Abstract
BackgroundThere were some debates about the water fluoridation program in South Korea, even if the program had generally substantial effectiveness. Because the out-of-pocket expenditures for dental care were higher in South Korea than in other countries, an efficient solution was needed. Therefore, we examined the relationship between the implementation of water fluoridation and the utilization of dental care.MethodsWe used the National Health Insurance Service National Sample Cohort. In this study, data finally included 472,250 patients who were newly diagnosed with dental caries during 2003–2013. We performed survival analysis using cox proportional hazard model, negative binomial-regression, and regression analyses using generalized estimating equation models.ResultsThere were 48.49 % outpatient dental care visit during study period. Individuals with water fluoridation had a lower risk of dental care visits (HR = 0.949, 95 % CI = 0.928–0.971). Among the individuals who experienced a dental care visit, those with water fluoridation program had a lower number of dental care visits (β = −0.029), and the period of water fluoridation had an inverse association with the dental care expenditures.ConclusionThe implementation of water fluoridation programs and these periods are associated with reducing the utilization of dental health care. Considering these positive impacts, healthcare professionals must consider preventive strategies for activating water fluoridation programs, such as changes in public perception and relations, for the effective management of dental care in South Korea.
Highlights
There were some debates about the water fluoridation program in South Korea, even if the program had generally substantial effectiveness
In the previous study which was conducted based on systematic review in UK, Cho et al BMC Oral Health (2016) 16:119 the water fluoridation had positive impact for reducing dental caries about 14 % [8]
To examine the association between the implementation of water fluoridation program and the utilization of outpatient care for dental caries, represented by factors such as the frequency of outpatient visits and the medical expenditures by individuals, we only included patients who lived in non-metropolitan areas, because water fluoridation programs were rarely implemented in metropolitan areas
Summary
Study population The data used in this study was the National Health Insurance Service National Sample Cohort 2002–2013. The patient variables were as follows: age, sex, income, type of insurance coverage, study year, dental care expenditures in the previous year, dental care visits in the previous year, dentofacial anomalies, and disorders of tooth development and eruption. We performed χ2 tests and Cochran–Mantel–Haenszel tests to investigate the association between each categorical variables and visiting dental care by the implementation of water fluoridation as unit of person-years during study period. For the patients who had experienced outpatient care for dental caries during the study period, to examine the associations with the number of dental care visits and the dental care expenditures, we performed a multiple negative binomial regression, and regression analysis using a Generalized Estimating Equation (GEE) model with link logit regarding the overdispersion of outcome variables [16]. The statistical analyses in used this study were analyzed using SAS statistical software version 9.4
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