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Tooth decay trends for 12 year olds in nonfluoridated and fluoridated countries

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Chris Neurath at Yale University
Chris Neurath
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Abstract

Graphs of tooth decay trends for 12 year olds in 24 countries, prepared using the most recent World Health Organization data, show that the decline in dental decay in recent decades has been comparable in 16 nonfluoridated countries and 8 fluoridated countries which met the inclusion criteria of having (i) a mean annual per capita income in the year 2000 of US$10,000 or more, (ii) a population in the year 2000 of greater than 3 million, and (iii) suitable WHO caries data available. The WHO data do not support fluoridation as being a reason for the decline in dental decay in 12 year olds that has been occurring in recent decades.
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Research note
Fluoride 38(4)324–325
November 2005
Tooth decay trends in nonfluoridated and fluoridated countries
Neurath 324
324
TOOTH DECAY TRENDS FOR 12 YEAR OLDS IN NONFLUORIDATED
AND FLUORIDATED COUNTRIES
C Neuratha
Canton, NY, USA
SUMMARY: Graphs of tooth decay trends for 12 year olds in 24 countries, prepared
using the most recent World Health Organization data, show that the decline in dental
decay in recent decades has been comparable in 16 nonfluoridated countries and 8
fluoridated countries which met the inclusion criteria of having (i) a mean annual per
capita income in the year 2000 of US$10,000 or more, (ii) a population in the year 2000
of greater than 3 million, and (iii) suitable WHO caries data available. The WHO data
do not support fluoridation as being a reason for the decline in dental decay in 12
year olds that has been occurring in recent decades.
Keywords: Fluoridated countries; Nonfluoridated countries; Tooth decay trends; World Health
Organization data.
INTRODUCTION AND METHOD
Tooth decay trends in nonfluoridated and fluoridated countries were studied by
preparing graphs using the most recent World Health Organization data from
national studies on 12 year old boys and girls.1
The criteria required for inclusion of a country were:
• a mean annual per capita income in the year 2000 of US$10,000 or more
• a population in the year 2000 of greater than 3 million
• suitable WHO caries data available.
No countries with
appropriate data were
excluded. Countries were
considered fluoridated when
more than 40% of their
population had fluoridated
water containing about 1 ppm
of fluoride and nonfluoridated
when less than 10% of their
population had such water. For
clarity, the nonfluoridated
countries were represented in
two graphs.
RESULTS
Figures 1a, 1b, and 2 show
that the decline in dental decay
in recent decades has been
comparable in both
nonfluoridated and fluoridated
countries.
aAmerican Environmental Health Studies Project, 82 Judson Street, Canton NY 13617, USA.
E-mail: cneurath@AmericanHealthStudies.org
Figure 1a. Tooth decay trends, as indicated by the DMFT
Index (Decayed, Missing, or Filled Permanent Teeth), for 12
year olds in eight nonfluoridated countries (Austria,
Belgium, Denmark, Finland, France, Germany, Greece,
Italy) using World Health Organization data.
Figure 1a
Nonfluoridated countries
Research note
Fluoride 38(4)324–325
November 2005
Tooth decay trends in nonfluoridated and fluoridated countries
Neurath 325
325
REFERENCE
1 WHO Oral Health Country/Area Profile Programme. WHO Headquarters Geneva, Oral Health
Programme (NPH), WHO Collaborating Centre, Malmö University Sweden [homepage on the
Internet]. Geneva and Malmö: WHO Oral Health Country/Area Profile Programme; [updated 2005
June; cited 2005 Nov]. Oral health profiles for countries listed according to WHO regions [about 7
screens]. Available from: http://www.whocollab.od.mah.se/expl/regions.html
Copyright © 2005 International Society for Fluoride Research. www.fluorideresearch.org
Editorial Office: 727 Brighton Road, Ocean View, Dunedin 9051, New Zealand.
