Dental Cleaning, Community Water Fluoridation and Preterm Birth, Massachusetts: 2009-2016.

Objectives Data on the potential effect of dental cleaning and community water fluoridation (CWF) on pregnancy outcomes are scarce. While numerous studies confirm the cost-effectiveness of fluoride in preventing dental caries, the benefit of CWF during pregnancy has not been well established. Methods This cross-sectional study used data from 2009 to 2016 Massachusetts Pregnancy Risk Assessment Monitoring System and restricted to singleton live births (n = 9234, weighted response rate = 64.3%). Our exposures were: (1) dental cleaning alone during pregnancy; (2) CWF alone; and (3) dental cleaning and CWF combined (DC-CWF). Women without dental cleaning during pregnancy and CWF comprised our reference group. The outcome was preterm birth, (birth < 37 weeks gestation). This study used multivariate logistic regression modeling, controlling for maternal sociodemographic characteristics, previous medical risk and behavioral factors, and calculated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results During 2009-2016, the prevalence of preterm birth among women with a singleton live birth was 8.5% in Massachusetts. Overall, 58.7% of women had dental cleaning during pregnancy, and 63.6% lived in CWF. After adjusting for potential confounders, the associations between dental cleaning alone and preterm birth (aRR = 0.74 [95% CI 0.55-0.98]), and DC-CWF and preterm birth (aRR = 0.74 [95% CI 0.57-0.95]) were significant, while the association between CWF alone and preterm birth was not significant (aRR = 0.81 [95% CI 0.63-1.05]), compared to women without dental cleaning and CWF. Conclusions for Practice This study shows that the prevalence of preterm birth was lower among women with DC only and DC-CWF.

Trend Analysis of Studies on Water Fluoridation Related to Dental Caries in PubMed.

Water fluoridation has been cited as one of the top 10 public health achievements of the 20th century. Herein, we analyzed water fluoridation articles related to dental caries published in PubMed between 1950 and 2016 using informetrics and linguistic methods to investigate trends in the studies. To this aim, queries such as "dental caries and (water fluoridation or fluoridated water)," "dental caries and (fluoride or fluoridation)," and "dental caries" were submitted to PubMed to retrieve information about articles on water fluoridation within the area of dental caries and fluoride - their titles, abstracts, publication dates, author affiliations, and publication journals. This article information was then collected by an automatic web crawler and examined through informetrics and linguistic analyses. It was found that the number of articles concerned with water fluoridation and dental caries was 3,381 and declined over time after 1970. The articles were published by 750 journals - most notably, Community Dentistry and Oral Epidemiology and Caries Research. With regard to the geographic distribution of the authors, Europe and North America, especially the USA and UK, accounted for 59.9% of the articles published during the years 1987 to 2015, though there was a sharp increase in the number of authors in Oceania and Asia in recent years. In the titles and abstracts of the articles, "community" and "fluorosis" were mentioned more frequently than the other key terms selected in this study, regardless of the period examined. Our findings may allow one to assess how the research on water fluoridation has evolved over the past several decades.

Association between water fluoride and the level of children's intelligence: a dose-response meta-analysis.

OBJECTIVES: Higher fluoride concentrations in water have inconsistently been associated with the levels of intelligence in children. The following study summarizes the available evidence regarding the strength of association between fluoridated water and children's intelligence. STUDY DESIGN: Meta-analysis. METHODS: PubMed, Embase, and Cochrane Library databases were systematically analyzed from November 2016. Observational studies that have reported on intelligence levels in relation to high and low water fluoride contents, with 95% confidence intervals (CIs) were included. Further, the results were pooled using inverse variance methods. The correlation between water fluoride concentration and intelligence level was assessed by a dose-response meta-analysis. RESULTS: Twenty-six studies reporting data on 7258 children were included. The summary results indicated that high water fluoride exposure was associated with lower intelligence levels (standardized mean difference : -0.52; 95% CI: -0.62 to -0.42; P < 0.001). The findings from subgroup analyses were consistent with those from overall analysis. The dose-response meta-analysis suggested a significant association between water fluoride dosage and intelligence (P < 0.001), while increased water fluoride exposure was associated with reduced intelligence levels. CONCLUSIONS: Greater exposure to high levels of fluoride in water was significantly associated with reduced levels of intelligence in children. Therefore, water quality and exposure to fluoride in water should be controlled in areas with high fluoride levels in water.

