TITLE: Fluoridated Water for Cavity Prevention: Clinical and Cost-Effectiveness and

Transcription

1 TITLE: Fluoridated Water for Cavity Prevention: Clinical and Cost-Effectiveness and Guidelines DATE: 29 April 2009 RESEARCH QUESTIONS: 1. What is the evidence for the clinical benefit and safety of fluoridated water for cavity prevention? 2. What is the cost-effectiveness of fluoridated water for cavity prevention? 3. What are the guidelines for methods to deliver fluoride for cavity prevention? METHODS: A limited literature search was conducted on key health technology assessment resources, including PubMed, the Cochrane Library (Issue 2, 2009), University of York Centre for Reviews and Dissemination (CRD) databases, ECRI, EuroScan, international health technology agencies, and a focused Internet search. The search was limited to English language articles published between 2004 and April, 2009 with exception of randomized controlled trials. The search for randomized controlled trials was restricted to English language articles published between 2006 and April, Filters were applied to limit the retrieval to health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, economic studies, and guidelines. Internet links were provided, where available. RESULTS: HTIS reports are organized so that the higher quality evidence is presented first. Therefore, health technology assessment reports, systematic reviews, and meta-analyses are presented first. These are followed by randomized controlled trials, economic evaluations, and evidencebased guidelines. Disclaimer: The Health Technology Inquiry Service (HTIS) is an information service for those involved in planning and providing health care in Canada. HTIS responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. HTIS responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report. Copyright: This report contains CADTH copyright material and may contain material in which a third party owns copyright. This report may be used for the purposes of research or private study only. It may not be copied, posted on a web site, redistributed by or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner. Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners own terms and conditions.

2 Two systematic reviews, one meta-analysis, and four economic evaluations were identified from the literature results regarding the clinical benefit and safety, and the cost-effectiveness of fluoridated water for cavity prevention. Three guidelines for methods of delivering fluoride for cavity prevention were identified. Two systematic reviews, one randomized controlled trial, and one economic evaluation were identified regarding the clinical benefit and safety, and the costeffectiveness of alternative methods of fluoridation for cavity prevention. Additional articles that may be of interest have been included in the appendix. Health technology assessments No literature identified Systematic reviews and meta-analyses 1. Yeung CA. A systematic review of the efficacy and safety of fluoridation. Evid Based Dent 2008;9(2): PubMed: PM Griffin SO, Regnier E, Griffin PM, Huntley V. Effectiveness of fluoride in preventing caries in adults. J Dent Res 2007;86(5): PubMed: PM National Health and Medical Research Council (Australia). A systematic review of the efficacy and safety of fluoridation: part A: review of methodology and results. Canberra: NHMTC, Available: (accessed 29 April 2009). 4. Yeung CA, Hitchings JL, Macfarlane TV, Threlfall AG, Tickle M, Glenny AM. Fluoridated milk for preventing dental caries. Cochrane Database Syst Rev 2005;(3):CD PubMed: PM Twetman S, Petersson L, Axelsson S, Dahlgren H, Holm AK, Kallestal C, et al. Cariespreventive effect of sodium fluoride mouthrinses: a systematic review of controlled clinical trials. Acta Odontol Scand 2004;62(4): PubMed: PM Randomized controlled trials 6. Nicol AJ, Creanor S, Hall AF, Macpherson LM. A randomised, observer-blind, clinical study investigating the effect of fluoridated milk on artificially created early enamel caries using transverse microradiography. Caries Res 2008;42(4): PubMed: PM Economic evaluations 7. Splieth CH, Flessa S. Modelling lifelong costs of caries with and without fluoride use. Eur J Oral Sci 2008;116(2): PubMed: PM Fluoridated Water for Cavity Prevention 2

