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examinations . By 1946, studies to evaluate fluoridation were underway in four other pairs of cities in Illinois, New York, Canada and the Netherlands . Results were published in the 1950s, replicating the effects seen in the Grand Rapids- Muskegon study ( Table 1 ) . Table 1 : Summary of findings from children aged 14A5 years in five intervention studies * Country United States United States United States Canada Netherlands ( baseline year) ( 1947 ) ( 1946 ) ( 1944 ) ( 1944) ( 1952 ) Test city Grand Rapids Evanston Newburgh Brantford Tiel Control city Muskegon Oak Park Kingston Sarnia Culemborg Mean DMFT : Test city 12 . 4 11 . 3 10 . 4 8 . 0 13 . 9 Mean DMFT : Control 6 . 2 5 . 9 6 . 0 3 . 9 6 . 8 city difference 50 48 42 51 51 Data are from Backer- Dirks35 and Ast and Fitzgerald36 as tabulated in the 1991 National Health and Medical Research Council report37 2 . 3. 3 Studies and narrative reviews in the second half of the 20`h century and the first decade of the 21S` century In 1962 , based primarily on evidence from studies discussed above, the U . S . Public Health Service first recommended fluoridation of public water systems to prevent dental caries . 38 Communities responded quickly, and by 1970, 49 % of the U . S . population was served by a fluoridated public water system . 39 This rapid spread of fluoridation motivated a new round of observational epidemiologic studies, both in the U . S . and in other countries that had adopted fluoridation . There are three comprehensive narrative reviews that evaluated studies in children during the period : a ) one was a review of 55 studies reported primarily before the 1980s;40 b ) another review assessed 24 studies reported between the late 1970s and 1980S; 4' and c ) another review focused primarily on 58 studies reported after 1990 .42 In each instance , the reviews concluded that children living in communities with fluoridated water had significantly less dental caries that children living in non -fluoridated areas . 2. 3 . 4 Systematic reviews of dental caries preventive effects of fluoridated drinking water in children The reviews cited above40-4Z are nowadays classified as narrative reviews to distinguish them from systematic reviews . The distinguishing features are methodological : systematic reviews begin by defining a structured research question ; strategies to search bibliographic sources and database are then specified ; before the search , criteria are developed for inclusion and exclusion of studies; researchers conduct an initial review of study titles and abstract to determine those that meet selection criteria ; and each study is synthesized according to a checklist of features that appraise the quality of the studies . The compiled review summarizes findings, comments on the scientific quality of each study, and creates tabular and graphical summaries . In some instances, systematic reviews combine results from two or more studies using meta analysis, a statistical method that pools quantitative results published from different studies . Methods for systematic reviews were first developed in the 1990s, spearheaded by the Cochrane collaboration , which aims to improve rigor in evaluating healthcare, and in particular, the results from clinical trials comparing treatments . While any