{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:16:00Z","timestamp":1792030560330,"version":"4.4.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,6,26]],"date-time":"2022-06-26T00:00:00Z","timestamp":1656201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100002141","name":"Public Health England","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002141","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The protective effect of community water fluoridation (CWF) against dental caries may be modified by secular changes in health behaviour. We aimed to determine the contemporary association between fluoride in public water supplies (PWS) and dental caries indicators and inequalities in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We estimated exposure to CWF and PWS fluoride concentrations from national monitoring data, using Geographic Information Systems and water supply boundaries, categorizing mean period exposure into &amp;lt;0.1, 0.1\u2013&amp;lt;0.2, 0.2\u2013&amp;lt;0.4, 0.4\u2013&amp;lt;0.7 and \u22650.7\u00a0mg\/l. We used area-level health outcome and confounder data in multivariable regression models to determine the association between fluoride and caries outcomes and calculated preventive fractions using these coefficients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The odds of caries and of severe caries in 5-year-olds fell with increasing fluoride concentration in all SES quintiles (P\u00a0&amp;lt;\u00a00.001 to P\u00a0=\u00a00.003). There was a negative trend between increasing fluoride concentration and dental extractions (P\u00a0&amp;lt;\u00a00.001). Compared to PWS with &amp;lt;0.2\u00a0mg\/l, CWF prevented 17% (95% confidence interval (CI): 5\u201327%) to 28% (95% CI: 24\u201332%) of caries (high-low SES) and 56% (95% CI: 25\u201374%) of dental extractions. The association between fluoride concentration and caries prevalence\/severity varied by socioeconomic status (SES) (P\u00a0&amp;lt;\u00a00.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Exposure to fluoride in PWS appears highly protective against dental caries and reduces oral health inequalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/pubmed\/fdac066","type":"journal-article","created":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T03:02:51Z","timestamp":1656298971000},"page":"462-469","source":"Crossref","is-referenced-by-count":14,"title":["The effect of community water fluoridation on dental caries in children and young people in England: an ecological study"],"prefix":"10.1093","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5955-0574","authenticated-orcid":false,"given":"David J","family":"Roberts","sequence":"first","affiliation":[{"name":"Field Epidemiology Training Programme, Public Health England , London NW9 5EQ , UK"},{"name":"European Programme for Interventional Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC) , 169 73 Solna, Stockholm , Sweden"},{"name":"Environmental Epidemiology Group, Centre for Radiation Chemical and Environmental Hazards, Public Health England , Oxford OX11 0RQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky","family":"Massey","sequence":"additional","affiliation":[{"name":"Public Health England West Midlands , Birmingham B3 2PW , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8729-7588","authenticated-orcid":false,"given":"John","family":"Morris","sequence":"additional","affiliation":[{"name":"School of Dentistry, University of Birmingham , Birmingham B5 7EG , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neville Q","family":"Verlander","sequence":"additional","affiliation":[{"name":"Data and Analytical Sciences, Public Health England , London NW9 5EQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayoub","family":"Saei","sequence":"additional","affiliation":[{"name":"Data and Analytical Sciences, Public Health England , London NW9 5EQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Young","sequence":"additional","affiliation":[{"name":"Public Health England South West , Bristol, BS1 6EH , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Semina","family":"Makhani","sequence":"additional","affiliation":[{"name":"Health Improvement, Public Health England , London SE1 8UG , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wilcox","sequence":"additional","affiliation":[{"name":"Health Improvement, Public Health England , London SE1 8UG , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gill","family":"Davies","sequence":"additional","affiliation":[{"name":"Health Improvement, Public Health England , London SE1 8UG , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"White","sequence":"additional","affiliation":[{"name":"Health Improvement, Public Health