Figure 1b. Tooth decay trends, as
indicated by the DMFT Index
(Decayed, Missing, or Filled
Permanent Teeth), for 12 year olds in
eight nonfluoridated countries (Japan,
The Netherlands, Norway, Portugal,
Spain, Sweden, Switzerland, The
United Kingdom) using World Health
Organization data.
Figure 1b
Nonfluoridated countries
Figure 2
Fluoridated countries
Figure 2. Tooth decay trends, as
indicated by the DMFT Index
(Decayed, Missing, or Filled
Permanent Teeth), for 12 year olds in
eight fluoridated countries (Australia,
Canada, Hong Kong, Iceland, Israel,
New Zealand, Singapore, The United
States of America) using World Health
Organization data.
DISCUSSION
The World Health
Organization data on dental
decay trends in 12 year olds in
24 countries do not support
fluoridation as being a reason
for the decline in dental decay
that has been occurring in
recent decades.
... 6 Since then, rates of tooth decay have plummeted in the US and other countries that fluoridate their drinking water, but the rates have also plummeted in countries without fluoridation. 7 The decline in countries without water fluoridation may have been due to the use of fluoride toothpaste or strategies to reduce sugar intake. Reducing sugar consumption, however, was not part of the US strategy. ...
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For over 70 years, the addition of fluoride to public water as community water fluoridation (CWF or fluoridation) with intent to prevent dental caries continues to be controversial, and risks are seldom included in monetary evaluations. Published operational costs and benefits of fluoridation are used, whereas published and clinical experience treating dental fluorosis are utilized to estimate treatment costs of patient‐perceived dental fluorosis and lost wages from lower IQ (intelligence quotient). Published estimated caries averted, less operational costs at 8PPPY(perpersonperyear)wereused,compensationforfunctionalandcosmeticdentalfluorosis8 PPPY (per person per year) were used, compensation for functional and cosmetic dental fluorosis 126 PPPY, and lower earnings from presumed harm of developmental neurotoxicity estimated at 438PPPY.NetlossfromCWFisestimatedat438 PPPY. Net loss from CWF is estimated at 556 PPPY, although some individuals will have significantly more or less loss. Previous economic evaluations of fluoridation have estimated caries averted and costs of operations; however, few evaluations include the costs of treating harm. Fluoridation is not cost‐effective if the cost of harm is included. Alternatives for the prevention of dental caries should be promoted, and the cessation of fluoridation is indicated.
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COMMUNITY WATER FLUORIDATION A COST-BENEFIT-RISK CONSIDERATION
Preprint
Full-text available
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Background For over 70 years the addition of fluoride to public water with intent to prevent dental caries continues to be controversial and risks are seldom included in monetary evaluations. Objectives To estimate an economic cost-benefit-risk of Community Water Fluoridation (CWF) using 2021 USA dollars Per Person Per Year (PPPY), with the inclusion of two risks: dental fluorosis and lower income resulting from developmental neurotoxicity as measured with lower IQ. Methods Published operational costs and benefits of CWF are used. Published and clinical experience treating dental fluorosis are utilized to estimate treatment costs of patient perceived dental fluorosis, and lost wages from lower IQ. Patients of record provided consent for photographs. Results: Published estimated caries averted, less operational costs, were calculated at 8PPPYandestimatesofcompensationforfunctionalandcosmeticdentalfluorosiswere8 PPPY and estimates of compensation for functional and cosmetic dental fluorosis were 126 PPPY. Lower earnings from presumed harm of developmental neurotoxicity 438PPPY.NetlossfromCWFisestimatedat438 PPPY. Net loss from CWF is estimated at 556 PPPY. Conclusions Previous economic evaluations of CWF have estimated caries averted and costs of operations. Few evaluations include the costs of treating harm. CWF is not cost effective if the cost of harm is included. Policy Implications Alternatives for the prevention of dental caries should be promoted and the cessation of CWF is indicated.
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