Drinking water fluoridation and oral health inequalities in Canadian children
Authors: Lindsay McLaren and J. C. Herbert Emery
Objectives: One argument made in favor of drinking water fluoridation is that it is equitable in its impact on oral health. We examined the association between exposure to fluoridation and oral health inequalities among Canadian children. Methods: We analyzed data from 1,017 children age 6-11 from Cycle 1 of the Canadian Health Measures Survey, a cross-sectional, nationally-representative survey that includes a clinic oral health exam and a household interview. Data were analyzed using linear (OLS) and multinomial logistic regression; we also computed the concentration index for educationrelated inequality in oral health. Water fluoridation status (the intervention) was assigned based on data collection site location. Results: fluoridation was associated with better oral health (fewer dmftDMFT), adjusting for socioeconomic and behavioral variables, and the effect was particularly strong for more severe oral health problems (3 or more dmftDMFT). The effect of fluoridation on dmftDMFT was observed across income and education categories, but appeared especially pronounced in the lower education and higher income adequacy households. Caries were found to be disproportionately concentrated in lower education households, though this did not vary by fluoridation status. Conclusions: The robust main effect of fluoridation on dmftDMFT, and the beneficial effect across SES groups, support fluoridation as a beneficial and justifiable population health intervention. fluoridation was equitable in the sense that its benefits were particularly apparent in those groups with the poorest oral health profiles, though the nature of findings prompts consideration of the values underlying the judgment of health equity.
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