Publications & presentations

Publications

Study Protocol

James, P., Harding, M., Beecher, T., Parnell, C., Browne, D., Tuohy, M., Kavanagh, D., O'Mullane, D., Guiney, H., Cronin, M., & Whelton, H. (2018) Fluoride And Caring for Children’s Teeth (FACCT): Clinical Fieldwork Protocol [version 1; referees: 2 approved]. HRB Open Research, 1:4 (doi: 10.12688/hrbopenres.12799.1)

Abstract

Background: The reduction in dental caries seen between Irish national surveys of children’s oral health in 1984 and 2002 was accompanied by an increase in the prevalence of enamel fluorosis. To minimise the risk of enamel fluorosis in Irish children, in 2007, the level of fluoride in drinking water was reduced from 0.8-1.0 ppm to 0.6-0.8 ppm fluoride. Recommendations on the use of fluoride toothpastes in young children were issued in 2002. Fluoride and Caring for Children’s Teeth (FACCT) is a collaborative project between the Oral Health Services Research Centre, University College Cork and the Health Service Executive dental service, with funding from the Health Research Board.
Aim: FACCT aims to evaluate the impact and the outcome of the change in community water fluoridation (CWF) policy (2007) on dental caries and enamel fluorosis in Irish schoolchildren, while also considering the change in policy on the use of fluoride toothpastes (2002).
Methods/Design: A cross-sectional study with nested longitudinal study will be conducted in school year (SY) 2013-2014 by trained and calibrated dental examiners in primary schools in counties Dublin, Cork and Kerry for a representative sample of children born either prior to or post policy changes; age 12 (born 2001) and age 5, (born 2008). Five-year-olds will be followed-up when they are 8-year-olds (SY 2016-2017). The main explanatory variable will be fluoridation status of the children (lifetime exposure to CWF yes/no). Information about other explanatory variables will be collected via parent (of 5-, 8- and 12-year-olds) and child completed (8- and 12-year-olds only) questionnaires. The main outcomes will be dental caries (dmf/DMF Index), enamel fluorosis (Dean’s Index) and oral health-related quality of life (OHRQoL). Multivariate regression analyses will be used to determine the impact and outcome of the change in CWF policy on oral health outcomes controlling for other explanatory variables.

Supplementary material

Supplementary File 1: the documents contained in the FACCT consent packs in 2013–2014 and 2016–2017.

Supplementary File 2: Fieldwork manuals used to assist the examining teams to organise and conduct the oral epidemiological fieldwork.

Supplementary File 3: The rules that guided the classification of the fluoridation status of each child and the rationale for the classification system used.

FACCT Fluoridation Status Rules

Study Results

James, P., Harding, M., Beecher, T., Browne, D., Cronin, M., Guiney, H., O’Mullane, D. and Whelton, H. (2020) 'Impact of Reducing Water Fluoride on Dental Caries and Fluorosis', Journal of Dental Research, (8 pp). (doi: 10.1177/0022034520978777). Full text will be available from CORA, the Cork Open Research Archive in January 2022: https://cora.ucc.ie/handle/10468/10898

Abstract

Guidance intended to reduce fluoride toothpaste ingestion in early childhood was introduced in Ireland in 2002. In 2007, water fluoride concentration was adjusted from 0.8–1.0 to 0.6–0.8 ppm. The objective of this study was to determine the difference in caries and fluorosis levels following introduction of these 2 policy measures. A before-and-after study compared caries and fluorosis in random samples of 8-y-olds in Dublin (n = 707) and Cork-Kerry (n = 1148) in 2017 with 8-y-olds in Dublin (n = 679) and Cork-Kerry (n = 565) in 2002. Dentinal caries experience (primary teeth, d3vcmft(cde)) and fluorosis (permanent teeth, Dean’s index of very mild or higher) were clinically measured. Lifetime exposure to community water fluoridation (CWF) was classified as “full CWF”/“no CWF.” Effect of examination year on caries prevalence and severity and fluorosis prevalence was assessed using multivariate regression adjusting for other explanatory variables. There was little change in commencement of fluoride toothpaste use at ≤24 mo following introduction of toothbrushing guidance. Among children with full CWF, there was no statistically significant difference in caries prevalence or severity between 2017 and 2002. In 2017, caries prevalence was 55% in Dublin (full CWF) and 56% in Cork-Kerry (full CWF), and mean d3vcmft(cde) among children with caries was 3.4 and 3.7, respectively. Caries severity was less in 2017 (mean 4.2) than 2002 (mean 4.9) among children with no CWF (P = 0.039). The difference in caries severity between children with full CWF and no CWF was less in 2017 than in 2002 (interaction P = 0.013), suggesting a reduced benefit for CWF in 2017. In 2017, fluorosis prevalence was 18% in Dublin (full CWF) and 12% in Cork-Kerry (full CWF). Fluorosis was predominantly “very mild” with no statistically significant difference between 2017 and 2002. CWF at 0.6 to 0.8 ppm is an effective caries-preventive measure. Results suggested low uptake of toothbrushing guidance, a reduced caries-preventive effect for CWF in primary teeth, and no reduction in fluorosis following introduction of the policy measures.

