Abstract
Juneau, Alaska, ceased community water fluoridation (CWF) in 2007, and previous research found a substantial increase in dental caries-related procedures and treatment costs for children from low-income families in Juneau between 2003 and 2012. We collected comparable dental caries-related procedures and treatment cost data for the same years for children in Anchorage, Alaska, where CWF has been continuously maintained. This retrospective study analyzed all Medicaid dental claims records in two separate years for caries-related procedures and associated costs among children (aged 0 to 18 years) residing in Anchorage’s 99502 zip code and compared these records to data from Juneau. We obtained descriptive statistics and conducted bivariate analyses and binomial logistic regression. Between 2003 and 2012, children in Anchorage experienced a nonsignificant modest decrease in the mean number of caries-related procedures and only small, statistically nonsignificant changes to the mean inflation-adjusted service costs of caries-related restorative care. The lack of significant change in child dental caries-related procedures and treatment costs in Anchorage between 2003 and 2012 contrasted with the substantial increase in caries-related procedures and treatment costs over the same period in Juneau. Our results are consistent with previous research that has demonstrated a significant protective effect of CWF against dental caries.
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26 January 2022
The journal title in the running head was published as ‘The Journal of Primary Prevention’. This has been corrected as ‘Journal of Prevention’.
References
Armfield, J. M. (2010). Community effectiveness of public water fluoridation in reducing children’s dental disease. Public Health Reports, 125(5), 655–664. https://doi.org/10.1177/003335491012500507
Blinkhorn, A. S., Brown, M. D., Attwood, D., & Downer, M. C. (1981). The effect of fluoridation on the dental health of urban Scottish Schoolchildren. Journal of Epidemiology and Community Health, 35(2), 98–101. https://doi.org/10.1136/jech.35.2.98
CDC. (2019a). Dental caries in primary teeth. https://www.cdc.gov/oralhealth/publications/OHSR-2019-dental-caries-primary-teeth.html. Accessed 17 May 2021.
CDC. (2019b). Fluorosis, community water fluoridation. https://www.cdc.gov/fluoridation/faqs/dental_fluorosis/index.htm. Accessed 17 November 2020.
CDC. (2020a). 2016 water fluoridation statistics. https://www.cdc.gov/fluoridation/statistics/2016stats.htm. Accessed 14 February 2020.
CDC. (2020b). Community water fluoridation. https://www.cdc.gov/fluoridation/index.html. Accessed 11 September 2020.
Cho, H. J., Jin, B. H., Park, D. Y., Jung, S. H., Lee, H. S., Paik, D. I., & Bae, K. H. (2014). Systemic effect of water fluoridation on dental caries prevalence. Community Dentistry and Oral Epidemiology, 42(4), 341–348. https://doi.org/10.1111/cdoe.12091
DeCoster, J., Gallucci, M., & Iselin, A. M. R. (2011). Best practices for using median splits, artificial categorization, and their continuous alternatives. Journal of Experimental Psychopathology, 2(2), 197–209. https://doi.org/10.1002/0471249688
Dye, B. A., Li, X., & Thornton-Evans, G. (2012). Oral health disparities as determined by selected Healthy People 2020 oral health objectives for the United States, 2009–2010. NCHS data brief, no 104. Hyattsville, MD: National Center for Health Statistics.
Fairbanks Fluoride Task Force. (2011). Report of the Fairbanks fluoride task force. Prepared for the Fairbanks city council. http://ffo-olf.org/files/FairbanksFinalReport.pdf. Accessed 15 February 2020.
Griffin, S. O., Jones, K., & Tomar, S. L. (2001). An economic evaluation of community water fluoridation. Journal of Public Health Dentistry, 61(2), 78–86. https://doi.org/10.1111/j.1752-7325.2001.tb03370.x
Guth, S., Hüser, S., Roth, A., Degen, G., Diel, P., Edlund, K., Eisenbrand, G., Engel, K.-H., Epe, B., Grune, T., Heinz, V., Henle, T., Humpf, H.-U., Jäger, H., Joost, H.-G., Kulling, S. E., Lampen, A., Mally, A., Marchan, R., & Hengstler, J. G. (2020). Toxicity of fluoride: Critical evaluation of evidence for human developmental neurotoxicity in epidemiological studies, animal experiments and in vitro analyses. Archives of Toxicology, 94(5), 1375–1415. https://doi.org/10.1007/s00204-021-03072-6
Iacobucci, D., Posavac, S. S., Kardes, F. R., Schneider, M. J., & Popovich, D. L. (2015). The median split: Robust, refined, and revived. Journal of Consumer Psychology, 25(4), 690–704. https://doi.org/10.1016/j.jcps.2015.06.014
Iheozor-Ejiofor, Z., Worthington, H. V., Walsh, T., O’Malley, L., Clarkson, J. E., Macey, R., & Glenny, A. M. (2015). Water fluoridation for the prevention of dental caries. The Cochrane Database of Systematic Reviews, 2015(6), CD010856. https://doi.org/10.1002/14651858.CD010856.pub2
Juneau Fluoride Study Commission. (2006). Report to the assembly of the city and borough of Juneau. https://www.juneau.org/beta_transfer/clerk/boards/Fluoride/Fluoride_Study_Commission_Report-Minus_Exhibits.pdf. Accessed 15 February 2020.
