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Pontigo-Loyola AP, Mendoza-Rodriguez M, de la Rosa-Santillana R, Rivera-Pacheco MG, Islas-Granillo H, Casanova-Rosado JF, Márquez-Corona MDL, Navarrete-Hernández JDJ, Medina-Solís CE, Manton DJ. Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods. Pediatr Rep 2024; 16:243-253. [PMID: 38651460 PMCID: PMC11036215 DOI: 10.3390/pediatric16020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
The maintenance of oral health is a crucial aspect of general well-being; however, a significant proportion of the worldwide population experiences a range of oral diseases. Dental caries is a highly prevalent non-communicable disease globally, especially in children and adolescents. Fluoride is involved in the control of dental caries, primarily by decreasing the critical pH for dental hard tissue dissolution and decreasing enamel solubility. Due to the substantial data supporting the efficacy of fluoride in controlling dental caries, many community-level fluoridation initiatives have been devised and executed as global public health preventive interventions. These initiatives encompass the fluoridation of water, salt, and milk. Water fluoridation is considered safe and effective when fluoride levels are maintained within the recommended range (0.6 to 1.1 mg/L). Salt fluoridation has a cariostatic potential similar to that of water fluoridation, and a fluoride concentration of 250 micrograms per gram in salt is not associated with an increased risk of developing dental fluorosis. However, there is currently an effort to reduce the consumption of table salt in order to mitigate the harmful effects of excessive salt consumption. It has been hypothesized that fluoride food supplementation, such as fluoridated milk, is associated with a decrease in caries experience in permanent teeth; however, the effect is not clear in primary teeth. Public-level fluoride interventions are more cost-effective than the operative care of caries lesions and limit the burden of care. The administration of fluorides should be conducted using safe methods, limiting ingestion, and adhering to the guidelines set by international and national health agencies in each country. This is particularly important when considering children with developing dentitions. Fluoride is an important tool in the control of dental caries, but it is crucial to combine it with good oral hygiene, a healthy diet, and regular visits to a dental professional to maintain long-term oral health.
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Affiliation(s)
- América Patricia Pontigo-Loyola
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Martha Mendoza-Rodriguez
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Rubén de la Rosa-Santillana
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Maria Gracia Rivera-Pacheco
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
- Department of Cariology, Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Horacio Islas-Granillo
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | | | - María de Lourdes Márquez-Corona
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - José de Jesús Navarrete-Hernández
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Carlo Eduardo Medina-Solís
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
- Advanced Studies and Research Center in Dentistry “Dr. Keisaburo Miyata” of Faculty of Dentistry, Autonomous University of the State of Mexico, Toluca 50130, Mexico
| | - David J. Manton
- Department of Cariology, Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
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Sanders AE, Divaris K, Godebo TR, Slade GD. Effect of bottled fluoridated water to prevent dental caries in primary teeth: study protocol for a phase 2 parallel-group 3.5-year randomized controlled clinical trial (waterBEST). Trials 2024; 25:167. [PMID: 38443989 PMCID: PMC10913546 DOI: 10.1186/s13063-024-08000-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Fluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles. METHODS waterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo-controlled, parallel-group trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first 4 years of life. Two hundred children living in eastern North Carolina, USA, and aged 2-6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child's home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children's water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child's fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit. DISCUSSION waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has the potential to prevent early childhood caries in a large segment of the US population that currently does not benefit from fluoridated public water. TRIAL REGISTRATION ClinicalTrials.gov NCT04893681. Registered on March 2022. Last update posted on 10 October 2023. https://clinicaltrials.gov/study/NCT04893681?cond=Dental%20Caries%20in%20Children&term=fluoride&locStr=North%20Carolina,%20USA&country=United%20States&state=North%20Carolina&distance=50&rank=1.
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Affiliation(s)
- Anne E Sanders
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kimon Divaris
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tewodros R Godebo
- Department of Environmental Health Sciences, Tulane University, New Orleans, LA, USA
| | - Gary D Slade
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sanders AE, Godebo TR, Divaris K, Slade GD. Effect of bottled fluoridated water to prevent dental caries in primary teeth: study protocol for a phase 2 parallel group 3.5-year randomized controlled clinical trial (waterBEST). RESEARCH SQUARE 2024:rs.3.rs-3632524. [PMID: 38410455 PMCID: PMC10896389 DOI: 10.21203/rs.3.rs-3632524/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background Fluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles. Methods waterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo controlled, parallel group, trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first four years of life. Two hundred children living in eastern North Carolina, USA, and aged 2-6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child's home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children's water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child's fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit. Discussion waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has potential to prevent early childhood caries in a large segment of the U.S. population that currently does not benefit from fluoridated public water.
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Affiliation(s)
- Anne E Sanders
- UNC-Chapel Hill: The University of North Carolina at Chapel Hill
| | | | - Kimon Divaris
- UNC-Chapel Hill: The University of North Carolina at Chapel Hill
| | - Gary D Slade
- UNC-Chapel Hill: The University of North Carolina at Chapel Hill
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Shoaee S, Masinaei M, Saeedi Moghaddam S, Sofi-Mahmudi A, Hessari H, Shamsoddin E, Heydari MH, Larijani B, Fakhrzadeh H, Farzadfar F. National and Subnational Trend of Dental Caries of Permanent Teeth in Iran, 1990-2017. Int Dent J 2024; 74:129-137. [PMID: 37574408 PMCID: PMC10829359 DOI: 10.1016/j.identj.2023.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/14/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE There are currently no integrated data on the trend of dental caries amongst distinct age groups in Iran. We aimed to assess the national and subnational trend of dental caries of permanent teeth in Iran from 1990 to 2017. METHODS A literature search about dental caries and the decayed-missing-filled teeth index (DMFT) was performed in PubMed, Web of Science, Scopus, and 3 national databases (in Persian). All eligible national oral health surveys in these 28 years were included. We categorised and aggregated the DMFT values and their components based on age (5-year-based groups from 5 to 9 to 60+ years), sex, year, and province. The data for missing spots were estimated using the spatiotemporal Bayesian hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. RESULTS Nationally, the all-ages mean DMFT increased by nearly 58.0% (6.8 [95% UI, 4.1-10.5] in 1990 to 10.8 [95% UI, 7.5-14.5] in 2017). Decayed teeth (DT) and missing teeth (MT) rose by 84.5% and 31.6% during this period, respectively. Filled teeth (FT) showed almost a 2.6-fold increase in the same period from 0.6 (95% UI, 0.01-1.6) in 1990 to 1.7 (95% UI, 0.6-2.8) in 2017. The proportion of DT and FT continuously increased in both sexes. In 2017, the highest DT, MT, and FT were estimated in the 25-29 (4.9 [95% UI, 2.5-7.2]), 60+ (21.5 [95% UI, 17.5-25.4]), and 35-39 (2.6 [95% UI, 1.3-4.0]) year age groups. CONCLUSIONS Caries of permanent dentition levies a growing burden on the Iranian population. Considering the continuous increase in caries during the 1990-2017 period, Iranian policymakers should pay heed to these findings and react more proactively to mitigate this perpetuating issue. Implementing nationwide interventions such as sugar consumption management should be encouraged to achieve sustainable outcomes in this regards.
