Salivary fluoride levels after daily brushing with 5000 ppm fluoride toothpaste: A randomised, controlled clinical trial.

This study explored salivary fluoride levels following toothbrushing with 5000 and 1450 ppm fluoride toothpaste and determined the decline in salivary fluoride levels following the return from 5000 to 1450 ppm fluoride toothpaste. The study was a randomised, controlled double-blind parallel clinical trial (n = 24/group) measuring salivary fluoride five times during a 3-week trial phase involving 2×/day use of 5000 or 1450 ppm fluoride toothpaste, and five times during an ensuing 2-week wash-out phase where all participants used 1450 ppm toothpaste. Salivary fluoride was measured using a fluoride electrode and data were analysed using multilevel mixed-effects linear regression. Baseline salivary fluoride geometric means were 0.014 and 0.016 ppm for the 1450 and 5000 ppm groups, while the values at the end of the trial phase were 0.023 and 0.044 ppm, respectively. During the trial phase, except at baseline, differences between groups were statistically significant. The salivary fluoride levels for the 5000 ppm group remained statistically significantly higher than for the 1450 ppm group only at the first measurement in the wash-out phase (≈30 h after the last 5000 ppm brushing), indicating that higher salivary fluoride levels resulting from use of 5000 ppm are sustained only as long as the brushing habit continues.

Osteopontin adsorption to Gram-positive cells reduces adhesion forces and attachment to surfaces under flow.

The bovine milk protein osteopontin (OPN) may be an efficient means to prevent bacterial adhesion to dental tissues and control biofilm formation. This study sought to determine to what extent OPN impacts adhesion forces and surface attachment of different bacterial strains involved in dental caries or medical device-related infections. It further investigated if OPN's effect on adhesion is caused by blocking the accessibility of glycoconjugates on bacterial surfaces. Bacterial adhesion was determined in a shear-controlled flow cell system in the presence of different concentrations of OPN, and interaction forces of single bacteria were quantified using single-cell force spectroscopy before and after OPN exposure. Moreover, the study investigated OPN's effect on the accessibility of cell surface glycoconjugates through fluorescence lectin-binding analysis. OPN strongly affected bacterial adhesion in a dose-dependent manner for all investigated species (Actinomyces naeslundii, Actinomyces viscosus, Lactobacillus paracasei subsp. paracasei, Staphylococcus epidermidis, Streptococcus mitis, and Streptococcus oralis). Likewise, adhesion forces decreased after OPN treatment. No effect of OPN on the lectin-accessibility to glycoconjugates was found. OPN reduces the adhesion and adhesion force/energy of a variety of bacteria and has a potential therapeutic use for biofilm control. OPN acts upon bacterial adhesion without blocking cell surface glycoconjugates.

Methodological issues in the quantification of subgingival microorganisms using the checkerboard technique.

The reproducibility and reliability of quantitative microbiological assessments using the DNA-DNA hybridization "checkerboard method" (CKB) were assessed. The data originated from 180 chronic periodontitis patients, who were enrolled in a clinical trial and sampled at baseline, and 3 and 12m post-therapy. The samples were divided into two portions allowing evaluation of reproducibility. In total, 531 samples were analyzed in a first run, using standard bacterial preparations of cells and 513 samples were accessible for analysis in the second, using standards based on purified DNA from the species. The microbial probe panel consisted of periodontitis marker bacteria as well as non-oral microorganisms. Three different ways of quantifying and presenting data; the visual scoring method, VSM, the standard curve method, SCM, and the percent method, PM, were compared. The second set of analyses based on the use of standard preparations of pure DNA was shown to be more consistent than the first set using standards based on cells, while the effect of storage time per se up to 2.5y seemed to be marginal. The best reproducibility was found for Tannerella forsythia, irrespective of quantification technique (Spearman's rho=0.587, Pearson's r≥0.540). The percent method (PM) based on percent of High Standard (10(6) cells) was more reliable than SCM based on a linear calibration of the High Standard and a Low Standard (10(5) cells). It was concluded that the reproducibility of the CBK method varied between different bacteria. High quality and pure specific DNA whole genomic probes and standards may have a stronger impact on the precision of the data than storage time and conditions.

A functional natural dentition for all--and for life? The oral healthcare system needs revision.

