Abstract
BackgroundThe general aim of this research was to determine whether cessation of community water fluoridation (CWF) increased oral health disparities, as measured by dental caries procedures and restoration costs for children and adolescents.MethodsThe analysis was based on all Medicaid dental claims records of 0- to 18-year-old patients residing in zip code 99801 (Juneau, Alaska) during an optimal CWF year (2003, n = 853) compared to all claims for the same age group from 2012 (n = 1052), five years after cessation of CWF. A bivariate analysis (Mann-Whitney U test) of the mean number of caries procedures performed per client was conducted in the study groups under both independent CWF conditions. Furthermore, logistic regression was performed using the dependent variables of caries procedures and the cost of caries-related procedures, with adjustments for CWF group, gender, and race.ResultsThe statistically significant results included a higher mean number of caries-related procedures among 0- to 18-year-old and < 7-year-old patients in the suboptimal CWF group (2.35 vs. 2.02, p < 0.001; 2.68 vs. 2.01, p = 0.004, respectively). The mean caries-related treatment costs per patient were also significantly higher for all age groups, ranging from a 28 to 111% increase among the suboptimal CWF cohorts after adjusting for inflation. The binary logistic regression analysis results indicated a protective effect of optimal CWF for the 0- to 18-year-old and < 7-year-old age groups (OR = 0.748, 95% CI [0.62, 0.90], p = 0.002; OR = 0.699, 95% CI [0.52, 0.95], p = 0.02, respectively). Additionally, the age group that underwent the most dental caries procedures and incurred the highest caries treatment costs on average were those born after CWF cessation.ConclusionsThese results expand our understanding of caries epidemiology under CWF cessation conditions and reaffirm that optimal CWF exposure prevents dental decay. These findings can offer fiscal estimates of the cost burden associated with CWF cessation policies and help decision-makers advance oral health, prevent dental caries, and promote equity in oral health outcomes.
Highlights
While the oral health of most Americans has improved over the last century, it remains a significant unmet health care need for children and structurally marginalized groups [1, 2]
More than one-half (53.9%) of the participants self-identified as American Indian or Alaska Native (AI/AN), and 30.9% self-identified as white/Caucasian
While the AI/AN community accounts for only 13.4% of Alaska’s total population, they are over-represented in the Medicaid group due to historical oppression resulting in poverty
Summary
While the oral health of most Americans has improved over the last century, it remains a significant unmet health care need for children and structurally marginalized groups [1, 2]. (CWF) and reductions in both pediatric dental caries and adult tooth loss are important for improving economic, racial, and ethnic disparities in oral health [9,10,11,12,13,14,15]. Estimates specify that for every $1 spent on oral health preventative measures, such as CFW, taxpayers can save $50 in annual treatment costs for each low-income citizen who relies on state and federal subsidies for dental care [3, 16, 20,21,22,23,24]. The general aim of this research was to determine whether cessation of community water fluoridation (CWF) increased oral health disparities, as measured by dental caries procedures and restoration costs for children and adolescents
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