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Affiliation(s)
- Shervan Shoaee
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Kerman Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Masinaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Sofi-Mahmudi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Hossein Hessari
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Shamsoddin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Mohammad-Hossein Heydari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Fakhrzadeh
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Hung M, Mohajeri A, Chiang J, Park J, Bautista B, Hardy C, Lipsky MS. Community Water Fluoridation in Focus: A Comprehensive Look at Fluoridation Levels across America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7100. [PMID: 38063530 PMCID: PMC10706776 DOI: 10.3390/ijerph20237100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
Objective: This study reports on the number and percentage of community water systems (CWSs) meeting fluoride concentration standards set by the U.S. Department of Health and Human Services (DHHS). The study also explored changes in the population exposed to optimally fluoridated water in these systems between 2006 and 2020. Methods: This study analyzed U.S. Centers for Disease Control and Prevention data from 2006 to 2020, tabulating state-specific CWS fluoridation rates, ranking them, and calculating the percent change. Results: In 2020, 72.7% of the US population received CWS water, with 62.9% of those individuals served by a CWS system meeting DHHS fluoridation standards. This compares to 69.2% receiving CWS water in 2006 and 74.6% in 2012. The overall change in those receiving fluoridated water was 1.4%, from 61.5% in 2006 to 62.9% in 2020. State-specific percentages ranged from 8.5% in Hawaii to 100% in Washington DC in 2020 (median: 76.4%). Conclusions: Although endorsed by the American Dental Association, the percentage of individuals receiving fluoridated water did not increase substantially from 2006 to 2020, indicating that there has not been much progress toward meeting the Healthy People 2030 goal that 77.1% of Americans receive water with enough fluoride to prevent tooth decay.
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Affiliation(s)
- Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
- College of Social Work, University of Utah, Salt Lake City, UT 84112, USA
- Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA
| | - Amir Mohajeri
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Jody Chiang
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Jungweon Park
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- College of Dentistry, Ohio State University, Columbus, OH 43210, USA
| | - Beatrice Bautista
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Chase Hardy
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- College of Dentistry, University of Texas Health Sciences, San Antonio, TX 78253, USA
| | - Martin S. Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- Institute on Aging, Portland State University, Portland, OR 97201, USA
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Hung M, Mohajeri A, Vu T, Moparthi H, Lipsky MS. Association between fluoride exposure and blood pressure. J Public Health Res 2023; 12:22799036231204323. [PMID: 37822995 PMCID: PMC10563487 DOI: 10.1177/22799036231204323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/22/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives This study investigated whether fluoride was associated with an increased prevalence of high blood pressure (BP) among adolescents in the United States. Methods The study sample consisted of 2015-2016 National Health and Nutrition Examination Survey participants aged 13-17 years. Independent-samples t-tests, Chi-square tests, and regression models were used to analyze the data. Results A total of 814 participants met the study criteria. The findings showed that the proportion of patients with high levels of water or plasma fluoride in the high BP group was higher than that in the normal BP group. However, after adjusting for sociodemographic covariates, neither water nor plasma fluoride levels were significantly associated with a high BP. Conclusions This study did not find an association between either water or plasma fluoride levels and high BP. Further study is needed to exclude a dose dependent effect at higher levels of fluoride.
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Affiliation(s)
- Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
- Division of Public Health, University of Utah, Salt Lake City, UT, USA
- Veteran Affairs Salt Lake City Health Care, Salt Lake City, UT, USA
| | - Amir Mohajeri
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
| | - Teresa Vu
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
| | - Hyma Moparthi
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
| | - Martin S Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
- Institute on Aging, Portland State University, Portland, OR, USA
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Boehmer TJ, Lesaja S, Espinoza L, Ladva CN. Community Water Fluoridation Levels To Promote Effectiveness and Safety in Oral Health -
United States, 2016-2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:593-596. [PMID: 37261997 DOI: 10.15585/mmwr.mm7222a1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Drinking water fluoridated at the level recommended by the U.S. Public Health Service (USPHS) reduces dental caries (cavities) by approximately 25% in children and adults (1). USPHS recommends fluoride levels to achieve oral health benefits and minimize risks associated with excess fluoride exposure. To provide the benefits of community water fluoridation, water systems should target a level of 0.7 mg/L and maintain levels ≥0.6 mg/L (2). The Environmental Protection Agency (EPA) sets a safety standard at 2.0 mg/L to prevent mild or moderate dental fluorosis, a condition that causes changes in the appearance of tooth enamel caused by hypermineralization resulting from excess fluoride intake during tooth-forming years (i.e., before age 8 years). During 2016-2021, fluoride measurements for 16.3% of population-weighted monthly fluoride measurements (person-months) reported by community water systems to CDC's Water Fluoridation Reporting System (WFRS) were <0.6 mg/L; only 0.01% of person-months exceeded 2.0 mg/L. More than 80% of population-weighted fluoride measurements from community water systems reporting to WFRS were above 0.6 mg/L. Although 0.7 mg/L is the recommended optimal level, ≥0.6 mg/L is still effective for the prevention of caries. A total of 4,080 community water systems safely fluoridated water 99.99% of the time with levels below the secondary safety standard of 2.0 mg/L. Water systems are encouraged to work with their state programs to report their fluoride data into WFRS and meet USPHS recommendations to provide the full benefit of fluoridation for caries prevention.