The cost of dental care adds to the costs of the already overburdened health sector. Do we - as patients and as society -receive oral health care that is both aligned with the actual disease experience and also, critically based on up-to-date scientific knowledge about the major oral diseases? In many places, the practice of dentistry reflects a response to disease patterns that once existed and is based on diagnostic and therapeutic approaches that are no longer valid. Instead, a new cadre of dental professionals is needed, one that is capable of meeting the actual health needs of our populations. This cadre should ensure that patients maintain a functioning dentition from cradle to grave based on cost-effective disease control principles. There is an urgent need to: (i) reconsider the roles of the different oral health cadres involved in the provision of oral health care; (ii) integrate oral health into general healthcare services; and (iii) restructure the training of oral health personnel. We advocate a radical reform of the oral healthcare system involving the training of two new types of professionals integrated with the general healthcare system: The oral healthcare provider - a highly skilled professional specialised in the diagnosis and control of oral diseases and with a profound understanding of oral health as part of general health - and the oral clinical specialist - whose role is the provision of advanced oral rehabilitation, able also to treat people with complex chronic diseases and multiple medications.

Saliva fluoride before and during 3 years of supervised use of fluoride toothpaste.

OBJECTIVES: The purpose of the study was to examine pre-brushing saliva fluoride concentrations before and during a large, 3-year, prospective toothpaste study on the effect of post-brushing rinsing on dental caries. The aims were to study saliva fluoride over time and the effect of rinsing on saliva fluoride and to relate saliva fluoride to caries increments and accumulation of plaque. MATERIALS AND METHODS: Saliva samples (baseline and 1, 2, and 3 years) were collected from 11-year-old children attending two schools (A and B) in Kaunas, Lithuania, who refrained from brushing the evening and morning before saliva collection. Numbers of saliva samples collected varied from 264 at baseline to 188 at the 3-year follow-up. Children in school A rinsed with water after daily brushing, while children in school B did not rinse. Total caries and visible plaque were registered at baseline and after 3 years. RESULTS: Mean saliva fluoride concentrations at baseline and after 1, 2, and 3 years from school A (rinsing) were 0.014, 0.026, 0.029, and 0.034 ppm and from school B (no rinsing) were 0.013, 0.028, 0.031, and 0.031 ppm, respectively. Increases in saliva fluoride from baseline were significant (Wilcoxon's test, p < 0.001), but the increase from baseline to year 1 was not statistically significantly different between schools. Saliva fluoride did not increase beyond year 1 and did at no time point differ between schools. Reductions in numbers of tooth surfaces with dental plaque were significantly positively related to the number of caries reversals over the 3 years. CONCLUSIONS: Background saliva fluoride concentration is increased by brushing at least once daily on schooldays, does not increase further over 3 years, and is not affected by rinsing after brushing. CLINICAL RELEVANCE: Continuous use of fluoride toothpaste produces ambient saliva fluoride levels similar to saliva fluoride in areas with fluoridated water.

Inter-examiner variability in orthodontic treatment decisions for Danish children with 'borderline' treatment need.

This study explored the variation between examiners in the orthodontic treatment need assessments of fifth-grade children with a borderline orthodontic treatment need. Each of three groups of children with borderline treatment need (n = 18, 19, and 19, respectively) were examined by one of three groups of orthodontists (33 in each group), whereby each of 56 children had 33 orthodontic treatment need assessments based on a clinical examination. This treatment need determination exercise was subsequently repeated with treatment need determined based on study casts and extraoral photographs. The proportion of positive treatment decisions based on the clinical examination was 49.3, 49.6, and 52.5 per cent, respectively, and 45.7, 46.3, and 50.5 per cent, based on the model assessments. There was a considerable disagreement between examiners in the treatment need assessments, whether assessments were based on a clinical examination or on a model-based case presentation. The average percentage agreement between two orthodontists for the treatment need based on clinical examination was 69, 66, and 61, respectively, corresponding to mean kappa values of 0.38, 0.32, and 0.22. When the model-based assessments were considered, the average percentage agreement between two orthodontists was 62, 58, and 69, respectively, corresponding to mean kappa values of 0.25, 0.16, and 0.37. Linear regression analysis of the orthodontists' treatment propensity as a function of their gender, place of education, years of orthodontic treatment experience, type of workplace, and place of work showed that only the orthodontic experience was influential for the model-based treatment propensity [ß = 0.34 per cent/year (95 per cent confidence interval = 0.01-0.66)].

The validity of self-reported dental agenesis.

