Field Epidemiology Training Programme, Public Health England, London NW9 5EQ, UK.
European Programme for Interventional Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), 169 73 Solna, Stockholm, Sweden.
J Public Health (Oxf). 2023 Jun 14;45(2):462-469. doi: 10.1093/pubmed/fdac066.
The protective effect of community water fluoridation (CWF) against dental caries may be modified by secular changes in health behaviour. We aimed to determine the contemporary association between fluoride in public water supplies (PWS) and dental caries indicators and inequalities in England.
We estimated exposure to CWF and PWS fluoride concentrations from national monitoring data, using Geographic Information Systems and water supply boundaries, categorizing mean period exposure into <0.1, 0.1-<0.2, 0.2-<0.4, 0.4-<0.7 and ≥0.7 mg/l. We used area-level health outcome and confounder data in multivariable regression models to determine the association between fluoride and caries outcomes and calculated preventive fractions using these coefficients.
The odds of caries and of severe caries in 5-year-olds fell with increasing fluoride concentration in all SES quintiles (P < 0.001 to P = 0.003). There was a negative trend between increasing fluoride concentration and dental extractions (P < 0.001). Compared to PWS with <0.2 mg/l, CWF prevented 17% (95% confidence interval (CI): 5-27%) to 28% (95% CI: 24-32%) of caries (high-low SES) and 56% (95% CI: 25-74%) of dental extractions. The association between fluoride concentration and caries prevalence/severity varied by socioeconomic status (SES) (P < 0.001).
Exposure to fluoride in PWS appears highly protective against dental caries and reduces oral health inequalities.
社区饮水氟化（CWF）对龋齿的保护作用可能会因健康行为的长期变化而改变。我们旨在确定英格兰公共供水（PWS）中氟化物与龋齿指标之间的当代关联以及不平等现象。
我们使用地理信息系统和供水边界从国家监测数据中估算了 CWF 和 PWS 氟化物浓度的暴露情况，将平均时期暴露分为<0.1、0.1-<0.2、0.2-<0.4、0.4-<0.7 和≥0.7 mg/l。我们使用多变量回归模型中的区域水平健康结果和混杂因素数据来确定氟化物与龋齿结果之间的关联，并使用这些系数计算预防分数。
在所有 SES 五分位数中，儿童龋齿和严重龋齿的几率随着氟化物浓度的增加而降低（P<0.001 至 P=0.003）。随着氟化物浓度的增加，拔牙呈负相关（P<0.001）。与氟化物浓度<0.2 mg/l 的 PWS 相比，CWF 可预防 17%（95%置信区间[CI]：5-27%）至 28%（95% CI：24-32%）的龋齿（高 SES-低 SES）和 56%（95% CI：25-74%）的拔牙。氟化物浓度与龋齿患病率/严重程度之间的关联因社会经济地位（SES）而异（P<0.001）。
PWS 中氟化物的暴露似乎对龋齿具有高度保护作用，并减少了口腔健康的不平等现象。