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Hung M, Hon ES, Mohajeri A, Moparthi H, Vu T, Jeon J, Lipsky MS. A National Study Exploring the Association Between Fluoride Levels and Dental Fluorosis. JAMA Netw Open 2023; 6:e2318406. [PMID: 37351888 PMCID: PMC10290240 DOI: 10.1001/jamanetworkopen.2023.18406] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/30/2023] [Indexed: 06/24/2023] Open
Abstract
Importance While the effects of fluoride on health have been widely researched, fewer high-quality studies examine the association of fluoride levels in water and dental fluorosis. Objective To investigate the association between fluoride exposure from drinking water and dental fluorosis. Design, Setting, and Participants This cross-sectional study used the 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey (NHANES) data (January 1, 2013, through December 31, 2016). NHANES uses a complex sampling technique to develop nationally representative sample estimates of the US population that consists of interviews and physical assessments. Children and adolescents aged 6 to 15 years were included because NHANES contains their data for all 3 forms of fluoride measures: plasma fluoride levels, water levels of fluoride, and dietary fluoride supplementation. Data were analyzed from January 1 to April 30, 2023. Exposures Water and plasma fluoride levels were measured by laboratory personnel. Dietary fluoride supplement data were self-reported. Main Outcomes and Measures The Dean's Fluorosis Index was used to evaluate fluorosis status for each tooth. The dental fluorosis severity value was based on the second most affected tooth. Independent variables included plasma and water fluoride concentrations and dietary fluoride supplementation. An independent samples t test was used to compare fluoride exposures between groups, and Pearson correlation assessed the association between plasma and water fluoride levels. To assess whether fluoride exposures were associated with dental fluorosis, logistic regression analyses were conducted. Results There were 1543 participants in the 2013-2014 NHANES cycle (weighted proportion male, 51.9%; mean [SD] age, 11.0 [2.7] years) and 1452 in the 2015-2016 cycle (weighted proportion male, 52.6%; mean [SD] age, 11.1 [2.8] years). A weighted 87.3% exhibited some degree of fluorosis in the 2013-2014 cycle and 68.2% in the 2015-2016 cycle. Higher fluoride levels in water and plasma were significantly associated with higher odds of dental fluorosis (adjusted odds ratios, 2.378 [95% CI, 2.372-2.383] in the 2013-2014 cycle and 1.568 [95% CI, 1.564-1.571] in the 2015-2016 cycle). Conclusions and Relevance The findings of this cross-sectional study suggest that exposure to higher concentrations of fluoride in water and having higher plasma levels of fluoride were associated with a greater risk of dental fluorosis. Further research can help policy makers develop policies that balance substantial caries prevention with the risk of dental fluorosis.
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Affiliation(s)
- Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
- Division of Public Health, University of Utah, Salt Lake City
- College of Social Work, University of Utah, Salt Lake City
- College of Education, University of Utah, Salt Lake City
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Eric S. Hon
- Department of Economics, University of Chicago, Chicago, Illinois
| | - Amir Mohajeri
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
| | - Hyma Moparthi
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
| | - Teresa Vu
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
| | - Jason Jeon
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
| | - Martin S. Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
- Portland State University Institute on Aging, Portland, Oregon
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Crouch E, Nelson J, Radcliff E, Merrell MA, Martin A. Safe, supportive neighborhoods: Are they associated with childhood oral health? J Public Health Dent 2023; 83:9-17. [PMID: 36257835 DOI: 10.1111/jphd.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/06/2022] [Accepted: 09/28/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There has been limited examination of how community-level supports may influence oral health metrics among children. The purpose of our study is to examine the association between two types of community-level positive childhood experiences and oral healthcare and oral health outcomes among children ages 6 to 17 years of age. METHODS This study uses a cross-sectional data set from the 2018-2019 National Survey of Children's Health. Two oral health metrics were used: preventive dental care, measured as one or more preventive dental visits in the past 12 months, and tooth decay, measured as tooth decay or cavities in the last 12 months. To quantify living in safe, stable, equitable environments, questions on residing in a safe and supportive neighborhood were used. Descriptive statistics and bivariate analyses were used to calculate frequencies, proportions, and unadjusted associations for each variable (n = 40,290). Multivariable logistic regression models were used. RESULTS In an adjusted analysis, children who lived in a supportive neighborhood had a higher likelihood of receiving a preventive dental visit than children who did not live in a supportive neighborhood (aOR 1.41; 95% CI 1.21-1.65). Children who lived in a safe neighborhood were less likely to have tooth decay than children who did not live in a safe neighborhood (aOR 0.75; 95% CI 0.65-0.86). CONCLUSIONS The findings from this study highlight the role of social structures in tightening the safety net for oral healthcare in children.
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Affiliation(s)
- Elizabeth Crouch
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Joni Nelson
- Department of Stomatology, Division of Population Oral Health, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth Radcliff
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Melinda A Merrell
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Amy Martin
- Department of Stomatology, Division of Population Oral Health, Medical University of South Carolina, Charleston, South Carolina, USA
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10
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Dickson-Swift V, Crocombe L, Bettiol S, Bracksley-O'Grady S. Access to community water fluoridation in rural Victoria: It depends where you live…. Aust J Rural Health 2023. [PMID: 36825829 DOI: 10.1111/ajr.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 01/08/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To explore the water fluoridation status of rural Victorian towns over 1000 population and document the oral health profile in the local government areas (LGAs) currently with no water fluoridation. To assist/inform future LGA planning, we describe a case study of a community-based co-design approach to increase access to fluoridated water in rural communities. DESIGN A descriptive design and a case study. SETTING Rural Victorian towns over 1000 population. PARTICIPANTS Twenty-nine LGAs in rural areas. MAIN OUTCOME MEASURE(S) LGA water fluoridation status and oral health profiles. RESULTS Sixty-six (33%) of the 203 Victorian rural towns with >1000 population, representing 149 251 people, did not have access to fluoridated water. Towns in 29 rural LGAs were included with 62% without water fluoridation with many having higher than the Victorian average of preventable hospital admissions due to dental conditions in children aged 0-9 years. Over 50% of children aged 0-12 years living in these rural nonfluoridated LGAs had above-the-state average rates of decayed, missing and filled teeth (dmft/DMFT). In those aged 0-5 years, this was the highest with 78% above-the-state average. In the case study, meetings were well attended, and the group resolved to lobby for water fluoridation, which was successful. CONCLUSION Many Victorian rural towns do not have access to fluoridated water. A community-based co-design approach can dispel ill-informed concerns about dangers of water fluoridation to successfully lobby the state government to fluoridate the local water supply.
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Affiliation(s)
- Virginia Dickson-Swift
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Leonard Crocombe
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Silvana Bettiol
- Tasmanian School of Medicine, College of Health & Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Stacey Bracksley-O'Grady
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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11
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Nguyen TM, Tonmukayakul U, Le LKD, Calache H, Mihalopoulos C. Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:53-70. [PMID: 36089630 PMCID: PMC9834378 DOI: 10.1007/s40258-022-00758-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia.
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | - Long Khanh-Dao Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
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12
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Abstract
Oral health is an integral part of the overall health of children. Dental caries is a common and chronic disease process with significant short- and long-term consequences. The prevalence of dental caries remains greater than 40% among children 2 to 19 years of age. Although dental visits have increased in all age, race, and geographic categories in the United States, disparities continue to exist, and a significant portion of children have difficulty accessing dental care. As health care professionals responsible for the overall health of children, pediatricians frequently confront morbidity associated with dental caries. Because the youngest children visit the pediatrician more often than they visit the dentist, it is important that pediatricians be knowledgeable about the disease process of dental caries, prevention of disease, interventions to maintain and restore health, and the social determinants of children's oral health.