3 8. Ehsani JP, Bailie R. Feasibility and costs of water fluoridation in remote Australian Aboriginal communities. BMC Public Health 2007;7:100. PubMed: PM Goldsmith LJ, Hutchison B, Hurley J. Economic evaluation across the four faces of prevention: a Canadian perspective. In: CHEPA working papers series [database online]. Hamilton: Centre for Health Economics and Policy Analysis; Paper Available: Note: see 8D. Community Water Fluoridation, page O'Connell JM, Brunson D, Anselmo T, Sullivan PW. Costs and savings associated with community water fluoridation programs in Colorado. Prev Chronic Dis 2005;2 Spec no:a06. PubMed: PM Marino R, Morgan M, Weitz A, Villa A. The cost-effectiveness of adding fluorides to milkproducts distributed by the National Food Supplement Programme (PNAC) in rural areas of Chile. Community Dent Health 2007;24(2): PubMed: PM Guidelines and recommendations 12. Health Canada. Findings and recommendations of the fluoride expert panel (January 2007). Ottawa: Health Canada; Available: Levy M, Corbeil F. Water fluoridation: an analysis of benefits and risks: scientific advisory. Quebec City: Institut national de santé publique du Québec (INSPQ). Available: Note: see Costs and Benefits of Water Fluoridation, page 21, and Observations and Recommendations, page Department of Health: Dental and Ophthalmic Services Division. Choosing better oral health: an oral health plan for England. London: The Department, Available: talasset/dh_ pdf Note: see Optimising exposure to fluorides, page 36 PREPARED BY: Michelle Clark, BSc, Research Assistant Raymond Banks, AB, MA, MLS, Information Specialist Health Technology Inquiry Service htis@cadth.ca Tel: Fluoridated Water for Cavity Prevention 3

4 APPENDIX FURTHER INFORMATION: Observational studies 15. Spencer AJ, Armfield JM, Slade GD. Exposure to water fluoridation and caries increment. Community Dent Health 2008;25(1): PubMed: PM Do LG, Spencer AJ. Risk-benefit balance in the use of fluoride among young children. J Dent Res 2007;86(8): PubMed: PM Whelton H, Crowley E, O'Mullane D, Donaldson M, Cronin M, Kelleher V. Dental caries and enamel fluorosis among the fluoridated population in the Republic of Ireland and non fluoridated population in Northern Ireland in Community Dent Health 2006;23(1): PubMed: PM Position statements 18. British Medical Association. Fluoridation of water. In: Briefing paper [database online]. London: BMA; Available: Canadian Cancer Society. Water fluoridation. Toronto: The Society; Available: Palmer C, Wolfe SH. Position of the American Dietetic Association: the impact of fluoride on health. J Am Diet Assoc 2005;105(10): PubMed: PM Chartered Institution of Water and Environmental Management. Fluoridation of public water supplies. In: CIWEM policy position statements [database online]; CIWEM: London; Available: (accessed 2009 Apr 29). 22. National Institute of Dental and Craniofacial Research (NIDCR). Statement on water fluoridation. Rockville (MD): NIDCR; Available: 8F45E20E1457/3442/SGstatement.pdf Review articles 23. Centers for Disease Control and Prevention. Populations receiving optimally fluoridated public drinking water: United States, In: Morbidity and mortality weekly report [database online]. Atlanta: CDC; (27). Available: Fluoridated Water for Cavity Prevention 4

5 24. Pizzo G, Piscopo MR, Pizzo I, Giuliana G. Community water fluoridation and caries prevention: a critical review. Clin Oral Investig 2007;11(3): PubMed: PM British Fluoridation Society, UK Public Health Association, British Dental Association, Faculty of Public Health. One in a million: the facts about water fluoridation. 2nd edition. Manchester: The Society; Available: Kauffman JM. Water fluoridation: a review of recent research and actions. J Am Physicians Sur 2005;10(2): Available: Alternative methods of fluoridation 27. Banoczy J, Rugg-Gunn AJ. Caries prevention through the fluoridation of milk. A review. Fogorv Sz 2007;100(5): PubMed: PM Jones S, Burt BA, Petersen PE, Lennon MA. The effective use of fluorides in public health. Bull World Health Organ 2005;83(9): PubMed: PM Marthaler TM, Pollak GW. Salt fluoridation in Central and Eastern Europe. Schweiz Monatsschr Zahnmed 2005;115(8): PubMed: PM Petersen PE, Lennon MA. Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach. Community Dent Oral Epidemiol 2004;32(5): PubMed: PM Additional references 31. Centers for Disease Control and Prevention. Community water fluoridation. Atlanta: CDC; Available: Cooney P. Canada's chief dental officer weighs in on fluoride Ottawa: Health Canada; Available: Health Canada. Fluoride and human health. Ottawa: Health Canada; Available: Fluoridated Water for Cavity Prevention 5