Kumar, J. V., Adekugbe, O., & Melnik, T. A. (2010). Geographic variation in medicaid claims for dental procedures in New York State: Role of fluoridation under contemporary conditions. Public Health Reports, 125(5), 647–654. https://doi.org/10.1177/003335491012500506
Mariño, R., & Zaror, C. (2020). Economic evaluations in water-fluoridation: a scoping review. BMC Oral Health, 20(1), 115. https://doi.org/10.1186/s12903-020-01100-y
Maupome, G., Clark, D. C., Levy, S. M., & Berkowitz, J. (2001). Patterns of dental caries following the cessation of water fluoridation. Community Dentistry and Oral Epidemiology, 29(1), 37–47. https://doi.org/10.1034/j.1600-0528.2001.00007.x
McDonagh, M. S., Whiting, P. F., Wilson, P. M., Sutton, A. J., Chestnutt, I., Cooper, J., & Kleijnen, J. (2000). Systematic review of water fluoridation. BMJ, 321(7265), 855–859. https://doi.org/10.1136/bmj.321.7265.855
McLaren, L., McNeil, D. A., Potestio, M., Patterson, S., Thawer, S., Faris, P., & Shwart, L. (2016). Equity in children’s dental caries before and after cessation of community water fluoridation: Differential impact by dental insurance status and geographic material deprivation. International Journal for Equity in Health, 15, 24. https://doi.org/10.1186/s12939-016-0312-1
McLaren, L., Patterson, S., Thawer, S., Faris, P., McNeil, D., Potestio, M. L., & Shwart, L. (2017). Exploring the short-term impact of community water fluoridation cessation on children’s dental caries: A natural experiment in Alberta, Canada. Public Health, 146, 56–64. https://doi.org/10.1016/j.puhe.2016.12.040
McLaren, L., Patterson, S. K., Faris, P., Chen, G., Thawer, S., Figueiredo, R., & Potestio, M. (2021). Fluoridation cessation and children’s dental caries: A 7-year follow-up evaluation of Grade 2 schoolchildren in Calgary and Edmonton. Canada: Community Dentistry and Oral Epidemiology. https://doi.org/10.1111/cdoe.12685
McLaren, L., & Petit, R. (2017). Universal and targeted policy to achieve health equity: A critical analysis of the example of community water fluoridation cessation in Calgary, Canada in 2011. Critical Public Health, 28(2), 153–164. https://doi.org/10.1080/09581596.2017.1361015
McLaren, L., & Singhal, S. (2016). Does cessation of community water fluoridation lead to an increase in tooth decay? A systematic review of published studies. Journal of Epidemiology and Community Health, 70(9), 934–940. https://doi.org/10.1136/jech-2015-206502
Meyer, J., Margaritis, V., & Mendelsohn, A. (2018). Consequences of community water fluoridation cessation for Medicaid-eligible children and adolescents in Juneau Alaska. BMC Oral Health, 18(1), 215. https://doi.org/10.1186/s12903-018-0684-2
Murthy, V. H. (2015). Surgeon general’s perspectives. Public Health Reports, 130(4), 296–298.
Nagarkar, S. R., Kumar, J. V., & Moss, M. E. (2012). Early childhood caries-related visits to emergency departments and ambulatory surgery facilities and associated charges in New York state. Journal of the American Dental Association, 143(1), 59–65. https://doi.org/10.14219/jada.archive.2012.0021
Newacheck, P. W., Hughes, D. C., Hung, Y. Y., Wong, S., & Stoddard, J. J. (2000). The unmet health needs of America’s children. Pediatrics, 105(4 Pt 2), 989–997.
