Water Fluoridation Has Topical Effect in Preventing Caries in Adults

Take-Home Pearl: The caries-preventive effects of water fluoridation are at least as great in adults born before widespread implementation of fluoridation as after such implementation.

Article Reviewed: Slade GD, Sanders AE, et al. Effects of Fluoridated Drinking Water on Dental Caries in Australian Adults. J Dent Res 2013;92 (April): 376-382.

Objective: To investigate the relationship of water fluoridation with dental caries in adults.

Methods: The 2004-2006 Australian National Survey of Adult Oral Health (NSAOH) examined 5505 randomly selected adults (adults who are 15 and older) from all parts of the country. Thirty trained dentist examiners evaluated all teeth in each patient using mirrors and compressed air but not explorers or radiographs. Dental caries, based on visual evidence of enamel cavitation or carious dentin, were classified on all 5 surfaces of each tooth. A tooth was classified as filled if it had been restored because of caries. Examiners, therefore, recorded decayed, missing, filled teeth (DMF-Teeth) and decayed and filled tooth surfaced(DF-Surfaces). By questionnaire, subjects were asked to indicate their residential location history from 1964 to 2003. Prior to 1964, only a few small towns had fluoridated water. Subjects were also asked about their use of fluoride supplementsa nd frequency of toothbrushing. A database of water fluoride concentrations in nearly 100% of the country was used, along with the patient's age and years in a specific location, to calculate the proportion of their lifetime exposed to the equivalent of 1 ppm fluoride in drinking water (which the authhors termed "fluoridation exposure").

Results: In the fully adjusted statical model, subjects with more than 75%  of lifetime exposure to fluoridation, relative to those with less than 25 % of lifetime exposure, had 10% to 11% fewer DMF-Teeth. Reductions in DF-Surfaces were 21% to 30%, depending on age of the cohort.

Conclusions: The caries-preventive effects of water fluoridation were at least as great in adults born before widespread implementation of fluoridation as after such implementation.

Reviewer's Comments: This study has been reported not only in the dental literature, but also in the popular press. You would have to be a trained statistician to understand the details of how the data were processed and analyzed. However, the results and implications are clear. First, there was an inverse relationship between water fluoridation and caries experience. that part is not particularly surprising, but something else is. The effects of water fluoridation was evident not only in subjects who were exposed to it throughout their lives (including tooth development), but also in those who were exposed only as adults. In other words, water fluoridation had a topical effect in preventing caries.

Reviewer: Edward J. Swift, Jr, DMD, MS

E-Mail: gary_slade@dentistry.unc.edu

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