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Jung, Kim, Kim, Lee, Kim, and Jeong: Caries-preventing effects of a suburban community water fluoridation program on permanent dentition after adjusting for the number of fissure-sealed teeth
Original Article

J Korean Acad Oral Health 2016;40(1):61-68.

Published online: 12 March 2016

DOI: https://doi.org/10.11149/jkaoh.2016.40.1.61

Caries-preventing effects of a suburban community water fluoridation program on permanent dentition after adjusting for the number of fissure-sealed teeth

Ji-In Jung1, Ji-Eun Kim1, Se-Yeon Kim1, 2, Jung-Ha Lee1, Jin-Bom Kim1, 2, Seung-Hwa Jeong1, 2

1Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, Yangsan, Korea

2BK21 Plus Project of Center for Professional Education on Technosciences of Oral Health, Yangsan, Korea

Corresponding Author: Seung-Hwa Jeong Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-51-510-8222 Fax: +82-51-510-8221 E-mail: jsh0917@pusan.ac.kr

Received 3 March 2016       Revised 22 March 2016       Accepted 24 March 2016

Copyright © 2016 Journal of Korean Academy of Oral Health

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The aim of this study is to evaluate the effect of suburban community water fluoridation programs on preventing caries in permanent teeth.

Methods

In 2012, surveys were administered to children aged 8, 12, and 15 years residing in fluoridated Habcheon township area. Samples collected during the national survey in 2012 from children of the same age residing in non-fluoridated township areas were used as the control, and the caries prevalence data from this sample were used to estimate the caries preventive effect in the studied regions. This study included 457 subjects from the Habcheon township area and 1,792 in the control group. The data obtained from the survey were analyzed using the IBM SPSS statistical package version 21.0. The caries preventive effect exerted by fluoride in the community water supply was determined by calculating the differences in the DMFT and DMFS indices between the study and control groups. The cofounders of the mean number of fissure-sealed teeth and surfaces were controlled to estimate the effectiveness of caries prevention.

Results

The odds ratio of subjects with no dental caries in the fluoridated region was 0.75 compared to that in the control group. The mean DMFT scores or DMFS scores adjusted for the number of fissure-sealed teeth or tooth surfaces were lower than those in the control group. The caries prevention fraction was estimated to be 23.4% based on the difference in the adjusted mean DMFT scores between the control and study groups.

Conclusions

These results suggest that fluoridation of the community water in the suburban area was highly effective in preventing dental caries in permanent teeth, and therefore, this community water fluoridation program should be implemented in other regions in Korea.

Keywords: Dental caries, Fluoride, Permanent teeth, Prevention, Suburban area, Water fluoridation

References

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Table 1.
Subject numbers of control and water fluoridation program in Habcheon
Age (yr) Control*
 Program
N % N %
Total 1,792 100.0 457 100.0
8 598 33.4 143 31.3
12 600 33.5 170 37.2
15 594 33.1 144 31.5

*Subjects of suburban regions except community water fluoridation program area in 2012 National Oral Health Survey conducted by Ministry of Health and Welfare.

Table 2.
Distribution of subjects by age and gender
Age Gender Control*
 Program
 P†
N % N %
Total Male 887 49.5 245 53.6 0.129
Female 905 50.5 212 46.4
8 Male 295 49.3 79 55.2 0.226
Female 303 50.7 64 44.8
12 Male 300 50.0 91 53.5 0.435
Female 300 50.0 79 46.5
15 Male 292 49.2 75 52.1 0.577
Female 302 50.8 69 47.9

*Subjects of suburban regions except for community water fluoridation program area in 2012 National Oral Health Survey conducted by Ministry of Health and Welfare.

† Chi-square test.

Table 3.
Numbers of fissure-sealed teeth and surfaces
Variables Age (yr) Control*
 Program
 P§
N† Mean SE‡ N† Mean SE‡
Fissure-sealed teeth Total 1,792 2.08 0.06 457 3.18 0.14 <0.001
8 598 1.80 0.07 143 1.30 0.12 <0.001
12 600 2.11 0.11 170 4.84 0.24 <0.001
15 594 2.32 0.13 144 3.07 0.22 0.008
Fissure-sealed surfaces Total 1,792 2.53 0.07 457 3.49 0.15 <0.001
8 598 2.33 0.10 143 1.65 0.17 0.001
12 600 2.51 0.13 170 5.21 0.26 <0.001
15 594 2.74 0.15 144 3.30 0.25 0.055

*Subjects of suburban regions except for community water fluoridation program area in 2012 National Oral Health Survey conducted by Ministry of Health and Welfare.

† Numbers of subjects.

‡ Standard error.

§ Independent samples t-test.

Table 4.
Rate of subjects with dental caries experience on permanent dentition
Age Control*
 Program
 P‡
N† % N† %
Total 1,792 53.5 457 44.6 0.001
8 598 27.6 143 24.5 0.529
12 600 60.0 170 47.6 0.005
15 594 73.1 144 61.1 0.006

*Subjects of suburban regions except for community water fluoridation program area in 2012 National Oral Health Survey conducted by Ministry of Health and Welfare.

