Modelling the potential impact of water fluoridation on dental caries in Scotland: a pilot study

Introduction Dental caries remains a significant public health issue in Scotland. While the Childsmile programme has improved children's oral health, recent data suggest that improvement has plateaued and inequalities persist. Despite strong evidence for its effectiveness, there are currently no active water fluoridation schemes in Scotland.Aim To estimate the potential impact of water fluoridation on dental caries among Scottish children using data from the National Dental Inspection Programme (NDIP) and published effect sizes, with a focus on socioeconomic variation.Design Descriptive, estimation-based quantitative analysis.Setting Scotland.Materials and methods Data were obtained from the 2023 and 2024 NDIP reports. Effect sizes were sourced from the 2024 Cochrane Review. Predicted post-fluoridation values were calculated by subtracting effect sizes from baseline dmft/DMFT (decayed, missing, and filled primary and permanent teeth) values and caries-free proportions. R software was used for data processing, calculations, and visualisation.Results Overall mean dmft/DMFT were reduced, and caries-free proportions were increased among Primary 1 and Primary 7 children. All Scottish Index of Multiple Deprivation quintiles showed predicted improvements in dental caries outcomes across both age groups. Greater absolute improvements were seen in the least deprived groups.Discussion Estimates suggest a beneficial effect; although, the use of a uniform effect size may underestimate reductions in high caries risk groups.Conclusion Reintroduction of water fluoridation could offer important public health benefits. Future studies should include socioeconomic status-specific effect sizes to improve accuracy of modelling socioeconomic impacts.