Researchers from Trinity College Dublin, in collaboration with University College London, have demonstrated for the first time the low environmental impact of water fluoridation compared to other preventive measures against tooth decay.
The study was published in the British Dental Journal.
Water fluoridation: an important public health intervention
Water fluoridation is considered one of the most significant public health interventions of the twentieth century. But as the climate crisis worsens, we need to consider the contribution of healthcare and disease prevention to the crisis. The action is urgent.
Influenced by this urgency, researchers quantified the environmental impact of water fluoridation for a single five-year-old child over a one-year period and compared it to traditional use of fluoridated paint and water programs. toothbrushing, taking place in selected schools across the UK. , and international.
Today, over 35% of the world's population has access to water fluoridation, and studies demonstrate a significant reduction in dental caries. Although data on clinical effectiveness and cost analysis are available, no data regarding its environmental impact is available so far.
To quantify this impact, the research team performed a life cycle assessment (LCA) carefully measuring the combined travel, weight and quantities of all products and processes involved in all three preventative programs (toothbrush, fluoride paint and water fluoridation programs). The data was entered into a specific environmental program (OpenLCA) and the team used the Ecoinvent database, allowing them to calculate environmental outcomes, including the carbon footprint, the amount of water used for each product and the amount of usage of the soil.
The results of the study, led by Brett Duane, associate professor of dental public health at Trinity College, concluded that water fluoridation had the lowest environmental impact across all categories studied and had the lowest impact on disability-adjusted life years compared to all other studies. community-based caries prevention programs. The study also found that fluoridation offers the greatest return on investment.
Considering the balance between clinical effectiveness, cost-effectiveness and environmental sustainability, researchers believe that water fluoridation should be the preventive intervention of choice. This research strengthens the international case for water fluoridation programs to reduce dental caries, especially in the most vulnerable populations.
The fluoridation of American drinking water was one of the great public health achievements of the twentieth century, but over the past three decades, studies investigating the impact of water fluoridation on dental health in the U.S. population have been sparse. A recent study “Fluoridation of a. and Dental Caries in U.S. Children and Adolescents,” published in the Journal of Dental Research , evaluated associations between the availability of fluoridation in the community and the experience of dental caries (cavities) in U.S. child and adolescent populations.
In this large study, county-level estimates of the percentage of population with community fluoridation from the Centers for Disease Control and Prevention's fluoridation reporting system were merged with dental exam data from 10 years of National Health and Nutrition Examination Surveys (1999). -2004 and 2011-2014).
The analysis showed that U.S. children and adolescents with greater access to fluoridated drinking water were less likely to develop dental cavities. Counties where more than 75% of the population had access to community water fluoridation saw a 30% reduction in the experience of dental caries in the primary dentition and a 12% reduction in the experience of dental caries in the permanent dentition, compared to counties where fewer than 75% had access to community fluoridation.
The findings are consistent with evidence over the past half century showing that community fluoridation continues to provide a substantial dental health benefit for U.S. children and adolescents. The current study strengthens the evidence by showing that the benefit is most pronounced early in life, in the primary teeth of children aged 2 to 8 years.
“This study confirms previously reported findings and provides further evidence to support water fluoridation as a critical public health intervention that promotes oral health,” said Maria Ryan, President of the American Association for Dental Research. “The AADR supports community fluoridation as a safe and effective, evidence-based intervention for the prevention of dental caries and this report further adds to that evidence base.”
Community water fluoridation (CWF) and other fluoride modalities have historically been and remain the cornerstone for the prevention and control of dental caries. There is extensive evidence on the effectiveness and cost-effectiveness of these interventions, as well as assessments of the risks associated with fluoride ingestion.
In 2006, the National Research Council identified severe fluorosis as the only documented health effect of fluoride at concentrations of 2 – 4 mg/L in drinking water.
Recommended concentrations for CWF and current dosing schedules for other modalities ensure safety. Systematic reviews of fluorides have identified gaps in knowledge or the need to replicate some of the previous studies in the current widespread use of fluorides.
The learning objectives of this symposium are: the link between caries rates and water fluoridation; reviewing research on the safety and value of fluoridation; and understand how community water is fluoridated.
The learning objectives will be addressed in the following four presentations:
Effectiveness of Fluorides: Results of Evidence-Based Reviews, E. Angeles Martinez-Mier, Indiana University School of Dentistry, Indianapolis, USA.
The Health Assessment of Fluoride in Drinking Water: National Research Council Conclusions and Subsequent Scientific Assessments by EPA, Jayanth Kumar, New York State Department of Health, New York City, USA.
Community Water Fluoridation: Translating the Evidence into Public Health Practice, Barbara F. Gooch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Gaps in scientific knowledge regarding water fluoridation and other fluoride modalities, Gary Slade, University of North Carolina Chapel Hill, Chapel Hill, USA.
Community water fluoridation remains cost-effective, despite an overall reduction in the average number of decayed teeth in both fluoridated and non-fluoridated communities.
The latest economic analysis on community water fluoridation (The cost-effectiveness of fluoridated water supplies in New Zealand published by Janice Wright, Michael Bates, Terry Curess and Martin Lee in the Australian and New Zealand Journal of Public Health in 2001) and used national data on the difference in tooth decay between fluoridated and non-fluoridated communities.
It found that community water fluoridation (CWF) was more cost-effective in larger communities, but also that the intervention remained cost-effective even in smaller communities (with fewer than 5,000 people).
New Zealand was one of the first countries to adopt community-wide water fluoridation to reduce dental caries rates. The results of early studies found that children born and raised in fluoridated areas had, on average, 50% less dental decay than children from non-fluoridated areas. Today, around 56% of New Zealanders have access to fluoridated water.
In Massey's latest study, researchers found that communities with a higher risk of dental caries – for example, those with a high level of economic deprivation or those with a higher proportion of Māori ethnicity – benefited most from fluoridation community.
Ms Fyfe says the team collected information on the costs of installing and running community fluoridation by sending questionnaires to local authorities that fluoridate their water supplies.
“We used data from the 2009 New Zealand Oral Health Survey to calculate the cost savings from reducing demand for dental treatments. The cost-effectiveness of CWF per decayed tooth prevented was compared with an alternative to treating a decayed tooth. Cost-effectiveness was also compared between communities of different population sizes.”
Overall, community water fluoridation was considered a cost-effective public health intervention, despite a reduction in the average number of decayed teeth in all communities over time.
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