Fluoride And Caring for Children’s Teeth (FACCT): Clinical Fieldwork Protocol

James, P. M. C.; Harding, Máiréad; Beecher, Darragh; Parnell, C. J.; Browne, Deirdre; Tuohy, Marie; Kavanagh, Dympna; O'Mullane, D; Guiney, Helena; Cronin, Michael; Whelton, Helen

doi:10.12688/hrbopenres.12799.1

Cited by 7 publications

(25 citation statements)

References 13 publications

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“…This cost-effectiveness analysis, guided by methodologies applied in previous analyses [21-24, 30, 32], and using epidemiological data from a representative sample of 5-, 8-, and 12-year-old schoolchildren collected in FACCT [31], compared the incremental costs and consequences associated with exposure to the CWF intervention compared to no CWF exposure for this cohort living in Ireland in 2017. The incremental costeffectiveness ratio (ICER) of CWF was re-calculated to include the potential savings associated with the reduced need for dental treatment.…”

Section: Methodsmentioning

confidence: 99%

“…It is therefore appropriate that an evaluation is performed to understand whether the continued investment of finite public resources is justified under these altered circumstances. This research was conducted as a component of the Fluoridation and Caring for Children's Teeth (FACCT) study [31]. The primary aim of FACCT was a valuation of health outcomes in schoolchildren following the reduction in the level of fluoride in the PWS [31].…”

mentioning

confidence: 99%

“…This research was conducted as a component of the Fluoridation and Caring for Children's Teeth (FACCT) study [31]. The primary aim of FACCT was a valuation of health outcomes in schoolchildren following the reduction in the level of fluoride in the PWS [31].…”

mentioning

confidence: 99%

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A cost-effectiveness analysis of community water fluoridation for schoolchildren

et al. 2021

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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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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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A cost-effectiveness analysis of community water fluoridation for schoolchildren

et al. 2021

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“…Eight-year-olds in 2017 were participants in a longitudinal study that commenced in 2014 (FACCT phase 1) when they were 5-y-olds (first year of primary school). The methods of the FACCT study and the 2002 survey were previously reported (Whelton et al 2006; James et al 2018). As domestic water supplies throughout urban Dublin are fluoridated, no concurrent control group was available in Dublin.…”

Section: Methodsmentioning

confidence: 99%

“…The same experienced benchmark examiner (HW), supported by assistant benchmark examiners, trained and calibrated different groups of examiners in 2002 and 2017 (Appendix Table 1). Methods for measuring caries and fluorosis were identical in 2002 and 2017 as described previously (James et al 2018). Teeth were not dried for either examination.…”

Section: Measurement Of Dental Caries and Fluorosismentioning

confidence: 99%

Impact of Reducing Water Fluoride on Dental Caries and Fluorosis

et al. 2020

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Guidance intended to reduce fluoride toothpaste ingestion in early childhood was introduced in Ireland in 2002. In 2007, water fluoride concentration was adjusted from 0.8–1.0 to 0.6–0.8 ppm. The objective of this study was to determine the difference in caries and fluorosis levels following introduction of these 2 policy measures. A before-and-after study compared caries and fluorosis in random samples of 8-y-olds in Dublin ( n = 707) and Cork-Kerry ( n = 1148) in 2017 with 8-y-olds in Dublin ( n = 679) and Cork-Kerry ( n = 565) in 2002. Dentinal caries experience (primary teeth, d3vcmft(cde)) and fluorosis (permanent teeth, Dean’s index of very mild or higher) were clinically measured. Lifetime exposure to community water fluoridation (CWF) was classified as “full CWF”/“no CWF.” Effect of examination year on caries prevalence and severity and fluorosis prevalence was assessed using multivariate regression adjusting for other explanatory variables. There was little change in commencement of fluoride toothpaste use at ≤24 mo following introduction of toothbrushing guidance. Among children with full CWF, there was no statistically significant difference in caries prevalence or severity between 2017 and 2002. In 2017, caries prevalence was 55% in Dublin (full CWF) and 56% in Cork-Kerry (full CWF), and mean d3vcmft(cde) among children with caries was 3.4 and 3.7, respectively. Caries severity was less in 2017 (mean 4.2) than 2002 (mean 4.9) among children with no CWF ( P = 0.039). The difference in caries severity between children with full CWF and no CWF was less in 2017 than in 2002 (interaction P = 0.013), suggesting a reduced benefit for CWF in 2017. In 2017, fluorosis prevalence was 18% in Dublin (full CWF) and 12% in Cork-Kerry (full CWF). Fluorosis was predominantly “very mild” with no statistically significant difference between 2017 and 2002. CWF at 0.6 to 0.8 ppm is an effective caries-preventive measure. Results suggested low uptake of toothbrushing guidance, a reduced caries-preventive effect for CWF in primary teeth, and no reduction in fluorosis following introduction of the policy measures.

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