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Community water fluoridation exposure and dental caries experience in newly enrolled members of the Canadian Armed Forces 2006–2017



This cross-sectional study examines the dental caries experience of new Canadian Armed Forces (CAF) members in relation to enrollment from municipalities with and without water fluoridation.


The study population consisted of recruits who enrolled in the CAF between 2006 and 2017 with an enrollment address in municipalities with known fluoridation status (n = 24,552). Odontogram statistics from dental examinations were used to calculate the number of decayed, missing, and filled teeth (DMFT) and tooth surfaces (DMFS) for each recruit. The average difference between recruits from municipalities with and without fluoridation was determined using a linear regression model which adjusted for confounding by age and gender and allowed effect modification based on socio-economic status.


The average recruit was male, 24 years of age, with 5.6 DMFT and 11.6 DMFS. After adjusting for age and gender, recruits residing in municipalities with water fluoridation had lower DMFT by 0.67 (CI − 0.55, − 0.79) points and lower DMFS by 1.77 (− 1.46, − 2.09) points. When allowing for effect modification by median income quintile of the recruits’ home census tract, the average reduction in DMFT and DMFS was similar in all income quintiles, with average reductions in DMFT ranging from 0.47 to 1.02 and average reductions in DMFS ranging from 1.33 to 2.70.


Residence in a municipality with water fluoridation was associated with reduced caries experience in a national sample of newly enrolled CAF members. The benefits of water fluoridation were uniform across neighbourhood income and military rank classes.



Cette étude transversale examine l’importance du niveau de la carie dentaire des nouveaux membres des Forces armées canadiennes (FAC) par rapport à l’enrôlement provenant des municipalités avec et sans fluoration de l’eau.


La population étudiée était constituée de recrues qui se sont enrôlés dans les FAC entre 2006 et 2017 avec une adresse d’inscription dans les municipalités dont le statut de fluoration est connu (n = 24 552). Les statistiques en provenance des odontogrammes des examens dentaires ont été utilisées pour calculer le nombre de dents et surfaces cariés, absents et obturés (CAOD & CAOF) pour chaque recrue. La différence moyenne entre les recrues des municipalités avec ou sans fluoration a été déterminée à l’aide d’un modèle de régression linéaire qui a été ajusté pour prendre en considération l’âge et le sexe et a permis une modification de l’effet en fonction du statut socioéconomique.


La recrue moyenne était un homme de 24 ans avec 5,6 CAOD et 11,6 CAOF. Après ajustement en fonction de l’âge et du sexe, les recrues résidant dans les municipalités avec fluoration de l’eau avaient un CAOD inférieur de 0,67 points (IC -0,55, -0,79) et un CAOF inférieur de 1,77 points (-1,46, -2,09). En permettant la modification de l’effet par l’indice de revenu médian du secteur de recensement d’origine des recrues, la réduction moyenne du CAOD et du CAOF était similaire dans tous les niveaux de revenu, avec des réductions moyennes du CAOD d’entre 0,47 et 1,02 et des réductions moyennes du CAOF d’entre 1,33 et 2,70.


La résidence dans une municipalité avec fluoration de l’eau a été associée avec une réduction des caries dans un échantillonnage national de nouveaux membres enrôlés dans les FAC. Les avantages de la fluoration de l’eau étaient uniformes dans l’ensemble des niveaux de revenu du quartier et des différentes classes de grade militaire.

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The authors would like to acknowledge the work of Evilda Covrk for her continued efforts in maintaining the relevant data and providing research-ready databases to complete this project.


This study received financial support from the Canadian Institute for Military and Veteran Health Research.

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Correspondence to Randy Boyes.

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Batsos, C., Boyes, R. & Mahar, A. Community water fluoridation exposure and dental caries experience in newly enrolled members of the Canadian Armed Forces 2006–2017. Can J Public Health 112, 513–520 (2021).

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  • Fluoridation
  • Public health dentistry
  • Dental caries
  • DMF index
  • Military personnel


  • Fluoration
  • dentisterie de santé publique
  • caries dentaires
  • Index CAOD
  • personnel militaire