Fluoridated water impact on tooth decay and fluorosis in 17–20‐year‐olds exposed to fluoride toothpaste

Abstract

Objective To determine the impact of water fluoridation on the prevalence and severity of dental caries and fluorosis in individuals aged 17–20 years exposed to fluoride toothpaste. Methods The study population consisted of 660 students from public schools, residents of areas supplied with fluoridated water (exposed group) or not (not exposed group). Students from both groups had access to fluoride toothpaste throughout life. A questionnaire about socioeconomic demographic aspects, conditions related to access and exposure to fluoridated water, and habits related to oral health was applied. Dental caries was measured by the DMFT index and dental fluorosis by the TF index. The chi‐square test, t test, and subsequently logistic regression were applied for data analysis. Results Caries experience (DMFT≠0) was significantly higher in students from areas not exposed to fluoridated water, after adjustments to clinical conditions, demographic socioeconomic profile, and hygiene habits. The DMFT mean (±SD) was significantly higher in students from areas not exposed to fluoridated water than exposed (3.83 [±3.28] and 2.48 [±2.71] respectively). The prevalence of very mild/mild and moderate fluorosis was 41.1% and 21% for students either exposed to fluoridated water or not, respectively. Conclusion Exposure to fluoridated water was associated with a lower prevalence and severity of tooth decay, in spite of the use of fluoridated toothpaste. The prevalence of dental fluorosis at all levels was higher in fluoridated areas, however, in both groups, there were few cases with esthetic implications.

Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation

“…The identified studies were published between 2009 and 2022. The majority were carried out in Brazil 59,61,64,[67][68][69]73,74 and Australia. 57,58,60,63,65,66 All of the studies were of cross-sectional or ecological design.…”

“…Most of the Brazilian studies were secondary analyses from the 2003 59,61 and 2010 67,68,73 SB Brazil national surveys of oral health, while two were the same cohort of participants at different time points 64,69 and one was a school-based sample. 74 Four of the Australian studies were secondary analyses of the Australian National Survey of Adult Oral Health (ANSAOH) 2004-6, 57,60,63,66 while one examined young offenders 58 and one was an opportunistic follow-up of a childhood study sample. 65 Three of the studies utilised dental service data from South Korea, 71 the USA 75 and Sweden.…”

“…70 One study included Canadian Army recruits, 76 and one was a secondary analysis of data from the telephone-based US Behavioural Risk Factors Survey 1995-9. 62 The outcomes assessed included self-reported number of lost teeth, 62,69 clinically examined number of lost teeth, 59,61,68,73 clinically examined prevalence and severity of decay (DMFT/S) 57,60,[63][64][65][66][67]74,76 and dental visits and/or treatments received. 70,71,75 All of the Brazilian studies reported that greater exposure to water fluoridation resulted in improved oral health, and the size of the differences between fluoridated and sub/non-optimally fluoridated groups was relatively large in comparison to the studies from Australia or the USA.…”

“…Most of the studies identified conducted multivariable analysis with consideration of confounders including a minimum of age, sex and socioeconomic status; only two studies did not. 75,76 However, much of the recent evidence comes from contexts which are not comparable to the UK and may have higher levels of dental disease and unmet treatment needs, including those studies conducted in Brazil 59,61,64,[67][68][69]73,74 and those with specific population subgroups such as young offenders or Army recruits. 58,76 The studies which are most applicable to the UK general population (i.e.…”

Deterministic and probabilistic human health risk assessment for fluorides in drinking groundwater from Lukavac, Bosnia and Herzegovina

“…Also, their widespread use as insecticides and rodenticides lasts for decades [11][12][13]. Although fluorides are essential in preventing dental decay [14][15][16][17], rising health concerns are accounted for by increased groundwater pollution and the intensive fluoridation of drinking water.…”