Water Fluoridation and Dental Caries Prevention Globally: A Systematic Review and Meta-Analysis
Abstract
Fluoridation of community water supplies constitutes one of the most effective public health interventions for preventing dental caries. In recent years, questions have been raised about its effectiveness and safety. This study aims to systematically review and summarize the existing evidence on community water fluoridation (CWF) and dental caries in permanent and deciduous teeth. Five databases and 3 gray databases were searched for relevant studies. Paired reviewers independently screened the studies, extracted data, and assessed their methodological quality. Standard mean differences (SMDs) for dmf(s)/DMFT(S) (decayed, missing, and filled teeth/surface) and odds ratios (ORs) for caries prevalence were measured between exposure or not to CFW for deciduous and permanent teeth. Subgroup analysis was performed to explore whether the study design, continent, or decade of publication changed the point estimates. Seventy-four studies were included in the qualitative analysis: 57 cross-sectional, 13 before-and-after, and 4 cohort studies. Thirty-two studies provided sufficient data for meta-analyses. The overall SMD of DMFT and dmf in those exposed to CWF compared with unexposed were -0.32 (95% confidence interval [CI]: -0.48 to -0.17, I2 = 96%, P < 0.01) and -0.30 (95% CI: -0.39 to -0.21, I2 = 88%, P < 0.01), respectively. The prevalence of caries was smaller in those exposed to CWF for both the permanent (OR = 0.52, 95% CI: 0.43 to 0.63) and deciduous (OR = 0.60, 95% CI: 0.48…
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