post-brushing water rinsing on caries-like lesions at approximal and buccal sites. Caries Res 1995;9:337--42.
161. Conti AJ, Lotzkar S, Daley R, Cancro L, Marks RG, McNeal DR. A 3-year clinical trial to compare efficacy of dentifrices containing 1.14% and 0.76% sodium monofluorophosphate. Community Dent Oral Epidemiol 1988;16:135--8.
162. Fogels HR, Meade JJ, Griffith J, Miragliuolo R, Cancro LP. A clinical investigation of a high-level fluoride dentifrice. J Dent Child 1988;55:210--5.
163. Hanachowicz L. Caries prevention using a 1.2% sodium monofluorophosphate dentifrice in an aluminum oxide trihydrate base. Community Dent Oral Epidemiol 1984;12:10--6.
164. O'Mullane DM, Kavanagh D, Ellwood RP, et al. A three-year clinical trial of a combination of trimetaphosphate and sodium fluoride in silica toothpastes. J Dent Res 1997;76:1776--81.
165. Lalumandier JA, Rozier RG. The prevalence and risk factors of fluorosis among patients in a pediatric dental practice. Pediatr Dent 1995;17:19--25.
166. Mascarenhas AK, Burt BA. Fluorosis risk from early exposure to fluoride toothpaste. Community Dent Oral Epidemiol 1998;26:241--8.
167. 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.
168. Riordan PJ. Dental fluorosis, dental caries and fluoride exposure among 7-year-olds. Caries Res 1993;27:71--7.
169. Skotowski MC, Hunt RJ, Levy SM. Risk factors for dental fluorosis in pediatric dental patients. J Public Health Dent 1995;55:154--9.
170. Pendrys DG, Katz RV, Morse DE. Risk factors for enamel fluorosis in a nonfluoridated population. Am J Epidemiol 1996;143:808--15.
171. Nacacche H, Simard PL, Trahan L, et al. Factors affecting the ingestion of fluoride dentrifice by children. J Public Health Dent 1992;52:222--6.
172. Simard PL, Naccache H, Lachapelle D, Brodeur JM. Ingestion of fluoride from dentifrices by children aged 12 to 24 months. Clin Pediatr 1991;30:614--7.
173. Barnhart WE, Hiller LK, Leonard GJ, Michaels SE. Dentifrice usage and ingestion among four age groups. J Dent Res 1974;53:1317--22.
174. Baxter PM. Toothpaste ingestion during toothbrushing by school children. Br Dent J 1980;148:125--8.
175. Hargreaves JA, Ingram GS, Wagg BJ. A gravimetric study of the ingestion of toothpaste by children. Caries Res 1972;6:236--43.
176. Beltrán ED, Szpunar SM. Fluoride in toothpastes for children: suggestion for change. Pediatr Dent 1988;10:185--8.
177. Levy SM. A review of fluoride intake from fluoride dentifrice. J Dent Child 1993;61:115--24.
178. Koch G, Petersson L-G, Kling E, Kling L. Effect of 250 and 1000 ppm fluoride dentifrice on caries: a three-year clinical study. Swed Dent J 1982;6:233--8.
179. Mitropoulos CM, Holloway PJ, Davies TGH, Worthington HV. Relative efficacy of dentifrices containing 250 or 1000 ppm F- in preventing dental caries---report of a 32-month clinical trial. Community Dent Health 1984;1:193--200.
180. Winter GB, Holt RD, Williams BF. Clinical trial of a low-fluoride toothpaste for young children. Int Dent J 1989;39:227--35.
181. Holt RD, Morris CE, Winter GB, Downer MC. Enamel opacities and dental caries in children who used a low fluoride toothpaste between 2 and 5 years of age. Int Dent J 1994;44:331--41.
182. Horowitz HS. The need for toothpastes with lower than conventional fluoride concentrations for preschool-aged children. J Public Health Dent 1992;52:216--21.
183. Zero DT, Raubertas RF, Fu J, Pedersen AM, Hayes AL, Featherstone JDB. Fluoride concentrations in plaque, whole saliva, and ductal saliva after application of home-use topical fluorides. J Dent Res 1992;71:1768--75.
