Area-level deprivation, childhood dental ambulatory sensitive hospitalizations and community water fluoridation: evidence from New Zealand

Abstract

Background We examined the association between area-level deprivation and dental ambulatory sensitive hospitalizations (ASH) and considered the moderating effect of community water fluoridation (CWF). The hypothesis was that higher levels of deprivation are associated with higher dental ASH rates and that CWF will moderate this association such that children living in the most deprived areas have greater health gain from CWF. Methods Dental ASH conditions (dental caries and diseases of pulp/periapical tissues), age, gender and home address identifier (meshblock) were extracted from pooled cross-sectional data (Q3, 2011 to Q2, 2017) on children aged 0–4 and 5–12 years from the National Minimum Dataset, New Zealand (NZ) Ministry of Health. CWF was obtained for 2011 and 2016 from the NZ Institute of Environmental Science and Research. Dental ASH rates for children aged 0–4 and 5–12 years (/1000) were calculated for census area units (CAUs). Multilevel negative binomial models investigated associations between area-level deprivation, dental ASH rate and moderation by CWF status. Results Relative to CWF (2011 and 2016), no CWF (2011 and 2016) was associated with increased dental ASH rates in children aged 0–4 [incidence rate ratio (IRR) = 1.171 (95% confidence interval 1.064, 1.288)] and aged 5–12 years [IRR = 1.181 (1.084, 1.286)]. An interaction between area-level deprivation and CWF showed that the association between CWF and dental ASH rates was greatest within the most deprived quintile of children aged 0–4 years [IRR = 1.316 (1.052, 1.645)]. Conclusions CWF was associated with a reduced dental ASH rate for children aged 0–4 and 5–12 years. Children living in the most deprived areas showed the greatest effect of CWF on dental ASH rates, indicating that the greater health gain from CWF occurred for those with the highest socio-economic disadvantage. Variation in CWF contributes to structural inequities in oral-health outcomes for children.

Missed opportunities for improving oral health in rural Victoria: The role of municipal public health planning in improving oral health

“…Community‐based water fluoridation is a cost‐effective and equitable initiative that is supported by overwhelming scientific evidence and internationally recognised as one of the most important public health interventions 40,41 . The provision of fluoride plays a crucial role in both preventing and reducing tooth decay 17,40,42‐45 . There is evidence that MPHWPs can be used as a platform to raise awareness of local oral health issues (like lack of water fluoridation) and to lobby for improved oral health.…”

“…40,41 The provision of fluoride plays a crucial role in both preventing and reducing tooth decay. 17,40,[42][43][44][45] There is evidence that MPHWPs can be used as a platform to raise aware- LGs to include oral health within their plans, 2,12,[14][15][16][17]20 oral health remains a low priority for LG action. 31,47 Understanding the causal pathways between determinants, common risk factors and health outcomes (including oral health) enable identification of ways of preventing disease and promoting good health.…”

Prevalence of Dental Caries Among Costa Rican Male Students Aged 12-22 Years Using ICDAS-II

“…In our study, the activity of dental caries was only evaluated at the initial stages, demonstrating that carious lesions can often become inactive and stop its advance. This indicates that oral health education and access to topical and community fluoridations (39), are essential to intervene in the natural progress of the disease avoiding severe stages (40).…”

Pandemics and emergent digital inequalities

“…However, COVID‐19 has exploited apathy in addressing long‐standing health inequalities and likely will continue to do so (Paremoer, Nandi, Serag, & Baum, 2021). In addition to socio‐economic and demographic factors, there are also well‐known geographical inequalities in NZ with respect to health outcomes (Campbell, Apparicio, & Day, 2014; Hobbs et al, 2020); access to health‐promoting or damaging features in the environment, such as green spaces or alcohol outlets, respectively (Marek, Hobbs, Wiki, Kingham, & Campbell, 2021; Wiki, Kingham, & Campbell, 2019); and access to vaccines (Marek et al, 2020; Whitehead, Scott, Atatoa Carr, & Lawrenson, 2021).…”