Predictors of dental visits among primary school children in the rural Australian community of Lithgow.

BACKGROUND: Regular dental attendance is significant in maintaining and improving children's oral health and well-being. This study aims to determine the factors that predict and influence dental visits in primary school children residing in the rural community of Lithgow, New South Wales (NSW), Australia. METHODS: All six primary schools of Lithgow were approached to participate in a cross-sectional survey prior to implementing water fluoridation in 2014. Children aged 6-13 years (n = 667) were clinically examined for their oral health status and parents were requested to complete a questionnaire on fluoride history, diet, last dental visit, and socio-demographic characteristics. Multiple logistic regression analyses were employed to examine the independent predictors of a 6-monthly and a yearly dental visit. RESULTS: Overall, 53% of children visited a dentist within six months and 77% within twelve months. In multiple logistic regression analyses, age of the child and private health insurance coverage were significantly associated with both 6-monthly and twelve-month dental visits. In addition, each serve of chocolate consumption was significantly associated with a 27% higher odds (OR = 1.27, 95% CI: 1.05-1.54) of a 6-monthly dental visit. CONCLUSION: It is imperative that the socio-demographic and dietary factors that influence child oral health must be effectively addressed when developing the oral health promotion policies to ensure better oral health outcomes.

Exploring the short-term impact of community water fluoridation cessation on children's dental caries: a natural experiment in Alberta, Canada.

OBJECTIVES: Dental caries (tooth decay) is common and can be serious. Dental caries is preventable, and community water fluoridation is one means of prevention. There is limited current research on the implications of fluoridation cessation for children's dental caries. Our objective was to explore the short-term impact of community water fluoridation cessation on children's dental caries, by examining change in caries experience in population-based samples of schoolchildren in two Canadian cities, one that discontinued community water fluoridation and one that retained it. STUDY DESIGN: We used a pre-post cross-sectional design. METHODS: We examined dental caries indices (deft [number of decayed, extracted, or filled primary teeth] and DMFT [number of decayed, missing, or filled permanent teeth]) among grade 2 schoolchildren in 2004/05 and 2013/14 in two similar cities in the province of Alberta, Canada: Calgary (cessation of community water fluoridation in 2011) and Edmonton (still fluoridated). We compared change over time in the two cities. For Calgary only, we had a third data point from 2009/10, and we considered trends across the three points. RESULTS: We observed a worsening in primary tooth caries (deft) in Calgary and Edmonton, but changes in Edmonton were less consistent and smaller. This effect was robust to adjustment for covariates available in 2013/14 and was consistent with estimates of total fluoride intake from biomarkers from a subsample. This finding occurred despite indication that treatment activities appeared better in Calgary. The worsening was not observed for permanent teeth. For prevalence estimates only (% with >0 deft or DMFT), the three data points in Calgary suggest a trend that, though small, appears consistent with an adverse effect of fluoridation cessation. CONCLUSIONS: Our results suggest an increase in dental caries in primary teeth during a time period when community fluoridation was ceased. That we did not observe a worsening for permanent teeth in the comparative analysis could reflect the limited time since cessation. It is imperative that efforts to monitor these trends continue.

Biotechnology and Consumer Decision-Making.

