Tavener J A, Davies G M, Davies R M, Ellwood R P
Dental Health Unit, Manchester, UK.
Community Dent Health. 2004 Sep;21(3):217-23.
To assess the impact of a programme regularly supplying free fluoride toothpaste to children on the prevalence and severity of fluorosis and other developmental defects of enamel.
Randomised, controlled, parallel three-group clinical trial. Two groups received toothpaste containing either 440 or 1450 ppm F; the third group received no intervention. Children were supplied with toothpaste and advice on its use from the age of 12 months until they were 5-6 years old. The participants were a sub sample of those involved in a study that considered the caries benefits of providing free fluoride toothpaste. They were eligible if they completed the main study, lived in four of the nine districts involved and attended schools with 6 or more eligible participants.
Children from the north west of England consuming drinking water containing less than 0.1 ppm F were examined in primary schools.
3731 children completed the main study. Of the 1833 children in the four selected districts, 927 were from schools with six or more participants.
Digital images encompassing the upper and lower anterior sextants were taken of each child when they were 8-9 years old.
Developmental defects of enamel and dental fluorosis (TF index) were recorded on upper central incisors from wet and dry images.
A total of 703 children were included in the data analysis. In the 1450 ppm F (n=218), 440 ppm F (n = 226) and control (n = 259) groups the prevalence of dental fluorosis (TF > 0) was 17%, 15% and 12% for the wet (p > 0.05) and 26%, 24% and 25% for the dry (p > 0.05) photographs respectively. The prevalence of TF scores 2 or 3 (highest score) was 5%, 4% and 2% and for the wet (p > 0.05) and 7%, 4% and 5% for the dry (p > 0.05) photographs respectively. All subjects identified with TF score 3 were found in the group using the 1450 ppm F toothpaste (3 wet and 4 dry) and there were statistically significant differences between the three groups for both wet (p = 0.03) and dry photographs (p < 0.01). However, the pairwise comparisons between the groups failed to attain statistical significance. The highest prevalence and severity of demarcated opacities was seen in the control group and for the wet photographs the difference between the three groups attained statistical significance (p = 0.04). For both the wet and dry photographs the prevalence of any enamel defects (including fluorosis) and large demarcated or TF score 3 was similar for the three groups (p > 0.05).
Previously it has been reported that only the provision of 1450 ppm F toothpaste provides anticaries benefits in a programme of this type. This benefit is accompanied by a slight increase in prevalence of TF score 3 but not the overall prevalence of developmental defects of enamel. Careful targeting and implementation of a programme of this type is required to maximise benefits and minimise risks of fluoride exposure.
评估一项定期为儿童提供免费含氟牙膏的项目对氟斑牙患病率及严重程度以及其他牙釉质发育缺陷的影响。
随机、对照、平行三组临床试验。两组儿童分别使用含440 ppm氟或1450 ppm氟的牙膏；第三组不进行干预。从12个月大到5 - 6岁，为儿童提供牙膏并给予使用指导。参与者是参与一项考虑提供免费含氟牙膏对龋齿益处研究的子样本。若他们完成了主要研究、居住在九个参与地区中的四个地区且所在学校有6名或更多符合条件的参与者，则符合入选标准。
对英格兰西北部饮用含氟量低于0.1 ppm水的儿童在小学进行检查。
3731名儿童完成了主要研究。在四个选定地区的1833名儿童中，927名来自有6名或更多参与者的学校。
在儿童8 - 9岁时，拍摄包含上下前牙六个区段的数字图像。
根据湿、干图像记录上颌中切牙的牙釉质发育缺陷和氟斑牙（TF指数）情况。
共有703名儿童纳入数据分析。在含1450 ppm氟组（n = 218）、含440 ppm氟组（n = 226）和对照组（n = 259）中，湿图像上氟斑牙（TF > 0）的患病率分别为17%、15%和12%（p > 0.05），干图像上分别为26%、24%和25%（p > 0.05）。TF评分为2或3（最高分）的患病率，湿图像上分别为5%、4%和2%（p > 0.05），干图像上分别为7%、4%和5%（p > 0.05）。所有TF评分为3的受试者均在使用1450 ppm氟牙膏组（湿图像3例，干图像4例），三组在湿图像（p = 0.03）和干图像（p < 0.01）上均存在统计学显著差异。然而，组间两两比较未达到统计学显著差异。界限清晰的釉质浑浊的最高患病率和严重程度出现在对照组，湿图像上三组间差异具有统计学显著性（p = 0.04）。对于湿、干图像，三组任何牙釉质缺陷（包括氟斑牙）以及界限清晰或TF评分为3的患病率相似（p > 0.05）。
此前有报道称，在这类项目中，仅提供1450 ppm氟的牙膏具有防龋益处。此益处伴随着TF评分为3的患病率略有增加，但牙釉质发育缺陷的总体患病率未增加。需要仔细确定此类项目的目标人群并实施，以最大化益处并最小化氟暴露风险。
