Abstract
BackgroundDental caries inequalities still severely burden individuals’ and society’s health, even in countries where fluoride toothpastes are widely used and the incidence of dental caries has been decreasing. School-based fluoride mouth-rinse (S-FMR) programs, a population strategy for dental caries prevention, might decrease dental caries inequalities. This study investigated the association between S-FMR and decreasing dental caries prevalence and caries-related inequalities in 12-year-olds by Japanese prefecture.MethodsWe conducted an ecological study using multi-year prefecture-level aggregated data of children born between 1994 and 2000 in all 47 Japanese prefectures. Using two-level linear regression analyses (birth year nested within prefecture), the association between S-FMR utilization in each prefecture and 12-year-olds’ decayed, missing, or filled permanent teeth (DMFT), which indicates dental caries experience in their permanent teeth, were examined. Variables that could explain DMFT inequalities between prefectures, such as dental caries experience at age 3 years, dentist density, and prefectural socioeconomic circumstances, were also considered.ResultsHigh S-FMR utilization was significantly associated with low DMFT at age 12 (coefficient −0.011; 95% confidence interval, −0.018 to −0.005). S-FMR utilization explained 25.2% of the DMFT variance between prefectures after considering other variables. Interaction between S-FMR and dental caries experience at age 3 years showed that S-FMR was significantly more effective in prefectures where the 3-year-olds had high levels of dental caries experience.ConclusionsS-FMR, administered to children of all socioeconomic statuses, was associated with lower DMFT. Utilization of S-FMR reduced dental caries inequalities via proportionate universalism.
Highlights
Dental caries experience at 3 years old seemed to mediate the influence of these associations
An increase of 1% in School-based fluoride mouth-rinse (S-FMR) utilization was significantly associated with 0.011 lower DMFT in 12-year-olds, even after considering other variables
S-FMR largely reduced the prefecture-level variance compared to other variables: 25.2% of the variance was explained by S-FMR in model 4, whereas 21.3% was explained by other variables in model 2
Summary
International and domestic health inequalities have emerged as important research topics[1] and represent a global public health issue.[1,2,3] Dental caries was the most common disease in the Global Burden of Disease 2010 Study,[4] and its global inequalities are remarkable.[5,6,7,8,9] Even in developed countries, there are significant variations in dental health inequality by area.[10,11] Owing to high dental disease prevalence, the total cost of medical care for dental diseases is the highest across all diseases in Japan, exceeding 26 billion United States dollars (1 US dollar ≈ 100 Japanese yen) in 2011.12 despite the recent decline in dental caries, the health burden of dental caries on individuals and societies remains high.Fluoride Mouth Rinse in School and Caries Inequality Among Prefectures in JapanHealth intervention dissemination is often affected by socioeconomic circumstances.[13]. Interventions that depend on individual motivation often increase health inequalities.[13,14] In contrast, interventions aimed at changing social environment are beneficial regardless of individual socioeconomic circumstances and can reduce health inequalities They are sometimes more beneficial for people with poor socioeconomic circumstances.[3,15,16] Such interventions are known as population strategies.[17] Water fluoridation is an example of a population strategy[16,17] that reduces dental health inequalities.[15,18] water fluoridation has not been established in Japan except on United States Army bases, even though it is recommended by Japanese Society for Oral Health[19] and Ministry of Health, Labour and Welfare stated for technical support to fluoridation.[20] Japanese government and advocate activities are conducted in several municipalities. This study investigated the association between S-FMR and decreasing dental caries prevalence and caries-related inequalities in 12-year-olds by Japanese prefecture. Variables that could explain DMFT inequalities between prefectures, such as dental caries experience at age 3 years, dentist density, and prefectural socioeconomic circumstances, were considered. Utilization of S-FMR reduced dental caries inequalities via proportionate universalism
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