Hospitalizations for dental infections: Optimally versus nonoptimally fluoridated areas in Israel

Abstract

BackgroundOdontogenic infections may result in local, systemic, and even potentially life-threatening complications. The authors investigated whether water fluoridation was associated with reduction in rates of hospitalizations due to odontogenic infections. MethodsThe authors included cities in Israel that had fluoride concentrations of either 0.7 milligrams per liter or more (optimally fluoridated) or 0.5 mg/L or less (nonoptimally fluoridated) and that had a public water fluoride concentration consistent for the last decade. The authors compared hospitalization rates (per 10,000 children) for odontogenic infections in children younger than 18 years in each socioeconomic group between optimally and nonoptimally fluoridated cities. ResultsThe authors included 1,413 hospitalizations between January 2005 and December 2011 of children residing in the 38 studied municipalities. The cities with the higher fluoride concentration reported a lower hospitalization rate (2.0 versus 4.3 for cities with a lower fluoride concentration; relative risk [RR]: 2.16; P < .001). When the authors divided cities into 3 socioeconomic groups, a large difference in hospitalization rates was seen in the lowest socioeconomic group (10.1 versus 2.6; RR: 3.79; P < .001) and the middle socioeconomic group (3.6 versus 1.9; RR: 2.35; P < .001) in optimally and nonoptimally fluoridated cities, respectively. No significant difference in hospitalization rates was apparent between the 2 fluoridation groups in the higher socioeconomic level. ConclusionsThese results clearly indicate that there is an association between adequacy of water fluoridation and hospitalization due to dental infections among children and adolescents. This effect is more prominent in populations of lower socioeconomic status. Practical ImplicationsWater fluoridation is associated with reduction in dental health disparity.