Franzolin 2008.
| Methods |
FLUOROSIS STUDY Country of study: Brazil Geographic location: Sao Paulo Year of study: not stated Year of change in fluoridation status: 1975 Study design: cross‐sectional |
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| Participants | Inclusion criteria: residence in the same geographical area as the school since birth Exclusion criteria: not stated Social class: homogenous population comprising entirely of public school students Ethnicity: white = 243 (67.5%); black = 41 (11.4%); admixture = 73 (20.3%); Asian = 3 (0.8%) Residential history: lifetime residents Other confounding factors: not stated |
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| Interventions | Group 1: 'optimal' level ‐ ppm not stated (artificial fluoridation via water treatment station) Group 2: 'optimal' level ‐ ppm not stated (artificial fluoridation via direct fluoridation in well) Group 3: 'low' level ‐ ppm not stated (natural fluoridation) | |
| Outcomes | Dental fluorosis (TF Index); caries data collected, however, excluded from the review due to study design Age at assessment: 12 years |
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| Funding | Not stated | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Sampling | Low risk | Multi‐stage random sampling was used whereby schools were selected randomly and the children within them |
| Confounding | High risk | Did not account for the use of other fluoride sources or SES |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | The examiner and recorder were reported to have been blinded to the type of water supply of the schools |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data presented for all participants |
| Selective reporting (reporting bias) | High risk | Data not in suitable format for analysis |
| Other bias | Unclear risk | Examinations carried out by a single, previously calibrated examiner, however, kappa score not reported |