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Community water fluoridation and health outcomes in England: a cross‐sectional study
Author(s) -
Young Nicholas,
Newton John,
Morris John,
Morris Joan,
Langford John,
Iloya Jonathan,
Edwards Diane,
Makhani Semina,
Verne Julia
Publication year - 2015
Publication title -
community dentistry and oral epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.061
H-Index - 101
eISSN - 1600-0528
pISSN - 0301-5661
DOI - 10.1111/cdoe.12180
Subject(s) - medicine , water fluoridation , confounding , environmental health , dentistry , public health , cross sectional study , population , fluoride , dental fluorosis , incidence (geometry) , demography , inorganic chemistry , chemistry , physics , nursing , pathology , sociology , optics
Background Six million people in England live in areas where the level of fluoride in water is adjusted to reduce the significant public health burden of dental caries. The dental effects of fluoride are well established, but evidence for suggested adverse health effects is limited, with a lack of rigorous small area population studies that control for confounding. This study aims to test the association between water fluoridation schemes and selected health outcomes using the best available routine data sources. Methods Ecological level exposure to fluoridated water was estimated for standard small areas and administrative districts in England using Geographical Information Systems and digitized boundaries based on known patterns of water supply. The association between fluoridation and dental and nondental health indicators was tested using multivariable regression models including ecological level confounding variables. Health indicator data were obtained from routine sources. Results There was strong evidence of lower prevalence of dental caries ( P < 0.001) among children living in fluoridated areas, they also had fewer teeth affected on average ( P < 0.001), and lower admission rates for tooth extraction (55% lower; 95% CI ‐73%, ‐27%; P = 0.001). There was no strong evidence of an association between fluoridation and hip fracture, Down syndrome, all‐cancer, all‐cause mortality or osteosarcoma. Fluoridation was negatively associated with the incidence of renal stones (7.9% lower; 95% CI ‐9.6%,‐6.2%; P < 0.001) and bladder cancer (8.0% lower; 95% CI ‐9.9%,‐6.0%; P < 0.001). Conclusion This study uses the comprehensive data sets available in England to provide reassurance that fluoridation is a safe and highly effective public health measure to reduce dental decay. Although lower rates of certain nondental outcomes were found in fluoridated areas, the ecological, observational design prohibits any conclusions being drawn regarding a protective role of fluoridation.