Preventive benefit of access to fluoridated water for young adults

Abstract

Early life access to fluoridated water was not as strongly associated with caries outcomes than either full lifetime access or access across the more proximal years with the caries outcome of young adults, especially after adjustment for covariates which may become increasingly important across longer spans of the life course.

Community‐level predictors of Australian children’s dental caries and injury

“…Previous literature using time and state‐based comparisons, support water fluoridation as an effective measure of caries prevention in children . An increase in the extent and severity of caries experience has been observed in communities with difficulties accessing fluoridated water . With water fluoridation having increased across the state of Queensland since 2008, further studies should be undertaken to examine if caries experience has decreased in more recent cohorts of children .…”

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

“…Spencer et al and Crocombe et al provided further support for the effectiveness of exposure to FW into the adult years from broader population studies. Spencer et al, using a longitudinal cohort design, found that South Australian young adults aged 22‐35 years with relatively low (<75%) per cent lifetime access to fluoridated water (% LAFW) had substantially higher caries experience than those with 100% lifetime access to FW. Crocombe et al used the National Survey of Adult Oral Health (NSAOH) 2004‐06 data to examine the effectiveness of water fluoridation among rural adults aged 15‐44 years old.…”

How effective and cost-effective is water fluoridation for adults?

“…Several more recent studies from the US (17,18) and Australia (14,(19)(20)(21)(22)(23) have taken a natural experiment approach to studying the effect of water fluoridation in adults. Exposure to the intervention has been allocated in a non-random way, for example by the participant living in fluoridated regions for a varying percentage of their life times, (14,(19)(20)(21)(22)(23) or by varied start dates and coverage of water fluoridation programmes. (17,18) Information on place of residence and dental outcomes has been collected using cross-sectional or longitudinal surveys.…”

“…(17,18) Information on place of residence and dental outcomes has been collected using cross-sectional or longitudinal surveys. (14,(19)(20)(21)(22)(23) A limitation of several of these studies is that they evaluate effects on a highly selective population, (17,19,20) experience substantial loss to follow-up, (23) or exclude large numbers of participants due to incomplete information on residential history. (14,21,22) Only one US study included information on dental treatment costs, and this was not relevant to the UK context because of the US health insurance system.…”

“…The proposed study has been designed to meet the needs of decision -makers by taking a pragmatic, natural experiment approach but avoiding the pitfalls of the previous studies by using readily available routine data held by the NHS Business Services Authority (NHS BSA), in the form of dental records. (14,(17)(18)(19)(20)(21)(22)(23) Individual exposure to water fluoridation will be identified by reference to home postcode held in the dental records. Using routine data has several advantages over designs using clinical examinations to assess outcomes.…”