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resident of non -fluoridated Bolder, CO , 58 the rates in Colorado Springs were approximately 60 percent lower . Ironically, those two studies were not included in a 2007 systematic review of the fluoridation and dental caries in adults because the search was limited to studies published since 1966 . Instead , that 2007 systematic review59 used results from nine published studies : one was a prospective cohort study, one was a an ecological study, and seven were cross-sectional studies of adults who were lifetime residents of either fluoridated or non -fluoridated areas . Pooled results from meta - analysis revealed a reduction of one third ( 34 . 6 %, 95 %CL : 12 . 6%, 51 . 0% ) in caries experience associated with lifetime exposure to approximately 1mg/ L F ( range 0 . 7 to 2 . 0 mg/ L F ) . Since that systematic review, six cross-sectional studies of adults have investigated the relationship, as summarized in Table 5 . The one U . S . study during that period investigated tooth loss, not total caries experience, using a nationally- representative sample of adults . Table 5 : Studies published since 2007 examination associations between fluoridation and dental caries experience in Adults Year(s ) and setting for Methods ( row 1 ) data collection Results ( row 2 ) 2006 Australia, DMFT of Cross-sectional clinical and radiographic examination survey of n= 876 armed forces recruits . Fluoridation status of 17-56 yr olds 16 each residential location was determined from a national database of fluoridation history of public water supplies . Mean DMFT in recruits with >_50% lifetime exposure was 24% lower than recruits with the < 10% lifetime exposure group . 2008, Australia , DMFT Cross-sectional clinical and radiographic examination survey of n= 1084 army recruits . A questionnaire asked about of 17-35 yr olds " socio-demographic characteristics and residential locations throughout life . Fluoridation status of each residential location was determined from a national database of fluoridation history of public water supplies . Mean DMFT in recruits with lifetime exposure to fluoridated drinking water was 3 . 02 compared to 3 .87 for recruits with no exposure . 1992- 1999, U . S. missing Cross-sectional telephone interview survey with 81, 337 adults in the Behavioral Risk Factor Surveillance System teeth of 23-49 yr olds '$ Survey, where tooth loss due to dental disease was reported in four categories . The 1992 Fluoridation Census was used to calculate each respondents county-of- residence at the time of the survey, 20 years earlier, and at birth . Lower levels of tooth loss were significantly associated with residence in fluoridated counties at the time of the respondent' s birth, but not to fluoridation at the time of the survey . 2004-06, Australia, Cross-sectional dental examination survey of a nationally representative sample of n=3, 779 adults who also DMFT and DFS of 18- completed a questionnaire asking about socio -demographic characteristics and residential locations throughout life . >65 yr olds19 Fluoridation status of each residential location was determined from a national database of fluoridation history of public water supplies . After adjustment for sociodemographic characteristics, adults with >75% of lifetime exposure to fluoridation had 10% fewer DMFT compared to adults with < 25% of lifetime exposure . The percentage difference was similar for people who were exposed to fluoridation before - and after birth, and for people exposed only after birth . 2012, Brazil, DMFT of Cross-sectional dental examination survey of n= 1, 140 people born in Florian6polis where fluoridation was 20-59 yr olds20 implemented in 1982 and 1986 in different parts of the city. Questionnaires asked about residential locations throughout life . Relative to people with access to fluoridated water for >75% of their lifetime, DMFT was greater for people with 50%-75% lifetime exposure ( ratio= 1 . 34) and for people with < 50% lifetime exposure ( ratio= 1 . 34) 2006-2011, Australia , Cross-sectional dental examination survey of n= 1, 221 people in South Australia who had first participated in a 1991- DMFS in 20-35 yr oldS21 1992 survey . Questionnaire asking about socio-demographic characteristics and residential locations throughout life were administered and percentage of lifetime with access to fluoridation was determined from a national database of fluoridation history of public water supplies . Relative to people with 100% lifetime exposure to fluoridation, people with <75% lifetime exposure had greater DMFS ( ratio= 1 . 26 ) . Relative effects were of a similar when fluoridation exposure was calculated separately as percentage of childhood exposed and percentage of adolescence/adulthood exposed . 2 . 3 . 8 Critical appraisal of studies of water fluoridation and dental caries in adults Overall , findings from studies of adults corroborate results from studies of children : exposure to water fluoridation is associated with lower levels of dental caries experience . There is also some indication that the magnitude of preventive