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Quantifying the diffused benefit from water fluoridation in the United States
S O Griffin1, B F Gooch, S A Lockwood
1Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. sig1@cdc.gov
Community Dentistry and Oral Epidemiology
|April 13, 2001
Summary
Water fluoridation significantly reduces tooth decay by 1.44 surfaces directly and an additional 1.09 surfaces indirectly through fluoride diffusion. This study highlights the widespread benefits of community water fluoridation.
Area of Science:
- Public Health
- Dental Research
- Epidemiology
Background:
- Water fluoridation is a key public health measure for caries prevention.
- Previous estimates may underestimate fluoridation's benefits by not accounting for fluoride diffusion.
- Fluoride can spread from fluoridated to non-fluoridated areas via food and beverage consumption.
Purpose of the Study:
- To quantify the total caries reduction attributable to water fluoridation, including indirect diffusion effects.
- To assess the impact of fluoride diffusion from bottled beverages and processed foods on caries reduction.
Main Methods:
- Analyzed data from 18,507 school children (aged 6-17) with complete fluoride exposure histories.
- Measured direct water fluoridation exposure (Lifetime Fluoridation Exposure - LFE) and diffusion exposure (DE).
- Used regression analysis to associate DMFS with Years of Fluoridation Exposure (YFE), controlling for DE and other factors.
Main Results:
- Direct water fluoridation benefit: 1.44 fewer DMFS (decayed, missing, or filled surfaces) in low DE children.
- Indirect diffusion benefit: 1.23 fewer DMFS in low LFE children due to high DE.
- Regression analysis indicated direct benefit of 1.44 fewer DMFS and indirect benefit of 1.09 fewer DMFS.
Conclusions:
- Water fluoridation provides significant direct and indirect benefits in caries reduction.
- Failure to consider fluoride diffusion can lead to underestimation of water fluoridation's total public health impact.
- The diffusion effect is particularly important in regions with high exposure to fluoridated products.
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