{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:00:49Z","timestamp":1790024449949,"version":"4.0.1"},"reference-count":48,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To pragmatically assess the clinical and cost\u2010effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults and adolescents, using a natural experiment design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 10\u2010year retrospective cohort study (2010\u20132020) using routinely collected NHS dental treatment claims data. Participants were patients aged 12\u2009years and over, attending NHS primary dental care services in England (17.8 million patients). Using recorded residential locations, individuals exposed to drinking water with an optimal fluoride concentration (\u22650.7\u2009mg\u2009F\/L) were matched to non\u2010exposed individuals using propensity scores. Number of NHS invasive dental treatments, DMFT and missing teeth were compared between groups using negative binomial regression. Total NHS dental treatment costs and cost per invasive dental treatment avoided were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Matching resulted in an analytical sample of 6.4 million patients. Predicted mean number of invasive NHS dental treatments (restorations \u2018fillings\u2019\/extractions) was 3% lower in the optimally fluoridated group (5.4) than the non\u2010optimally fluoridated group (5.6) (IRR 0.969, 95% CI 0.967, 0.971). Predicted mean DMFT was 2% lower in the optimally fluoridated group (IRR 0.984, 95% CI 0.983, 0.985). There was no difference in the predicted mean number of missing teeth per person (IRR 1.001, 95% CI 0.999, 1.003) and no compelling evidence that water fluoridation reduced social inequalities in dental health. Optimal water fluoridation in England 2010\u20132020 was estimated to cost \u00a310.30 per person (excludes initial set\u2010up costs). NHS dental treatment costs for optimally fluoridated patients 2010\u20132020 were 5.5% lower, by \u00a322.26 per person (95% CI \u2010\u00a321.43, \u2212\u00a323.09).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Receipt of optimal water fluoridation 2010\u20132020 resulted in very small positive health effects which may not be meaningful for individuals. Existing fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower NHS dental care utilization. This return should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cdoe.12930","type":"journal-article","created":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T22:38:33Z","timestamp":1704753513000},"page":"413-423","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["How effective and cost\u2010effective is water fluoridation for adults and adolescents? The\n                    <scp>LOTUS<\/scp>\n                    10\u2010year retrospective cohort study"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9965-9371","authenticated-orcid":false,"given":"Deborah","family":"Moore","sequence":"first","affiliation":[{"name":"Faculty of Biology, Medicine and Health, Division of Dentistry The University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9050-7926","authenticated-orcid":false,"given":"Blessing","family":"Nyakutsikwa","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine and Health, Division of Dentistry The University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2972-7911","authenticated-orcid":false,"given":"Thomas","family":"Allen","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics The University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Lam","sequence":"additional","affiliation":[{"name":"Independent lay advisor  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1372-0440","authenticated-orcid":false,"given":"Stephen","family":"Birch","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics The University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5348-5441","authenticated-orcid":false,"given":"Martin","family":"Tickle","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine and Health, Division of Dentistry The University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6298-4189","authenticated-orcid":false,"given":"Iain A.","family":"Pretty","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine and Health, Division of Dentistry The University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7003-8854","authenticated-orcid":false,"given":"Tanya","family":"Walsh","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine and Health, Division of Dentistry The University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,8]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31146-8"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.1962.0333"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0003-9969(61)90065-6"},{"issue":"12","key":"e_1_2_12_5_1","first-page":"241","article-title":"Ten great public health achievements \u2010 United States, 1900\u20101999","volume":"48","author":"Centre for Disease Control","year":"1999","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0722.1996.tb00104.x"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-863"},{"key":"e_1_2_12_8_1","first-page":"CD010856","article-title":"Water fluoridation for the prevention of dental caries","volume":"2015","author":"Iheozor\u2010Ejiofor Z","year":"2015","journal-title":"Cochrane Database of Systematic Reviews Published"},{"key":"e_1_2_12_9_1","unstructured":"York Health Economics Consortium Public Health England.A rapid review of evidence on the cost\u2010effectiveness of interventions to improve the oral health of children aged 0\u20105\u2009years. 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