An Australian nationwide population-based follow-up study published in the Journal of Dental Research (JDR) has provided evidence that young children’s exposure to fluoridated water was not negatively associated with emotional, behavioral and executive functioning development in their children. teenage years.
Summary This study aimed to evaluate the risk-benefit balance of various fluoride exposures. Fluoride exposure history was collected from randomly selected children to estimate exposure to fluoridated water, toothpaste, and other fluoride sources. We evaluated the risk-benefit balance of fluoride exposure by comparing dental fluorosis in the maxillary central incisors, recorded at the time of the study with the use of the Thylstrup and Fejerskov index, and the experience of deciduous caries, recorded at the age of six. years, from the same group of South Australian children who were aged 8–13 years in 2002–03. The attributable risk to the population for fluorosis and the prevented fraction of the population for caries were estimated. The prevalence of fluorosis was found to be 11.3%; caries prevalence, 32.3%; mean cpm, 1.57 (SD 3.3). Exposure to fluoridated water was positively associated with fluorosis, but negatively associated with caries. Use of 1000 ppm-F toothpaste (compared with 400 to 550 ppm-F toothpaste) and eating/licking toothpaste were associated with an increased risk of fluorosis without additional protective benefit against cavities. Assessment of the risk-benefit balance of fluoride exposure provides evidence to assist in the formulation of appropriate guidelines for fluoride use. |
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The study by Professor Loc Do of the University of Queensland’s School of Health and Behavioral Sciences, Faculty of Dentistry, and colleagues examined the effect of early childhood exposures to water fluoridation on measures of Executive functioning and emotional and behavioral development in a school-age population-based sample.
This longitudinal follow-up study used data from the 2012-14 Australian National Children’s Oral Health Study. Children aged 5 to 10 years at the start of the study were contacted again after 7 to 8 years, before they turned 18 years old.
The percentage of lifetime exposed to fluoridated water (%LEFW) from birth to age five years was estimated from residential history and zip code-level fluoride levels in public tap water.
Measures of children’s emotional and behavioral development were assessed using the Strengths and Difficulties Questionnaire (SDQ), and executive functioning was measured using the Behavioral Inventory of Executive Functioning (BRIEF).
Multivariable regression models were generated to compare associations between exposure and primary outcomes, controlling for covariates. An equivalence test was also performed to compare the primary outcomes of those with 100% fluoridated water (%LEFW) versus those with 0% fluoridated water (%LEFW).
A sensitivity analysis was also performed. A total of 2,682 children completed the SDQ and BRIEF, with mean scores of 7.0 (95% CI: 6.6, 7.4) and 45.3 (44.7, 45.8), respectively.
Those with lower %LEFW tended to have lower scores on the Strengths and Difficulties Questionnaire (SDQ) and Behavioral Executive Functioning (BRIEF). Multivariable regression models reported no association between exposure to fluoridated water and SDQ and BRIEF scores.
Low household income, identifying as Indigenous, and having a neurodevelopmental diagnosis were associated with lower SDQ/BRIEF scores.
The study concluded that exposure to fluoridated water during the first five years of life was not associated with altered measures of the child’s emotional and behavioral development or executive functioning.
Children who had been exposed to fluoridated water throughout early childhood had measures of emotional, behavioral development, and executive functioning at least equivalent to those of children who had not been exposed to fluoridated water.
"Water fluoridation is unquestionably effective in preventing dental caries, and this study is an important addition to the body of literature documenting the safety of water fluoridation," said IADR President Brian O’Connell, dean of the Faculty of Health Sciences, Trinity College Dublin, Ireland. “The IADR recently reaffirmed its support for water fluoridation as this public health measure has a high cost/benefit ratio and benefits the most disadvantaged communities, thus reducing health inequalities.”