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Affiliation(s)
- David M Krol
- Medical Director, Connecticut Children's Care Network.,Medical Director, Care Integration, Connecticut Children's, Hartford, Connecticut
| | - Kaitlin Whelan
- Peak Pediatrics, Thornton Colorado.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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13
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Goodwin M, Emsley R, Kelly MP, Sutton M, Tickle M, Walsh T, Whittaker W, Pretty IA. Evaluation of water fluoridation scheme in Cumbria: the CATFISH prospective longitudinal cohort study. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/shmx1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Water fluoridation was introduced in the UK against a background of high dental decay within the population. Levels of decay have dramatically reduced over the last 40 years following widespread use of fluoride toothpaste.
Objective
The aim of the CATFISH (Cumbrian Assessment of Teeth a Fluoride Intervention Study for Health) study was to address the question of whether or not the addition of fluoride to community drinking water, in a contemporary population, lead to a reduction in the number of children with caries and, if so, is this reduction cost-effective?
Design
A longitudinal prospective cohort design was used in two distinct recruited populations: (1) a birth cohort to assess systemic and topical effects of water fluoridation and (2) an older school cohort to assess the topical effects of drinking fluoridated water.
Setting
The study was conducted in Cumbria, UK. Broadly, the intervention group (i.e. individuals receiving fluoridated drinking water) were from the west of Cumbria and the control group were from the east of Cumbria.
Participants
Children who were lifetime residents of Cumbria were recruited. For the birth cohort, children were recruited at birth (2014–15), and followed until age 5 years. For the older school cohort, children were recruited at age 5 years (2013–14) and followed until the age of 11 years.
Intervention
The provision of a ‘reintroduced fluoridated water scheme’.
Main outcome measures
The primary outcome measure was the presence or absence of decay into dentine in the primary teeth (birth cohort) and permanent teeth (older school cohort). The cost per quality-adjusted life-year was also assessed.
Results
In the birth cohort (n = 1444), 17.4% of children in the intervention group had decay into dentine, compared with 21.4% of children in the control group. The evidence, after adjusting for deprivation, age and sex, with an adjusted odds ratio of 0.74 (95% confidence interval 0.56 to 0.98), suggested that water fluoridation was likely to have a modest beneficial effect. There was insufficient evidence of difference in the presence of decay in children in the older school cohort (n = 1192), with 19.1% of children in the intervention group having decay into dentine, compared with 21.9% of children in the control group (adjusted odds ratio 0.80, 95% confidence interval 0.58 to 1.09). The intervention was found to be likely to be cost-effective for both the birth cohort and the older school cohort at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. There was no significant difference in the performance of water fluoridation on caries experience across deprivation quintiles.
Conclusions
The prevalence of caries and the impact of water fluoridation was much smaller than previous studies have reported. The intervention was effective in the birth cohort group; however, the importance of the modest absolute reduction in caries (into dentine) needs to be considered against the use of other dental caries preventative measures. Longer-term follow-up will be required to fully understand the balance of benefits and potential risks (e.g. fluorosis) of water fluoridation in contemporary low-caries populations.
Limitations
The low response rates to the questionnaires reduced their value for generalisations. The observed numbers of children with decay and the postulated differences between the groups were far smaller than anticipated and, consequently, the power of the study was affected (i.e. increasing the uncertainty indicated in the confidence intervals).
Study registration
This study is registered as Integrated Research Application System 131824 and 149278.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matt Sutton
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - William Whittaker
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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14
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Harkness JS, Jurgens BC. Effects of imported recharge on fluoride trends in groundwater used for public supply in California. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 830:154782. [PMID: 35339540 DOI: 10.1016/j.scitotenv.2022.154782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/28/2022] [Accepted: 03/19/2022] [Indexed: 06/14/2023]
Abstract
Fluoride is a naturally occurring element in groundwater that supports bone and dental health at low concentrations but can cause health problems at elevated concentrations in drinking water. This study investigates spatial and temporal trends for fluoride concentrations in untreated groundwater from over 20,000 public supply wells in California. The presence of a significant temporal trend in fluoride concentrations in a well was assessed using the Mann-Kendall test and a spatial-weighting approach was used to identify the areal extent of the groundwater resources with significant trends. Less than 2% of the groundwater resources used for public supply in the state have concentrations above the California maximum contaminant level of 2 mg/L. Approximately 14% of the groundwater resource used for public supply show a significant recent trend (2000-2019), with decreasing trends occurring in 10% of the resource. Potential drivers for trends were evaluated in two of the areas in southern California with the greatest prevalence of trends but distinct climate and hydrogeological characteristics. Aquifers in the Mojave and Whitewater River watersheds, located in the desert region, and the Los Angeles Basin, located on the coast, have been replenished with imported and treated water over the last half century to maintain sustainable groundwater levels. The recharge of imported water with different chemistries has altered the geochemical conditions in the aquifers, driving changes in fluoride concentrations.
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15
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Naddafi K, Mesdaghinia A, Abtahi M, Hassanvand MS, Beiki A, Shaghaghi G, Shamsipour M, Mohammadi F, Saeedi R. Assessment of burden of disease induced by exposure to heavy metals through drinking water at national and subnational levels in Iran, 2019. ENVIRONMENTAL RESEARCH 2022; 204:112057. [PMID: 34529973 DOI: 10.1016/j.envres.2021.112057] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
The burden of disease attributable to exposure to heavy metals via drinking water in Iran (2019) was assessed at the national and regional levels. The non-carcinogenic risk, carcinogenic risk, and attributable burden of disease of heavy metals in drinking water were estimated in terms of hazard quotient (HQ), incremental lifetime cancer risk (ILCR), and disability-adjusted life year (DALY), respectively. The average drinking water concentrations of arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), mercury (Hg), and nickel (Ni) in Iran were determined to be 2.3, 0.4, 12.1, 2.5, 0.7, and 19.7 μg/L, respectively, which were much lower than the standard values. The total average HQs of heavy metals in drinking water in the entire country, rural, and urban communities were 0.48, 0.65 and 0.45, respectively. At the national level, the average ILCRs of heavy metal in the entire country were in the following order: 1.06 × 10-4 for As, 5.89 × 10-5 for Cd, 2.05 × 10-5 for Cr, and 3.76 × 10-7 for Pb. The cancer cases, deaths, death rate (per 100,000 people), DALYs, and DALY rate (per 100,000 people) attributed to exposure to heavy metals in drinking water at the national level were estimated to be 213 (95% uncertainty interval: 180 to 254), 87 (73-104), 0.11 (0.09-0.13), 4642 (3793-5489), and 5.81 (4.75-6.87), respectively. The contributions of exposure to As, Cd, Cr, and Pb in the attributable burden of disease were 14.7%, 65.7%, 19.3%, and 0.2%, respectively. The regional distribution of the total attributable DALY rate for all heavy metals was as follows: Region 5> Region 4> Region 1> Region 3> Region 2. The investigation and improvement of relatively high exceedance of As levels in drinking water from the standard value, especially in Regions 5 and 3 as well as biomonitoring of heavy metals throughout the country were recommended.
