Kunzel 1976.
| Methods |
FLUOROSIS STUDY Country of study: Cuba Geographic location: La Salud (low F); Mir (medium F); San Augustin and Blanqizal (high F) Year of study: 1973 Year of change in fluoridation status: NA Study design: cross‐sectional |
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| Participants | Inclusion criteria: children resident in study areas. Exclusion criteria: not stated Other sources of fluoride: not stated Social class: not stated Ethnicity: not stated Residential history: not stated however, most of the children were born in the area Other confounding factors: not stated |
|
| Interventions | All natural fluoridation Group 1: 2.3‐3.6 ppm Group 2: 1.1‐1.6 ppm Group 3: 0.6‐0.8 ppm Group 4: 0.1 ppm | |
| Outcomes | Dental fluorosis (Dean's Index); caries data also evaluated within the study but excluded from review due to study design Age at assessment: 9‐10 years |
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| Funding | Not stated | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Sampling | Unclear risk | There was insufficient detail reported to determine how selection took place |
| Confounding | High risk | Did not account for the use of fluoride from other sources or SES |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "The dental examinations were carried out while the fluoride content of the water consumed was unknown" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data presented for all participants |
| Selective reporting (reporting bias) | Low risk | All expected outcome reported |
| Other bias | Low risk | No other apparent biases |