Hospitalizations for dental infections: optimally versus nonoptimally fluoridated areas in Israel

Community water fluoride cessation and rate of caries-related pediatric dental treatments under general anesthesia in Alberta, Canada

OBJECTIVE

This study examined the rate of caries-related dental treatments under general anesthesia (GA) in fluoridated and non-fluoridated communities in Alberta, Canada, between 2010 and 2019.

METHODS

This retrospective, population-based study included all children ( < 12 years of age) living in Calgary (non-fluoridated) and Edmonton (fluoridated) who underwent caries-related dental treatments under GA at publicly funded facilities. Demographics and dental data were extracted from health administrative databases for three time periods of 2010/11 (pre-cessation), 2014/15, and 2018/19 (post-cessation).

RESULTS

Among 2659 children receiving caries-related treatments under GA, the mean (SD) and median (IQR) age were 4.8 (2.3) and 4 (3-6) years, respectively, and 65% resided in the non-fluoridated area. The analysis revealed that the cessation of water fluoridation was significantly associated with an increased rate of caries-related GA events per 10,000 children in both age groups (0-5 and 6-11 years), with a more pronounced effect in 0-5-year-olds in non-fluoridated areas. The risk of dental treatments under GA was also positively associated with post-cessation time.

CONCLUSION

Discontinuing water fluoridation appears to negatively affect young children's oral health, potentially leading to a significant increase in caries-related dental treatments under GA and oral health disparities in this pediatric population.

Association of Nationwide Water Fluoridation, Changes in Dental Care Legislation, and Caries-Related Treatment Needs: A 9-Year Record-Based Cross-Sectional Study

OBJECTIVES

The implementation of nationwide water fluoridation in Israel in 2002 led to a significant reduction in caries among children. However, this practice was discontinued in 2014 due to a change in legislation. In 2010, as part of the Israeli National Health Insurance Law, free dental care for children under 10 years of age was legislated. This policy was gradually extended to include adolescents under 18 years of age in 2018. We examined the association between these efforts and changes in the caries-related treatment needs of young adults over the course of two decades.

METHODS

This cross-sectional study analyzed data on the need for dental restorations, root canal therapy, and extractions that were retrieved from dental records of 34,450 soldiers recruited into military service between 2012-2021. These data were cross-matched with the subjects' year of birth to determine whether the implementation of water fluoridation, dental care legislation, or both were associated with changes in the need for and provision of dental care. Sociodemographic data, including sex, age, socioeconomic cluster (SEC), intellectual capability score (ICS), body mass index, and place of birth, were also extracted.

RESULTS

A multivariate generalized linear model (GLM) revealed that male sex, older age, low ICS, and low SEC were significant predictors for greater caries-related treatment needs (P < 0.001). Our findings indicated that subjects exposed to fluoridated water during their childhood had significantly lower rates of caries-related treatment, regardless of access to free dental care.

CONCLUSION

Mandatory water fluoridation was associated with significantly lower caries-related treatment needs while national dental health legislation providing free dental care to children and adolescents was not. Therefore, we suggest that water fluoridation should be continued to maintain the observed reduction in treatment needs.

CLINICAL SIGNIFICANCE

Our findings provide support for the effectiveness of water fluoridation in preventing caries, whereas the impact of free dental care programs focused on clinical intervention remains to be determined.

A retrospective cohort study of pediatric hospitalization due to dentoalveolar infection before and after a change in national health insurance

This retrospective cohort study aimed to examine trends in pediatric (0-18 years old) hospitalizations due to dentoalveolar infection, before and after the inclusion of pediatric dental care in Israel's National Health Insurance Law. Data were collected from the medical records of one oral and maxillofacial surgery department. Data were compared between patients hospitalized during 2002-2010 (group A, n = 531) and 2011-2019 (group B, n = 381). The mean age of the cohort was 8 years. A dentoalveolar abscess was the main cause of hospitalizations in both groups. Group B exhibited a higher rate of previous dental treatment in general (p = 0.001), and of previous dental treatment for the tooth responsible for the infection (p = 0.03). The prevalent treatment during hospitalization combined intravenous antibiotics and extraction, with or without drainage (58.1%) for group A; and intravenous antibiotics and drainage (49.4%) for group B (p < 0.01). Dental care provided by the Israel's National Health Insurance should focus not only on operative treatment but also on oral health promotion and caries prevention, to reduce hospitalizations due to dentoalveolar infections.

