BOH Agenda 032520 - Laserfiche WebLink

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Evidence from observational studies fulfills all criteria for a causal interpretation that water fluoridation prevents caries: • Findings are consistent, over time and in different populations; • The strength of association is of public health importance, typically in the range of 30-40% reductions in caries; • The preventive association applies specifically to dental caries, not to other oral diseases; • Studies establish the required temporal sequence between exposure to the fluoridation and caries prevention; • There is a biological gradient in which the benefit increases with increasing extent of exposure to fluoridation; • Results are analogous to caries-preventive effects of other (non-water) sources of fluoride; • Several features of an experimental study are reproduced in studies of fluoridation; and • The causal interpretation is biologically plausible, with good evidence that dental caries prevention is due to a combination of pre-eruptive mechanisms (i.e., incorporation of fluoride into developing enamel which becomes more resistant to subsequent acid attacks) and post- eruptive mechanisms (i.e., concentration of intra-oral fluoride in dental biofilm, inhibiting demineralization and enhancing remineralization). This evidence from observational studies is bolstered by findings from prospective, community- level intervention studies, showing greater reductions in decay rates in communities that implement fluoridation compared to communities that remain non-fluoridated. Most studies that have assessed changes following cessation of fluoridation report an increase in dental caries compared to comparison communities. See Attachment 23 for a detailed response and references. 49