England , London SE1 8UG , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Health Improvement, Public Health England , London SE1 8UG , UK"},{"name":"Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine , London WC1H 9SH , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Health Improvement, Public Health England , London SE1 8UG , UK"},{"name":"Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine , London WC1H 9SH , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Newton","sequence":"additional","affiliation":[{"name":"Health Improvement, Public Health England , London SE1 8UG , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,6,26]]},"reference":[{"key":"2023061611123691600_ref1","volume-title":"Oral Health Survey of Five-year-old Children 2015. A Report on the Prevalence and Severity of Dental Decay","author":"Public Health England","year":"2016"},{"key":"2023061611123691600_ref2","volume-title":"Oral Health Survey of Three-year-old Children 2013. A Report on the Prevalence and Severity of Dental Decay","author":"Public Health England","year":"2013"},{"key":"2023061611123691600_ref3","volume-title":"The State of Childrens\u2019 Oral Health in England","author":"Faculty of Dental Surgery","year":"2015"},{"key":"2023061611123691600_ref4","volume-title":"Improving Oral Health: A Community Water Fluoridation Toolkit for Local Authorities","author":"Public Health England","year":"2016"},{"key":"2023061611123691600_ref5","first-page":"CD010856","article-title":"Water fluoridation for the prevention of dental caries","volume":"2015","author":"Iheozor-Ejiofor","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"2023061611123691600_ref6","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/j.1752-7325.1996.tb02448.x","article-title":"The effectiveness of community water fluoridation in the United States","volume":"56","author":"Horowitz","year":"1996","journal-title":"J Public Health Dent"},{"key":"2023061611123691600_ref7","volume-title":"Guidance on the Implementation of the Water Supply (Water Quality) Regulations 2016 in England and the Water Supply (water quality) Regulations 2010 (as Amended) in Wales","author":"Drinking Water Inspectorate","year":"2016"},{"key":"2023061611123691600_ref8","volume-title":"Statutory Instrument 2016 No. 614. The Water Supply (Water Quality) Regulations 2016","author":"Department of Environment Food and Rural Affairs","year":"2016"},{"key":"2023061611123691600_ref9","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/j.1752-7325.2006.tb04074.x","article-title":"Sources of dietary fluoride intake in 6\u20137-year-old English children receiving optimally, sub-optimally, and non-fluoridated water","volume":"66","author":"Zohouri","year":"2006","journal-title":"J Public Health Dent"},{"key":"2023061611123691600_ref10","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1177\/154405910508401104","article-title":"Bioavailability of fluoride in drinking water: a human experimental study","volume":"84","author":"Maguire","year":"2005","journal-title":"J Dent Res"},{"key":"2023061611123691600_ref11","doi-asserted-by":"crossref","first-page":"767","DOI":"10.2307\/4589515","article-title":"Urinary fluoride levels associated with use of fluoridated waters","volume":"71","author":"Zipkin","year":"1956","journal-title":"Public Health Rep"},{"key":"2023061611123691600_ref12","doi-asserted-by":"crossref","first-page":"107001","DOI":"10.1289\/EHP3546","article-title":"Community water fluoridation and urinary fluoride concentrations in a national sample of pregnant women in Canada","volume":"126","author":"Till","year":"2018","journal-title":"Environ Health Perspect"},{"key":"2023061611123691600_ref13","first-page":"884","article-title":"Correlation of F in drinking water with urine, plasma, and serum F levels in Pakistan","volume":"45","author":"Ahmed","year":"2012","journal-title":"Fluoride"},{"key":"2023061611123691600_ref14","first-page":"g17","article-title":"Fluoridation exposure status based on location of data collection in the Canadian Health Measures Survey: Is it valid?","volume":"82","author":"McLaren","year":"2016","journal-title":"J Can Dent Assoc"},{"key":"2023061611123691600_ref15","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/j.1753-6405.2012.00899.x","article-title":"Use of GIS to allocate water fluoridation status in the NSW Teen Dental Survey 2010","volume":"36","author":"Skinner","year":"2012","journal-title":"Aust N Z J Public Health"},{"key":"2023061611123691600_ref16","doi-asserted-by":"crossref","first-page":"eS49","DOI":"10.1007\/BF03404460","article-title":"Drinking water fluoridation and oral health inequities in Canadian children","volume":"103","author":"McLaren","year":"2012","journal-title":"Can