Associations of Community Water Fluoridation with Caries Prevalence and Oral Health Inequality in Children

Abstract

This study aimed to confirm the association between the community water fluoridation (CWF) programme and dental caries prevention on permanent teeth, comparing to a control area, neighbouring population without the programme, and verifying whether the programme can reduce the socio-economic inequality related to the oral health of children in Korea. Evaluation surveys were conducted among 6-, 8-, and 11-year-old children living in Okcheon (CWF) and neighbouring Yeongdong (non-CWF, control area) towns in South Korea. Data on monthly family income, caregiver educational level, and Family Affluence Scale scores were evaluated using questionnaires that were distributed to the parents. The effectiveness of CWF in caries reduction was calculated based on the differences in decayed, missing, and filled teeth and decayed, missing, and filled tooth surfaces indices between the two towns. The data were analysed using logistic regression and univariate analysis of variance. Both 8- and 11-year-old children living in the CWF area had lower dental caries prevalence than those living in the non-CWF community. Differences in dental caries prevalence based on educational level were found in the control area but not in the CWF area. Socio-economic factor-related inequality in oral health were observed in the non-CWF community. Additionally, 8- and 11-year-old children living in the CWF area displayed lower dental caries prevalence in the pit-and-fissure and smooth surfaces than those living in the non-CWF community. These results suggest that CWF programmes are effective in the prevention of caries on permanent teeth and can reduce oral health inequalities among children. The implementation of CWF programmes should be sustained to overcome oral health inequalities due to socio-economic factors and improve children's overall oral health.

Keywords: children; community water fluoridation; dental caries; dental caries reduction; inequality; oral health; social inequalities.

Figure 1

Distribution of decayed, missing, and filled teeth (DMFT) scores based on the monthly family income. The scores were calculated from the univariate analysis of variance: ^a Covariates appearing in the model are evaluated at the following values: age = 8.58; ^b Covariates appearing in the model are evaluated at the following values: age = 8.27; ^c Covariates appearing in the model are evaluated at the following values: age = 8.66; ^d Covariates appearing in the model are evaluated at the following values: age = 8.89.

Figure 2

Distribution of decayed, missing, and filled teeth (DMFT) scores based on the householder educational levels (year). The scores were calculated from the univariate analysis of variance: ^a Covariates appearing in the model are evaluated at the following values: age = 9.93; ^b Covariates appearing in the model are evaluated at the following values: age = 8.61; ^c Covariates appearing in the model are evaluated at the following values: age = 8.40.

Figure 3

Distribution of decayed, missing, and filled teeth (DMFT) scores based on the Family Affluence Scale scores. The scores were calculated from the univariate analysis of variance: ^a Covariates appearing in the model are evaluated at the following values: age = 8.53; ^b Covariates appearing in the model are evaluated at the following values: age = 8.56; ^c Covariates appearing in the model are evaluated at the following values: age = 8.63.

Figure 4

Box plots for the decayed, missing, and filled teeth (DMFT) scores of 11-year-old children based on the Family Affluence Scale (FAS) levels.