Influence of exposure to fluoridated water on socioeconomic inequalities in children's caries experience

Abstract

This study aimed to evaluate inequalities in children's dental caries experience among socioeconomic status (SES) groups and to investigate effects of exposure to fluoride in water on those inequalities. Cross-sectional data were obtained from 6704 Queensland children aged 5-12 years and 6814 South Australian children aged 5-15 years. School dental therapists and dentists recorded dmfs and DMFS data. A questionnaire to parents sought information about household SES and each child's lifetime exposure to fluoridated drinking water. SES fluoride exposure and multiplicative interactions between the two were used as explanatory variables in least squares models in which dmfs and DMFs were dependent variables. Additive interactions were evaluated by calculating the excess rate of disease. In both states, children from low SES groups (categorized by household income or parental education) had higher mean dmfs and DMFS values than children from high SES groups (P < 0.01). Independent effects of income and education remained significant (P < 0.01) after controlling for exposure to fluoride in drinking water. In Queensland, there was a significant multiplicative interaction whereby SES inequalities were lower among children exposed to fluoride: dmfs ratios between low- and high-income groups ranged among ages from 1.54 to 3.56 for children with no exposure to fluoride and from 0.84 to 2.07 for children with lifetime exposure to fluoride. Multiplicative interactions were not statistically significant in South Australia or when DMFS was the dependent variable. However, additive interactions were consistent and most pronounced for deciduous teeth in both States. Absolute differences in caries experience between low and high SES children were greater among non-exposed groups due to the higher underlying levels of caries experience of children with no exposure to fluoride in water.

The relationship between water fluoridation and socioeconomic deprivation on tooth decay in 5-year-old children

“…[8][9][10][11] These findings have been confirmed using a number of different deprivation indices. 12,13 However, a review of the literature shows a number of studies which show no differential benefit of fluoridation to more deprived children and some which show the opposite effect.…”

Prevalência de cárie dentária em escolares de 12 e 15 anos de Salvador, Bahia, 2001

“…3 A partir da década de 90, os apontam na detecção de piores condições de saúde bucal em crianças de menor renda, sendo que já se identificou que o acesso a fluoretos, através da fluoretação das águas de abastecimento público ou da pasta fluoretada, é um fator protetor capaz de minimizar os diferenciais entre classes ou níveis socioeconômicos. 4,5 A detecção dos diferenciais na condição de saúde bucal através do uso de categorias analíticas como o espaço social, definido por limites geográficos, administrativos ou indicadores sociais ainda é pouco comum nos estudos em saúde bucal. 6,7 Resgatando o uso de variáveis socioeconômicas como preditoras da ocorrência de cárie dentária em populações no Brasil, a partir dos dados do levantamento em saúde bucal disponibilizados pelo Ministério da Saúde 8 para cada macro-região, Moysés 9 tentou correlacionar o Índice de Desenvolvimento Humano (IDH) ao Índice Dentes Cariados, Perdidos e Obturados (CPO-D) obtido, considerando as desigualdades regionais.…”

Water fluoridation: It really is this simple

“…However, the methodology used in the studies varied, and statistical analysis was not possible, so the reviewers suggested caution in interpreting the results. Other studies demonstrating a greater difference in caries reduction from CWF for low vs high socioeconomic groups include communities from New Zealand, [105,113] Australia, [114] Ireland [115], and a recent blinded study from the UK. [116] Cost-effectiveness…”