Chondur, Ramakrishna

Raymond, Kate

Zhao, Yuejen

Bailie, Ross

Burgess, Paul

2024-09

Community water fluoridation (CWF) is a cost-effective intervention to reduce dental caries at population level. This Australian study used a difference-in-difference (DiD) analysis to measure dental caries in children exposed to CWF in the Northern Territory (NT), Australia.Oral health data obtained from the NT Department of Health contained 64 399 person-year observations from 2008 to 2020, totalling 24 546 children aged 1-17 years. Drinking water quality data for fluoride levels, held by the Power and Water Corporation, were obtained for 50 remote communities and linked to the oral health dataset. The DiD analysis used a treatment group and two control groups to compare the effects of CWF on dental caries outcomes in children, measured using the decayed, missing and filled teeth (dmft/DMFT) index. The treatment group consisted of records from children residing in five remote NT communities that implemented CWF in 2014.The control 1 group included records of children residing in communities with naturally occurring fluoride in drinking water supplies at levels at or above the Department of Health policy threshold of 0.5 mg/L. The control 2 group included records of children residing in communities with naturally occurring fluoride in drinking water supplies below the level recommended by the Department of Health policy (<0.5 mg/L). The data were grouped into time periods prior to the inception of CWF in five remote communities in 2014 (pre-intervention) and after 2014 (post-intervention).Our results demonstrated that dental caries was significantly decreased for children in the treatment group following the implementation of CWF at a greater magnitude than both control groups for the same time period. Overall, children assigned to the treatment group exhibited a decline in the number of teeth affected by caries by an average of 0.28 (p=0.001). Notably, children of ages 7-10 years and 11-17 years experienced significantly greater post-intervention declines in average dmft/DMFT, by 0.32 (p=0.051) and 0.40 (p=0.012) fewer affected teeth respectively.While dental caries disproportionately impacts Aboriginal children in remote and very remote NT, it is clear that CWF produces population-level reductions in overall dental caries for these populations. Additionally, our study demonstrates the application of the DiD method in a public health policy evaluation. Our findings suggest that the longstanding policy position of the NT Department of Health on CWF has supported improvements in oral health among child populations that experience high levels of dental caries in remote NT communities.

(Chondur; Zhao; Burgess) Health Statistics and Informatics, Northern Territory Department of Health, Casuarina, NT, Australia.

(Raymond) Commissioning and System Improvement, Northern Territory Department of Health, Casuarina, NT, Australia.

(Bailie) Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.

Chondur, R., Raymond, K. J., Zhao, Y., Bailie, R., & Burgess, P. (2024). Effects of community water fluoridation on child dental caries in remote Northern Territory, Australia: a difference-in-difference analysis. Rural and remote health, 24(3), 8904. https://doi.org/10.22605/RRH8904

1445-6354

https://pubmed.ncbi.nlm.nih.gov/39318180/?otool=iaurydwlib

https://hdl.handle.net/10137/13874

Australia

Northern Territory

dental caries

fluoridation

oral health

Aboriginal

Humans

Dental Caries

Fluoridation

Child

Northern Territory

Child, Preschool

Male

Female

Adolescent

Infant

Rural Population

DMF Index

Effects of community water fluoridation on child dental caries in remote Northern Territory, Australia: a difference-in-difference analysis

Journal Article

Publication