† Numbers of subjects.

‡ Chi-square test.

Table 5.
Odds ratios and confidence intervals of variables related to rate of subjects with dental caries experience on permanent dentition*
Age (yr) Variables P Exp (B) 95% CI†
Total Age <0.001 1.34 1.29, 1.38
8 Area (Control=0, Program=1) 0.013 0.75 0.60, 0.94
Number of fissure-sealed teeth <0.001 0.89 0.86, 0.92
Area (Control=0, Program=1) 0.165 0.74 0.48, 1.13
Number of fissure-sealed teeth <0.001 0.73 0.66, 0.82
12 Area (Control=0, Program=1) 0.654 0.92 0.63, 1.34
Number of fissure-sealed teeth <0.001 0.85 0.81, 0.90
15 Area (Control=0, Program=1) 0.008 0.60 0.41, 0.88
Number of fissure-sealed teeth 0.083 0.96 0.91, 1.01

Binominal logistic regression model. Confidence Interval. Total: df=3, Nagelkerke R

2 =0.197, 8-yr olds: df=2, Nagelkerke R

2 =0.064. 2-yr olds: df=2, Nagelkerke R

2 =0.069, 15-yr olds: df=2, Nagelkerke R

2 =0.020.

Table 6.
Mean numbers of decayed, missing and filled teeth and caries prevention fraction in permanent dentition
Age Control*
 Program
 P∥ Control*
 Program
 P** Prevention fraction (%)***
N† Mean‡ SE§ N† Mean‡ SE§ Mean (A) SE§ Mean (B) SE§
Total 1,792 2.05 0.07 457 1.36 0.10 <0.001 2.01a 0.06 1.54a 0.12 0.001 23.4
8 598 0.56 0.04 143 0.55 0.09 0.872 0.58b 0.04 0.47b 0.09 0.267 19.0
12 600 1.98 0.11 170 1.32 0.16 0.001 1.85c 0.10 1.77c 0.20 0.700 4.3
15 594 3.58 0.16 144 2.22 0.21 <0.001 3.59d 0.14 2.36d 0.29 <0.001 34.3

*Subjects of suburban regions except community water fluoridation program area in 2012 National Oral Health Survey conducted by Ministry of Health and Welfare.

† Numbers of subjects.

‡ Unadjusted mean for the number of fissure-sealed teeth in permanent dentition.

§ Standard error.

∥ Independent samples t-test.

Estimated marginal means by univariate analysis of variance adjusted for the number of fissure-sealed teeth in permanent dentition. **ANCOVA (analysis of covariance). ***[(A-B)/A]×100, Bold numbers denote prevention fractions from significant differences between both groups.

a Covariates appearing in the model are fixed at the following values: number of fissure-sealed teeth=2.3024, age=11.67.

b Covariates appearing in the model are fixed at the following values: number of fissure-sealed teeth=1.7058.

c Covariates appearing in the model are fixed at the following values: number of fissure-sealed teeth=2.7156.

d Covariates appearing in the model are fixed at the following values: number of fissure-sealed teeth=2.4702.

Table 7.
Mean numbers of decayed, missing and filled surfaces and caries prevention fraction in permanent dentition
Age Control*
 Program
 P∥ Control*
 Program
 P** Prevention fraction (%)***
N† Mean‡ SE§ N† Mean‡ SE§ Mean (A) SE§ Mean (B) SE§
Total 1,792 3.33 0.12 457 2.09 0.17 <0.001 3.28a 0.10 2.30a 0.21 <0.001 29.9
8 598 0.87 0.07 143 0.78 0.16 0.589 0.90b 0.07 0.68b 0.15 0.192 24.4
12 600 3.22 0.18 170 1.96 0.27 <0.001 3.04c 0.17 2.60c 0.34 0.261 14.5
15 594 5.91 0.27 144 3.53 0.38 <0.001 5.88d 0.25 3.68d 0.51 <0.001 37.4

*Subjects of suburban regions except community water fluoridation program area in 2012 National Oral Health Survey conducted by Ministry of Health and Welfare.

† Numbers of subjects.

‡ Unadjusted mean for the number of fissure-sealed surfaces in permanent dentition.

§ Standard error.

∥ Independent samples t-test.

Estimated marginal means by univariate analysis of variance adjusted for the number of fissure-sealed surfaces in permanent dentition. **ANCOVA (analysis of covariance). ***[(A-B)/A]×100, Bold numbers denote prevention fractions from significant differences between both groups.

a Covariates appearing in the model are fixed at the following values: number of fissure-sealed surfaces=2.7239, age=11.67.

b Covariates appearing in the model are fixed at the following values: number of fissure-sealed surfaces=2.1984.

c Covariates appearing in the model are fixed at the following values: number of fissure-sealed surfaces=3.1078.

d Covariates appearing in the model are fixed at the following values: number of fissure-sealed surfaces=2.8509.

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