184. Horowitz HS, Creighton WE, McClendon BJ. The effect on human dental caries of weekly oral rinsing with a sodium fluoride mouthwash: a final report. Arch Oral Biol 1971;16:609--16.
185. Rugg-Gunn AJ, Holloway PJ, Davies TGH. Caries prevention by daily fluoride mouthrinsing: report of a three-year clinical trial. Br Dent J 1973;135:353--60.
186. DePaola PF, Soparkar P, Foley S, Bookstein F, Bakhos Y. Effect of high-concentration ammonium and sodium fluoride rinses in dental caries in schoolchildren. Community Dent Oral Epidemiol 1977;5:7--14.
187. Leverett DH, Sveen OB, Jensen ØE. Weekly rinsing with a fluoride mouthrinse in an unfluoridated community: results after seven years. J Public Health Dent 1985;45:95--100.
188. Ripa LW, Leske GS, Sposato A, Rebich T. Supervised weekly rinsing with a 0.2 percent neutral NaF solution: final results of a demonstration program after six school years. J Public Health Dent 1983;43:53--62.
189. Ripa LW, Leske GS, Sposato AL, Rebich T Jr. Supervised weekly rinsing with a 0.2% neutral NaF solution: results after 5 years. Community Dent Oral Epidemiol 1983;11:1--6.
190. Ripa LW, Leske G. Effect on the primary dentition of mouthrinsing with a 0.2 percent neutral NaF solution: results from a demonstration program after four school years. Pediatr Dent 1981;3:311--5.
191. Ripa LW. A critique of topical fluoride methods (dentifrices, mouthrinses, operator-, and self-applied gels) in an era of decreased caries and increased fluorosis prevalence. J Public Health Dent 1991;51:23--41.
192. Haugejorden O, Lervik T, Riordan PJ. Comparison of caries prevalence 7 years after discontinuation of school-based fluoride rinsing or toothbrushing in Norway. Community Dent Oral Epidemiol 1985;13:2--6.
193. Leske GS, Ripa LW, Green E. Posttreatment benefits in a school-based fluoride mouthrinsing program: final results after 7 years of rinsing by all participants. Clin Prev Dent 1986;8:19--23.
194. Holland TJ, Whelton H, O'Mullane DM, Creedon P. Evaluation of a fortnightly school-based sodium fluoride mouthrinse 4 years following its cessation. Caries Res 1995;29:431--4.
195. Disney JA, Graves RC, Stamm JW, Bohannan HM, Abernathy JR. Comparative effects of a 4-year fluoride mouthrinse program on high and low caries forming grade 1 children. Community Dent Oral Epidemiol 1989;17:139--43.
196. Klein SP, Bohannan HM, Bell RM, Disney JA, Foch CB, Graves RC. The cost and effectiveness of school-based preventive dental care. Am J Public Health 1985;75:382--91.
197. Nourjah P, Horowitz AM, Wagener DK. Factors associated with the use of fluoride supplements and fluoride dentifrice by infants and toddlers. J Public Health Dent 1994;54:47--54.
198. Leverett DH, Adair SM, Vaughan BW, Proskin HM, Moss ME. Randomized clinical trial of the effect of prenatal fluoride supplements in preventing dental caries. Caries Res 1997;31:174--9.
199. Aasenden R, Peebles TC. Effects of fluoride supplementation from birth on human deciduous and permanent teeth. Arch Oral Biol 1974;19:321--6.
200. 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--8.
201. D'Hoore W, Van Nieuwenhuysen J-P. Benefits and risks of fluoride supplementation: caries prevention versus dental fluorosis. Eur J Pediatr 1992;151:613--6.
202. Allmark C, Green HP, Linney AD, Wills DJ, Picton DCA. A community study of fluoride tablets for school children in Portsmouth: results after six years. Br Dent J 1982;153:426--30.
