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Table 4 : Systematic reviews reported since the 2015 Cochrane systematic review Year( s ) and setting for Methods ( row 1 ) data collection Results ( row 2 ) 2016, Australia , Review of previous systematic reviews (through 2015 ) and subsequently- published association studies through 2016 Evidence evaluation of ( n= 15 studies of primary dentition caries; n =21 studies of permanent dentition ) by the Fluoride Reference Group of fluoridation and dental the Australian National Health and Medical Research Council . caries 55 Main conclusions : • "water fluoridation reduces tooth decay by 26-44% in children, teenagers and adults" . • "there is consistent evidence that water fluoridation reduces tooth decay for all socio-economic groups " • " there is some additional evidence that suggests water fluoridation reduces inequality in tooth decay experienced by those in lower socio-economic groups and those living in regional areas . 2016, Canada, Systematic review of n = 15 studies that investigated caries experience before- and after-cessation of community Systematic review of water fluoridation . fluoridation cessation 56 Of 9 studies that met criteria for methodological quality, five showed an increase in caries after cessation of fluoridation, 3 studies did not show an increase, and one could not be adjudicated . 2 . 3 . 6 Critical appraisal of studies reported since the 2015 Cochrane systematic review In each instance of primary studies reported since 2015 (Table 2 ) , the study designs were of the type that did not meet the criteria for study selection in the 2015 Cochrane review . That is, the subsequently reported studies either used a cross-sectional design or sequential cross-sectional surveys before and after fluoridation ( or defluoridation ) , but with no comparison community . Hence , if a systematic review were to be repeated today using the same study selection criteria as applied for the Cochrane review,43 none of the new studies would be included . Yet, other systematic reviews conducted since 2015 were more inclusive in their selection criteria than the 2015 Cochrane systematic review . In each instance, those other systematic reviews evaluated a considerably larger body of evidence, and they were more affirmative in concluding that fluoridation was associated with lower levels of dental caries than was the 2015 Cochrane systematic review . Specifically, the Australian evidence review considered cross-sectional studies excluded by the 2015 Cochrane systematic review, along with 26 studies published since the 2015 Cochrane systematic review, concluding that fluoridation reduces tooth decay by 26-44 % ( a higher upper bound than the 26 -35 % reported in the 2015 Cochrane systematic review ) . The Australian review was also more affirmative with respect to effects of fluoridation on socio- economic inequalities in dental caries . Likewise , the systematic review of fluoridation cessation,56 in concluding that " overall, the published research points more to an increase in dental caries post-CWF [ community water fluoridation ] cessation than otherwise " , was more assertive than the 2015 Cochrane systematic review which concluded " there is insufficient information to determine the effect of stopping water fluoridation programmes on caries levels " . In summary, studies reported since 2015 continue to show dental caries preventive benefits associated with exposure to fluoridated drinking water . The two new systematic reviews used more inclusive selection criteria than the 2015 Cochrane systematic review and were more affirmative in their conclusions of a caries- preventive benefit . 2 . 3. 7 Epidemiologic studies of water fluoridation and dental caries in adults Epidemiologic studies in adults of the association between water fluoridation and dental caries date back to 194857 when a markedly lower-than expected rate of dental decay and tooth extraction was seen in adults who were lifetime residents of Colorado Springs, CO , where drinking water contained 2 . 6 mg/ L F . When later compared with lifetime