The optimal tools for obtaining a diagnosis of dental agenesis (DA) among adults are childhood dental records and radiographs. However, these are often not available, and therefore the present study aimed to assess whether DA in adults could be validly assessed by self-reported information guided by a questionnaire. A questionnaire eliciting information on DA of permanent teeth was constructed, pilot-tested, and subsequently posted to a case group consisting of 334 young adults, for whom the DA status had been ascertained in the period from 1992 to 2002. A control group, consisting of 258 young adults randomly selected from the population from which the cases originated, was also approached with questionnaires. The response rate was 53.7% among cases and 46.4% among controls. The sensitivity and specificity of self-reported DA were estimated to be at least 0.88 (95% CI = 0.82-0.92) and 0.95 (95% CI = 0.89-0.98), respectively. These diagnostic test parameters are clearly inadequate for population-screening purposes. However, when screening patient groups with a higher occurrence of DA than is characteristic of the background population, the self-reported DA status may be a useful tool for identifying risk groups for conditions associated with the presence of DA.

Periodontal disease in research beagle dogs--an epidemiological study.

OBJECTIVES: To estimate the prevalence and describe the extent and severity of periodontal disease and associated periodontal parameters in beagle dogs. METHODS: A full-mouth, site-specific examination was performed in 98 beagle dogs. Focus was placed on clinical attachment loss, pocket depth and bleeding on probing. RESULTS: The prevalence of clinical attachment loss greater than equal to 1 mm was 20 per cent in the one-year-old dogs, increasing to 84 per cent of the dogs aged more than three years. The number of sites affected with clinical attachment loss greater than equal to 1 mm showed a skewed distribution. The prevalence of clinical attachment loss greater than equal to 4 mm was only seven per cent. A probing pocket depth of 4+ mm was observed in 44 to 81 per cent of the dogs, depending on age. Also, the distribution of the number of deepened pockets/dog was skewed. The teeth most prone to clinical attachment loss greater than equal to 1 mm were the P2, the P3 and the P4 of the maxilla. The teeth most prone to pocket depth greater than equal to 4 mm were the maxillary canines. CLINICAL SIGNIFICANCE: Periodontal disease in terms of clinical attachment loss greater than equal to 1 mm and pocket depth greater than equal to 4 mm is common in beagle dogs, but the major disease burden is carried by only a few dogs. The prevalence increases with increased age but is high already at the age of two years.

Caries management: technical solutions to biological problems or evidence-based care?

Caries-related clinical decision-making remains a centrepiece of clinical dentistry. However, the oral disease patterns are rapidly changing towards the better among major sections of the populations, most notably in the high-income countries. The caries decline is well documented among children and younger adults, and is gradually seen to trickle into middle and old age as well. Although it is tempting for the dental profession to take the credit for this development, the evidence points in a different direction. The major contribution of dentistry seems primarily related to changes in the treatment philosophies towards a less interventionist approach. This review aims to spur a further change in the diagnostic and treatment criteria used in the management of dental caries for the benefit of the oral health status of our patients. We must come to terms with the fact that our traditional core skills, our manual dexterity and technical competence, have less to offer to oral health than we have been accustomed to think. The dental schools and the professional dental organizations must carry the responsibility for promoting the necessary changes in the caries related clinical decision-making strategies to allow practicing dentists to provide appropriate oral health care to our populations.

A global perspective on changes in the burden of caries and periodontitis: implications for dentistry.

The structure and contents of most oral health care systems and the contents of dental curricula reflect a deep-rooted tradition for attempting to cure oral diseases by refined technological means. However, better oral health conditions for the world's populations necessitate the application of up-to-date scientific knowledge to control the major oral diseases. This review points out that not only should the structure and contents of oral health care delivery systems be based on state-of-the-art knowledge about the biology of the oral diseases; they must also take into account the trends for change in caries and periodontal diseases within and between populations, and acknowledge the impact of changes in treatment philosophies for these trends. The oral disease profiles for populations in low- and high-income countries are briefly described, and it is concluded that the rapidly changing disease profiles observed in high-income countries necessitate re-thinking of the future role and organization of dentistry in such countries. The priorities for low- and middle-income countries must be to avoid repeating the mistakes made in the high-income countries. Instead, these societies might take advantage of setting priorities based on a population-based common risk factor approach. If such an approach is adopted, the training of personnel with oral health care competence must be rethought. The authors suggest three different cadres of dental care providers to be considered for an approach that allows health care planners in different populations around the world to prioritize appropriate oral health care with due respect for the socio-economic conditions prevailing.

