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Community Water Fluoridation: What's the Evidence?
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Community Water Fluoridation: What's the Evidence?

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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.


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  • 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.