203. Fanning EA, Cellier KM, Somerville CM. South Australian kindergarten children: effects of fluoride tablets and fluoridated water on dental caries in primary teeth. Aust Dent J 1980;25:259--63.
204. Marthaler TM. Caries-inhibiting effect of fluoride tablets. Helv Odont Acta 1969;13:1--13.
205. Widenheim J, Birkhed D. Caries-preventive effect on primary and permanent teeth and cost-effectiveness of an NaF tablet preschool program. Community Dent Oral Epidemiol 1991;19:88--92.
206. Widenheim J, Birkhed D, Granath L, Lindgren G. Preeruptive effect of NaF tablets on caries in children from 12 to 17 years of age. Community Dent Oral Epidemiol 1986;14:1--4.
207. Margolis FJ, Reames HR, Freshman E, Macauley JC, Mehaffey H. Fluoride: ten-year prospective study of deciduous and permanent dentition. Am J Dis Child 1975;129:794--800.
208. Bagramian RA, Narendran S, Ward M. Relationship of dental caries and fluorosis to fluoride supplement history in a non-fluoridated sample of schoolchildren. Adv Dent Res 1989;3:161--7.
209. Holm A-K, Andersson R. Enamel mineralization disturbances in 12-year-old children with known early exposure to fluorides. Community Dent Oral Epidemiol 1982;10:335--9.
210. Awad MA, Hargreaves JA, Thompson GW. Dental caries and fluorosis in 7--9 and 11--14 year old children who received fluoride supplements from birth. J Can Dent Assoc 1994;60:318--22.
211. Friis-Hasché E, Bergmann J, Wenzel A, Thylstrup A, Pedersen KM, Petersen PE. Dental health status and attitudes to dental care in families participating in a Danish fluoride tablet program. Community Dent Oral Epidemiol 1984;12:303--7.
212. Kalsbeek H, Verrips GH, Backer Dirks O. Use of fluoride tablets and effect on prevalence of dental caries and dental fluorosis. Community Dent Oral Epidemiol 1992;20:241--5.
213. DePaola PF, Lax M. The caries-inhibiting effect of acidulated phosphate-fluoride chewable tablets: a two-year double-blind study. J Am Dent Assoc 1968;76:554--7.
214. Driscoll WS, Heifetz SB, Korts DC. Effect of chewable fluoride tablets on dental caries in schoolchildren: results after six years of use. J Am Dent Assoc 1978;97:820--4.
215. Stephen KW, Campbell D. Caries reduction and cost benefit after 3 years of sucking fluoride tablets daily at school: a double-blind trial. Br Dent J 1978;144:202--6.
216. Stephen KW, McCall DR, Gilmour WH. Incisor enamel mottling in child cohorts which had or had not taken fluoride supplements from 0--12 years of age. Proc Finn Dent Soc 1991;87:595--605.
217. Larsen MJ, Kirkegaard E, Poulsen S, Fejerskov O. Dental fluorosis among participants in a non-supervised fluoride tablet program. Community Dent Oral Epidemiol 1989;17:204--6.
218. Riordan PJ, Banks JA. Dental fluorosis and fluoride exposure in Western Australia. J Dent Res 1991;70:1022--8.
219. Suckling GW, Pearce EIF. 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.
220. Wöltgens JHM, Etty EJ, Nieuwland WMD. Prevalence of mottled enamel in permanent dentition of children participating in a fluoride programme at the Amsterdam dental school. J Biol Buccale 1989;17:15--20.
221. Woolfolk MW, Faja BW, Bagramian RA. Relation of sources of systemic fluoride to prevalence of dental fluorosis. J Public Health Dent 1989;49:78--82.
222. Ismail AI, Brodeur J-M, Kavanagh M, Boisclair G, Tessier C, Picotte L. Prevalence of dental caries and dental fluorosis in students, 11--17 years of age, in fluoridated and non-fluoridated cities in Quebec. Caries Res 1990;24:290--7.
223. Margolis FJ, Burt BA, Schork A, Bashshur RL, Whittaker BA, Burns TL. Fluoride supplements for children: a survey of physicians' prescription practices. Am J Dis Child 1980;134:865--8.
