Water fluoridation, tooth decay in 5 year olds, and social deprivation measured by the Jarman score: analysis of data from British dental surveys

Abstract

M. Prospective relations between Helicobacter pylori infection, coronary heart disease, and stroke in middle aged men. Heart 1996;75:568-72.14 Ohmann C, Thon K, Hengels K-J, Imhof M, DÜSUK Study Group. AbstractObjective: To examine the effect of water fluoridation, both artificial and natural, on dental decay, after socioeconomic deprivation was controlled for.

The relationship between water fluoridation and socioeconomic deprivation on tooth decay in 5-year-old children

“…The results are similar to those previously reported using the Jarman scores as a proxy for deprivation and confirm that dental decay in 5-year-old children has a strong positive association with deprivation as measured by the Townsend score at an electoral ward level, regardless of fluoridation status. 22 The study areas are all in the north of England and therefore the District Townsend scores are higher than the English mean score of zero. The electoral wards in each of the three study areas covered a wide range of socioeconomic status, from very deprived wards with a score of 10 or more, to affluent wards with scores of -5 or less.…”

“…22 The first was non-fluoridated Salford and Trafford Health Authority in 1993/4. The second was fluoridated wards in Newcastle District Health Authority and eight wards in North Tyneside District Health Authority which had received consistent water fluoridation (1 mgF/litre) in 1993/4.…”

“…21 A previous study which clearly showed a differential benefit to more deprived children used Jarman scores as a measure of deprivation. 22 Jarman was designed to weight payments to general medical practitioners and has recently been introduced to weight capitation payments to dentists and is not an index of deprivation. This study also failed to take account of the unequal number of children in each ward.…”

“…30 Recent surveys show an increase in tooth decay in 5-year-olds which may reflect increasing levels of child poverty. 22 Deprivation per se does not cause tooth decay and the causes of dental decay results from an inability or unwillingness to eat or buy a non-cariogenic diet, and behavioural risk factors such as high frequency of sugar intake and not brushing with a fluoride toothpaste. 4 Even if water fluoridation was introduced more widely, we would still see a social class gradient in disease levels, though unlike many health promotion initiatives, on the evidence from this study, the 'dental' caries divide would become narrower.…”

The privatised water industry and public health: back to square one

“…3 Despite this, at present only about 10% of the population of the United Kingdom drink fluoridated water at the optimal one part per million, some where it occurs naturally, most through water treatment. Best current estimates are that for about 25% of the population water fluoridation would be cost-effective where water treatment plants serve large numbers of people with high caries rates.…”