Background: Dental caries is a chronic oral disease that continues to be highly prevalent in the United States and globally, and it remains a public health concern. Community water fluoridation, considered a key public health strategy for the prevention of dental caries, was initiated in the United States in 1945 and is currently practiced in approximately 25 countries.
Clinical question: What is the effect of water fluoridation (artificial or natural) on tooth decay prevention and on fluorosis of tooth enamel?
Summary and methods: A wide range of databases were searched from 1975 to February 2015 by two review authors, independently and in duplicate, who screened the titles and abstracts using a selection criteria and a validity assessment checklist.
Critical appraisal: The review process met the criteria of a well-conducted systematic review following established research requirements. The data for this review were extracted from prospective studies. The majority of the studies were conducted prior to 1975. The applicability of the results to current lifestyles is unclear because 71% of the studies examining tooth decay were conducted before fluoride toothpastes and other preventive measures were widely used in many US communities. The review for risk of bias showed 97% of the studies were at high risk for bias, which reduces the overall validity of the results.
Practical implications: Although findings from studies have demonstrated the effectiveness of fluoride at reducing the level of dental caries in adults and children, the studies in this review provided insufficient data to determine the effect that stopping water fluoridation programs would have on caries levels. More research is needed to understand the contribution of fluoride from sources other than water.