224. Szpunar SM, Burt BA. Fluoride exposure in Michigan schoolchildren. J Public Health Dent 1990;50:18--23.
225. Levy SM, Muchow G. Provider compliance with recommended dietary fluoride supplement protocol. Am J Public Health 1992:82:281--3.
226. Pendrys DG, Morse DE. Use of fluoride supplementation by children living in fluoridated communities. J Dent Child 1990;57:343--7.
227. Pendrys DG, Morse DE. Fluoride supplement use by children in fluoridated communities. J Public Health Dent 1995;55:160--4.
228. Jackson RD, Kelly SA, Katz BP, Hull JR, Stookey GK. Dental fluorosis and caries prevalence in children residing in communities with different levels of fluoride in the water. J Public Health Dent 1995;55:79--84.
229. Lasagna L. Balancing risks versus benefits in drug therapy decisions. Clin Ther 1998;20(suppl C):72--9.
230. Dijkman TG, Arends J. The role of `CaF2-like' material in topical fluoridation of enamel in situ. Acta Odontol Scand 1988;46:391--7.
231. Houpt M, Koenigsberg S, Shey Z. The effect of prior toothcleaning on the efficacy of topical fluoride treatment: two-year results. Clin Prev Dent 1983;5:8--10.
232. Brudevold F, Savory A, Gardner DE, Spinelli M, Speirs R. A study of acidulated fluoride solutions. I. In vitro effects on enamel. Arch Oral Biol 1963;8:167--77.
233. Ripa LW. Professionally (operator) applied topical fluoride therapy: a critique. Int Dent J 1981;31:105--20. 234. Wei SHY, Yiu CKY. Evaluation of the use of topical fluoride gel. Caries Res 1993;27(suppl I):29--34.
235. Hagen PP, Rozier RG, Bawden JW. The caries-preventive effect of full- and half-strength topical acidulated phosphate fluoride. Pediatr Dent 1985;7:185--91.
236. Ripa LW. An evaluation of the use of professional (operator-applied) topical fluorides. J Dent Res 1990;69(special issue):786--96.
237. Horowitz HS, Doyle J. The effect on dental caries of topically applied acidulated phosphate-fluoride: results after three years. J Am Dent Assoc 1971;82:359--65.
238. Johnston DW, Lewis DW. Three-year randomized trial of professionally applied topical fluoride gel comparing annual and biannual application with/without prior prophylaxis. Caries Res 1995;29:331--6.
239. Petersson LG. Fluoride mouthrinses and fluoride varnishes. Caries Res 1993;27(suppl 1):35--42.
240. Mandel ID. Fluoride varnishes---a welcome addition [Editorial]. J Public Health Dent 1994;54:67.
241. Wakeen LM. Legal implications of using drugs and devices in the dental office. J Public Health Dent 1992;52:403--8.
242. Clark DC, Stamm JW, Tessier C, Robert G. The final results of the Sherbrooke-Lac Mégantic fluoride varnish study. J Can Dent Assoc 1987;53:919--22.
243. de Bruyn H, Arends J. Fluoride varnishes---a review. J Biol Buccale 1987;15:71--82.
244. Helfenstein U, Steiner M. Fluoride varnishes (Duraphat): a meta-analysis. Community Dent Oral Epidemiol 1994;22:1--5.
245. Twetman S, Petersson LG, Pakhomov GN. Caries incidence in relation to salivary mutans streptococci and fluoride varnish applications in preschool children from low- and optimal-fluoride areas. Caries Res 1996;30:347--53.
246. Seppä L. Studies of fluoride varnishes in Finland. Proc Finn Dent Soc 1991;87:541--7.
247. Seppä L, Leppänen T, Hausen H. Fluoride varnish versus acidulated phosphate fluoride gel: a 3-year clinical trial. Caries Res 1995;29:327--30.
248. Seppä L, Tolonen T. Caries preventive effect of fluoride varnish applications performed two or four times a year. Scand J Dent Res 1990;98:102--5.