Oral health impact of periodontal diseases in adolescents.

The need for treatment of destructive periodontal diseases is based on observations made by oral health professionals, who, prompted by clinical findings, recommend treatment. We hypothesized that clinical signs of periodontal destruction have an impact on the oral-health-related quality of life of adolescents. We conducted a cross-sectional study among 9203 Chilean high school students sampled by a multistage random cluster procedure. We recorded clinical attachment levels and the presence of necrotizing ulcerative gingivitis. The students answered the Spanish version of the Oral Health Impact Profile and provided information on several socio-economic indicators. The results of multivariable logistic regression analyses (adjusted for age, gender, and tooth loss) showed that both attachment loss [OR = 2.0] and necrotizing ulcerative gingivitis [OR = 1.6] were significantly associated with higher impact on the Oral Health Related Quality of Life of adolescents. Individuals in lower socioeconomic positions systematically reported a higher impact on their oral-health-related quality of life.

Tunnel or saucer-shaped restorations: a survival analysis.

The aim of the present effectiveness trial was to compare the survival of restorations placed in saucer-shaped cavities to that of restorations placed in tunnel preparations. Ten operators placed a total of 85 tunnel and 97 saucer-shaped restorations. The dentinal part of the tunnel was restored by resin-modified glass ionomer cement. The remaining part of the tunnel was restored by composite resin using an adhesive technique. Composite resin was used to restore the saucer-shaped cavities. The restorations were assessed clinically and radiographically for up to 79 months, with a mean observation time of 28.8 months for tunnel, and 30.3 months for saucer-shaped restorations. The survival proportion of the tunnel restorations was 46%, and the survival proportion for the saucer-shaped restorations was 76%. A main reason for failure of the tunnel restorations was fracture of the marginal ridge (24% after 24 months). Caries development in relation to the restoration was significantly higher for tunnel restorations compared with saucer-shaped restorations (41 and 19%, respectively, after 24 months). There was no difference between the two types of restoration in marginal deterioration and caries progression in the neighboring tooth (40% after 24 months). Based on findings from the present study, it is suggested that saucer-shaped restorations should be preferred for tunnel restorations in small- and mid-sized cavities.

Association between sharing of toothbrushes, eating and drinking habits and the presence of Actinobacillus actinomycetemcomitans in Moroccan adolescents.

BACKGROUND/AIMS: Actinobacillus actinomycetemcomitans is frequently detected in dental plaque collected from Moroccan adolescents, and has been shown to be associated with clinical attachment loss in this population. The aim of this study was to assess whether behaviors such as the sharing of toothbrushes, and eating and drinking habits were associated with the presence of A. actinomycetemcomitans in Moroccan adolescents. MATERIALS AND METHODS: A total of 121 adolescents were clinically examined. Interviews regarding sharing of toothbrushes, eating and drinking habits were performed, and plaque samples were collected and analyzed for A. actinomycetemcomitans with different leukotoxin promoter types by polymerase chain reaction. Based on eating and drinking habits, the study population was divided in a low risk behavior group (LRB) and a high risk behavior group (HRB). RESULTS: No association was found between the sharing of toothbrushes and the presence of A. actinomycetemcomitans. The odds ratios between the HRB and LRB group for being positive for the JP2 type, for non-JP2 types, and for any type of A. actinomycetemcomitans were 4.74 (95% CI 0.55; 40.71), 2.49 (95% CI 1.03; 5.97), and 2.97 (95% CI 1.28; 6.91), respectively. The difference in the mean number of teeth with a clinical attachment loss of > or = 3 mm between the HRB and the LRB group was 0.91(95% CI 0.09; 1.72). CONCLUSION: Sharing of toothbrushes does not seem to be associated with the presence of A. actinomycetemcomitans in young Moroccans. Eating and drinking habits conducive to exchange of saliva are positively associated with presence of A. actinomycetemcomitans, and with a higher level of clinical attachment loss.

Risk determinants of periodontal disease--an analysis of the Study of Health in Pomerania (SHIP 0).

