studied in 1978 experienced almost four times the number of decayed teeth as those studied in 1983. Also, the cavities seen today are usually much smaller than 20 years ago. This improvement is due to several changes in our community. The first and most obvious change was the Fluoride Programme.

Additional benefits were seen with the institution of the Preventive Education Programme in the primary schools and the Sealant Programme. Before the Fluoride Programme, decay between the teeth was very common, but this is now rarely seen in permanent teeth.

Fluoride becomes part of the enamel of each tooth as it develops and the enamel becomes more resistant to acids which are produced by bacteria commonly found in the mouth. This effect is best seen on the smooth surfaces such as the areas between the teeth. Decay seen today is usually found in the lines and grooves of the teeth. Sealants are used to help prevent this type of decay. Proper hygiene and good dietary practices help to prevent decay on all areas of the tooth.

In many communities, fluoride is added to the water supply. However, this is not feasible in Bermuda because of our system of collecting water. Therefore, supplements are provided starting at four months. The enamel of permanent teeth has started to develop by this time and the last tooth completes enamel development between 12 and 16 years old. Locally, fluoride supplementation is available until age 14.

It is important that children receiving fluoride supplementation do not receive fluoride from other sources. Overdosing with fluoride causes a cosmetic problem called `fluorosis'. This varies from a very mild discolouration in most cases to pitting of the enamel in a few severe cases.

The most common cause of fluorosis is eating toothpaste. Young children do not usually spit out toothpaste after brushing and often put too much toothpaste is put on the brush. A barely visible smear is enough for children who have not learned to spit out and rinse. Most children can not do this adequately until four or five years old. Once this skill has been learned slightly more toothpaste can be used (about the size of a green pea).

Some children like the taste of toothpaste so much they will try to eat it like candy. Therefore, toothpaste and fluoride supplements should be stored out of reach of young children.

Most young children do not have the coordination to adequately brush their own teeth. They usually suck or chew and brush. Your child requires help and supervision during brushing at least until age five. Older children should be checked regularly to make sure that they are brushing all surfaces of all teeth.

Information on fluoride, sealants and proper oral hygiene is available at the dental clinics of the Department of Health.

Dr. Celia Musson Nzabalinda HEALTH AND SOCIAL ISSUES HTH