Critique of the review of 'Water fluoridation for the prevention of dental caries' published by the Cochrane Collaboration in 2015.

The Cochrane Review on water fluoridation for the prevention of dental caries was published in 2015 and attracted considerable interest and comment, especially in countries with extensive water fluoridation programmes. The Review had two objectives: (i) to evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries, and (ii) to evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis. The authors concluded, inter alia, that there was very little contemporary evidence, meeting the Review's inclusion criteria, that evaluated the effectiveness of water fluoridation for the prevention of dental caries. The purpose of this critique is to examine the conduct of the above Review, and to put it into context in the wider body of evidence regarding the effectiveness of water fluoridation. While the overall conclusion that water fluoridation is effective in caries prevention agrees with previous reviews, many important public health questions could not be answered by the Review because of the restrictive criteria used to judge adequacy of study design and risk of bias. The potential benefits of using wider criteria in order to achieve a fuller understanding of the effectiveness of water fluoridation are discussed.

Predetermination as a cost-containment mechanism in a social allowances dental program in Manitoba.

OBJECTIVES: A review of dental consultant actions during predetermination of benefits in the publicly insured indemnity program in Manitoba under which Social Allowances Health Services certificate holders receive dental care was undertaken to determine the value of this process as a cost-containment mechanism. METHODS: Dollar amounts of services denied by a dental consultant during eight predetermination sessions selected to represent the 96 sessions during the 1990-91 fiscal year were determined and grouped according to category of service. RESULTS: Approximately one-third of average total expenditures each month were reviewed by the dental consultant through the predetermination process. Of the requested dollar amount reviewed, 26 percent was denied, a savings of 8.5 percent of average total monthly expenditures. The categories of services that made up the denied requests were: prosthodontics (30%); endodontics (32%); restorative (5%); periodontics (12%); and miscellaneous (21%), including diagnostic, surgical, preventive, orthodontic, and adjunctive. CONCLUSIONS: A properly administered predetermination process can save a third party 8.5 percent of total plan expenditures; dollar changes to altered treatment plans amount to a 26 percent reduction of expenditures relating to these requests. A predetermination process with an unbiased appeal mechanism provides a system to advise and protect providers regarding what treatment is covered.

A fissure sealant pilot project in a third party insurance program in Manitoba.

The Manitoba Children's Dental Program provides children living in rural Manitoba with provincially-subsidized dental services through private dental offices and school-based clinics. In 1989, the Manitoba government funded a fissure sealant pilot project for an initial period of two years. The first and second molar teeth of high-risk children were targeted for the study. Light-cured Fluoroshield pit and fissure sealant and Max Curing Lites were provided by L.D. Caulk for the sealant trial. After two years, evaluation focused on three specific areas: a) retention rates; b) was there a trend toward decreased treatment requirements?; and c) were sealants a cost-effective measure in preventing dental disease? A total of 1,631 children received fissure sealants during the study. The majority of these sealants, 62.5 per cent, were placed on six-year molars, while the remainder, 37.4 per cent, were placed on 12-year molars. One hundred children were recalled for clinical evaluation. Retention rates averaged as follows: 85 per cent completely present, 13 per cent partially present and two per cent failed. Children in the sample area experienced a decrease in their need for one- and two-surface restorations that was almost double the decrease experienced by children in the equivalent control group (18.5 per cent need decrease in the sample area versus a 10.9 per cent need decrease in the control group over the two years of the study).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the dental health status of six-year-old children in Manitoba.

The caries rates of six-year-old Manitoba children from a non-fluoridated Northern community were compared with those of a representative group of southern Manitoba children from non-fluoridated areas. All of the surveyed children became eligible for dental treatment coverage under Manitoba Health's Children's Dental Program approximately two months prior to the survey. Access to dental care was equivalent for all children. Screening (data collection) was completed by Manitoba Dental Health staff and was based on standard World Health Organization (WHO) criteria. The initial assessment of the data indicated that the Northern Manitoba children experienced an average of 82 per cent more decay per child than the southern group. Caries treatment requirements in the north were 59 per cent greater than in the south. The southern Manitoba children were almost twice as likely to be caries free than the Northern children. Closer examination of the Northern data, based on a socioeconomic delineation, indicated that the Northern middle- to high-income group experienced 24 per cent more decay per child than the southern group. The Northern middle- to low-income group experienced 124 per cent more decay per child than the southern group. In this study, it was demonstrated that although increased dental caries experience was closely related to geographic location, socioeconomic factors may play an even greater role in dental caries experience.