McLaren L, Patterson S, Thawer S, Faris P, McNeil D, Potestio M L, Shwart L
Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada.
School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada.
Public Health. 2017 May;146:56-64. doi: 10.1016/j.puhe.2016.12.040. Epub 2017 Feb 7.
Dental caries (tooth decay) is common and can be serious. Dental caries is preventable, and community water fluoridation is one means of prevention. There is limited current research on the implications of fluoridation cessation for children's dental caries. Our objective was to explore the short-term impact of community water fluoridation cessation on children's dental caries, by examining change in caries experience in population-based samples of schoolchildren in two Canadian cities, one that discontinued community water fluoridation and one that retained it.
We used a pre-post cross-sectional design.
We examined dental caries indices (deft [number of decayed, extracted, or filled primary teeth] and DMFT [number of decayed, missing, or filled permanent teeth]) among grade 2 schoolchildren in 2004/05 and 2013/14 in two similar cities in the province of Alberta, Canada: Calgary (cessation of community water fluoridation in 2011) and Edmonton (still fluoridated). We compared change over time in the two cities. For Calgary only, we had a third data point from 2009/10, and we considered trends across the three points.
We observed a worsening in primary tooth caries (deft) in Calgary and Edmonton, but changes in Edmonton were less consistent and smaller. This effect was robust to adjustment for covariates available in 2013/14 and was consistent with estimates of total fluoride intake from biomarkers from a subsample. This finding occurred despite indication that treatment activities appeared better in Calgary. The worsening was not observed for permanent teeth. For prevalence estimates only (% with >0 deft or DMFT), the three data points in Calgary suggest a trend that, though small, appears consistent with an adverse effect of fluoridation cessation.
Our results suggest an increase in dental caries in primary teeth during a time period when community fluoridation was ceased. That we did not observe a worsening for permanent teeth in the comparative analysis could reflect the limited time since cessation. It is imperative that efforts to monitor these trends continue.
龋齿（蛀牙）很常见且可能很严重。龋齿是可预防的，社区水氟化是预防手段之一。目前关于停止水氟化对儿童龋齿影响的研究有限。我们的目的是通过检查加拿大两个城市学龄儿童人群样本中龋齿经历的变化，来探讨社区水氟化停止对儿童龋齿的短期影响，其中一个城市停止了社区水氟化，另一个城市保留了该措施。
我们采用了前后横断面设计。
我们检查了2004/05年和2013/14年加拿大艾伯塔省两个相似城市二年级学龄儿童的龋齿指数（乳牙龋失补牙数[deft，即乳牙龋、失、补牙的数量]和恒牙龋失补牙数[DMFT，即恒牙龋、失、补牙的数量]）：卡尔加里（2011年停止社区水氟化）和埃德蒙顿（仍进行水氟化）。我们比较了两个城市随时间的变化。仅对于卡尔加里，我们有2009/10年的第三个数据点，并考虑了这三个时间点的趋势。
我们观察到卡尔加里和埃德蒙顿的乳牙龋齿（deft）情况都在恶化，但埃德蒙顿的变化不太一致且较小。这种影响在对2013/14年可用协变量进行调整后依然显著，并且与来自子样本生物标志物的总氟摄入量估计值一致。尽管有迹象表明卡尔加里的治疗活动似乎更好，但仍出现了这种恶化情况。恒牙未观察到恶化情况。仅就患病率估计（deft或DMFT大于0的百分比）而言，卡尔加里的三个数据点显示出一种趋势，尽管很小，但似乎与停止水氟化的不利影响一致。
我们的结果表明，在社区水氟化停止期间，乳牙龋齿有所增加。在比较分析中我们未观察到恒牙情况恶化，这可能反映了停止水氟化后时间有限。继续监测这些趋势的努力势在必行。