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Affiliation(s)
- Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mesdaghinia
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Abtahi
- Workplace Health Promotion Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ayoub Beiki
- Center of Environmental and Occupational Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Gholamreza Shaghaghi
- Center of Environmental and Occupational Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mohammadi
- Department of Health and Safety, and Environment (HSE), School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Saeedi
- Workplace Health Promotion Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Health and Safety, and Environment (HSE), School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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16
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Meyer J, Margaritis V, Jacob M. The Impact of Water Fluoridation on Medicaid-Eligible Children and Adolescents in Alaska. JOURNAL OF PREVENTION (2022) 2022; 43:111-123. [PMID: 35048263 DOI: 10.1007/s10935-021-00656-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
Juneau, Alaska, ceased community water fluoridation (CWF) in 2007, and previous research found a substantial increase in dental caries-related procedures and treatment costs for children from low-income families in Juneau between 2003 and 2012. We collected comparable dental caries-related procedures and treatment cost data for the same years for children in Anchorage, Alaska, where CWF has been continuously maintained. This retrospective study analyzed all Medicaid dental claims records in two separate years for caries-related procedures and associated costs among children (aged 0 to 18 years) residing in Anchorage's 99502 zip code and compared these records to data from Juneau. We obtained descriptive statistics and conducted bivariate analyses and binomial logistic regression. Between 2003 and 2012, children in Anchorage experienced a nonsignificant modest decrease in the mean number of caries-related procedures and only small, statistically nonsignificant changes to the mean inflation-adjusted service costs of caries-related restorative care. The lack of significant change in child dental caries-related procedures and treatment costs in Anchorage between 2003 and 2012 contrasted with the substantial increase in caries-related procedures and treatment costs over the same period in Juneau. Our results are consistent with previous research that has demonstrated a significant protective effect of CWF against dental caries.
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Affiliation(s)
- Jennifer Meyer
- Assistant Professor of Public Health, College of Health, Division of Population Health Sciences, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, Alaska, 99508, USA.
| | - Vasileios Margaritis
- Senior Core (FT) Faculty Member, School of Health Sciences, College of Health Sciences, Walden University, 100 Washington Ave. South. Suite 900, Minneapolis, MN, 55401, USA
| | - Matt Jacob
- Jacob Strategies LLC, 2311 Connecticut Avenue NW #205, Washington, DC, 20008, USA
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17
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Murchio J, White ND. Maintaining Good Oral Health With Fluoridated Water. Am J Lifestyle Med 2022; 16:176-179. [PMID: 35370508 PMCID: PMC8971694 DOI: 10.1177/15598276211062175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Community water fluoridation (CWF) has been a public health measure against tooth decay since 1945. Strong evidence supports the use of CWF in reduction in caries risk in the pediatric population, and numerous studies also show benefit in adults. CWF remains an important contributor to oral health despite the availability and widespread use of other fluoride-containing dental products. The efficacy, safety, and optimal use of CWF will be discussed.
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Affiliation(s)
| | - Nicole D. White
- Nicole D. White, PharmD, CDCES, NBC-HWC, DipACLM, Department of Pharmacy Practice Creighton University School of Pharmacy and Health Professions, 2500 California Plaza, Omaha, NE 68178, USA.
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18
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Lin M, Griffin S, Park S, Li C, Robison V, Espinoza L. Associations between Household Water Fluoridation Status and Plain Tap or Bottled Water Consumption. JDR Clin Trans Res 2021; 6:440-447. [PMID: 32940115 PMCID: PMC8938999 DOI: 10.1177/2380084420960419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The benefits of community water fluoridation for preventing dental caries are attenuated if people do not consume tap water. OBJECTIVES We examined associations between household water fluoride content and consuming plain tap or bottled water among US youth. METHODS We used National Health and Nutrition Examination Survey data for 2013 to 2016 for 5,193 youth aged 2 to 19 y. Fluoride content in youth's household tap water samples was measured electrometrically with ion-specific electrodes and designated low (<0.6 mg/L) or about optimal (0.6 to 1.2 mg/L). Plain tap and bottled water consumption was obtained from one 24-h dietary recall. We used binomial regression models to estimate adjusted prevalence ratios (APRs) and 95% CIs for consuming plain tap water (including tap only or both tap and bottled) and consuming only bottled water as related to household water fluoride content (low or about optimal) and sociodemographic characteristics. RESULTS On a given day, 52.6% of youth consumed plain tap water (43.8% exclusively and 8.8% both tap and bottled) and 28%, only bottled water. Neither tap water (APR, 0.96; 95% CI, 0.84 to 1.10) nor only bottled water (APR, 1.03; 95% CI, 0.86 to 1.22) consumption was associated with household water fluoride content. Non-Hispanic Black youth and Hispanic youth were about 30% relatively less likely to consume tap water and 60% to 80% relatively more likely to consume only bottled water than non-Hispanic Whites. Low income, low parental education, and no past-year dental visit were associated with not consuming tap water. CONCLUSION Half of youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This study is the first to find that up to 50% of the population served by fluoridated water may not receive its full caries-preventive benefits due to not consuming plain tap water. KNOWLEDGE TRANSFER STATEMENT Half of US youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This finding suggests that up to 50% of the population served by fluoridated water systems may not receive its full caries-preventive benefits due to not consuming plain tap water. Our findings add support for the need to identify and address barriers to tap water consumption and promote health benefits of fluoridation.
