Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Sheba Hospital at Tel Hashomer, Israel; ″Bina" Program, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel.
Department of Community Dentistry, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel.
J Dent. 2023 Jul;134:104550. doi: 10.1016/j.jdent.2023.104550. Epub 2023 May 15.
The implementation of Nationwide Water Fluoridation in Israel in 2002 led to a significant reduction in caries among children. However, this practice was discontinued in 2014 due to a change in legislation. In 2010, as part of the Israeli National Health Insurance Law, free dental care for children under 10 years of age was legislated. This policy was gradually extended to include adolescents under 18 years of age in 2018. We examined the association between these efforts and changes in the caries-related treatment needs of young adults over the course of two decades.
This cross-sectional study analyzed data on the need for dental restorations, root canal therapy, and extractions that were retrieved from dental records of 34,450 soldiers recruited into military service between 2012 and 2021. These data were cross-matched with the subjects' year of birth to determine whether the implementation of water fluoridation, dental care legislation, or both were associated with changes in the need for and provision of dental care. Sociodemographic data, including sex, age, socioeconomic cluster (SEC), intellectual capability score (ICS), body mass index, and place of birth, were also extracted.
A multivariate generalized linear model (GLM) revealed that male sex, older age, low ICS, and low SEC were significant predictors for greater caries-related treatment needs (P < 0.001). Our findings indicated that subjects exposed to fluoridated water during their childhood had significantly lower rates of caries-related treatment, regardless of access to free dental care.
Mandatory water fluoridation was associated with significantly lower caries-related treatment needs while national dental health legislation providing free dental care to children and adolescents was not. Therefore, we suggest that water fluoridation should be continued to maintain the observed reduction in treatment needs.
Our findings provide support for the effectiveness of water fluoridation in preventing caries, whereas the impact of free dental care programs focused on clinical intervention remains to be determined.
2002 年以色列在全国范围内实施饮用水加氟，导致儿童龋齿发生率显著降低。然而，由于立法的改变，这一做法于 2014 年停止。2010 年，作为以色列国家健康保险法的一部分，立法规定为 10 岁以下儿童提供免费牙科护理。这项政策在 2018 年逐渐扩大到包括 18 岁以下的青少年。我们研究了这些措施与过去二十年中年轻人龋齿相关治疗需求变化之间的关系。
本横断面研究分析了从 2012 年至 2021 年期间招募入伍的 34450 名士兵的牙科记录中提取的关于牙体修复、根管治疗和拔牙治疗需求的数据。这些数据与研究对象的出生年份进行交叉匹配，以确定饮用水加氟、牙科护理立法或两者的实施是否与牙科护理需求和提供的变化相关。还提取了社会人口统计学数据，包括性别、年龄、社会经济集群（SEC）、智力能力评分（ICS）、体重指数和出生地。
多变量广义线性模型（GLM）显示，男性、年龄较大、ICS 较低和 SEC 较低是龋齿相关治疗需求较大的显著预测因素（P<0.001）。我们的研究结果表明，无论是否获得免费牙科护理，儿童时期接触氟化水的受试者的龋齿相关治疗率明显较低。
强制性饮用水加氟与龋齿相关治疗需求显著降低相关，而向儿童和青少年提供免费牙科护理的国家牙科健康立法则没有。因此，我们建议继续进行饮用水加氟，以维持观察到的治疗需求降低。
我们的研究结果支持饮用水加氟在预防龋齿方面的有效性，而以临床干预为重点的免费牙科护理计划的影响仍有待确定。
