Consequences of community water fluoridation cessation for Medicaid-eligible children and adolescents in Juneau, Alaska.
BACKGROUND
The general aim of this research was to determine whether cessation of community water fluoridation (CWF) increased oral health disparities, as measured by dental caries procedures and restoration costs for children and adolescents.


METHODS
The analysis was based on all Medicaid dental claims records of 0- to 18-year-old patients residing in zip code 99801 (Juneau, Alaska) during an optimal CWF year (2003, n = 853) compared to all claims for the same age group from 2012 (n = 1052), five years after cessation of CWF. A bivariate analysis (Mann-Whitney U test) of the mean number of caries procedures performed per client was conducted in the study groups under both independent CWF conditions. Furthermore, logistic regression was performed using the dependent variables of caries procedures and the cost of caries-related procedures, with adjustments for CWF group, gender, and race.


RESULTS
The statistically significant results included a higher mean number of caries-related procedures among 0- to 18-year-old and < 7-year-old patients in the suboptimal CWF group (2.35 vs. 2.02, p < 0.001; 2.68 vs. 2.01, p = 0.004, respectively). The mean caries-related treatment costs per patient were also significantly higher for all age groups, ranging from a 28 to 111% increase among the suboptimal CWF cohorts after adjusting for inflation. The binary logistic regression analysis results indicated a protective effect of optimal CWF for the 0- to 18-year-old and < 7-year-old age groups (OR = 0.748, 95% CI [0.62, 0.90], p = 0.002; OR = 0.699, 95% CI [0.52, 0.95], p = 0.02, respectively). Additionally, the age group that underwent the most dental caries procedures and incurred the highest caries treatment costs on average were those born after CWF cessation.


CONCLUSIONS
These results expand our understanding of caries epidemiology under CWF cessation conditions and reaffirm that optimal CWF exposure prevents dental decay. These findings can offer fiscal estimates of the cost burden associated with CWF cessation policies and help decision-makers advance oral health, prevent dental caries, and promote equity in oral health outcomes.
['Meyer|Jennifer|J|', 'Margaritis|Vasileios|V|0000-0002-7790-2243', 'Mendelsohn|Aaron|A|']
D000293:Adolescent D000367:Age Factors D000413:Alaska D002648:Child D002675:Child, Preschool D003731:Dental Caries D003793:Dental Restoration, Permanent D005260:Female D005457:Fluoridation D017048:Health Care Costs D054624:Health Status Disparities D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D008484:Medicaid D014481:United States
Water fluoridation Alaska Dental caries