Community Water Fluoridation: What's the Evidence?

  • 763 views
Uploaded on

A webinar hosted by the Health Evidence team, funded by the Canadian Institutes of Health Research (KTB-112487), interpreting the evidence in the topic area of community water fluoridation.

A webinar hosted by the Health Evidence team, funded by the Canadian Institutes of Health Research (KTB-112487), interpreting the evidence in the topic area of community water fluoridation.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
763
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
26
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide
  • Pre-webinar polls: (open-ended questions) 1. What has been your experience in finding/using evidence related to water fluoridation? 2. How do you use research evidence to inform your practice?
  • Poll 3.Where are you from (province/country/continent)?BCABSKMBONQCNBNSPENFNUNTYK USASouth America, Central America, CaribbeanEuropeAfricaAsiaOceania
  • Poll question #4:When searching for evidence, where do you look first? Clinical Guidelines (e.g. National Guidelines Clearinghouse)GoogleGoogle ScholarHealth-evidence.caPubMed
  • Poll Question #5Do you know the difference between a Systematic Review and a Literature Review?YesNo
  • FINAL Polls: 6 and 7Did you find the information presented today helpful?YesNo Was this information new to you?Yes No

Transcript

  • 1. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome! Fluoridation:What’s the evidence? You will be placed on hold until the webinar begins.The webinar will begin shortly, please remain on the line.
  • 2. What’s the evidence? This webinar will focus on a number of sources of information, including a systematic review featured on Health Evidence: http://www.health-evidence.ca/articles/show/15981
  • 3. Participant Side PanelHousekeeping in WebEx Use Q&A to post comments/questions during the webinar  ‘Send’ questions to All (not privately to ‘Host’) Connection issues  Recommend using a wired Internet connection (vs. wireless), to help Q&A prevent connection challenges  WebEx 24/7 help line: 1-866-229- 3239
  • 4. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome! Fluoridation:What’s the evidence?
  • 5. The Health Evidence Team Kara DeCorby Heather Husson Jennifer Yost Administrative Director Project Manager Guest PresenterMaureen DobbinsScientific DirectorTel: 905 525-9140 ext 22481E-mail: dobbinsm@mcmaster.ca Lori Greco Robyn Traynor Lyndsey McRae Knowledge Broker Research Coordinator Research Assistant
  • 6. What is www.health-evidence.ca? Evidence inform Decision Making
  • 7. Why use www.health-evidence.ca? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  • 8. Knowledge Translation Supplement Project CIHR-funded KTB-112487
  • 9. Discussion question: What is the evidence on the effectiveness of water fluoridation for caries prevention?
  • 10. Questions?
  • 11. Searching for relevantevidence: The pyramid Insert pic of 6S pyramid here DiCenso, Bayley, & Haynes, 2009
  • 12. What is the “BestAvailable” Evidence?
  • 13. Relevance Criteria: Addresses impact of water fluoridation in the context of developed countries Produced within the last 15 years English-language
  • 14. Search Strategy: Searched review-level evidence in public health related to fluoridation on health-evidence.ca Reviewed reference lists of relevant reviews
  • 15. Evidence Reviewed: PHAC: Drinking Water Fluoridation in Canada: Review and Synthesis of Published Literature, 2011 Quebec PH: Water Fluoridation: An Analysis of the Health Benefits and Risks, 2007 Australian Government, NHMRC: A Systematic Review of the Efficacy and Safety of Fluoridation, 2007 NHS Centre for Reviews and Dissemination: A Systematic Review of Water Fluoridation, 2000
  • 16. Is it a Systematic Review? Is there a methods section? Does the methods section outline a search strategy? Are there inclusion criteria given? Did the reviewers assess relevance systematically? Did the reviewers conduct a quality assessment?
  • 17. Literature Reviews: Quebec PH: Water Fluoridation: An Analysis of the Health Benefits and Risks, 2007  No methodology reported PHAC: Drinking Water Fluoridation in Canada: Review and Synthesis of Published Literature, 2011  Report some inclusion/exclusion criteria  Report some searching methodology  No quality assessment
  • 18. Systematic Reviews: Australian Government, NHMRC: A Systematic Review of the Efficacy and Safety of Fluoridation, 2007  Major Strength: Includes systematic reviews and primary studies  Major Limitation: Quality assessment (lack of information about # of reviewers and criteria)  Minor Limitation: Search strategy (English-only, limited number of databases)
  • 19. Systematic Reviews: NHS Centre for Reviews and Dissemination: A Systematic Review of Water Fluoridation, 2000  Health Evidence Quality Rating: 9  Major Strength: Meta-analyses, when appropriate  Minor Limitation: Quality assessment (criteria for case-control studies devised by reviewers)
  • 20. Water Fluoridation is Effective Significantly increases the percentage of caries-free children by 15.4%  Range from as little of a 10.8% increase to as much as 20.1% increase [95% Confidence Interval (CI)] Six children need to receive fluoridated water for one additional child to be caries-free  Range from five children to as many as nine children [Number Needed To Treat (NNT)]
  • 21. Water Fluoridation is Effective Significantly decreases the number of decayed, missing, filled teeth (dmft/DMFT score) by 2.3 teeth  Range from a decrease of1.8 teeth to as many as 2.8 teeth [95% Confidence Interval (CI)] Based on moderate quality, moderate risk of bias evidence Across children of all ages
  • 22. Water Fluoridation is Safe Significant increase in the prevalence of fluorosis  Flouride levels of 1.0ppm and 1.2ppm versus 0.4ppm Prevalence of fluorosis causing “aesthetic concern”  No significant difference between fluoride levels of 0.7ppm, 1.0ppm, and 1.2pmm versus 0.4ppm
  • 23. Water Fluoridation is Safe No significant increase in the prevalence of bone fractures Unable to be determined for the prevalence of cancer (all causes, osteosarcoma, bone, thyroid) Based on lowest quality evidence with high risk of bias Across children of all ages
  • 24. Overall ConsiderationsDrinking water fluoridationClinically important increase in the prevalence of caries-freechildren of all agesSmall number of children need access in order for one childto be caries-freeNo statistically significant increase in fluorosis of aestheticconcerns with increasing fluoride levels or bone fracturesEvidence suggesting there is a relationship between waterfluoridation and other health outcomes is low quality evidenceNote: Consistent across “Evidence Reviewed”
  • 25. General ImplicationsPublic health should support the fluoridation ofdrinking waterAmong all children of all agesAt levels that are unlikely to cause to fluorosis and fluorosisof “aesthetic concern”
  • 26. Practice & Policy Implications Support policies for the fluoridation of drinking water at safe levels of fluoridation Be aware of community fluoridation status Be aware of the average daily intake of water by the and the intake of fluoride from other sources Communicate evidence on the effectiveness and harms associated with drinking water fluoridation to communities considering  initiating drinking water fluoridation  continuing drinking water fluoridation
  • 27. Questions?
  • 28. Posting BoardPlease continue to discuss this topic and other topics on our posting board. http://forum.health-evidence.ca/Login with your health-evidence username and password or register if you aren’t a member yet.