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Affiliation(s)
- M. Lin
- Division of Oral Health, Centers for Disease Control and
Prevention, Atlanta, GA, USA
| | - S.O. Griffin
- Division of Oral Health, Centers for Disease Control and
Prevention, Atlanta, GA, USA
| | - S. Park
- Division of Nutrition, Physical Activity and Obesity,
Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C. Li
- Northrop Grumman Corporation, Atlanta, GA, USA
| | - V. Robison
- Division of Oral Health, Centers for Disease Control and
Prevention, Atlanta, GA, USA
| | - L. Espinoza
- Division of Oral Health, Centers for Disease Control and
Prevention, Atlanta, GA, USA
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19
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Erim D, Obadan-Udoh E, Agaku I. Cost savings from averted prescription opioidattributable dental diseases in the United States between 2013 and 2019. POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/136488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Seeking community water fluoridation information on state health department websites. PLoS One 2021; 16:e0251139. [PMID: 34015008 PMCID: PMC8136706 DOI: 10.1371/journal.pone.0251139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/20/2021] [Indexed: 11/29/2022] Open
Abstract
Community water fluoridation (CWF) is the most effective and equitable approach to preventing dental caries (tooth decay). Yet millions of Americans, especially those at highest risk of caries, do not know what CWF is or its preventive benefits. State health departments are responsible for educating their respective populations. Thus, this study assessed health department websites (N = 50) to determine if CWF content existed, the ease of finding it, and if it was written in plain language and for a consumer audience. We used the web component of the HLE2: The Health Literacy Environment of Hospitals and Health Centers (HLE2) to assess how easy or difficult it was to the navigate a website and find information. Forty-one websites had CWF information; 37 states had content written for a consumer audience. HLE2 scores ranged from 0 to 54 points (60 possible). Only five states had websites with a HLE2 score of 50 or higher. SHDs with higher HLE2 scores were easy to navigate and their content was written for a consumer audience. Study findings suggest most SHDs should improve their website’s CWF content and its accessibility to better promote the role of fluoridated water in preventing dental caries.
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21
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Cronin J, Moore S, Harding M, Whelton H, Woods N. A cost-effectiveness analysis of community water fluoridation for schoolchildren. BMC Oral Health 2021; 21:158. [PMID: 33765985 PMCID: PMC7995596 DOI: 10.1186/s12903-021-01490-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/07/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Community 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. METHODS Following 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. RESULTS In 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. CONCLUSION Despite 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.
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Affiliation(s)
- Jodi Cronin
- Centre for Policy Studies, Cork University Business School, University College Cork, Cork, Ireland.
| | - Stephen Moore
- Centre for Policy Studies, Cork University Business School, University College Cork, Cork, Ireland
| | - Máiréad Harding
- Oral Health Services Research Centre, University College Cork, Cork, Ireland
| | - Helen Whelton
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Noel Woods
- Centre for Policy Studies, Cork University Business School, University College Cork, Cork, Ireland
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22
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Mariño R, Zaror C. Economic evaluations in water-fluoridation: a scoping review. BMC Oral Health 2020; 20:115. [PMID: 32299417 PMCID: PMC7164347 DOI: 10.1186/s12903-020-01100-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Background Community water fluoridation (CWF) is considered one of the 10 greatest public health achievements of the twentieth century and has been a cornerstone strategies for the prevention and control of dental caries in many countries. However, for decision-makers the effectiveness and safety of any given intervention is not always sufficient to decide on the best option. Economic evaluations (EE) provide key information that managers weigh, alongside other evidence. This study reviews the relevant literature on EE in CWF. Methods A systematic database search up to August 2019 was carried out using MEDLINE, EMBASE, Cochrane Library, LILACS, Paediatric Economic Database Evaluation and National Health Service Economic Evaluation Database. The review included full economic evaluations on CWF programs, written in English, Spanish or Portuguese. The selection process and data extraction were carried out by two researchers independently. A qualitative synthesis of the results was performed. Results Of 498 identified articles, 24 studies met the inclusion criteria; 11 corresponded to cost-benefit analysis; nine were cost-effectiveness analyses; and four cost-utility studies. Two cost-utility studies used Disability-Adjusted Life Years,, one used Quality-Adjusted Tooth Years, and another Quality-Adjusted Life Years. EEs were conducted in eight countries. All studies concluded that water fluoridation was a cost-effective strategy when it was compared with non-fluoridated communities, independently of the perspective, time horizon or discount rate applied. Four studies adopted a lifetime time horizon. The outcome measures included caries averted (n = 14) and savings cost of dental treatment (n = 4). Most of the studies reported a caries reduction effects between 25 and 40%. Conclusion Findings indicated that CWF represents an appropriate use of communities’ resources, using a range of economic evaluation methods and in different locations. These findings provide evidence to decision-makers which they could use as an aid to deciding on resource allocation.
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Affiliation(s)
- Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Carlos Zaror
- Department of Pediatric Dentistry and Orthodontics; Faculty of Dentistry, Universidad de La Frontera, Manuel Montt #112, Temuco, Chile. .,Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.
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Effects of Community Water Fluoridation on Dental Caries Disparities in Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062020. [PMID: 32204333 PMCID: PMC7175225 DOI: 10.3390/ijerph17062020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
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.
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Souza Neto ACD, Frazão P. Princípios invocados numa política intersetorial de saúde: o caso da fluoretação da água no Brasil. SAUDE E SOCIEDADE 2020. [DOI: 10.1590/s0104-12902020190048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo foi identificar princípios invocados numa política intersetorial de saúde, tomando como caso uma proposta legislativa de revogação da fluoretação da água no Brasil apresentada em 2003. Realizou-se estudo descritivo por meio de pesquisa documental, na qual foram selecionados registros gerados na tramitação do Projeto de Lei nº 510/2003 na Câmara dos Deputados. Buscou-se destacar estratégias discursivas utilizadas pelos atores conforme o jogo de interesses e o contexto conflitivo, utilizando-se o institucionalismo histórico como referencial teórico. O Projeto de Lei tramitou 13 meses, passando pelo Plenário, por três comissões, e sendo arquivado. Três deputados de partidos distintos, órgãos do Poder Executivo federal, agências reguladoras e entidades representativas da categoria odontológica, da saúde pública/coletiva, da engenharia sanitária e das empresas de saneamento participaram diretamente do debate em que emergiram os princípios da segurança da intervenção, dos custos econômicos e do direito à saúde. Em relação às estratégias discursivas utilizadas, os principais elementos invocados no debate da política intersetorial de saúde foram o princípio da incerteza, criando-se falsas categorias científicas a fim de sobrevalorizar os efeitos desfavoráveis e sustentar a implementação de medidas individualizantes; e os princípios morais que definem diferentes tipos de bens econômicos e dimensões de liberdade associadas ao exercício de direitos.
