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What is the FACCT study?

FACCT is an important research study about children’s oral health. The FACCT study is a joint University College Cork/Health Services research project and is funded by the Health Research Board. FACCT stands for Fluoride And Caring for Children’s Teeth. The study took place in primary schools in Dublin, Cork and Kerry.

Why is fluoride important for teeth?

Fluoride helps to strengthen our teeth and makes them more resistant to tooth decay. Water contains some fluoride naturally and in Ireland water fluoride levels are adjusted upwards to help protect our teeth against tooth decay. This is called community water fluoridation. In Ireland, 71% of people have access to fluoridated water supplies. Fluoride is also found in most toothpastes and mouthwashes. Having community water fluoridation and using fluoride toothpaste have helped to reduce tooth decay levels in Irish children and adults.

What is dental fluorosis?  

If children swallow too much fluoride when their permanent teeth are forming in the gums (up to about age 3 for the permanent front teeth), the fluoride can alter the mineralisation (hardening) of the tooth enamel. When the permanent teeth cut through the gum, they may have faint white lines or white marks on them. These faint white lines or white marks are called dental fluorosis. However, not all white marks on teeth are dental fluorosis. Some white marks on teeth can result from an injury to the mouth or an illness when the teeth were developing.

At the levels seen in Ireland, dental fluorosis does not weaken the teeth. Most dental fluorosis in Ireland is not noticeable and can only be detected by a trained dental health professional. In countries like Ireland, with community water fluoridation and widespread use of fluoride toothpaste, it is inevitable that some children will develop dental fluorosis. However, a small amount of dental fluorosis in the population is considered an acceptable trade off in return for the significant protection that fluoride provides against tooth decay. Nevertheless, every effort must be made to minimise the occurrence of dental fluorosis in the population.

Why was the FACCT study conducted?

In 2002, the Report of the Forum on Fluoridation included recommendations for the use of fluoride toothpaste in young children. Parents were advised not to use fluoride toothpaste in children under the age of 2 and to supervise toothbrushing with a small pea-sized amount of fluoride toothpaste from age 2 to age 7. In 2007, following the recommendation Forum on Fluoridation the level of fluoride in drinking water was reduced from a range of 0.8 to 1.0 parts per million (ppm) fluoride to a range of 0.6 to 0.8ppm fluoride with a target value of 0.7ppm fluoride. The FACCT study assessed the impact of these changes on tooth decay and dental fluorosis levels in children living in Dublin, Cork and Kerry.

How many children participated in the FACCT study?

  • In the school year 2013-14, 2,894 children in Junior Infants (aged 4-6 years) and 2,378 children in 6th class (aged 9-11 years) participated in wave 1 of the FACCT study.
  • In the school year 2016-17, 2,315 children in 2nd class (aged 7-9) who had been part of wave 1 of FACCT when they were in Junior Infants participated in wave 2 of the study.

What are the results of the FACCT study?

The FACCT study generated a wealth of information and analysis of the dataset is on-going. As results from the study become available, they are posted to the Publications and Presentations section of the website.

Additional funding was secured from the Health Research Board ‘Knowledge Exchange and Dissemination Scheme (KEDS)’ in 2017 and 2018 to facilitate dissemination of the study results.

  • The infographics generated as a result of the Knowledge Exchange and Dissemination Scheme (KEDS) 2017: “Supporting individuals and organisations involved in implementation of community water fluoridation” are accessible via the Infographics tab.
  • Dissemination materials for General Dental Practitioners developed as part of the Health Research Board (HRB), Knowledge Exchange and Dissemination Scheme (KEDS) 2018: “What the Researcher and the Dentist want to share, supporting knowledge dissemination" are available via the Educational Resources for Dental Professionals tab.


The FACCT study research team are grateful for the support of the many schools, parents and children who generously gave their time to participate in the FACCT study.

The FACCT study was funded by the Health Research Board (CARG/2012/34) with additional support from the National Oral Health Office of the Health Service Executive and the Department of Health and Children, Ireland.

We are deeply indebted to the FACCT Scientific Advisory Group; Dr Peter Cooney, Dr Roger Ellwood, Emeritus Professor Andrew Rugg-Gunn and Emeritus Professor John Spencer for all advice and critique generously provided from inception to completion of the FACCT study.

We are very grateful to the members of the Project Management Committee (PMC) and Programme Steering Group (PSG) who provided ideas and solutions that positively contributed to the study methodology.

We would like to acknowledge the commitment and dedication of the examining teams who undertook the clinical fieldwork for wave 1 and 2 of the FACCT study.

Finally, we like to acknowledge the generous support of the OHSRC staff.

Oral Health Services Research Centre

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