Equity in children's dental caries before and after cessation of community water fluoridation: differential impact by dental insurance status and geographic material deprivation.

BACKGROUND: One of the main arguments made in favor of community water fluoridation is that it is equitable in its impact on dental caries (i.e., helps to offset inequities in dental caries). Although an equitable effect of fluoridation has been demonstrated in cross-sectional studies, it has not been studied in the context of cessation of community water fluoridation (CWF). The objective of this study was to compare the socio-economic patterns of children's dental caries (tooth decay) in Calgary, Canada, in 2009/10 when CWF was in place, and in 2013/14, after it had been discontinued. METHODS: We analyzed data from population-based samples of schoolchildren (grade 2) in 2009/10 and 2013/14. Data on dental caries (decayed, missing, and filled primary and permanent teeth) were gathered via open mouth exams conducted in schools by registered dental hygienists. We examined the association between dental caries and 1) presence/absence of dental insurance and 2) small area index of material deprivation, using Poisson (zero-inflated) and logistic regression, for both time points separately. For small-area material deprivation at each time point, we also computed the concentration index of inequality for each outcome variable. RESULTS: Statistically significant inequities by dental insurance status and by small area material deprivation were more apparent in 2013/14 than in 2009/10. CONCLUSIONS: Results are consistent with increasing inequities in dental caries following cessation of CWF. However, further research is needed to 1) confirm the effects in a study that includes a comparison community, and 2) explore possible alternative reasons for the findings, including changes in treatment and preventive programming.

[Evaluation of semiannual combined-treatment with fluoride-chlorhexidine varnish and toothbrushing with chlorhexidine toothpaste for 15 days every 3 months in hypercariogenic children]. / Valoración del tratamiento combinado de aplicaciones semestrales de barniz-flúor-clorhexidine y del cepillado dental por 15 días cada tres meses con la crema dental con clorhexidine en niños hipercariogénicos.

An investigation was carried out in hypercaries-producing children, who had have previously curative treatment. Twenty three children were treated with semestral applications of fluorine-chlorhexidine varnish and daily brushing for 15 days every three months, with dental creme with chlorhexidine, while 21 children were selected as control group. Four analysis of Str. mutants in saliva (Matsukubo technique) were performed to each child in both groups, during a year. It was found that children treated reduced, remarkably, the degree of infection by Str. mutans, while degree of infection did not suffer modification in those children of the control group. The final examination performed after one year showed that 15 children of the control group resulted affected by caries (71.4%) with an incidence of 27 caries (1.29 index), while in the group under treatment only a child resulted affected with a caries. Reduction found in the incidence of caries was 96.9%. Problematic of hypercaries-producing child is analyzed and it is concluded that it is necessary to control and record him, and that investment in a strict treatment, such as that successfully assayed by us, should be rentable, since it should reduce amount of extractions of teeth and to contribute in that way to a real promotion of oral health with the infantile population.