J Public Health"},{"key":"2023061611123691600_ref17","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1007\/s10661-020-08304-3","article-title":"Use of public water supply fluoride concentration as an indicator of population exposure to fluoride in England 1995\u20132015","volume":"192","author":"Roberts","year":"2020","journal-title":"Environ Monit Assess"},{"key":"2023061611123691600_ref18","volume-title":"The English Indices of Deprivation 2015- Research report Appendix A","author":"Smith","year":"2015"},{"key":"2023061611123691600_ref19","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1177\/0049124194023002004","article-title":"Sampling weights and regression analysis","volume":"23","author":"Winship","year":"1994","journal-title":"Sociol Methods Res"},{"key":"2023061611123691600_ref20","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1002\/(SICI)1097-0258(19961030)15:20<2253::AID-SIM368>3.0.CO;2-7","article-title":"Threshold models in a methadone programme evaluation","volume":"15","author":"Saei","year":"1996","journal-title":"Stat Med"},{"key":"2023061611123691600_ref21","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1177\/1536867X0600600104","article-title":"Generalized ordered logit\/partial proportional odds models for ordinal dependent variables","volume":"6","author":"Williams","year":"2006","journal-title":"STATA J"},{"key":"2023061611123691600_ref22","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1177\/003335491513000408","article-title":"U.S. Public Health Service recommendation for fluoride concentration in drinking water for the prevention of dental caries","volume":"130","author":"U. S. Department of Health Human Services Federal Panel on Community Water Fluoridation","year":"2015","journal-title":"Public Health Rep"},{"key":"2023061611123691600_ref23","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1111\/cdoe.12180","article-title":"Community water fluoridation and health outcomes in England: a cross-sectional study","volume":"43","author":"Young","year":"2015","journal-title":"Community Dent Oral Epidemiol"},{"key":"2023061611123691600_ref24","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1177\/003335491012500507","article-title":"Community effectiveness of public water fluoridation in reducing children\u2019s dental disease","volume":"125","author":"Armfield","year":"2010","journal-title":"Public Health Rep"},{"key":"2023061611123691600_ref25","volume-title":"Information Paper \u2013 Water Fluoridation: Dental and Other Human Health Outcomes","author":"Australian Government National Health and Medical Review Council","year":"2017"},{"key":"2023061611123691600_ref26","volume-title":"Community Water Fluoridation Programs: A Health Technology Assessment","author":"Canadian Agency for Drugs and Technologies in Health","year":"2019"},{"key":"2023061611123691600_ref27","volume-title":"Fluoridation: An Update on Evidence","author":"Office of the Prime Minister\u2019s Chief Science Advisor (New Zealand)","year":"2021"},{"key":"2023061611123691600_ref28","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1038\/sj.bdj.2012.138","article-title":"What do we really know about UK paediatric dental general anaesthesia services?","volume":"212","author":"Robertson","year":"2012","journal-title":"Br Dent J"},{"key":"2023061611123691600_ref29","doi-asserted-by":"crossref","first-page":"E10","DOI":"10.1038\/sj.bdj.2014.180","article-title":"An alternative marker for the effectiveness of water fluoridation: hospital extraction rates for dental decay, a two-region study","volume":"216","author":"Elmer","year":"2014","journal-title":"Br Dent J"},{"key":"2023061611123691600_ref30","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1038\/sj.bdj.2014.1013","article-title":"Unlikely reasons","volume":"217","author":"Elmer","year":"2014","journal-title":"Br Dent J"}],"container-title":["Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jpubhealth\/article-pdf\/45\/2\/462\/50600471\/fdac066.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpubhealth\/article-pdf\/45\/2\/462\/50600471\/fdac066.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T07:15:49Z","timestamp":1686899749000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpubhealth\/article\/45\/2\/462\/6618072"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,26]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,6,26]]},"published-print":{"date-parts":[[2023,6,14]]}},"URL":"https:\/\/doi.org\/10.1093\/pubmed\/fdac066","relation":{},"ISSN":["1741-3842","1741-3850"],"issn-type":[{"value":"1741-3842","type":"print"},{"value":"1741-3850","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,6]]},"published":{"date-parts":[[2022,6,26]]}}}