Society is facing major challenges in climate change, health care and overall quality of life. Scientific advances to address these areas continue to grow, with overwhelming evidence that the application of highly tested forms of biotechnology is safe and effective. Despite scientific consensus in these areas, consumers appear reluctant to support their use. Research that helps to understand consumer decision-making and the public's resistance to biotechnologies such as vaccines, fluoridated water programs and genetically engineered food, will provide great social value. This article is forward-thinking in that it suggests that important research in behavioral decision-making, specifically affect and ambiguity, can be used to help consumers make informed choices about major applications of biotechnology. This article highlights some of the most controversial examples: vaccinations, genetically engineered food, rbST treated dairy cows, fluoridated water, and embryonic stem cell research. In many of these areas, consumers perceive the risks as high, but the experts calculate the risks as low. Four major thematic approaches are proposed to create a roadmap for policymakers to consider for policy design and implementation in controversial areas of biotechnology. This article articulates future directions for studies that implement decision-making research to allow consumers to appropriately assign risk to their options and make informed decisions.

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.

Community water fluoridation predicts increase in age-adjusted incidence and prevalence of diabetes in 22 states from 2005 and 2010.

Community water fluoridation is considered a significant public health achievement of the 20th century. In this paper, the hypothesis that added water fluoridation has contributed to diabetes incidence and prevalence in the United States was investigated. Panel data from publicly available sources were used with population-averaged models to test the associations of added and natural fluoride on the outcomes at the county level in 22 states for the years 2005 and 2010. The findings suggest that a 1 mg increase in the county mean added fluoride significantly positively predicts a 0.23 per 1,000 person increase in age-adjusted diabetes incidence (P < 0.001), and a 0.17% increase in age-adjusted diabetes prevalence percent (P < 0.001), while natural fluoride concentration is significantly protective. For counties using fluorosilicic acid as the chemical additive, both outcomes were lower: by 0.45 per 1,000 persons (P < 0.001) and 0.33% (P < 0.001), respectively. These findings are adjusted for county-level and time-varying changes in per capita tap water consumption, poverty, year, population density, age-adjusted obesity and physical inactivity, and mean number of years since water fluoridation started. Sensitivity analyses revealed robust effects for both types of fluoride. Community water fluoridation is associated with epidemiological outcomes for diabetes.

Fluoride Exposure Effects and Dental Fluorosis in Children in Mexico City.

BACKGROUND The objective of the present study was to determine the prevalence and severity of dental fluorosis and to evaluate exposure to fluoridated products in students in the southwest part of the Federal District (Mexico City). MATERIAL AND METHODS Students between 10 and 12 years of age who were born and raised in the study zone were evaluated. The level of dental fluorosis was determined using the modified Dean index (DI) using criteria recommended by the World Health Organization (WHO). A bivariate analysis was performed with the χ2 test, and odds ratios (OR) and 95% confidence intervals (CI) are presented. Logistic regression was performed to evaluate the association between dental fluorosis and the independent variables. RESULTS A total of 239 students were evaluated. Their mean age was 11±0.82 years, and there were 122 (51%) males. Overall, dental fluorosis was found in 59% of participants; 29.3% had very mild fluorosis, 20.9% had mild fluorosis, 6.7% had moderate fluorosis, and 2.1% had severe fluorosis. The mean fluorosis score was 0.887±0.956. In the final logistic regression model, dental fluorosis was significantly associated with frequency of brushing (OR: 0.444; 95% CI: 0.297-0.666) and with the absence of parental supervision (OR: 0.636; 95% CI: 0.525-0.771). CONCLUSIONS The association found with frequency of brushing and lack of parental supervision may be contributing to the prevalence and severity of dental fluorosis.

Effects of water fluoridation on caries experience in the primary dentition in a high caries risk community in Queensland, Australia.

