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McLaren L, Patterson SK, Faris P, Chen G, Thawer S, Figueiredo R, Weijs C, McNeil DA, Waye A, Potestio ML. Fluoridation cessation and oral health equity: a 7-year post-cessation study of Grade 2 schoolchildren in Alberta, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:955-968. [PMID: 35799095 PMCID: PMC9663766 DOI: 10.17269/s41997-022-00654-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Community water fluoridation, because of its universal scope and passive mechanism of uptake, is one component of a multifaceted approach to promoting equity in dental health. The objective of this study was to examine social inequities in children's dental health in the Canadian cities of Calgary (fluoridation cessation in 2011) and Edmonton (still fluoridated). METHODS We analyzed data from surveys of population-based samples of Grade 2 (approx. age 7) children in Calgary in 2009/2010 (pre-cessation; n=557) and in both Calgary and Edmonton in 2013/2014 (Calgary, n=3230; Edmonton, n=2304) and 2018/2019 (Calgary, n=2649; Edmonton, n=2600) (post-cessation). We estimated associations between several socioeconomic indicators and dental caries indicators (i.e., dental caries experience [deft, DMFT] and untreated decay in two or more teeth [untreated decay]) using zero-inflated Poisson, binary logistic regression, and the concentration index of inequality. We compared those associations over time (between survey waves) and between cities at post-cessation. RESULTS Persistent social inequities in deft and untreated decay were evident; for example, having no dental insurance was significantly associated with higher odds of untreated decay across city and survey wave. In most (but not all) cases, differences between cities and survey waves were consistent with an adverse effect of fluoridation cessation on dental health inequities. For example, the association between no dental insurance and higher odds of untreated decay in Calgary was greater in 2018/2019 (later post-cessation) than in 2009/2010 (pre-cessation; odds ratio [OR] for comparison of coefficients = 1.89 [1.36-2.63], p<0.001) and 2013/2014 (early post-cessation; OR for comparison of coefficients = 1.67 [1.22-2.28], p=0.001); that same association in 2018/2019 was greater in Calgary (fluoridation cessation) than in Edmonton (still fluoridated) (OR for comparison of coefficients = 1.44 [1.03-2.02], p=0.033). CONCLUSION Social inequities in dental caries were present in both Calgary and Edmonton. Those inequities tended to be worse in Calgary where fluoridation was ceased. Our findings may be relevant to other settings where income inequality is high, dental services are costly, and dental public health infrastructure is limited.
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Affiliation(s)
- Lindsay McLaren
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB Canada
| | - Steven K. Patterson
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB Canada
| | - Peter Faris
- Data & Analytics, Alberta Health Services, Calgary, AB Canada
| | - Guanmin Chen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB Canada ,Data & Analytics, Alberta Health Services, Calgary, AB Canada
| | - Salima Thawer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB Canada ,Faculty of Education, Western University, London, ON Canada
| | - Rafael Figueiredo
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB Canada ,Provincial Oral Health Office, Provincial Population and Public Health, Alberta Health Services, Calgary, AB Canada
| | - Cynthia Weijs
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB Canada ,Department of Geography, Faculty of Arts, University of Calgary, Calgary, AB Canada
| | - Deborah A. McNeil
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB Canada ,Strategic Clinical Networks, Alberta Health Services, Calgary, AB Canada
| | - Arianna Waye
- Health Innovation & Excellence, Provincial Clinical Excellence, Alberta Health Services, Calgary, AB Canada
| | - Melissa L. Potestio
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB Canada
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Satou R, Aikawa H, Sugihara N. Risk assessment by seasonal variation of well water fluoride in Japan. FRENCH-UKRAINIAN JOURNAL OF CHEMISTRY 2020. [DOI: 10.17721/fujcv8i2p104-112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study clarified the existence of seasonal variations of Fluoride concentrations in multiple wells with different depths, and determined the appropriate time to assess chronic Fluoride toxicity considering these variations. There was up to 3.6 times more seasonal variation in F concentration at the same point. The mean F ion concentration was the lowest at 0.0766 ± 0.0197 mg/L in March, and highest at 0.2412 ± 0.0345 mg/L in December. The hazard quotients (HQ) were all < 1 at all points, and the risk of chronic Fluoride toxicity in children was low. It is necessary to carry out multiple measurements, including in periods with low rainfall, due to seasonal variations.
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Critique of the review of 'Water fluoridation for the prevention of dental caries' published by the Cochrane Collaboration in 2015. Br Dent J 2017; 220:335-40. [PMID: 27056513 DOI: 10.1038/sj.bdj.2016.257] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/09/2022]
Abstract
The Cochrane Review on water fluoridation for the prevention of dental caries was published in 2015 and attracted considerable interest and comment, especially in countries with extensive water fluoridation programmes. The Review had two objectives: (i) to evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries, and (ii) to evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis. The authors concluded, inter alia, that there was very little contemporary evidence, meeting the Review's inclusion criteria, that evaluated the effectiveness of water fluoridation for the prevention of dental caries. The purpose of this critique is to examine the conduct of the above Review, and to put it into context in the wider body of evidence regarding the effectiveness of water fluoridation. While the overall conclusion that water fluoridation is effective in caries prevention agrees with previous reviews, many important public health questions could not be answered by the Review because of the restrictive criteria used to judge adequacy of study design and risk of bias. The potential benefits of using wider criteria in order to achieve a fuller understanding of the effectiveness of water fluoridation are discussed.
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