Effectiveness of water fluoridation in an upper‐middle‐income country: A systematic review and meta‐analysis

Abstract

Aim To summarize the information on the effectiveness of community water fluoridation (CWF) on the reduction of dental caries in the context of the wide use of fluoridated toothpaste in Brazil. Design A systematic review was conducted regarding the effect of CWF based on studies with Brazilian population groups using the following electronic databases: MEDLINE/PubMed, LILACS, SciELO, and SCOPUS. The literature search was conducted up to August 2019. Studies that compared caries experience in at least two areas, one fluoridated and the other non‐fluoridated, by mean dmft/DMFT (decayed, missing, and filled teeth) index or caries prevalence (caries vs. caries‐free) were included. Considering the beginning of widespread use of fluoride dentifrice and the time for producing dental caries decline, studies published before 1995 were excluded. Descriptive analysis and meta‐analyses were carried out. The effect size was measured by mean difference for dmft and DMFT ± SD and odds ratios on a logarithmic scale for caries prevalence. Results Of the 574 studies retrieved, 16 and 10 were included in the qualitative and quantitative analysis, respectively. Fluoridated areas exhibited lower mean dmft/DMFT than non‐fluoridated areas did. The mean difference in the dmft between non‐fluoridated and fluoridated areas was −2.28 (95% CI −3.26; −1.30) for children aged 5–8 years and −1.12 (95% CI −1.93; −0.32) for those aged 3–12 years; the mean difference in the DMFT was −0.61 (95% CI −0.80; −0.42) for the children aged between 7 and 12 years. The caries prevalence was 1.4 times and 57% lower, respectively, at primary and permanent dentition in fluoridated areas. Heterogeneity was observed in all age groups, ranging from 77.6% to 98.2%. Conclusion Community water fluoridation remains effective in preventing dental caries in children younger than 13 years, even with the widespread use of fluoridated toothpaste.

New Method of Avoiding Underestimation of Caries Incidence and Its Association with Possible Risk Factors in Japanese University Students: A Prospective Cohort Study

“…On the other hand, the findings in the present study suggest that it is important to prevent dental caries in students before they enter university. Dentists and healthcare providers should continue to provide and also expand public health methodology for dental caries prevention, including supervised regular use of fluoride mouth rinses [29] and water fluoridation [30].…”

The Use of Fluorides in Public Health: 65 Years of History and Challenges from Brazil

“…Thus, it would be plausible to investigate the reason why fluoridation provisions did not reach more municipalities, given that the cost of the measure was reduced when a water treatment and supply structure existed and that the efficiency of the service was not affected [ 76 , 77 ]. Moreover, it has proven to be effective even with the widespread use of fluoridated toothpaste [ 78 ]. A study based on the theory of street-level bureaucracy investigated small towns in a high-coverage region of the country.…”

Fluoride Concentration in Tap Water from Different Regions in Thailand

“…In permanent dentition, water fluoridation can also reduce caries prevalence. However, the systematic review and meta-analysis indicated that water fluoridation had a higher impact on caries prevention in the primary dentition 8 . The lack of water fluoridation is associated with the increase in severity and prevalence of dental caries 7 .…”