Using fluoridation to reduce dental surgery

Recent research has affirmed that water fluoridation programs can reduce the number of severe dental caries that children get with their initial set of teeth. A new report in JAMA Network Open looks in whether the programs can also reduce the number of pediatric dental surgery procedures performed on children who are enrolled in Medicaid.¹

Investigators used deidentified 2011 to 2012 data from Medicaid claims and enrollee files from Connecticut, Florida, Illinois, Massachusetts, and Texas. The files data included children aged 9 and younger who were enrolled in either fee-for-service or managed care plan via their state’s Medicaid program.

The researchers’ data covered 436 counties in the 5 states, for a total of 872 county-year observations. Following adjusted analysis, they found that a 10% increase in the proportion of a county’s population access to community water fluoridation was linked with lower caries-related visit prevalence (−0.45 percentage points; 95% CI, −0.59 to −0.31 percentage points; P < .001). Additionally, increased access to community water fluoridation in 10% increments was tied with reduced prevalence of dental surgery under general anesthesia (−0.39 percentage points; 95% CI, −0.67 to −0.12 percentage points; P = .006). However, this decrease was not found in an adjusted analysis (−0.23 percentage points; 95% CI, −0.49 to 0.02 percentage points; P = .07). Increased access to community water fluoridation was not linked to prevalence of exacerbations linked to diabetes (−0.0003 percentage points; 95% CI, −0.0014 to 0.0009 percentage points; P = .66) or asthma-related exacerbations (−0.02 percentage points; 95% CI, −0.10 to 0.05 percentage points; P = .53).

The researchers spoke to the possible confounding factors that could explain the link between low community low fluoridation and higher prevalence of dental surgery under general anesthesia by adjusting for dental practitioner density and other demographics. However, there were some limitations to the study. The data were only from 5 states and included neither noncontiguous states, despite both states being very low on the list of access to community water fluoridation. The sources of the data restricted how the populations used public water systems and additionally how much of the population’s water consumption was from community water fluoridation and how much was from bottled water.

The investigators concluded that increased access to community water fluoridation was linked to decreased visits because of dental caries and this could be linked to a decreased need for dental surgery.

Reference

1. Lee H, Faundez L, LoSasso A. A cross-sectional analysis of community water fluoridation and prevalence of pediatric dental surgery among medicaid enrollees. JAMA Netw Open. 2020;3(8):e205882. doi:10.1001/jamanetworkopen.2020.5882