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 Paul Melters’ response to Billy Budd’s comment
concerning the 5 studies listed by Louise Mantella
in Comment 47741 - Ken Perrott blog.

In COMMENT 47831 Billy Budd writes:

BUDD: “That fluorosis prevents cavities is not a theory, but rather the result of clinical examinations in a data set which included over 39,000 US school children. Those data included tooth level observations by calibrated examiners. Nearly 17,000 subjects with complete residence histories formed the basis of Iida and Kumar’s statistical analysis. Focusing on the first molar, these data showed that fluorosis prevents cavities.

I note that none of the articles with appropriate publishing dates were of sufficient quality to be included in the exhaustive review published by the National Academy of Sciences in 2006. An entire chapter was devoted to enamel fluorosis. The bibliography upon which the report was based was a monumental accomplishment. One can be confident that your references would have been included if they deserved to be.”

PM Response: Stop deflecting. That the older studies were not included in some review by the NRC does in no way diminish the quality or the findings by the researchers. We’re not here to discuss inclusion criteria by the NRC.

BUDD: “The paper by Pontigo-Loyola AP et al., (J Public Health Dent 67(1):8-13, 2007) well illustrates why these smaller and less well designed studies are not applicable in the US.

The subjects lived an altitude above >6,560 ft and drank water that exceeded 1.38 ppm. Their state is included in Mexico’s fluoridated domestic salt program. Over 80% had fluorosis which was moderate or severe in about a third. Because every child was exposed to fluoride and there was such a high level of advanced fluorosis and every child it is difficult to assess the relationship between fluorosis and caries. “

PM Response: This sounds like you’re grasping for straws. Dental fluorosis is caused by excessive fluoride intake. As you stated to Louise - Surely there is no argument that fluorosis is a systemic effect”.  Surely you’re not going to dispute that now? HOW the dental fluorosis was caused has no relevance on the findings that children with dental fluorosis - even very mild to mild forms - had an increase in caries AND caries severity.

BUDD: Dental work to improve appearance is likely common making it difficult to know if the ”fillings” observation was due to cavities or cosmetic dentistry.

Factors such as age, gender, dental visit, socioeconomic status and locale had an effect on the study’s cavity measurements in the bivariate analysis. Therefore those factors must be controlled for to accurately measure an association between fluorosis and cavities.”

PM Response: Again - you’re grasping at straws. What is there to control for here?  Let me know.

The researchers came to their conclusions when they investigated WHAT was causing an increase in caries. When they did account for established confounding variables as best as possible, they found that an increase in SES, dental fluorosis, increase in dental visits, etc.. were associated with an INCREASE in caries. Not exactly what you would expect, is it? 

The authors discuss these factors at length. Perhaps have a look at table 3 and the discussion?

And - yes indeed - confounding factors are also VERY important when investigating studies claiming that water fluoridation causes a decrease in caries, as there are many other factors which can lead to a reduction of caries incidence.

Can you provide ONE study which has adjusted for established confounding factors such as race, gender, age, total intake, tooth eruption, brushing and other oral hygiene factors, SES -  that can show a decrease in caries in fluoridated areas as compared to non-fluoridated ones? Certainly - this study must exist SOMEWHERE? Your friend Johnny Johnson could not find one. Slott couldn’t find one either, but pretended he had ”countless”.

BUDD: “Compared to Iida and Kumars, this study is small, the population and fluoride exposure is not comparable to the US, observations of the filling component are not clear, and the analytical method lacks sophistication.”

PM Response: Once again - fluoride exposure and how the dental fluorosis was caused has NO bearing what-so-ever on the findings here.  41% of 12 to 15 year old children in the US have dental fluorosis - certainly, that is applicable?

Compared to Kumar, this study dealt with such 12 to 15 year old children. A total of  1,538 adolescents (representing 86.9 percent of the population) were included. Any factors and shortcoming concerning this study group are discussed by the authors.

If you have trouble with the analytical methods employed feel free to explain their shortcomings and “lack of sophistication”.

BUDD: “Adding more small poorly designed studies will not overturn the observations from a very large nation-wide US well designed study based on calibrated observations.”

PM Response: There are at least 30 studies which show that dental fluorosis increases caries. That is not a “small body of poorly designed” studies. Up to now, it has been thought an increase was only observable at TF score 3. That even very mild to mild DE can cause an increase in caries AND caries intensity, is a relatively new discovery. I notice you did not address the other papers.

BUDD:“Lastly, I can only restate the fact that the observational science upon which community water fluoridation’s (CWF) benefits have been demonstrated is not dependent on the mechanistic explanation for effectiveness.

CWF simply prevents cavities. Preschoolers have fewer operations for mouth fulls of rotten teeth, adult teeth have fewer cavities, restorations last longer and there are fewer cavities on the exposed root surfaces of elderly people.”

PM response: “Simply prevents cavities?” You’re simply stating nonsense. If there is real evidence  - show it to me. Not a line from some CDC or ADA statement. Real evidence.

I will ask once again - please provide ONE study capable of demonstrating this preventative effect of CWF that has accounted for established confounding factors such as race, gender, age, total intake, tooth eruption, brushing and other oral hygiene factors, SES.

Paul Melters

UPDATE - Dec. 2, 2013

Billy Budd posted three more comments on this issue.

COMMENT 48189,

UPDATE - Dec. 9, 2013

Paul Melters’s response to these comments can be seen here:

Response Melters to Billy Budd - COMMENT 48178 (Perrott)
December 9, 2013

Response Melters to Billy Budd - COMMENT 48180 (Perrott)
December 9, 2013

Response Melters to Billy Budd - COMMENT 48189 (Perrott)
December 9, 2013