Effectiveness of water fluoridation in the prevention of dental caries across adult age groups

Abstract

Access to FW was associated with caries experience in Australian adults. The magnitude of associations varied between age groups, dependent on the natural history of caries and its measurement by DMFS.

How effective and cost-effective is water fluoridation for adults?

“…Several more recent studies from the US (17,18) and Australia (14,(19)(20)(21)(22)(23) have taken a natural experiment approach to studying the effect of water fluoridation in adults. Exposure to the intervention has been allocated in a non-random way, for example by the participant living in fluoridated regions for a varying percentage of their life times, (14,(19)(20)(21)(22)(23) or by varied start dates and coverage of water fluoridation programmes. (17,18) Information on place of residence and dental outcomes has been collected using cross-sectional or longitudinal surveys.…”

“…(17,18) Information on place of residence and dental outcomes has been collected using cross-sectional or longitudinal surveys. (14,(19)(20)(21)(22)(23) A limitation of several of these studies is that they evaluate effects on a highly selective population, (17,19,20) experience substantial loss to follow-up, (23) or exclude large numbers of participants due to incomplete information on residential history. (14,21,22) Only one US study included information on dental treatment costs, and this was not relevant to the UK context because of the US health insurance system.…”

“…(14,(19)(20)(21)(22)(23) A limitation of several of these studies is that they evaluate effects on a highly selective population, (17,19,20) experience substantial loss to follow-up, (23) or exclude large numbers of participants due to incomplete information on residential history. (14,21,22) Only one US study included information on dental treatment costs, and this was not relevant to the UK context because of the US health insurance system. (17) Additionally, as with many of the other studies, there was no consideration of factors which may be linked to both area of residence and tooth decay outcomes such as socio-economic status, ethnicity, sex, and frequency of dental attendance.…”

“…The proposed study has been designed to meet the needs of decision -makers by taking a pragmatic, natural experiment approach but avoiding the pitfalls of the previous studies by using readily available routine data held by the NHS Business Services Authority (NHS BSA), in the form of dental records. (14,(17)(18)(19)(20)(21)(22)(23) Individual exposure to water fluoridation will be identified by reference to home postcode held in the dental records. Using routine data has several advantages over designs using clinical examinations to assess outcomes.…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…However, it is too early to recommend certain clinical strategies, and clinicians should adopt their carious tissue removal strategy according to tooth type and, more importantly, the depth of the lesion. 397 Silver diamine fluoride Fluoride has demonstrated anticaries effects in primary dentition in many in vivo and in vitro studies, and its cariostatic potential carried in various media such as fluoride varnishes, 296,398,399 tap water, 400,401 gels, dentifrices, [402][403][404] and mouthrinses 405 has been proven for decades. However, fluoride has a dose-response relationship, and improper delivery of fluoride agents may lead to adverse effects such as fluorosis, which may adversely affect quality of life, even when delivered through fluoridated water.…”