BACKGROUND: In this study, risk determinants were determined for periodontal disease in the representative population sample (n=3146) of the Study of Health in Pomerania. METHODS: After examining the net random sample (response 69%) and exclusion of edentulous cases and those with missing values, 2595 subjects remained. Using a multivariate, fully adjusted logistic regression, different definitions of "periodontally diseased/healthy" were examined as the dependent variable (extent of attachment loss (AL> or =4 mm, combined AL and tooth loss). The independent variables used were sociodemographic factors (age, gender, income, education), medical factors (systemic diseases, drugs), behavioral factors (regular dental checkup, smoking), and oral factors (presence of supragingival calculus and plaque). RESULTS: The following risk determinants were found for AL: male gender, presence of supragingival plaque and calculus, smoking, low educational level. For the combination of AL and tooth loss, risk determinants were female gender, supragingival plaque, smoking, and low educational level. Consumption of antiallergic medications and regular dental checkups proved to be protective. Smoking was the most influential risk determinant. These parameters explained approximately 43-55% of the variation. CONCLUSION: These results concur with those of the literature. In order to explain disease status further, host-response and microbiological factors must also be examined.

Comparison of diagnostic yields of clinical and radiographic caries examinations in children of different age.

AIM: This was to investigate if the pattern of distribution of caries lesions detected by clinical and radiographic examinations at different diagnostic thresholds changed over a 3-year period during the course of eruption of the permanent dentition. It has been hypothesized that the contribution of bitewing radiography to caries detection in posterior teeth may increase when approximal contacts are established during maturation of the dentition. METHODS: Clinical and radiographic caries recordings were made using the non- cavitated/enamel and cavity/dentine thresholds for caries detection among a group of 12-year-old Lithuanian children with a high caries experience. Examinations were repeated in the same children after 3 years. The bitewing radiographs from both examination sessions were coded to ensure unbiased recordings and were read by a single examiner. RESULTS: The diagnostic yields of the clinical and radiographic examination methods did not change after the permanent teeth had fully erupted. At both examination sessions the clinical examination resulted in the detection of significantly more lesions than did the radiographic method at the non-cavitated level (43- 47% lesions detected by clinical means only and 2-26% by radiographic means only). Only for approximal surfaces at the cavity/dentine diagnostic threshold did radiographs contribute to more lesions (15-16% lesions detected by clinical means only and 38-41% by radiographic means only). Establishment of approximal contacts in the permanent dentition did not increase the relative diagnostic yields of bite-wing radiography in this study group. CONCLUSION: The contribution of the two methods to caries diagnosis depends more on the diagnostic threshold selected than on the stage of maturation of the dentition.

The highly leukotoxic JP2 clone of Actinobacillus actinomycetemcomitans and progression of periodontal attachment loss.

The JP2 clone of Actinobacillus actinomycetemcomitans has been implicated in the etiology of periodontitis in adolescents. The aim of this two-year longitudinal study was to describe clinical attachment loss (CAL) progression and to assess its association with baseline occurrence of the JP2 and non-JP2 types of A. actinomycetemcomitans. Clinical re-examination of 121 adolescents in Morocco was performed. Progression of CAL > or = 1 mm, > or = 2 mm, > or = 3 mm, and > or = 4 mm on at least one site was found in 58%, 48%, 22%, and 6% of the subjects, respectively. Subjects who, at baseline, harbored the JP2 clone had a significantly higher progression of CAL than did subjects harboring non-JP2 types of A. actinomycetemcomitans. Subjects harboring non-JP2 types displayed a marginally higher CAL progression than did subjects who were culture-negative for A. actinomycetemcomitans.

Periodontal conditions among adults in Southern Thailand.

OBJECTIVE: To describe the periodontal conditions among 30-39- and 50-59-year-old rural Thais from the Province of Songkhla, Southern Thailand. METHODS: A total of 359 dentate persons were given a clinical examination comprising recordings of plaque and calculus in six teeth, and bleeding on probing, attachment level and pocket depth in six sites of all teeth present, except third molars. The same examiner carried out all examinations. Information on religious faith, smoking habits and use of betel was obtained by interview. A subset consisting of 60 persons was reexamined for attachment level 6 months later by another examiner. RESULTS: The oral hygiene conditions were poor with abundant amounts of both plaque and calculus. Gingival bleeding was essentially ubiquitous. The prevalence of attachment loss > or = 4 mm was 92% among 30-39-year-olds and 100% among 50-59-year-olds. The average percentage of sites affected in the two age groups was 23.9% and 63.9%. Pockets > or = 4 mm were seen in 84% of the 30-39-year-olds and in 93% of the 50-59-year-olds. Older age, Thai Buddhist faith and a high percentage of sites with calculus were significant positive predictors of a high percentage of sites with attachment loss > or = 4 mm, whereas older age and Thai Buddhist faith were the only statistically significant predictors of a high percentage of sites with attachment loss > or = 7 mm. CONCLUSION: The results indicate that this Thai population may have more widespread and severe periodontal destruction than other Asian populations, but failed to confirm the contention that Muslim faith is associated with more severe periodontal destruction.

