Critique of the review of 'Water fluoridation for the prevention of dental caries' published by the Cochrane Collaboration in 2015

Contemporary evidence on the effectiveness of water fluoridation in the prevention of childhood caries

“…It should be noted that all but two of 14 studies included in the assessment of caries as an outcome were conducted prior to 1975. The necessity to adopt this approach, re‐analysis of evidence mostly pre‐1975, is an indication of a significant problem in updating the evidence on effectiveness of water fluoridation to inform policymakers today …”

“…The necessity to adopt this approach, re-analysis of evidence mostly pre-1975, is an indication of a significant problem in updating the evidence on effectiveness of water fluoridation to inform policymakers today. 5 The dearth of prospective nonrandomised controlled before and after studies after 1975 may reflect the history of the implementation of water fluoridation. For instance, in Australia one of the countries with a high proportion of the population living in fluoridated areas, most water fluoridation programmes were implemented between 1964 and 1971.…”

“…7 Regardless of the merit of these explanations, the endpoint is that most of the studies in the evidence-base behind the most recent systematic review are dated. 5 Much has changed in the population exposure to risk and preventive factors for childhood caries over the last 35 years. Ready examples are the introduction and then widespread use of fluoridated toothpaste and the changing pattern of the consumption of free sugars.…”

Effectiveness of water fluoridation in the prevention of dental caries across adult age groups

“…4 However, that review was criticized for adopting unrealistic and inappropriate inclusion criteria. 5 Australian research on the benefit of fluoridation for adult caries experience initially focussed on young or middle-aged adults in the armed services. [6][7][8] These studies found that caries experience was lower when the per cent of lifetime access to FW was higher.…”

Guidelines for use of fluorides in Australia: update 2019

“…22 Some shortcomings of the Cochrane Review were noted. 23 Most prominent of these was the restriction of the included evidence to before and after non-randomized controlled studies. This had the effect of limiting the evidence to studies predominantly carried out prior to 1975.…”