The association between social deprivation and the prevalence and severity of dental caries and fluorosis in populations with and without water fluoridation

Abstract

BackgroundTo determine the association between social deprivation and the prevalence of caries (including caries lesions restricted to enamel) and enamel fluorosis in areas that are served by either fluoridated or non-fluoridated drinking water using clinical scoring, remote blinded, photographic scoring for caries and fluorosis. The study also aimed to explore the use of remote, blinded methodologies to minimize the effect of examiner bias.MethodsSubjects were male and female lifetime residents aged 11–13 years. Clinical assessments of caries and fluorosis were performed on permanent teeth using ICDAS and blind scoring of standardized photographs of maxillary central incisors using TF Index (with cases for fluorosis defined as TF > 0).ResultsData from 1783 subjects were available (910 Newcastle, 873 Manchester). Levels of material deprivation (Index of Multiple Deprivation) were comparable for both populations (Newcastle mean 35.22, range 2.77-78.85; Manchester mean 37.04, range 1.84-84.02). Subjects in the fluoridated population had significantly less caries experience than the non-fluoridated population when assessed by clinical scores or photographic scores across all quintiles of deprivation for white spot lesions: Newcastle mean DMFT 2.94 (clinical); 2.51 (photo), Manchester mean DMFT 4.48 (clinical); 3.44 (photo) and caries into dentine (Newcastle Mean DMFT 0.65 (clinical); 0.58 (photo), Manchester mean DMFT 1.07 (clinical); 0.98 (photo). The only exception being for the least deprived quintile for caries into dentine where there were no significant differences between the cities: Newcastle mean DMFT 0.38 (clinical); 0.36 (photo), Manchester mean DMFT 0.45 (clinical); 0.39 (photo). The odds ratio for white spot caries experience (or worse) in Manchester was 1.9 relative to Newcastle. The odds ratio for caries into dentine in Manchester was 1.8 relative to Newcastle. The odds ratio for developing fluorosis in Newcastle was 3.3 relative to Manchester.ConclusionsWater fluoridation appears to reduce the social class gradient between deprivation and caries experience when considering caries into dentine. However, this was associated with an increased risk of developing mild fluorosis. The use of intra-oral cameras and remote scoring of photographs for caries demonstrated good potential for blinded scoring.

Fluoridated Water Supply and Promotion of Oral Health in Children of Low Socioeconomic Status- A Cross-Section Study

“…A great need for procedures such as root canals, extractions and restorative treatments was observed in this study, which corroborates other research [16].…”

“…It is observed that the population served by this resource presents better oral health conditions. Our results, as well as those of other studies [15][16][17], confirm this relationship.…”

Total daily fluoride intake and fractional urinary fluoride excretion in 4‐ to 6‐year‐old children living in a fluoridated area: weekly variation?

“…Interestingly, a recent study 35 also conducted in Newcastle, UK, reported a Table 3. Number (%) of children with suggested suboptimal (<0.05 mgF/kg bw/day), optimal (0.05-0.07 mgF/kg bw/ day) and supra-optimal (>0.07 mgF/kg bw/day) F intake by data collection week, and overall mean (SD) contribution of toothpaste ingestion to total daily F intake (TDFI) by F intake group dental fluorosis (of aesthetic concern) prevalence of 7.1% in 11-to 13-year-olds.…”

New international review supports community water fluoridation as an effective and safe dental health promotion measure

“…The most deprived SES groups have the highest rates of tooth decay, and evidence indicates that the benefits of water fluoridation are greatest for this group. 13 An important benefit for disadvantaged communities is that CWF is a health promotion policy measure that does not need active behavioural action by the target audience. 5 For example, the introduction of water fluoridation in 2005 to five remote Indigenous communities where dental health was very poor resulted in significant reductions in both the prevalence and severity of dental caries by 2012.…”