The differences in healthcare utilization for dental caries based on the implementation of water fluoridation in South Korea

Abstract

BackgroundThere were some debates about the water fluoridation program in South Korea, even if the program had generally substantial effectiveness. Because the out-of-pocket expenditures for dental care were higher in South Korea than in other countries, an efficient solution was needed. Therefore, we examined the relationship between the implementation of water fluoridation and the utilization of dental care.MethodsWe used the National Health Insurance Service National Sample Cohort. In this study, data finally included 472,250 patients who were newly diagnosed with dental caries during 2003–2013. We performed survival analysis using cox proportional hazard model, negative binomial-regression, and regression analyses using generalized estimating equation models.ResultsThere were 48.49 % outpatient dental care visit during study period. Individuals with water fluoridation had a lower risk of dental care visits (HR = 0.949, 95 % CI = 0.928–0.971). Among the individuals who experienced a dental care visit, those with water fluoridation program had a lower number of dental care visits (β = −0.029), and the period of water fluoridation had an inverse association with the dental care expenditures.ConclusionThe implementation of water fluoridation programs and these periods are associated with reducing the utilization of dental health care. Considering these positive impacts, healthcare professionals must consider preventive strategies for activating water fluoridation programs, such as changes in public perception and relations, for the effective management of dental care in South Korea.

Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation

“…[59][60][61][62] Additional adult studies included in the Canadian review assessed caries severity (DMFT/S), [63][64][65][66] caries prevalence, 67 tooth loss 68,69 and dental service use. 70,71 Of these 15 primary studies, 9 were assessed as being of 'acceptable' quality by the review authors and 7 as 'low' quality. 49,51 The studies were ecological [57][58][59][60][61][62]65,67,70,71 and cross-sectional.…”

“…70,71 Of these 15 primary studies, 9 were assessed as being of 'acceptable' quality by the review authors and 7 as 'low' quality. 49,51 The studies were ecological [57][58][59][60][61][62]65,67,70,71 and cross-sectional. [64][65][66]68 The authors of the Australian review concluded that the quality of the evidence was 'low or very low', but it was consistent and 'indicates that water fluoridation improves the dental health of children and adults'.…”

“…74 Four of the Australian studies were secondary analyses of the Australian National Survey of Adult Oral Health (ANSAOH) 2004-6, 57,60,63,66 while one examined young offenders 58 and one was an opportunistic follow-up of a childhood study sample. 65 Three of the studies utilised dental service data from South Korea, 71 the USA 75 and Sweden. 70 One study included Canadian Army recruits, 76 and one was a secondary analysis of data from the telephone-based US Behavioural Risk Factors Survey 1995-9.…”

“…62 The outcomes assessed included self-reported number of lost teeth, 62,69 clinically examined number of lost teeth, 59,61,68,73 clinically examined prevalence and severity of decay (DMFT/S) 57,60,[63][64][65][66][67]74,76 and dental visits and/or treatments received. 70,71,75 All of the Brazilian studies reported that greater exposure to water fluoridation resulted in improved oral health, and the size of the differences between fluoridated and sub/non-optimally fluoridated groups was relatively large in comparison to the studies from Australia or the USA. For example, in the SB Brazil 2010, adults aged 35-44 living in sub/non-optimally fluoridated areas had a 27% higher mean ratio of missing teeth (MR 1.27, 95% CI 1.11 to 1.45).…”

“…62 Three studies used routinely collected dental service monitoring data. 70,71,76 A South Korean study used National Health Insurance data to explore the effect of regional water fluoridation status in 2013 on dental outpatient visits between 2003 and 2013. 71 Patient records were obtained from a randomly selected National Health Insurance Sample Cohort.…”