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of topically-applied fluorides were showing clear evidence of efficacy, representing proof- of- principle that fluoride ' s post-eruptive mechanisms of caries prevention could be significant . There was also a marked increase in microbiological , in -vitro , and animal -experimental studies of post- eruptive mechanisms in dental caries . By the 1980s, a narrative review of the limited epidemiologic evidence and the extensive biological studies concluded that the " major cariostatic effect of water fluoridation, fluoride tooth paste and mouth rinses can probably be ascribed to regular increases in fluoride ion activity in the oral fluids " . " The first persuasive epidemiological study to address the question came from re -analysis of data from the Tiel - Culemborg study . 9 A unique feature of the study was its recording of pre -cavitated carious lesions ( in addition to the conventional recording of caries experience at the level of cavitation ) . The re - analysis first confirmed the original finding10 that fluoridation was associated with a significant benefit in preventing caries at the cavitation threshold . However, when pre -cavitated lesions were included in the re -analysis, caries experience in fluoridated Tiel did not differ appreciably from non -fluoridated Culemborg . 9 The author concluded that fluoridated water did not alter the total caries attack rate ( manifesting as pre - cavitated AND cavitated caries ), and deduced that difference in cavitation - level caries must have been due to a post- eruptive effect, namely, that fluoride from drinking water favored remineralization of initial , pre -cavitated lesions, preventing their progression to cavitated lesions . By the turn of the century, another prominent narrative review concluded that the predominant caries- preventive effect of fluoridated drinking water was through post- eruptive mechanisms . " This represented an evolution in scientific thinking that was characterized as a " paradigm shift " . ' This century, the " predominantly post- eruptive " explanation for caries preventive benefits of fluoridated water has been corroborated by findings from two groups of epidemiologic studies : • In studies of children conducted this century, ..... sequential cross sectional studies conducted during a relatively short period after a change in community water fluoridation ( i . e . , addition or removal of fluoride ) reported changes in caries experience even in age -groups born years before the change in fluoridation . Because pre - eruptive mechanisms are an implausible explanation in such children, the observed trends in disease that are best explained in terms of post-eruptive effects of water fluoridation . • In studies of adults conducted this century, 16"zl greater lifetime exposure to fluoridation was associated with less caries experience , even among those born approximately one decade or more after implementation of fluoridation . Again , because pre -eruptive mechanisms are an implausible explanation , the observed trends in disease that are best explained in terms of post-eruptive effects of water fluoridation . The more persuasive evidence comes from epidemiologic studies that were designed specifically to test hypotheses about relative contributions of pre - and post- eruptive effects . One is the study summarized above, that re -analyzed the Tiel - Culemborg data , demonstrating that fluoridation prevented caries by promoting remineralization of initial carious lesions - a hallmark of post- eruptive mechanisms .