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Griffin SO, Li CH, Espinoza L, Gooch BF. Filled dietary fluoride supplement prescriptions for Medicaid-enrolled children living in states with high and low water fluoridation coverage. J Am Dent Assoc 2019; 150:854-862. [PMID: 31474301 DOI: 10.1016/j.adaj.2019.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although dietary fluoride (F) supplements (DFS) are recommended for children who use F-deficient drinking water, no studies have examined filled DFS prescriptions across multiple states to examine the dosage consistency with current recommendations or prescription length. METHODS This sequential cross-sectional analysis used Medicaid claims data for children aged 0.5 through 16 years who in 2011 lived in the 6 states with the lowest and the highest fluoridation coverage (≤ 34% and ≥ 95% of the public water system population fluoridated, respectively). For 2011, the authors calculated the mean percentage of children with filled DFS prescriptions and the change since 2000 across states with high and low fluoridation coverage, the percentage of children with filled DFS prescriptions containing F dosage consistent with current recommendations, and filled DFS prescription length and cost across states. RESULTS In states with high fluoridation coverage, the mean percentage of children with a filled prescription was < 1% in both years; in states with low fluoridation coverage, this value increased from 0.9% to 10.3%, the highest increase (16.4 percentage points) since 2000 among children aged 0.5 through 2 years. The average prescription length was 72 days. Across states, the mean costs per child prescribed supplements and per enrollee were $17.60 and $1.05, respectively. CONCLUSIONS AND PRACTICAL IMPLICATIONS Filled prescriptions largely followed current recommendations but reached only a small percentage of children in low-coverage states. The short prescription length indicated limited exposure for caries prevention. Results from these states suggest more children could have longer exposure to the caries-preventive benefits of F at a similar cost with water fluoridation as with DFS.
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Kroon J, Lalloo R, Tadakamadla SK, Johnson NW. Dental caries experience in children of a remote Australian Indigenous community following passive and active preventive interventions. Community Dent Oral Epidemiol 2019; 47:470-476. [PMID: 31328295 PMCID: PMC6899803 DOI: 10.1111/cdoe.12486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 06/21/2019] [Accepted: 07/01/2019] [Indexed: 11/29/2022]
Abstract
Objectives To report on changes in dental caries experience in children of a remote Indigenous community following 6 years of passive preventive intervention (PPI) and 2 years of active preventive intervention (API). Methods Five consecutive cross‐sectional surveys were conducted on 4‐ to 15‐year‐old school going children between 2004 and 2017 following phases of Community Water Fluoridation (CWF), post‐cessation of CWF and API. Following treatment of any cavities present, API included selective placement of fissure sealants (FS) and an annual application of povidone‐iodine (PI) and fluoride varnish (FV). The World Health Organization's (WHO) “Oral Health Surveys – Basic Methods (4th Edition)” methodology was used in the first two and the International Caries Detection and Assessment System (ICDAS‐II) in the latter three surveys. ICDAS‐II codes of 3‐6, representing advanced caries, were combined to allow comparison to the decayed component of the DMF caries index. Results Age‐weighted mean dmft decreased by 37.7% in the deciduous (DD) and DMFT by 35% in the permanent (PD) dentitions between the pre‐ and post‐CWF surveys, followed by increases of 25% and 7.7%, respectively, between the 1‐year and 4‐year post‐CWF surveys. After 2 years of API, mean dmft decreased by 14.3% and DMFT by 7.1%. Untreated dental caries however remained a concern in the DD and PD during both phases of PPI and of API. The decline in caries experience for both dentitions following 2 years of API exceeded that for the 6‐year period of PPI. Conclusions The annual reductions in caries experience of 7.2% (DD) and 8% (PD) during the phase of API exceeded annual decreases of 4.7% (DD) and 4.6% (PD) during the phase of PPI. Due to remoteness, cost and logistics in ensuring long‐term viability of API programmes, CWF remains necessary in this type of community.
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Affiliation(s)
- Jeroen Kroon
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Santhosh K Tadakamadla
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
| | - Newell W Johnson
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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Sanders AE, Grider WB, Maas WR, Curiel JA, Slade GD. Association Between Water Fluoridation and Income-Related Dental Caries of US Children and Adolescents. JAMA Pediatr 2019; 173:288-290. [PMID: 30688985 PMCID: PMC6439886 DOI: 10.1001/jamapediatrics.2018.5086] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cohort study examines the incidence of dental caries in children and adolescents of varying income levels living in areas with vs without water fluoridation.
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Affiliation(s)
- Anne E. Sanders
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill
| | | | | | - John A. Curiel
- Odum Institute for Research in Social Science, Department of Political Science, University of North Carolina at Chapel Hill
| | - Gary D. Slade
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill
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Meyer J, Margaritis V, Mendelsohn A. Consequences of community water fluoridation cessation for Medicaid-eligible children and adolescents in Juneau, Alaska. BMC Oral Health 2018; 18:215. [PMID: 30545358 PMCID: PMC6293551 DOI: 10.1186/s12903-018-0684-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/30/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The general aim of this research was to determine whether cessation of community water fluoridation (CWF) increased oral health disparities, as measured by dental caries procedures and restoration costs for children and adolescents. METHODS The analysis was based on all Medicaid dental claims records of 0- to 18-year-old patients residing in zip code 99801 (Juneau, Alaska) during an optimal CWF year (2003, n = 853) compared to all claims for the same age group from 2012 (n = 1052), five years after cessation of CWF. A bivariate analysis (Mann-Whitney U test) of the mean number of caries procedures performed per client was conducted in the study groups under both independent CWF conditions. Furthermore, logistic regression was performed using the dependent variables of caries procedures and the cost of caries-related procedures, with adjustments for CWF group, gender, and race. RESULTS The statistically significant results included a higher mean number of caries-related procedures among 0- to 18-year-old and < 7-year-old patients in the suboptimal CWF group (2.35 vs. 2.02, p < 0.001; 2.68 vs. 2.01, p = 0.004, respectively). The mean caries-related treatment costs per patient were also significantly higher for all age groups, ranging from a 28 to 111% increase among the suboptimal CWF cohorts after adjusting for inflation. The binary logistic regression analysis results indicated a protective effect of optimal CWF for the 0- to 18-year-old and < 7-year-old age groups (OR = 0.748, 95% CI [0.62, 0.90], p = 0.002; OR = 0.699, 95% CI [0.52, 0.95], p = 0.02, respectively). Additionally, the age group that underwent the most dental caries procedures and incurred the highest caries treatment costs on average were those born after CWF cessation. CONCLUSIONS These results expand our understanding of caries epidemiology under CWF cessation conditions and reaffirm that optimal CWF exposure prevents dental decay. These findings can offer fiscal estimates of the cost burden associated with CWF cessation policies and help decision-makers advance oral health, prevent dental caries, and promote equity in oral health outcomes.