OBJECTIVES: In December 2008, artificial water fluoridation was introduced for the first time to the Logan-Beaudesert district in the state of Queensland, Australia. The aim of this study was to evaluate the effects of water fluoridation in the primary dentition in this community after a period of 36 months. METHODS: Children aged 4-9 years with clinical examinations and bitewing radiographs (BWs) taken before water fluoridation (pre-F) were randomly selected as comparison controls for age matched children who had been exposed to a mean period of 36 months of water fluoridation (post-F). A total of 201 sets of pre-F BWs from children (mean age 6.95 ± 1.05 years) and 256 sets of post-F BWs from children (mean age 7.19 ± 1.23 years) attending schools in the district were randomly selected. Caries experience in the primary dentition was determined as decayed, missing or filled teeth/surfaces (dmft/dmfs). RESULTS: The caries prevalence for the pre-F group was 87% compared to 75% in the post-F group (Odds ratio (OR): 0.44, 95% CI: 0.27-0.72). Overall, there was a 19 percent reduction of mean dmft from 4.54 in the pre-F group to 3.66 in the post-F group (p = 0.005). After fluoridation, the dmfs was reduced from 6.68 to 5.17 (p = 0.0056). The distal surfaces of maxillary first primary molars experienced the greatest reduction (26%) in caries experience after water fluoridation (p < 0.001). CONCLUSIONS: After only 36 months of water fluoridation there was a significant drop in caries prevalence from 87 to 75% and a 19% reduction in caries experience in a community with one of the highest caries rates in Australia.

Assessing risk factors for dental caries: a statistical modeling approach.

The problem of identifying potential determinants and predictors of dental caries is of key importance in caries research and it has received considerable attention in the scientific literature. From the methodological side, a broad range of statistical models is currently available to analyze dental caries indices (DMFT, dmfs, etc.). These models have been applied in several studies to investigate the impact of different risk factors on the cumulative severity of dental caries experience. However, in most of the cases (i) these studies focus on a very specific subset of risk factors; and (ii) in the statistical modeling only few candidate models are considered and model selection is at best only marginally addressed. As a result, our understanding of the robustness of the statistical inferences with respect to the choice of the model is very limited; the richness of the set of statistical models available for analysis in only marginally exploited; and inferences could be biased due the omission of potentially important confounding variables in the model's specification. In this paper we argue that these limitations can be overcome considering a general class of candidate models and carefully exploring the model space using standard model selection criteria and measures of global fit and predictive performance of the candidate models. Strengths and limitations of the proposed approach are illustrated with a real data set. In our illustration the model space contains more than 2.6 million models, which require inferences to be adjusted for 'optimism'.

Global water fluoridation: what is holding us back?

Artificial water fluoridation was introduced more than 60 y ago as a public health intervention to control dental caries. Despite wide recommendations for its use from the World Health Organization (WHO) and studies showing the benefits of water fluoridation, many countries have opted out. Currently, only 25 countries, including the United Kingdom, the United States, and Australia have schemes for artificial water fluoridation. The issues faced in efforts to promote the global uptake of water fluoridation and the factors that affect the decision to implement it are unique in both developed and developing countries and must be explored. This article addresses the benefits and challenges of artificial water fluoridation. Further, it tackles the complexities faced with uptake of water fluoridation globally, such as ethical and political controversies and the use of alternative fluoride therapies. Potential future strategies to encourage the uptake of artificial water fluoridation are also discussed.

A 4-year assessment of a new water-fluoridation scheme in New South Wales, Australia.

