Effects of Community Water Fluoridation on Dental Caries Disparities in Adolescents

Abstract

Despite improvements in the prevalence of dental caries, disparities are still observed globally and in the U.S. This study examined whether community water fluoridation (CWF) reduced dental caries disparities in permanent teeth of 10-to 19-year-old schoolchildren in North Carolina. We used cross-sectional data representing K-12 schoolchildren in North Carolina (NC) public schools. A poisson regression model was used to determine whether the association between children's parental educational attainment and the prevalence of dental caries of children differed by children's lifetime CWF exposure. We analyzed data on 2075 students. Among the children without any CWF exposure in their life, statistically significant caries disparities by parental educational attainment were observed. Compared to the children of parents with more than high school education, the relative risk for those with a parent with a high school education was 1.16 (95% CI = 1.01, 1.33) and those with less than a high school education was 1.27 (95% CI = 1.02, 1.60). In contrast, these disparities were not observed among children exposed to CWF throughout their lives. Socioeconomic disparities in dental caries were not observed among 10-19-year-old schoolchildren with lifetime CWF exposure. CWF seemed to reduce dental caries disparities.

Cost-effectiveness of caries preventive interventions – a systematic review

“…However, several such studies were captured in the systematic process and although they were not fully assessed by the reviewers, they seem to show dominant results, i.e. water fluoridation was found to save costs and to reduce caries [51,52]. Also fluoridated salt or milk-products may be cost-effective [53][54][55] and able to address inequities in dental health, but those studies in the present review were appraised as not transferable.…”

Systematic Review of Intervention Studies Aiming at Reducing Inequality in Dental Caries among Children

“…The age group of the included intervention studies was between 0 and 18 years old. With the exception of water fluoridation in three papers [22,26,27], the duration of the other studies varied from 19 months to 6 years. The follow-up time of four articles was 19 months to 2 years [16,17,19,25], and the other six articles had a longer duration time, between 4 and 6 years.…”

“…The included studies used different criteria in measuring the same outcome. Five studies assessed dental caries based on World Health Organization (WHO) criteria [19,22,24,26,27], three studies used International Caries Detection and Assessment System (ICDAS) criteria in assessing decayed teeth [17,20,25], and one article used the British Association for the Study of Community Dentistry (BASCD) to assess dental caries [28].…”

Age period cohort analysis of chewing ability in Korea from 2007 to 2018

“…APC analysis revealed three trends in chewing difficulty: (1) there was an increase in chewing difficulty starting at around 60 years of age (age effect), (2) there was a steady decrease in chewing difficulty during the observation period (period effect), and (3) chewing ability improved with each successive generation born after 1951 (cohort effect). Regarding recent improvements in chewing ability, cohort effects were somewhat more important than period effects.Recent studies have suggested that oral health has been improving in many countries [1][2][3][4][5][6][7][8][9] , with decreased incidence of dental diseases and increased accessibility of dental care. Contributory factors could include improved proximal determinants of oral health (i.e., health behaviors and sugar consumption), as well as improving structural determinants (i.e., socioeconomic context and environmental context) over several decades.Oral health is affected by exposures throughout the entire life course, beginning in the prenatal period, and is strongly socially patterned 10 .…”

“…Recent studies have suggested that oral health has been improving in many countries [1][2][3][4][5][6][7][8][9] , with decreased incidence of dental diseases and increased accessibility of dental care. Contributory factors could include improved proximal determinants of oral health (i.e., health behaviors and sugar consumption), as well as improving structural determinants (i.e., socioeconomic context and environmental context) over several decades.…”