Whelton 2004.
| Methods | FLUOROSIS STUDY Country of study: Republic of Ireland (RoI) Geographic location: not stated Year of study: 2001/2002 Year of change in fluoridation status: 1964 Study design: cross‐sectional | |
| Participants | Inclusion criteria: children in Junior Infants, Second Class, Sixth Class, and Junior Certificate Exclusion criteria: not stated. Other sources of fluoride: participants in the fluoridated group may have had additional exposure to fluoride tablets and fluoride mouth rinses Ethnicity: not stated Social class: possesion of a medical card was used in this study as a surrogate for disadvantage; RoI medical card vs no medical card = 24% vs 75% (full F = 25.2% vs 74.4%; non‐F = 20.3% vs 79.4%); figures do not add up to 100%, however, authors reported that figures included children for whom medical card details were missing Residential history: fluoridated group subjects' home water supply had to have been fluoridated continuously since birth, and the non‐fluoridated group subjects' home water supply had never to have been fluoridated. No further details reported Other confounding factors: not stated |
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| Interventions | Group 1: 0.8‐1 ppm (artificial fluoridation) Group 2: 'non‐fluoridated' |
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| Outcomes | Fluorosis prevalence (Dean's Index); caries data (dmft/DMFT) evaluated in study but not included in review due to study design Age at assessment: 5, 8, 12 and 15 years | |
| Funding | Funded by the Department of Health and Children and the Health Boards in Ireland | |
| Notes | The authors carried out and reported power calculation for the primary outcome (DMFT) but not for the fluorosis outcome | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Sampling | Low risk | National survey using a cluster sampling technique with schools as the clustering unit and children in Junior Infants, Second Class, Sixth Class and Junior Certificate were selected |
| Confounding | High risk | SES accounted for in caries analysis; did not account for the use of fluoride from other sources or the dietary habits of the children |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Fluoride codes ascribed after examinations; unlikely to be systematic bias |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Outcome data presented as a percentage; unclear if accounted for all participants |
| Selective reporting (reporting bias) | Unclear risk | Fluorosis outcomes presented as percentages; unclear if accounted for all participants |
| Other bias | Low risk | No other apparent bias |