OBJECTIVE: To monitor the changes in dental caries prevalence of 5- to 7-year-old children living in a fluoridated area, a newly fluoridated area and in an area without water fluoridation, in NSW, Australia. METHODS: Dental caries prevalence was recorded for 5- to 7-year-old children, living in the three study locations, by six trained and calibrated examiners in 2008, 2010 and 2012. A questionnaire recorded demographic data, toothbrushing behaviour and sugary drink consumption. Caries experience was measured using the decayed, missing, and filled teeth (dmft) index for primary teeth, the percentage of children who were caries free and the significant caries index. Univariate analysis was undertaken to determine independent predictors of caries. RESULTS: The caries prevalence changed over time. In 2008, the mean dmft index was 1.40 for the fluoridated area, 2.02 for the area about to fluoridate and 2.09 for the unfluoridated control. By 2012, these mean dmft scores were 0.69, 0.72 and 1.21, respectively. In the two areas where children received fluoridated water, the significant caries index was 2.30 for the fluoridated area and 2.40 for the newly fluoridated area. The significant caries score for children in the unfluoridated location was 3.93. Multivariate analysis showed that over time the differences in dental caries prevalence between the established fluoride area and the newly fluoridated area diminished. However, children in the unfluoridated control area continued to demonstrate significant differences in the mean number of decayed teeth compared with children in the fluoridated comparator sites, and the proportions of children free from decay were significantly higher in the fluoridated areas than in the unfluoridated area. CONCLUSION: Fluoridation of public water supplies in Gosford and Wyong offers young children better dental health than those children who do not have access to this public health measure.

The Dental Health of primary school children living in fluoridated, pre-fluoridated and non-fluoridated communities in New South Wales, Australia.

BACKGROUND: The Local Government Area of Gosford implemented a water fluoridation scheme in 2008. Therefore the opportunity was taken to record the dental health of primary school children aged 5-7 years prior to the fluoridation and compare the results with other communities in NSW with different access to fluoridated water. The aim was to compare the oral health of New South Wales (Australia)s 5-7 year olds living in fluoridated, and non- fluoridated communities. One of the areas was due to implement water fluoridation and is termed the pre-fluoridation site. METHODS: Pupils in the first year of Public and Catholic Schools in three areas of NSW were recruited. Class lists were used to draw a sample of approximately 900 per area. This number allowed for a non-response rate of up to 30 per cent and would give a sample sufficient numbers to allow statistical inferences to be drawn. Children whose parents consented received a dental examination and the clinical data was collected on mark sense cards. RESULTS: In the 3 areas the proportion of children who received a dental examination varied; 77.5% (n = 825) for the fluoridated area, 80.1% (n = 781) for the pre-fluoridated area and 55.3% (n = 523) for the non-fluoridated area. The mean dmft was 1.40 for the fluoridated area, 2.02 for the pre-fluoridated area and 2.09 for the non-fluoridated area. These differences were statistically significant (p < 0.01). Differences were also noted in the proportion of children who were caries free, 62.6% fluoridated area, 50.8% for the pre-fluoride area and 48.6% for the non-fluoride location. CONCLUSION: The children living in the well-established fluoridated area had less dental caries and a higher proportion free from disease when compared with the other two areas which were not fluoridated. Fluoridation demonstrated a clear benefit in terms of better oral health for young children.

[Dental health in 12-year-old children including initial lesions and dentine caries]. / Zahngesundheit bei 12-Jährigen unter Einbeziehung von Initialläsionen und Dentinkaries.

AIM: The aim of this study was to assess caries prevalence among 12-year-olds, including initial lesions and dentine caries (ICDAS-II criteria, Codes 0-6). METHODS: The study was conducted in 2 regions of Hesse with different group prevention programmes (in region 1 children receive regular school-based prophylaxis using fluoride varnish twice a year from 1(st)-6(th) grade, in region 2 there is no use of fluoride varnish in schools. The samples were selected by a random sampling procedure using a list of all public schools. Dental caries was recorded on surface base and the presence of sealants was recorded. Additionally, a school-based analysis was performed. Statistical analysis was performed using SPSS 17.0. To compare the mean caries scores of the subgroups, non-parametric tests were performed (α=0.05). RESULTS: 270 12-year-olds were examined in each region. Mean DF-S values were: Region 1: D1-6FS=1.61; D1+2FS=1.5; D3-6FS=0.84; D5+6FS=0.74. Region 2: D1-6FS=2.8; D1+2FS=2.3; D3-6FS=1.1; D5+6FS=0.72. In region 2 significantly more initial lesions were assessed (p=0.01, D1+2FS). The difference between the regions was not statistically significant at the level of dentine caries (p=0.531, D3-6FS and p=0.113, D5+6FS). In region 1 mean DFS values differ significantly between children with and without fissure sealants at all levels (p<0.05). The analysis for region 1 based on the type of school visited showed a significant difference of mean D1+2F-S and D1-6F-S values (p=0.01 and p=0.012, respectively). CONCLUSION: In total, the caries prevalence in both regions was low. Differences between mean DFS values were clearer when initial lesions were included. The results point out the impact of assessing initial lesions for evaluation of prevention programs.

