IADR Abstract Archives
Water Fluoridation for Prevention of Caries: a Cochrane Systematic Review
Objectives: Dental caries is a major public health problem affecting populations globally. Community water fluoridation (CWF) is currently practised in about 25 countries around the world. This is an update of the 2015 Cochrane Review which aimed to evaluate the effects of initiation or cessation of CWF programmes for the prevention of dental caries.
Methods: A comprehensive search was conducted to August 2023. We included populations of all ages. Prospective controlled studies comparing populations receiving fluoridated water with those receiving non-fluoridated water were included. Measurement of caries needed to be within three years of change in fluoridation status and at follow-up. We stratified the results of the meta-analyses according to whether data were collected after the widespread use of fluoride toothpaste (after 1975) or 1975 and earlier.
Results: We included 21 studies of the initiation of water fluoridation and 1 study of cessation. Using contemporary evidence, we found low-certainty evidence that initiation of CWF may lead to a slightly greater change (reduction) in dmft (MD 0.24, 95% CI -0.03 to 0.52, P=0.09; 2 studies, 2908 children). It may also lead to a slightly greater change (increase) in the proportion of caries-free children with deciduous dentition (MD -0.04, 95% CI -0.09 to 0.01; P=0.12; 2 studies, 2908 children), and permanent dentition (MD -0.03 95% CI -0.07 to 0.01; P=0.14; 2 studies, 2368 children); these low-certainty findings were in favour of CWF. These effect estimates include the possibility of benefit and no benefit.
Conclusions: Contemporary studies indicate initiation of CWF may lead to a slightly greater reduction in dmft and may lead to a slightly greater increase in proportion of caries-free children. There is insufficient evidence to determine the effect of CWF cessation on caries and whether water fluoridation results in a change in disparities in caries according to socio-economic status.
Methods: A comprehensive search was conducted to August 2023. We included populations of all ages. Prospective controlled studies comparing populations receiving fluoridated water with those receiving non-fluoridated water were included. Measurement of caries needed to be within three years of change in fluoridation status and at follow-up. We stratified the results of the meta-analyses according to whether data were collected after the widespread use of fluoride toothpaste (after 1975) or 1975 and earlier.
Results: We included 21 studies of the initiation of water fluoridation and 1 study of cessation. Using contemporary evidence, we found low-certainty evidence that initiation of CWF may lead to a slightly greater change (reduction) in dmft (MD 0.24, 95% CI -0.03 to 0.52, P=0.09; 2 studies, 2908 children). It may also lead to a slightly greater change (increase) in the proportion of caries-free children with deciduous dentition (MD -0.04, 95% CI -0.09 to 0.01; P=0.12; 2 studies, 2908 children), and permanent dentition (MD -0.03 95% CI -0.07 to 0.01; P=0.14; 2 studies, 2368 children); these low-certainty findings were in favour of CWF. These effect estimates include the possibility of benefit and no benefit.
Conclusions: Contemporary studies indicate initiation of CWF may lead to a slightly greater reduction in dmft and may lead to a slightly greater increase in proportion of caries-free children. There is insufficient evidence to determine the effect of CWF cessation on caries and whether water fluoridation results in a change in disparities in caries according to socio-economic status.