Dental health and fluoride use in low SES children

Introduction: In France two sets of systemic fluoride recommendations exist. One advises fluoride supplements from birth, the other fluoridated salt and limits supplementation to children (> 6 months) at high risk of caries. Objectives: To evaluate fluoride use in a deprived area sample of 348 4-5 yr-olds in Clermont-Ferrand and assess the relationship between fluoride use, SES and dental health. Methods: All 4–5-yr-olds attending 9 deprived-area public schools were selected. High caries prevalence characterised the schools. Parents completed a questionnaire about SES and the child's fluoride use. Participants were examined at school by a dentist to record dft and DMFT. Non-parametric tests and logistic regression measured relationships. Results: 282 (81%) children participated. Their SES was poor; 33% lived with a single parent; 62% of mothers were unemployed; 55% had family immigrant background; 34% benefited from a 100% health insurance for economically deprived families. Caries experience was high; mean dft was 1.94 (sd 3.31), caries prevalence 43% and 30% had >1 carious teeth. Concerning fluoride use it appeared that 29% used fluoridated salt; salt type unknown for 18%. Only 26% brushed their teeth twice daily. Toothbrushing was adult supervised for 55%. Fluoride supplements were used from birth – 2 yrs by 66%. Only 15% still used supplements; 19% had never done so. Use of fluoridated salt/supplements, brushing twice a day and supervised toothbrushing were related to better dental status (p<0.05). Immigrant background, large families (3+) and having 100% health coverage were related to poorer dental status (p<0.05). In multivariate logistic regression, dental insurance level, immigrant status and supervised toothbrushing were significant oral health predictors. Systemic fluoride use was unrelated to dental health. Conclusion: When SES is considered, supervised toothbrushing is the only fluoride supply related with improved dental status