Dataset Information

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.

SUBMITTER: Matsuo G

PROVIDER: S-EPMC7175225 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Effects of Community Water Fluoridation on Dental Caries Disparities in Adolescents.

Matsuo Go G Aida Jun J Osaka Ken K Rozier Richard Gary RG

International journal of environmental research and public health 20200319 6

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 a ...[more]

PMID: 32204333

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Project description:Fluoridation of America's drinking water was among the great public health achievements of the 20th century. Yet there is a paucity of studies from the past 3 decades investigating its dental health benefits in the U.S. POPULATION:This cross-sectional study sought to evaluate associations between availability of community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention's Water Fluoridation Reporting System were merged with dental examination data from 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (decayed and filled tooth surfaces [dfs]) was calculated for 7,000 children aged 2 to 8 y and in the permanent dentition (decayed, missing, and filled tooth surfaces [DMFS]) for 12,604 children and adolescents aged 6 to 17 y. Linear regression models estimated associations between % CWF and dental caries experience with adjustment for sociodemographic characteristics: age, sex, race/ethnicity, rural-urban location, head-of-household education, and period since last dental visit. Sensitivity analysis excluded counties fluoridated after 1998. In unadjusted analysis, caries experience in the primary dentition was lower in counties with ?75% CWF (mean dfs = 3.3; 95% confidence limit [CL] = 2.8, 3.7) than in counties with <75% CWF (mean dfs = 4.6; 95% CL = 3.9, 5.4), a prevented fraction of 30% (95% CL = 11, 48). The difference was also statistically significant, although less pronounced, in the permanent dentition: mean DMFS (95% CL) was 2.2 (2.0, 2.4) and 1.9 (1.8, 2.1), respectively, representing a prevented fraction of 12% (95% CL = 1, 23). Statistically significant associations likewise were seen when % CWF was modeled as a continuum, and differences tended to increase in covariate-adjusted analysis and in sensitivity analysis. These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth.

Project description:ImportanceDental surgery under general anesthesia (DGA) is an ineffective, costly treatment for caries. Interventions to reduce the need for DGA are challenging because children's parents may not seek care until surgery is required. Community water fluoridation (CWF) effectively prevents early childhood caries, but its effectiveness in reducing severe early childhood caries is unknown.ObjectiveTo determine whether access to CWF is associated with the prevalence of DGA.Design, setting, and participantsThis is a cross-sectional analysis of Medicaid claims data from 2011 to 2012. Deidentified data were derived from Medicaid claims and enrollee files for Massachusetts, Texas, Connecticut, Illinois, and Florida for children aged 9 years and younger enrolled in either a fee-for-service or managed care plan through their state's Medicaid program. Linear regression models tested for associations between CWF and covariates. Multivariable linear regression models tested for associations between CWF and outcomes. Regression models included clustered SEs at the county level. Data analysis was performed from December 2018 to March 2020.ExposuresAccess to CWF was determined by estimating the proportion of a county's total population that had access to a fluoridated public water system.Main outcomes and measuresThe main outcome was county-level DGA prevalence. Other outcomes were caries-related visit prevalence and patient quality indicators (asthma and diabetes). Covariates included county-level demographic, socioeconomic, and dental practitioner variables.ResultsA total of 436 counties within 5 states per year (872 county-year observations), were included in the analysis. Adjusted analysis revealed that a 10% increase in the proportion of county's population access to CWF was associated with lower caries-related visit prevalence (-0.45 percentage points; 95% CI, -0.59 to -0.31 percentage points; P < .001). Increasing CWF access in 10% increments was associated with decreased DGA prevalence in unadjusted analysis (-0.39 percentage points; 95% CI, -0.67 to -0.12 percentage points; P = .006) but not in adjusted analysis (-0.23 percentage points; 95% CI, -0.49 to 0.02 percentage points; P = .07). Increasing the proportion of county's access to CWF by 10% was not associated with the prevalence of asthma-related exacerbations (-0.02 percentage points; 95% CI, -0.10 to 0.05 percentage points; P = .53) or diabetes-related exacerbations (-0.0003 percentage points; 95% CI, -0.0014 to 0.0009 percentage points; P = .66).Conclusions and relevanceThis study extends our understanding of CWF's benefits for children's oral health. Specifically, these findings suggest that increasing a population's access to CWF's is associated with decreased caries-related visits and may also be associated with use of dental surgical services within high-risk populations.

