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Water Fluoridation and Income-Related Dental Caries

JAMA Pediatrics; ePub 2019 Jan 28; Sanders, et al

Children in families with low income—but not those living in poverty—were less likely than other income groups to live in a predominantly fluoridated county, a recent study found. In this cross-sectional epidemiologic investigation, researchers merged county-level fluoridation data from the Centers for Disease Control and Prevention’s Water Fluoridation Reporting System with dental caries data from 1999-2004 and 2011-2014 cycles of the National Health and Nutrition Examination Survey (NHANES). Counties were classified as predominantly fluoridated where ≥75% of the population was served by fluoridated water and otherwise as less fluoridated. Dental caries was quantified as the sum of decayed and filled primary tooth surfaces (dfs) for children aged 2 to 10 years (n=5,835), and the sum of decayed, missing, and filled permanent tooth surfaces (DMFS) for those aged 6 to 17 years (n=8,384). They found:

  • In predominantly fluoridated counties, the income gradient in dfs was attenuated by 41% compared with less-fluoridated counties and the interaction was statistically significant.
  • Absolute and relative fluoridation-related caries reductions were most pronounced for the lowest income level.


Sanders AE, Grider WB, Maas WR, Curiel JA, Slade GD. Association between water fluoridation and income-related dental caries of US children and adolescents. [Published online ahead of print January 28, 2019]. JAMA Pediatrics. doi:10.1001/jamapediatrics.2018.5086.