How far have we come in 10 years in resolving uncertainties about the effects of fluoride on oral he

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How far have we come in 10 years in resolving
uncertainties about the effects of fluoride on
oral health? Iain ChalmersEditor, The James
Lind Library

• 10th birthday party of
• The Cochrane Oral Health Group
• Manchester, 30 May 2005

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Alexia Antczak-Bouckoms
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Many congratulations on your 10th anniversary!!
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How far have we come in 10 years in resolving
uncertainties about the effects of fluoride on
oral health?
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Fluoride reduces the incidence of caries
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The magnificent contribution of members of the
Cochrane Oral Health Group!!
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The MarinhoHigginsLogan-Sheiham TeamTopical
fluoride (toothpastes, mouthrinses, gels or
varnishes) for preventing dental caries in
children and adolescentsFluoride gels for
preventing dental caries in children and
adolescentsFluoride mouthrinses for preventing
dental caries in children and adolescentsFluorid
e toothpastes for preventing dental caries in
children and adolescentsFluoride varnishes for
preventing dental caries in children and
adolescentsCombinations of topical fluoride
(toothpastes, mouthrinses, gels, varnishes)
versus single topical fluoride for preventing
dental caries in children and adolescentsOne
topical fluoride (toothpastes, or mouthrinses, or
gels, or varnishes) versus another for preventing
dental caries in children and adolescents
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The benefits of topical fluorides have been
firmly established on a sizeable body of evidence
from randomized controlled trials. While the
formal examination of sources of heterogeneity
between studies has been important in the overall
conclusions reached, these should be interpreted
with caution. We were unable to reach definite
conclusions about any adverse effects that might
result from the use of topical fluorides, because
data reported in the trials are scarce.Marinho
VCC, Higgins JPT, Logan S, Sheiham A. Topical
fluoride (toothpastes, mouthrinses, gels or
varnishes) for preventing dental caries in
children and adolescents. The Cochrane Database
of Systematic Reviews 2003, Issue 4.
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What are the effects of mass medication using
water fluoridation?
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The origins of the York systematic review
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Main findings of York systematic review Water
fluoridation probably reduces caries by
an average of 15 overall probably has an
effect over and above toothpaste may
reduce some inequalities between social
groups probably causes more mottled teeth
than was previously thought may or may not
cause other harms such as cancer, bone
problems, etc.
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Main findings of York systematic review
(contd)The most serious defect of the studies
of possible beneficial effects of water
fluoridation was the lack of appropriate design
and analysis. Many studies did not present an
analysis at all, while others did not attempt to
control for potentially confounding
factors. McDonagh et al. BMJ 2000321855-9.
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Responses to the York Review
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BDA press release, 20 July 2000Water
fluoridation has been proven beyond doubt to be
safe and to massively reduce tooth decayThere is
no scientific controversy over the safety of
water fluoridation.
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Governments responseCommission another review
from the Medical Research Council
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MRC Working Group Report, 2002. Studies are
needed to provide estimates of the effects of
water fluoridation on children aged 3-15 years
against a background of widespread use of
fluoride toothpaste, and to extend knowledge
about the effect of water fluoridation by social
class (or other measures of socio-economic
status), taking into account potentially
important effect modifiers such as sugar
consumption and toothpaste usage.
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Joint BDA, BMA, FPHM and British Fluoridation
Society briefing for MPs on water fluoridation,
June 2003.No call for the support of further
research
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National Fluoridation Information Centre
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Suggestions in a 1 July 2003 letter (unanswered)
from Iain Chalmers to Melanie Johnston, Minister
for Public Health entitled Handling differing
public opinions about the desirability of water
fluoridation1. Commission the Cochrane Oral
Health Group to prepare and publish an update of
the York Review in The Cochrane Library Not
done, as far as I am aware
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2. Fund people with no vested interests in any
of the polarized positions on water fluoridation
to (i) develop methods to familiarize local
communities with the research evidence(ii)
develop and apply methods to help local
communities to make informed choices among
alternative policies. Not done, as far as I am
aware
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Why, 5 years after the York and MRC reviews
called for more research on the effects of water
fluoridation, is the dental health community
apparently unwilling to? call for an update of
the York Review? acknowledge the need for
better research? help to organise the better
research that is needed?
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