Project description:BackgroundCommunity water fluoridation (CWF), the controlled addition of fluoride to the water supply for the prevention of dental caries (tooth decay), is considered a safe and effective public health intervention. The Republic of Ireland (Ireland) is the only country in Europe with a legislative mandate for the fluoridation of the public water supply, a key component of its oral health policy. However, more recently, there has been an increase in public concern around the relevance of the intervention given the current environment of multiple fluoride sources and a reported increase in the prevalence of enamel fluorosis. The aim of this economic analysis is to provide evidence to inform policy decisions on whether the continued public investment in community water fluoridation remains justified under these altered circumstances.MethodsFollowing traditional methods of economic evaluation and using epidemiological data from a representative sample of 5-, 8-, and 12-year-old schoolchildren, this cost-effectiveness analysis, conducted from the health-payer perspective, compared the incremental costs and consequences associated with the CWF intervention to no intervention for schoolchildren living in Ireland in 2017. A probabilistic model was developed to simulate the potential lifetime treatment savings associated with the schoolchildren's exposure to the intervention for one year.ResultsIn 2017, approximately 71% of people living in Ireland had access to a publicly provided fluoridated water supply at an average per capita cost to the state of €2.15. The total cost of CWF provision to 5-, 8-, and 12-year-old schoolchildren (n = 148,910) was estimated at €320,664, and the incremental cost per decayed, missing, or filled tooth (d3vcmft/D3vcMFT) prevented was calculated at €14.09. The potential annual lifetime treatment savings associated with caries prevented for this cohort was estimated at €2.95 million. When the potential treatment savings were included in the analysis, the incremental cost per d3vcmft/D3vcMFT prevented was -€115.67, representing a cost-saving to the health-payer and a positive return on investment. The results of the analysis were robust to both deterministic and probability sensitivity analyses.ConclusionDespite current access to numerous fluoride sources and a reported increase in the prevalence of enamel fluorosis, CWF remains a cost-effective public health intervention for Irish schoolchildren.

Project description:Introduction:Obesity and dental caries are global public health problems. There are conflicting reports about the relationship between caries and obesity. Therefore, the study aimed to investigate the association between obesity and dental caries among male adolescents. Materials and Methods:This cross-sectional study included a sample of 258 male students' aged 12 to 15 years from schools in Dammam/Al-Khobar, Saudi Arabia. The study involved measuring caries prevalence and DMFT estimates, assessing body mass index (BMI), and administering a self-completion questionnaire. Independent samples Student's t-test, one-way ANOVA test, Pearson's correlation test, and bivariate and multivariate logistic regression analyses were performed. Results:Caries prevalence of the sample was 79.8%, and the mean score of DMFT was 3.55?±?2.94. The mean BMI of participants was 23.42?±?6.82 and 18% were obese (BMI?>?30). The obese participants had a higher mean DMFT score (4.46?±?3.54) than nonobese participants (3.35?±?2.77) (P=0.021). Similarly, the mean untreated caries was higher in obese (4.17?±?3.22) than in nonobese participants (3.01?±?2.66) (P=0.010). In the logistic regression analysis, after controlling for father's education, family history of obesity, meals per day, fast food per week, and physical activity in the final model, the participants with high caries experience (DMFT?=?5-15) were 2.21 times more likely to have obesity than those with low caries experience (DMFT?=?0-4) (P=0.04). No/school education of father (odds ratio 3.54, P=0.011), family history of obesity (odds ratio 3.27, P=0.002), and not performing physical activity (odds ratio 4.37, P=0.002) were significantly associated with an increased likelihood of obesity. Conclusion:The prevalence of caries and obesity was high in male adolescents in Saudi Arabia. Obesity was significantly associated with untreated caries and caries experience. Children with high caries experience were more likely to have obesity than children with low caries experience. Preventive programs and policies should address public health issues related to caries and obesity in male teenagers.

Dataset Information

Effects of Community Water Fluoridation on Dental Caries Disparities in Adolescents.

Publications

Effects of Community Water Fluoridation on Dental Caries Disparities in Adolescents.

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