The effect of community water fluoridation cessation on children's dental health: a national experience

BACKGROUND

Community water fluoride (CWF) is the proven cornerstone of primary dental health care promotion. In 2002 CWF was made mandatory at a national level in Israel, however a new government revoked these regulations in August 2014. "Maccabi" is the second largest national health care provider with 2.3 million members, "Maccabi-Dent", its dental branch, has 53 clinics, employing 1100 dentists. The aim of this study was to evaluate the cumulative effect on treatment rates 6 years after CWF was terminated in Israel, based on the number of dental treatments provided to children aged 3-12 years in "Maccabi-Dent" clinics.

METHODS

For this retrospective study, computerized dental treatment codes were collected. The "rate of treatment" was calculated by dividing the number of restorative treatments or extractions, by the number of individuals receiving treatment. The population size and the age group visiting the specific clinic were also considered.

RESULTS

The independent variables were fluoride concentration in drinking water, age and socioeconomic position (SEP). There was a significant increase in restorative dental treatments after 2014, (R2 = 0.0402), with approximately twice the number of treatments required in the absence of CWF. Age had a significant association (β =  - 0.389, p < 0.001) as did SEP (β = 0.086, p = 0.019).

CONCLUSION

After CWF cessation in Israel, rates of dental treatments significantly increased.

PRACTICAL IMPLICATION

By examining accepted notions with up-to-date information, new confirmatory evidence helps decision makers understand the importance of adding fluoride to drinking water.

Dental health of preschool children after two-years of a supervised tooth brushing program in Southern Israel

Background

Supervised tooth brushing is an important part of leading national oral health improvement programs in different countries.

With the cessation of water fluoridation in 2014, a new program was immediately required to provide community-based caries prevention, especially amongst young children.

The aim of this study was to determine whether a supervised tooth brushing program (STBP) in kindergartens could reduce dental caries amongst preschool children, when compared with children from the same community who did not participate in the program. The study was performed 2 years after the start of the program.

Methods

Two Jewish and two Arab local authorities (one participating and one control) were randomly chosen. In each local authority, 4 kindergartens (children aged 5) were randomly chosen, giving a total of 16 kindergartens. Children in the intervention group brushed once daily at kindergartens, with fluoridated toothpaste, for two school- years. All the children were examined using the WHO Oral Health Survey Methods Ed.4.

Results

Two hundred eighty-three five-year-old children were examined, 157 of them Jewish (86 participants in STBP, 71 non-participants) and 126 Arab (59 vs 67 respectively). Among Jewish children, the fraction of untreated decayed teeth was 61% in the participant group and 65% for non-participants, and amongst the Arab children 69% vs. 90% respectively. The fraction of treated decayed teeth for the participant group was 37% compared to 29% for the non-participants among Jewish children, whilst for the Bedouin group it was 23% vs. 8% respectively.

Conclusions

After 2 years, supervised tooth brushing with fluoride toothpaste shows a favorable effect. This study suggests that dental health of children participating in STBP was better than the control group. Fewer carious teeth and more treated carious lesions were recorded in this group. This program can be applied to low SES communities nationwide.

Guidelines for fluoride concentration in toothpaste for children should be re-considered based on high caries levels.

Reducing Potentially Preventable Dental Hospitalizations of Young Children: A Community-Level Analysis

