Subjects. A cohort of 5927 children in grades 2,3,8, and 9 living in British Columbia, Canada, were examined in 1993-1994. Approximately 50% of the children were re-examined in 1996-1997 when they were in grades 5, 6, 11, and 12. Exposure. In 1992, as a result of referenda, Comox/Courtenay/Campbell River stopped water fluoridation. Kamloops did not. Main Outcome Measure. Caries progression was defined as a change in surface status that could be interpreted as a worsening of caries status. More than 90 transitions in surface calls (eg, from filled to recurrent decay) qualified as caries progression. Main Results. After adjustment for age, fluoride regimen, and initial eruption status, smooth surfaces in fluoridation-ended communities had 142% increased odds for caries progression (odds ratio, 2.42; 95% confidence interval, 2.0-3.0). After adjustment for snacks, parental education, initial eruption status, and sealant use, pit-and-fissure surfaces in fluoridation-ended communities had 23% increased odds for caries progression (odds ratio, 1.23;95% confidence interval, 1.0-1.5).
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