O’Connell, J., Rockell, J., Ouellet, J., Tomar, S. L., & Maas, W. (2016). Costs and savings associated with community water fluoridation in the united states. Health Affairs, 35(12), 2224–2232. https://doi.org/10.1377/hlthaff.2016.0881
Ran, T., Chattopadhyay, S. K., & Community Preventive Services Task Force. (2016). Economic evaluation of community water fluoridation: A community guide systematic review. American Journal of Preventive Medicine, 50(6), 790–796. https://doi.org/10.1016/j.amepre.2015.10.014
Resneck, J. (2017). AK: The history of the water fluoride debate in Juneau. Alaska Public Media. https://www.alaskapublic.org/2017/02/24/ak-the-history-of-the-water-fluoride-debate-in-juneau/. Accessed 16 November 2020.
Rugg-Gunn, A. J., & Do, L. (2012). Effectiveness of water fluoridation in caries prevention. Community Dentistry and Oral Epidemiology, 40(Suppl 2), 55–64. https://doi.org/10.1111/j.1600-0528.2012.00721.x
Satcher, D., & Nottingham, J. H. (2017). Revisiting oral health in America: A report of the surgeon general. American Journal of Public Health, 107(S1), S32–S33. https://doi.org/10.2105/AJPH.2017.303687
Seppa, L., Karkkainen, S., & Hausen, H. (2000). Caries in the primary dentition, after discontinuation of water fluoridation, among children receiving comprehensive dental care. Community Dentistry and Oral Epidemiology, 28(4), 281–288. https://doi.org/10.1034/j.1600-0528.2000.280406.x
Shaffer, J. R., Wang, X., McNeil, D. W., Weyant, R. J., Crout, R., & Marazita, M. L. (2015). Genetic susceptibility to dental caries differs between the sexes: a family-based study. Caries Research, 49(2), 133–140. https://doi.org/10.1159/000369103
Singh, K. A. (2015). Water fluoridation has a pre-eruptive effect in preventing caries in children. Journal of Evidence-Based Dental Practice, 15(2), 64–65. https://doi.org/10.1111/j.1752-7325.2003.tb03469.x
Singhal, S., Farmer, J., & McLaren, L. (2017). Methodological considerations for designing a community water fluoridation cessation study. Community Dentistry and Oral Epidemiology, 45(3), 193–200. https://doi.org/10.1111/cdoe.12289
Slade, G. D., & Sanders, A. E. (2018). Two decades of persisting income-disparities in dental caries among US children and adolescents. Journal of Public Health Dentistry, 78(3), 187–191. https://doi.org/10.1111/jphd.12261
U.S. Department of Health and Human Services, & Centers for Disease Control and Prevention. (2017). Statement on the evidence supporting the safety and effectiveness of community water fluoridation. https://www.cdc.gov/fluoridation/pdf/cdc-statement.pdf. Accessed 12 February 2020.
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, & Healthy People 2030. (2020). Increase the proportion of people whose water systems have the recommended amount of fluoride – OH-11. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-policy/increase-proportion-people-whose-water-systems-have-recommended-amount-fluoride-oh-11. Accessed 21 October 2020.
Whistler, B. J. (2012). Alaska oral health plan: 2012–2016. Juneau, AK: Section of Women’s, Children’s and Family Health, Division of Public Health, Alaska Department of Health and Social Services.
Acknowledgements
The authors wish to thank Dr. Tom Hennessy, Dr. David Parker, Dr. Michael Foley, Dr. Ruby Fried and Lisa Bulkow, MS, for their edits and reviews.
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This project was self-funded.
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JM designed the study, wrote the manuscript, and assisted with data analysis; VM performed the data analysis, reviewed, and revised the manuscript; and MJ reviewed and revised the manuscript.
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Jennifer Meyer declares that she has no conflicts of interest and wishes to disclose that she is a Past President of the Alaska Public Health Association (ALPHA), an affiliate of the American Public Health Association (APHA) and that both entities publicly endorse community water fluoridation. Vasileios Margaritis declares that he has no conflicts of interest. Matt Jacob reports no conflicts of interest and wishes to disclose that three of his clients are organizations that publicly endorse community water fluoridation, namely, the American Academy of Pediatrics, the American Fluoridation Society, and the Arcora Foundation.
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This study was based entirely on claims data available from the Centers for Medicare and Medicaid (CMS) Research Data Assistance Center (ResDAC) in a research identifiable format. Walden University’s Institutional Review Board approved the study and granted permission to carry out this research (Walden IRB #10–31-16–0075333).
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This study involved secondary data analysis of claims records access with permission from the Centers for Medicare and Medicaid (CMS) Research Data Assistance Center (RecDAC).
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Meyer, J., Margaritis, V. & Jacob, M. The Impact of Water Fluoridation on Medicaid-Eligible Children and Adolescents in Alaska. J Primary Prevent 43, 111–123 (2022). https://doi.org/10.1007/s10935-021-00656-x
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DOI: https://doi.org/10.1007/s10935-021-00656-x