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Affiliation(s)
- Jennifer Meyer
- Health Sciences, University of Alaska Anchorage, College of Health, 3211 Providence Drive, Anchorage, AK 99508 USA
| | - Vasileios Margaritis
- Public Health Programs, School of Health Sciences, College of Health Sciences, Walden University, 100 Washington Ave. South, Suite 900, Minneapolis, MN 55401 USA
| | - Aaron Mendelsohn
- Public Health Programs, School of Health Sciences, College of Health Sciences, Walden University, 100 Washington Ave. South, Suite 900, Minneapolis, MN 55401 USA
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Abtahi M, Dobaradaran S, Jorfi S, Koolivand A, Mohebbi MR, Montazeri A, Khaloo SS, Keshmiri S, Saeedi R. Age-sex specific and sequela-specific disability-adjusted life years (DALYs) due to dental caries preventable through water fluoridation: An assessment at the national and subnational levels in Iran, 2016. ENVIRONMENTAL RESEARCH 2018; 167:372-385. [PMID: 30098524 DOI: 10.1016/j.envres.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
We assessed disability-adjusted life years (DALYs) due to dental caries preventable through water fluoridation apportioned by sex, age group, sequela, province, and community type in Iran, 2016. The burden of disease due to dental caries was extracted from the Global Burden of Disease Study 2016 (GBD 2016) and the caries preventive effect of water fluoridation was calculated using a database of fluoride levels in drinking water. All the preventable DALYs were caused by years lived with disability (YLDs) because of the non-fatal character of dental caries. DALYs and DALY rate (per 100,000 people) preventable through water fluoridation at the national level in 2016 were 14,971 (95% uncertainty interval 7348- 24,725) and 18.73 (9.19-30.93), respectively. The national population preventable fraction (PPF) of dental caries by water fluoridation was determined to be as high as 0.176 (0.141-0.189). The share of sequelae in the preventable DALYs at the national level were estimated to be 76.8% for edentulism and severe tooth loss, 21.4% for caries of permanent teeth, and 1.8% for caries of deciduous teeth. The national DALYs and DALY rate preventable through water fluoridation exhibited no difference by sex, but considerably increased by age from 110 (37-223) and 1.5 (0.5-3.1) for the age group 0-4 y to 4331 (2334-6579) and 88.9 (47.9-135.1) for the age group 65 y and older, respectively. Over 80% of the national preventable DALYs occurred in urban areas due to higher population and lower coverage of fluoridated drinking water. The highest provincial DALYs and DALY rate preventable by water fluoridation were observed in Tehran and Gilan to be 3776 (1866-6206) and 37.2 (18.6-60.8), respectively. The results indicated that water fluoridation can play a profound role in the promotion of dental public health and compensate the spatial inequality and increasing temporal trend of health losses from dental caries at the national level.
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Affiliation(s)
- Mehrnoosh Abtahi
- Department of Environmental Health Engineering, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Dobaradaran
- The Persian Gulf Marine Biotechnology Research Center, Bushehr University of Medical Sciences, Bushehr, Iran; Department of Environmental Health Engineering, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran; Systems Environmental Health, Oil, Gas and Energy Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Sahand Jorfi
- Environmental Technology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Koolivand
- Department of Environmental Health Engineering, Faculty of Health, Arak University of Medical Sciences, Arak, Iran
| | - Mohammad Reza Mohebbi
- Water Quality Control Bureau, National Water and Wastewater Engineering Company, Tehran, Iran
| | - Ahmad Montazeri
- Water Quality Control Bureau, National Water and Wastewater Engineering Company, Tehran, Iran
| | - Shokooh Sadat Khaloo
- School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, P.O. Box 16858-116, Tehran, Iran
| | - Saeed Keshmiri
- Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Reza Saeedi
- Department of Health Sciences, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Ajiboye A, Dawson D, Fox C. American Association for Dental Research Policy Statement on Community Water Fluoridation. J Dent Res 2018; 97:1293-1296. [DOI: 10.1177/0022034518797274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- A.S. Ajiboye
- American Association for Dental Research, Alexandria, VA, USA
| | - D.R. Dawson
- College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - C.H. Fox
- American Association for Dental Research, Alexandria, VA, USA
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Andiesta NS, Hamid MA, Lee K, Pau A. Dental Home Visits for Caries Prevention Among Preschool Children: Protocol for a Cost-Effectiveness Analysis on a Randomized Control Trial. JMIR Res Protoc 2018; 7:e10053. [PMID: 29875086 PMCID: PMC6010838 DOI: 10.2196/10053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2012, nearly 4000 children in Malaysia were referred to hospital pediatric dental services due to dental caries. Recent research has reported the effectiveness of dental home visits in preventing caries development in young children. Dental home visits (DHVs) are described as an ongoing relationship between the dentist and their patients, providing all aspects of a preventive oral health care program in the presence of the parents at home. OBJECTIVE The objective of this study is to evaluate the cost-effectiveness of dental home visits and oral health information, in the form of educational leaflets, in preventing new caries development in young children, compared to those receiving only educational leaflets over a period of two years. Cost-effectiveness analysis will be used to evaluate the cost-effectiveness of dental home visits. METHODS This is a collaborative project with the Oral Health Division of the Ministry of Health Malaysia. The Oral Health Division will provide access to a subsample from the National Oral Health of Preschoolers Survey which was carried out in 2015. The population of interest is children aged 5 and 6 years from kindergartens in the Selangor state of Malaysia. The study adopted a societal perspective for cost-effectiveness analysis and all types of resources that are of value to society will be included in analyzing the costs; such as cost to the patient, cost to the provider or institution, and indirect costs because of loss of productivity. RESULTS The trial has been approved by the International Medical University Malaysia's Joint Research and Ethics Committee (Project ID: IMU R157-2014 [File III - 2016]). This trial is currently recruiting participants. CONCLUSIONS The number of young children in Malaysia who have been referred to the hospital children's dentistry service for severe caries is disturbing. The cost of dental treatment in young children is high due to the severity of the caries which require an aggressive treatment, and the need for general anesthesia or sedation. This study will provide information on the cost and effectiveness of DHVs in caries prevention of young children in Malaysia. REGISTERED REPORT IDENTIFIER RR1-10.2196/10053.
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Affiliation(s)
| | - Maimunah A Hamid
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Kkc Lee
- School of Pharmacy, Monash University, Kuala Lumpur, Malaysia
| | - Allan Pau
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Shariff JA, Edelstein BL. Medicaid Meets Its Equal Access Requirement For Dental Care, But Oral Health Disparities Remain. Health Aff (Millwood) 2016; 35:2259-2267. [DOI: 10.1377/hlthaff.2016.0583] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jaffer A. Shariff
- Jaffer A. Shariff is a research associate in the Section of Population Oral Health and a periodontal resident in the Division of Periodontics, both at the College of Dental Medicine, Columbia University, in New York City
| | - Burton L. Edelstein
- Burton L. Edelstein is a senior fellow in public policy at the Children’s Dental Health Project, in Washington, D.C., and a professor of dental medicine and health policy and management at the Columbia University Medical Center
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