Clinical oral health of Australia's rural children in a sample attending school dental services.

OBJECTIVE: To examine the association between children's clinical oral health status and their residential location using the latest available data (2009) and to ascertain whether poor oral health among rural children is related to being Indigenous, having less access to fluoridated water or being of lower socioeconomic status (SES), than children from urban areas. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANT: Data were collected on 74, 467 children aged 5-12 years attending school dental services in Australia (data were not available for Victoria or New South Wales). MAIN OUTCOME MEASURES: Clinical oral health was determined by the mean number of permanent teeth with untreated caries, missing and filled permanent teeth, and the mean decayed, missing and filled permanent teeth index (DMFT) of 8 to 12-year-old-children and the mean number deciduous teeth with untreated caries, missing and filled deciduous teeth, and the mean decayed, missing and filled deciduous teeth index (dmft) of 5-10-year-olds. RESULTS: The multivariable models that included coefficients on whether the child was Indigenous, from an area with fluoridated water and SES, were controlled for age and sex. The mean DMFT of 8-12-year-old children and the mean dmft of 5-10-year-old-children were significantly higher in rural areas compared with urban centres after accounting for Indigenous status, fluoridated water and SES. CONCLUSION: Children's oral health was poorer in rural areas than in major city areas.

Consistency of information on the provision of water fluoridation in Brazil.

OBJECTIVE: This study aimed to assess the consistency of data regarding the provision of fluoridation in Brazilian municipalities with water supply systems. METHODS: Official data from the National Basic Sanitation Survey and the National Information System on Sanitation for 2017 were compared. RESULTS: Out of 5,570 municipalities in Brazil, 4,546 (81.6%) had water supply systems. The agreement between data sources was 84%, with a Kappa of 0.668, indicating substantial agreement. However, the estimates of fluoridation provision exhibited an average discrepancy of 8.1 percentage points, ranging from 1.2 points in the Central-West region to 21.4 points in the Northeast region. CONCLUSION: To address these inconsistencies, it is essential to enhance information sources, ensuring more reliable data for health, sanitation authorities, and society at large.

Cross-sectional study of association between caries and fluoridated water among third-grade students in Pennsylvania.

BACKGROUND: Caries is the most common chronic disease among children. In Pennsylvania, a comprehensive oral health Basic Screening Survey and assessment of the association between caries and community water fluoridation (CWF) among children have not been conducted. METHODS: From 2021 through 2022, the first Basic Screening Survey was conducted among third-grade students in Pennsylvania. Oral health and demographic data were collected. CWF data were provided by the Pennsylvania Department of Environmental Protection. The relative risk of developing caries in association with CWF was assessed using the GENMOD procedure in SAS, Version 9.4 (SAS Institute) in this cross-sectional study. RESULTS: Caries prevalence was 59.7% among 4,120 screened students. Participation in the free or reduced lunch program and CWF were each significantly associated with risk of developing caries after adjustment for age, sex, and race and ethnicity. The risk of developing caries was 33% higher among students who participated in the free or reduced lunch program than those who did not participate (relative risk, 1.33; 95% CI, 1.24 to 1.42). Students with the highest CWF coverage had a nearly 16% lower risk of developing caries than those without CWF coverage (relative risk, 0.84; 95% CI, 0.75 to 0.94). CONCLUSIONS: CWF was significantly associated with a reduced risk of developing caries. Efforts are needed to increase CWF coverage, along with promotion of oral health education and healthy dietary habits among Pennsylvania children. PRACTICAL IMPLICATIONS: Increasing CWF coverage will reduce caries burden among Pennsylvania children. Although Pennsylvania has no state laws to regulate CWF, these findings are persuasive for local municipalities to consider expanding CWF coverage.