An increasing number of Australians are being admitted to hospitals and day procedure centers to have dental treatment under a dental general anesthetic (DGA). Children younger than 2 y are having DGAs. These operations are costly and, although there have been improvements in safety, are not without risk. Most DGAs in children are to treat dental caries and have been defined as potentially preventable dental hospitalizations (PPDHs). This article reports on an analysis of the impact of access to community water fluoridation (CWF), availability of oral health professionals (OHPs), and socioeconomic status (SES) on PPDHs of 0- to 4-y-olds in 2012–2013 in Victoria, Australia. Data on these variables were obtained at the community (postcode) level. From the negative binomial multivariate analysis, each of the 3 independent variables was independently significantly associated with PPDHs at the postcode level. Children residing in postcodes without CWF on average had 59% higher rates than those with access (incident rate ratio [IRR], 1.59; P < 0.0001), children in postcodes with the lowest level of availability of OHPs had 65% higher rates than those with the highest access (IRR, 1.65; P < 0.0001), and children living in the most disadvantaged SES quintiles had 57% higher rates than children in the most advantaged quintiles (IRR, 1.57; P < 0.0001). There was a stepwise social gradient by SES quintile. In analysis of access to CWF and SES status, children without access to CWF had 86% higher PPDH rates than children with access (IRR, 1.86; P < 0.0001). In summary, no access to CWF, poor availability of OHPs, and lower SES status were independently associated with higher PPDH rates among 0- to 4-y-olds in Victoria at the postcode level. The study highlights the importance of considering 3 interacting factors—access to CWF, access to OHPs, and SES—in efforts to reduce PPDH rates in young children.

Knowledge Transfer Statement: Extending access to water fluoridation, increasing the availability of dental services, and raising disadvantaged families’ socioeconomic status are each likely to decrease the rate of dental general anesthetics in young children.

Critique of the review of 'Water fluoridation for the prevention of dental caries' published by the Cochrane Collaboration in 2015

The Cochrane Review on water fluoridation for the prevention of dental caries was published in 2015 and attracted considerable interest and comment, especially in countries with extensive water fluoridation programmes. The Review had two objectives: (i) to evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries, and (ii) to evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis. The authors concluded, inter alia, that there was very little contemporary evidence, meeting the Review's inclusion criteria, that evaluated the effectiveness of water fluoridation for the prevention of dental caries. The purpose of this critique is to examine the conduct of the above Review, and to put it into context in the wider body of evidence regarding the effectiveness of water fluoridation. While the overall conclusion that water fluoridation is effective in caries prevention agrees with previous reviews, many important public health questions could not be answered by the Review because of the restrictive criteria used to judge adequacy of study design and risk of bias. The potential benefits of using wider criteria in order to achieve a fuller understanding of the effectiveness of water fluoridation are discussed.

Concentrations of fluoride in water and plasma for US children and adolescents: Data from NHANES 2013-2014

For the first time, for 2013-2014, as part of ongoing National Health and Nutrition Examination Survey, data for fluoride concentrations in water and plasma for U.S. children and adolescents were released in the public domain. This study was undertaken to investigate how fluoride concentrations vary in water and plasma with age, gender, race/ethnicity, housing ownership, use of prescription fluoride drops and/or tablets, exposure to environmental tobacco smoke, and recent use of tobacco products (among adolescents). Fluoride concentrations in water were found to be lower among those aged 3-5 years than those aged 6-11 years (p=0.02), lower for non-Hispanic Asians than Hispanics (p=0.04) among 3-5 years old, lower for non-Hispanic Asians than non-Hispanic blacks (p=0.04) among 6-11 years old, and lower for those who used prescription fluoride drops and/or tablets than those who did not (p≤0.048) among 12-19 years old. Adjusted fluoride concentrations in plasma were found to be lower for females than males (p<0.01) among those aged 6-11 years, lower for Hispanics than non-Hispanic whites (p<0.01) among those aged 12-19 years, and lower for those who used prescription fluoride drops and/or tablets than those who did not (p=0.03) among 12-15 years old. Recent smokers were found to have higher fluoride concentration (p=0.03) in plasma than non-smoker adolescents. Over 60% of the children aged 6-11 years and adolescents aged 12-19 years were at the risk of developing dental caries/decay. About 30% of the children were at the risk of dental fluorosis.

Child Health Care in Israel

Israel is a relatively rapidly growing country with a high fertility rate and a young population. These data emphasize the importance of an efficient and appropriate pediatric service for its population. Although the pediatric service in Israel has attained several achievements, such as a relatively low infant mortality, high vaccination rates, and a primary care service that is mainly based on licensed pediatricians, several challenges, such as overcoming inequalities in health care and health indices between different regions and different populations within the country and the provision of a more organized mental and dental health care service to children, need to be addressed.