Construct and predictive validity of clinical caries diagnostic criteria assessing lesion activity.

Even though there is no "gold standard" for determining caries lesion activity, it is nonetheless possible to evaluate the validity of such diagnostic measures. The aim of this study was to estimate the construct and predictive validity of caries lesion activity assessments by means of their ability to reflect known effects of fluoride on caries. A three-year trial of the effect of daily supervised brushing with fluoride toothpaste was carried out among 273 12-year-old children. All children were examined clinically according to diagnostic criteria for activity assessment. The relative risk (fluoride vs. control) for caries lesion transitions among diagnostic categories was calculated. Fluoride inhibited progression of caries at all stages of lesion formation while at the same time enhancing lesion regression. The effects were most pronounced for active non-cavitated lesions. It is concluded that the clinical diagnostic criteria have construct and predictive validity for the assessment of caries lesion activity.

Epidemiology of necrotizing ulcerative gingival lesions in adolescents.

OBJECTIVE AND BACKGROUND: Relatively little is known about the epidemiology of necrotizing ulcerative gingival lesions (NUG) in adolescent populations. Most studies have comprised special target groups, such as military recruits, HIV patients, or severely malnourished subjects. METHODS: A multistage random cluster sampling scheme was used to obtain a sample of 9203 students aged 12-21 years from 98 of a total of 618 high schools in Santiago, Chile. Students were given a clinical oral examination and questionnaire information was obtained on smoking and oral hygiene habits, dental attendance patterns, and diabetic status. The diagnostic criteria for NUG were the presence of necrosis and ulceration of at least one interproximal papillae. RESULTS: The estimated prevalence of NUG was 6.7% (95% CI = [6.2; 7.3]). A multivariable logistic regression analysis showed that last seeing a dentist more than 1 year ago (OR = 1.60), or never (OR = 1.93), and reporting diabetes (OR = 2.12) showed a significant positive association with the presence of NUG; whereas neither gender nor smoking were important predictors. Students aged 18-21 years were more, albeit statistically insignificantly, likely to have NUG than were younger students (OR = 1.40). CONCLUSIONS: Our observation that reporting to be diabetic was positively associated with the presence of NUG is interesting, as diabetes has never been addressed as a possible risk factor. As the association between diabetes and periodontitis in adults is thought to relate to impaired function of neutrophils, microangiopathy, and impaired wound healing this finding suggests a significant role of the host response also for the occurrence of NUG.

Prospective study of the effect of post-brushing rinsing behaviour on dental caries.

Previous studies have indicated that rinsing the mouth with a beaker of water after toothbrushing may compromise the caries reducing effect of fluoride toothpaste. A 3-year clinical trial of daily supervised brushing with fluoride toothpaste at school was used to test the effect of post-brushing rinsing with water on caries increment. A total of 407 children, mean age 11.8 years, attending three schools in Kaunas, Lithuania were enrolled following informed consent of the children and their parents. Caries was recorded at baseline and annually for 3 years. During the study, children in two schools (A and B) performed daily supervised brushing with a 1,500-ppm fluoride toothpaste. Children in school A rinsed their mouths thoroughly with a beaker of water after toothbrushing whereas children in school B were only permitted to spit out once after brushing. Furthermore, the children in these schools were supplied with toothpaste and toothbrushes for use at home and in school. A third school (C), without daily brushing and without supply of toothpaste, served as control. Compliance with the protocol was consistently better in school B. After 3 years 276 children were available for examination. Three-year DMFS increments, including non-cavitated lesions (mean, 95% CI), were: school A, 6.8 (5.3; 8.3); school B, 6.2 (4.6; 7.8), and school C, 12.4 (10.6; 14.1). Mean increments for schools A and B did not differ significantly but were both significantly lower than those of school C (p< 0.001). It is concluded that post-brushing rinsing with water, under the conditions of this study, does not significantly affect the caries reducing effect of a fluoride toothpaste.