Presentations

Whelton, H., Beecher, T., Cronin, M., Harding, M., James, P., Parnell, C., & Tuohy, M. (2013, November) FACCT: Fluoride And Caring for Children's Teeth. Poster presented at the International Association for Dental Research (IADR) Irish Division Annual Scientific Meeting, Cork, Ireland. FACCT IADR Irish Division Nov 2013

James, P., Beecher, T., Harding, M., & Whelton, H. (2014, September) Translating Research Documents for Legislative Compliance and Promotion of Participation. Poster presented at the International Association for Dental Research (IADR) Pan European Regional (PER) Congress, Dubrovnik, Croatia. FACCT IADR PER Translating documents Sept 2014

Beecher, T., Harding, M., James, P., & Whelton, H. (2014, September) Exposure of Irish school children to domestic water fluoridation. Poster presented at the International Association for Dental Research (IADR) Pan European Regional (PER) Congress, Dubrovnik, Croatia. FACCT IADR PER Water F Sept 2014

Beecher, T., Harding, M., James, P., & Whelton, H. (2016, March) Self-Perception of Enamel Opacities among Irish 12-Year-Olds. Poster presented at the International Association for Dental Research (IADR) Irish Division Annual Scientific Meeting, Cork, Ireland. FACCT IADR Irish Division Mar 2016

Whelton, H., Harding, M., Beecher, T., James, P., & Guiney, H. (2016, June) Association between 0.7ppm water fluoridation and caries in primary teeth. Poster presented at the International Association for Dental Research (IADR) General Session, Seoul, Republic of Korea. FACCT IADR Gen Session Seoul Jun 2016

Harding, M., James, P., Beecher, T., Guiney, H., & Whelton, H. (2016, September) Fewer teeth with dentinal caries (D3_vcMFT) in 12-year-old children with community water fluoridation in the Republic of Ireland. Poster presented at the 21st Congress of the European Association of Dental Public Health (EADPH), Budapest, Hungary. FACCT EADPH Budapest Sept 2016

Whelton, H., Harding, M., James, P., Beecher, T., & Guiney, H. (2017, March) Effectiveness of Water Fluoridation at 0.7 ppm. Oral presentation at the International Association for Dental Research (IADR), American Association for Dental Research (AADR), Canadian Association for Dental Research (CADR) General Session, San Francisco, California, USA. Journal of Dental Research, 96(Special Issue A): 0269.

Harding, M., James, P., Beecher, T., & Guiney, H. (2017, June) Accurate Measurement of Enamel Fluorosis in the FACCT Study, Republic of Ireland. Oral presentation at the 22nd Congress of the European Association of Dental Public Health (EADPH), Vilnius, Lithuania. Community Dental Health, 34(3) (online-only supplement): 3550, s3.

Harding, M., James, P., Beecher, T., Fox, F., O'Mullane, D., & Whelton, H. (2018, June) Electronic Oral Health Records to Monitor Trends in Oral Health. Oral presentation at the International Association for Dental Research (IADR) Pan European Regional (PER) Congress, London, England. IADR Abstract Archives

Harding, M., Guiney, H., Beecher, T., James, P., Browne, D., O'Mullane, D., & Whelton, H. (2019, June) Impact of Caries and Enamel Opacities on Irish Schoolchildren's OHRQoL. Oral presentation at the International Association for Dental Research (IADR), American Association for Dental Research (AADR), Canadian Association for Dental Research (CADR) General Session, Vancouver, British Columbia, Canada. IADR Abstract Archives

Harding, M., James, P., Beecher, T., Browne, D., O’Mullane, D., Guiney, H., Cronin, M., & Whelton, H. (2019, October) Impact of downward adjustment of water fluoride concentration on caries. Oral presentation at the International Association for Dental Research (IADR) Irish Division Annual Scientific Meeting, Cork, Ireland. FACCT IADR Irish Division Oct 2019 Caries

James, P., Harding, M., Beecher, T., Browne, D., O’Mullane, D., Cronin, M., Guiney, H., & Whelton, H. (2019, October) Impact of downward adjustment of water fluoride concentration on fluorosis. Oral presentation at the International Association for Dental Research (IADR) Irish Division Annual Scientific Meeting, Cork, Ireland. FACCT IADR Irish Division Oct 2019 Fluorosis

Oral Health Services Research Centre

University Dental School & Hospital, Wilton, Cork T12 E8YV, Ireland.