Area-level deprivation, childhood dental ambulatory sensitive hospitalizations and community water fluoridation: evidence from New Zealand.

BACKGROUND: We examined the association between area-level deprivation and dental ambulatory sensitive hospitalizations (ASH) and considered the moderating effect of community water fluoridation (CWF). The hypothesis was that higher levels of deprivation are associated with higher dental ASH rates and that CWF will moderate this association such that children living in the most deprived areas have greater health gain from CWF. METHODS: Dental ASH conditions (dental caries and diseases of pulp/periapical tissues), age, gender and home address identifier (meshblock) were extracted from pooled cross-sectional data (Q3, 2011 to Q2, 2017) on children aged 0-4 and 5-12 years from the National Minimum Dataset, New Zealand (NZ) Ministry of Health. CWF was obtained for 2011 and 2016 from the NZ Institute of Environmental Science and Research. Dental ASH rates for children aged 0-4 and 5-12 years (/1000) were calculated for census area units (CAUs). Multilevel negative binomial models investigated associations between area-level deprivation, dental ASH rate and moderation by CWF status. RESULTS: Relative to CWF (2011 and 2016), no CWF (2011 and 2016) was associated with increased dental ASH rates in children aged 0-4 [incidence rate ratio (IRR) = 1.171 (95% confidence interval 1.064, 1.288)] and aged 5-12 years [IRR = 1.181 (1.084, 1.286)]. An interaction between area-level deprivation and CWF showed that the association between CWF and dental ASH rates was greatest within the most deprived quintile of children aged 0-4 years [IRR = 1.316 (1.052, 1.645)]. CONCLUSIONS: CWF was associated with a reduced dental ASH rate for children aged 0-4 and 5-12 years. Children living in the most deprived areas showed the greatest effect of CWF on dental ASH rates, indicating that the greater health gain from CWF occurred for those with the highest socio-economic disadvantage. Variation in CWF contributes to structural inequities in oral-health outcomes for children.

Investigating the prevalence of non-fluoride toothpaste use in adults and children using nationally representative data from New Zealand: a cross-sectional study.

Introduction Despite improvements in oral health outcomes in New Zealand over the last number of decades, there are still high levels of preventable tooth decay in adults and children. We investigate the prevalence and spatial variation of non-fluoride toothpaste use in a nationally representative sample of adults and children in New Zealand.Method Individual-level self-reported data were sourced from the New Zealand Health Survey (2017/18). Both child (n = 4,723) and adult (n = 13,869) data were used. Data included sociodemographic (for example, age), socioeconomic (for example, area-level deprivation) and dental-related (for example, type of toothpaste used) variables.Results Overall, 6.8% of adults and 6.4% of children use non-fluoride toothpaste. When split by deprivation, the highest prevalence of non-fluoride toothpaste use for children and adults was in the moderate to least deprived areas, while the lowest prevalence was in the most deprived areas. When disaggregated by ethnicity, the Asian population had the highest prevalence of non-fluoride toothpaste use for both adults and children compared to Maori, Pacific and European/Other. There was little difference in prevalence by rural/urban classification; however, prevalence varied geographically across the study area.Conclusion This is the first study that uses a nationally representative sample of adults and children to show variation in the use of non-fluoride toothpaste in New Zealand.