Community Effectiveness of Public Water Fluoridation in Reducing Children's Dental Disease

OBJECTIVES: Water fluoridation is one of the most effective public health programs of the past century. However, efforts to extend water fluoridation into currently non-fluoridated areas are often thwarted. Despite considerable evidence regarding the effectiveness of water fluoridation at an individual level, published national community-based studies are rare. This study compared children's decay experience and prevalence between areas with and without water fluoridation in Australia. METHODS: Oral health data were obtained from clinical examinations of 128, 990 5- to 15-year-old children attending for a regular visit with their respective Australian state or territory School Dental Service in 2002. Water fluoridation status, residence remoteness, and socioeconomic status (SES) were obtained for each child's recorded residential postcode area. RESULTS: Children from every age group had greater caries prevalence and more caries experience in areas with negligible fluoride concentrations in the water ( or = 0.7 ppm). Controlling for child age, residential location, and SES, deciduous and permanent caries experience was 28.7% and 31.6% higher, respectively, in low-fluoride areas compared with optimally fluoridated areas. The odds ratios for higher caries prevalence in areas with negligible fluoride compared with optimal fluoride were 1.34 (95% confidence interval [CI] 1.29, 1.39) and 1.24 (95% CI 1.21, 1.28) in the deciduous and permanent dentitions, respectively. CONCLUSIONS: This study demonstrates the continued community effectiveness of water fluoridation and provides support for the extension of this important oral health intervention to populations currently without access to fluoridated water.JM Armfieldhttp://www.ncbi.nlm.nih.gov/pubmed/2087328

A cognitive theory of the etiology of fear.

In an effort to address weaknesses in previous theories and to provide a stronger more inclusive theoretical account of the etiology of specific phobias and sub-clinical fears, a new cognitive model is proposed. It is argued that the development and expression of fear is cognitively determined, stemming directly from perceptions of any given stimulus or situation. In particular, perceptions of uncontrollability, unpredictability, dangerousness and disgustingness are proposed to form a vulnerability-related schema, which guides future perceptions and serves to channel emotional, behavioural, cognitive and physiological reactions upon encountering a fear-relevant stimulus or situation. The cognitive schema is based on both previous learning experiences and underlying personality traits which may predispose an individual to more readily perceive any given stimulus as uncontrollable, unpredictable, dangerous and disgusting, and to react with greater arousal given these perceptions. Other cognitive resources such as coping strategies may help to mitigate the fear response by impacting upon the general cognitive evaluation arising out of the fear-provoking encounter. The new model, termed the Cognitive Vulnerability Model, explains some of the more vexing aspects of specific phobias: (1) why some people do not acquire fears after traumatic experiences; (2) why some people with fears and phobias have never had a traumatic experience with their fear-relevant stimulus; (3) the uneven distribution of fears in the population; and (4) the apparent various modes of acquisition of fear. The model has implications for both understanding the origins of fear and for the treatment of fears and specific phobias. Ten studies are presented which investigate the Cognitive Vulnerability Model as it relates to fears and phobias. Each study takes the form of either a published scientific paper or a paper submitted for publication. The setting out of the studies forms two parts – the first deals with the model generally and uses primarily animal fears as the feared stimulus, whereas the second part focuses on dental fear as a special case. The first paper presents a literature review of the area and the theoretical development of the model. Subsequent papers explore the relationship between fear of eight different animals and perceptions of the animals as uncontrollable, unpredictable, dangerous and disgusting, experimental manipulations of perceptions of spiders and self-rated fear of an encounter with a spider, the extent to which vulnerability-related perceptions mediate the associations between personality trait-like dispositions and spider fear, and the recall and recognition bias for spider schema relevant words which suggests the active presence of a cognitive schema. The second part of the thesis moves to an examination of dental fear, including both those characteristics of dental fear which make it such an important social and health concern (such as the high population prevalence, the so-called ‘vicious cycle’ of dental fear, and the association of dental fear with numerous other fears) as well as the relationship between cognitive vulnerability perceptions and dental fear. Although there remain limitations to overcome and more studies are required to further test the model, the studies as a whole paint a consistent picture, providing strong support for the utility of the Cognitive Vulnerability Model in explaining specific fears. The model has important implications both for understanding the genesis of fear and for treating it.Thesis (Ph.D.) -- University of Adelaide, School of Dentistry, 200

The Child Dental Health Survey, New South Wales, 1997

AIHW Catalogue No. DEN 54AIHW Dental Statistics and Research Unit, The University of Adelaide, in collaboration with The Dental Health Branch, NSW Healthhttp://www.adelaide.edu.au/arcpoh/publications/reports/statistics

The Child Dental Health Survey, Tasmania, 1998

AIHW Catalogue No. DEN 79AIHW Dental Statistics and Research Unit, The University of Adelaide, in collaboration with The Tasmanian Department of Health and Human Serviceshttp://www.adelaide.edu.au/arcpoh/publications/reports/statistics

The Child Dental Health Survey, Tasmania 1997

AIHW Catalogue No. DEN 59AIHW Dental Statistics and Research Unit, The University of Adelaide, in collaboration with The Tasmanian Department of Community and Health Service

The Child Dental Health Survey, Western Australia 1997

AIHW Catalogue No. DEN 61AIHW Dental Statistics and Research Unit, The University of Adelaide, in collaboration with Dental Services, Health Department of Western Australi

The child dental health survey, Queensland, 1997

AIHW Catalogue No. DEN 55AIHW Dental Statistics and Research Unit, The University of Adelaidehttp://www.adelaide.edu.au/arcpoh/publications/reports/statistics

The Child Dental Health Survey, Northern Territory 1997

AIHW Catalogue No. DEN 60AIHW Dental Statistics and Research Unit, The University of Adelaid