Associations between exposure to fluoridated drinking water and dental caries experience among children in two Australian states

OBJECTIVES: This study assessed associations between exposure to fluoride in water and dental caries experience among children in two Australian states. METHODS: Cross-sectional data were obtained from 9,690 South Australian children aged 5-15 years and 10,195 Queensland children aged 5-12 years. School dental service practitioners recorded DMFS and dmfs data. A questionnaire to parents gained information about residential history that was used to calculate children's percent of lifetime exposed to fluoridated water. RESULTS: Greater exposure to fluoride in water was associated with lower dmfs and DMFS in both states (P < .01), although in South Australia the effect for DMFS was statistically significant only after controlling for extent of unknown fluoridation exposure and for fluoride supplements. Caries-fluoridation associations were stronger for dmfs compared with DMFS and for Queensland (5% of population fluoridated) compared with South Australia (70% of population fluoridated). Effects for DMFS persisted after controlling for socioeconomic factors. CONCLUSIONS: Fluoridation was associated with lower caries experience. The weaker association with DMFS in South Australia may be due to less caries and more fissure sealants in that state, and is consistent with a "diffusion" effect, whereby a high proportion of the population exposed to fluoridation diminishes differences among exposure groups