The effect of cessation of drinking water fluoridation on dental restorations and crowns in children aged 3-5 years in Israel - a retrospective study.

BACKGROUND: Community water fluoridation began in the 1945 as a public health measure to prevent and control caries and was implemented in Israel in 1981. Community water fluoridation reduced caries significantly, but in 2014, the Ministry of Health decided to stop Community water fluoridation in Israel. The aim of our study was to examine the effect of fluoridation cessation on the dental health of children aged 3-5, treated in "Assuta Tel Aviv" dental clinics, under general anesthesia or deep sedation. METHODS: The computerized Maccabi-Dent database provided data for this retrospective study. Records from the years 2014-2019 including treatment codes for procedures relevant to the study, the number of stainless-steel crowns and restorations of all types were examined. Kruskal-Wallis test was performed to compare the results from before and after fluoridation cessation. RESULTS: A statistically significant increase in the mean number of treatments in the years after fluoridation cessation (P < 0.05) was found. There was approximately a two-fold increase in the number of all treatments for all ages. CONCLUSION: The results of the study emphasize the advantages of water fluoridation and are further proof of the need to restore community water fluoridation in Israel.

The CATFISH study: An evaluation of a water fluoridation program in Cumbria, UK.

OBJECTIVES: The objective was to assess the effectiveness of a Water Fluoridation program on a contemporary population of children. METHODS: The study used a longitudinal prospective cohort design. In Cumbria, England, two groups of children were recruited and observed over a period of 5-6 years. The Birth Cohort consisted of families recruited from two hospitals in Cumbria where children were conceived after water fluoridation was reintroduced. The systemic and topical effects of community water fluoridation were evaluated in the Birth Cohort. The Older Cohort were approximately 5 years old and recruited from primary schools in Cumbria, shortly after water fluoridation was reintroduced. The predominantly topical effects of fluoridated water were evaluated in the Older Cohort. The primary outcome was the proportion of children with clinical evidence of caries experience in their primary (Birth Cohort) or permanent teeth (Older Cohort). Unadjusted and adjusted regression models were used for analysis. RESULTS: The final clinical examinations for the Birth Cohort involved 1444 participants (mean age 4.8 years), where 17.4% of children in the intervention group were found to have caries experience, compared to 21.4% in the control group. A beneficial effect of water fluoridation was observed adjusting for deprivation (a socioeconomic measure), sex, and age, (adjusted odds ratio 0.74 95% CI 0.55 to 0.98). The final Older Cohort clinical examinations involved 1192 participants (mean age 10.8 years) where 19.1% of children in the intervention group were found to have caries experience compared to 21.9% in the control group (adjusted odds ratio 0.80, 95% CI 0.58 to 1.09). For both the Birth Cohort and Older Cohort there was evidence of a beneficial effect on dmft/DMFT count (IRR 0.61, 95% CI 0.44, 0.86) and (IRR 0.69, 95% CI 0.52, 0.93) respectively. No conclusive proof was found to indicate that the effectiveness of water fluoridation differed across area deprivation quintiles. CONCLUSIONS: In the contemporary context of lower caries levels and widespread use of fluoride toothpaste, the impact of water fluoridation on the prevalence of caries was smaller than previous studies have reported. It is important to consider the clinical importance of the absolute reduction in caries prevalence against the use of other dental caries preventive measures.