249. Petersson LG, Arthursson L, Östberg C, Jönsson P, Gleerup A. Caries-inhibiting effects of different modes of Duraphat varnish reapplication: a 3-year radiographic study. Caries Res 1991;25:70--3.
250. Sköld L, Sundquist B, Eriksson B, Edeland C. Four-year study of caries inhibition of intensive Duraphat application in 11--15-year-old children. Community Dent Oral Epidemiol 1994;22:8--12.
251. Adriaens ML, Dermaut LR, Verbeeck RMH. The use of `Fluor Protector,' a fluoride varnish, as a caries prevention method under orthodontic molar bands. Eur J Orthod 1990;12:316--9.
252. Peyron M, Matsson L, Birkhed D. Progression of approximal caries in primary molars and the effect of Duraphat treatment. Scand J Dent Res 1992;100:314--8.
253. Marthaler TM. Cariostatic efficacy of the combined use of fluorides. J Dent Res 1990;69(special issue):797--800.
254. US Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Alexandria, VA: International Medical Publishing, 1996.
255. McKay FS. Relation of mottled enamel to caries. J Am Dent Assoc 1928;15:1429--37.
256. Clark DC, Hann HJ, Williamson MF, Berkowitz J. Effects of lifelong consumption of fluoridated water or use of fluoride supplements on dental caries prevalence. Community Dent Oral Epidemiol 1995;23:20--4.
257. Murray JJ, Rugg-Gunn AJ. Fluorides in caries prevention. 2nd ed. Boston, MA: Wright-PSG, 1982. (Dental practitioner handbook no. 20).
258. Warner KE, Luce BR. Cost-benefit and cost-effectiveness analysis in health care: principles, practice, and potential. Ann Arbor, MI: Health Administration Press, 1982.
259. Manski RJ, Moeller JF, Maas WR. Dental services: use, expenditures and sources of payment, 1987. J Am Dent Assoc 1999;130:500--8.
260. Burt BA, ed. Proceedings for the workshop: Cost-effectiveness of caries prevention in dental public health, Ann Arbor, Michigan, May 17--19, 1989. J Public Health Dent 1989;49(special issue):331--7.
261. Brown LJ, Lazar V. Dental procedure fees 1975 through 1995: how much have they changed? J Am Dent Assoc 1998;129:1291--5.
262. Downer MC, Blinkhorn AS, Attwood D. Effect of fluoridation on the cost of dental treatment among urban Scottish schoolchildren. Community Dent Oral Epidemiol 1981;9:112--6.
263. Attwood D, Blinkhorn AS. Reassessment of the effect of fluoridation on cost of dental treatment among Scottish schoolchildren. Community Dent Oral Epidemiol 1989;17:79--82.
264. Garcia AI. Caries incidence and costs of prevention programs. J Public Health Dent 1989:49(special issue):259--71.
265. Anonymous. Which toothpaste is right for you? Consumer Reports 1998;August:11--4.
266. Doherty NJG, Brunelle JA, Miller AJ, Li S-H. Costs of school-based mouthrinsing in 14 demonstration programs in USA. Community Dent Oral Epidemiol 1984;12:35--8.
267. Leverett DH. Effectiveness of mouthrinsing with fluoride solutions in preventing coronal and root caries. J Public Health Dent 1989;49(special issue):310--6.
268. van Rijkom HM, Truin GJ, van 't Hof MA. A meta-analysis of clinical studies on the caries-inhibiting effect of fluoride gel treatment. Caries Res 1998;32:83--92.
269. Eklund SA, Pittman JL, Heller KE. Professionally applied topical fluoride and restorative care in insured children. J Public Health Dent 2000;60:33--8.
270. Petersson LG, Westerberg I. Intensive fluoride varnish program in Swedish adolescents: economic assessment of a 7-year follow-up study on proximal caries incidence. Caries Res1994;28:59--63.
The are very few substances around that have been studied more than fluoride.
Anyway, I noticed you forgot to mention your silly "decay starts in the womb" quote. I'd like to hear your explanation.
And you forgot (again) to answer my question, so I'll ask it again:
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