Ending Water Fluoridation Could Lead to Millions of Caries
Removing fluoride from public water systems in the United States could have increased the prevalence of dental caries among children by 7.5 percentage points and added $9.8 billion in healthcare costs over 5 years, a modeling study projected.
METHODOLOGY:
Researchers developed a model to predict how ending water fluoridation — a change that has been advocated for by US Secretary of Health and Human Services Robert F. Kennedy, Jr — could affect children.
The model relied on data from more than 8400 participants aged 0-19 years who took part in the United States National Health and Nutrition Examination Survey between 2013 and 2016, which included oral health examinations.
Other inputs for the model, such as the effectiveness of water fluoridation on reducing tooth decay, were based on figures from peer-reviewed studies.
The base-case scenario assumed complete removal of fluoride from all water systems compared against maintaining current levels of fluoridation.
TAKEAWAY:
Eliminating fluoridation was projected to increase the prevalence of dental caries by 7.5 percentage points (95% uncertainty interval [UI], 6.3-8.5) and lead to 25.4 million additional decayed teeth (95% UI, 23.3-27.6 million) over 5 years.
Cases of fluorosis — discoloration of teeth due to excessive exposure to the mineral — would be expected to decrease by 200,000.
The model projected increased healthcare costs of $9.8 billion (95% UI, $8.7-10.8 billion) over 5 years, 'mainly due to increased risk of tooth decay and associated complications,' the researchers reported.
Children who are publicly insured or uninsured would be disproportionately affected by dental health problems following such a change, they found.
IN PRACTICE:
'Despite concerns regarding toxic effects associated with high levels of fluoride, this model demonstrates the substantial ongoing benefits of water fluoridation at safe levels currently recommended by the US Environmental Protection Agency, the National Toxicology Program, and the Centers for Disease Control and Prevention,' the authors of the study reported.
SOURCE:
The study was conducted by Sung Eun Choi, PhD, of the Harvard School of Dental Medicine, and Lisa Simon, MD, DMD, of Brigham and Women's Hospital, in Boston. It was published online on May 30 in JAMA Health Forum .
LIMITATIONS:
The study did not model potential cognitive harms from fluoride exposure because strong direct evidence of a link at fluoride levels seen in public water is lacking, the authors stated. The cost-effectiveness analysis did not consider indirect outcomes of dental health problems such as missed work or school. The study focused on children and adolescents.
DISCLOSURES:
Simon has received personal fees from Boston Medical Center, Alosa Health, the American College of Legal Medicine, the American Dental Therapy Association, the California Dental Association, the Santa Fe Group, the Society of Teachers of Family Medicine, the American College of Dentists, the CareQuest Foundation for Oral Health, and the American Dental Association.
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