Consequences of community water fluoridation cessation for Medicaid-eligible children and adolescents in Juneau, Alaska
Abstract
Background
The general aim of this
research was to determine whether cessation of community water
fluoridation (CWF) increased oral health disparities, as measured by
dental caries procedures and restoration costs for children and
adolescents.
Methods
The analysis was based on all
Medicaid dental claims records of 0- to 18-year-old patients residing in
zip code 99801 (Juneau, Alaska) during an optimal CWF year (2003, n = 853) compared to all claims for the same age group from 2012 (n = 1052),
five years after cessation of CWF. A bivariate analysis (Mann-Whitney U
test) of the mean number of caries procedures performed per client was
conducted in the study groups under both independent CWF conditions.
Furthermore, logistic regression was performed using the dependent
variables of caries procedures and the cost of caries-related
procedures, with adjustments for CWF group, gender, and race.
Results
The statistically significant
results included a higher mean number of caries-related procedures among
0- to 18-year-old and < 7-year-old patients in the suboptimal CWF
group (2.35 vs. 2.02, p < 0.001; 2.68 vs. 2.01, p = 0.004,
respectively). The mean caries-related treatment costs per patient were
also significantly higher for all age groups, ranging from a 28 to 111%
increase among the suboptimal CWF cohorts after adjusting for
inflation. The binary logistic regression analysis results indicated a
protective effect of optimal CWF for the 0- to 18-year-old
and < 7-year-old age groups (OR = 0.748, 95% CI [0.62, 0.90], p = 0.002; OR = 0.699, 95% CI [0.52, 0.95], p = 0.02,
respectively). Additionally, the age group that underwent the most
dental caries procedures and incurred the highest caries treatment costs
on average were those born after CWF cessation.
Conclusions
These results expand our
understanding of caries epidemiology under CWF cessation conditions and
reaffirm that optimal CWF exposure prevents dental decay. These findings
can offer fiscal estimates of the cost burden associated with CWF
cessation policies and help decision-makers advance oral health, prevent
dental caries, and promote equity in oral health outcomes.
Comments