Associations of Community Water Fluoridation with Caries Prevalence and Oral Health Inequality in Children

Abstract

This study aimed to confirm the association between the community water fluoridation (CWF) programme and dental caries prevention on permanent teeth, comparing to a control area, neighbouring population without the programme, and verifying whether the programme can reduce the socio-economic inequality related to the oral health of children in Korea. Evaluation surveys were conducted among 6-, 8-, and 11-year-old children living in Okcheon (CWF) and neighbouring Yeongdong (non-CWF, control area) towns in South Korea. Data on monthly family income, caregiver educational level, and Family Affluence Scale scores were evaluated using questionnaires that were distributed to the parents. The effectiveness of CWF in caries reduction was calculated based on the differences in decayed, missing, and filled teeth and decayed, missing, and filled tooth surfaces indices between the two towns. The data were analysed using logistic regression and univariate analysis of variance. Both 8- and 11-year-old children living in the CWF area had lower dental caries prevalence than those living in the non-CWF community. Differences in dental caries prevalence based on educational level were found in the control area but not in the CWF area. Socio-economic factor-related inequality in oral health were observed in the non-CWF community. Additionally, 8- and 11-year-old children living in the CWF area displayed lower dental caries prevalence in the pit-and-fissure and smooth surfaces than those living in the non-CWF community. These results suggest that CWF programmes are effective in the prevention of caries on permanent teeth and can reduce oral health inequalities among children. The implementation of CWF programmes should be sustained to overcome oral health inequalities due to socio-economic factors and improve children’s overall oral health.

Effects of Community Water Fluoridation on Dental Caries Disparities in Adolescents

“…These results are mostly consistent with those of previous studies performed in various countries, including the U.S. [13][14][15][16][17][18]. Cho et al [13] and Kim et al [14] showed that socioeconomic inequality exists in non-CWF areas but not in CWF areas in Korea. Cho [15] conducted their study in Australia and explored dental health disparities based on income and race.…”

“…We believe that education status is equally as important as income status in disparities studies [3]. Thus, because of the nature of our studies' strengths, we believe our findings add valuable information to the existing literature [13][14][15][16][17][18].…”

“…One of the strengths of the present study is that we used a retrospective history of CWF exposure for each year of life rather than the information from one point in time. Previous studies have used information on the CWF status of the area where the children were living at the time of the survey or their school's water system for the measurement of exposures [13][14][15][16][17][18]. A novel aspect of our study is that we accounted for the duration of exposures.…”

“…The review also found insufficient evidence of any impact on disparities when the proportion of caries-free children was used as the outcome or among the other age groups [12]. Following the "York Review", a few other studies investigated the effect of CWF on oral health inequalities in different countries [13][14][15][16][17]. Only one of these studies was conducted in the U.S. [18].…”

Physical Activity and Sedentary Behaviors of Young Children: Trends from 2009 to 2018

“…Parents were asked to provide information about their educational levels via a three-item list (primary education (6 years); secondary education (9-12 years); higher education (≥15 years)). Besides the parental educational level, the Family Affluence Scale (FAS) [45,46] was used to assess SES, since, based on family consumption, it appears to be more ecologically valid than parental income [47,48]. The FAS has been validated and used in several countries, including Greece [48].…”