Does fluoridation reduce the use of dental services among adults?
OBJECTIVE
The authors determine whether prevention influences the use of health services. Fluoridation's effect on restorative dental demand among 972 Washington state employees and spouses, aged 20 to 34 years, in two fluoridated communities and a nonfluoridated community was examined.


METHODS
At baseline, adults were interviewed by telephone, and oral assessments were conducted to measure personal characteristics, lifetime exposure to fluoridated water, oral disease, and the quality of restorations. Adults were followed for 2 years to measure dental demand from dental claims. Each adult's baseline and claims data were linked with provider and practice variables collected from the dentist who provided treatment.


RESULTS
Relative to adults with no lifetime exposure to fluoridated water, adults drinking fluoridated water for half or more of their lives had less disease at baseline and a lower but nonsignificant probability of receiving a restoration in the follow-up period. In the 2-year follow-up period, however, more than half of the restorations were performed to replace fillings of satisfactory or ideal quality at baseline. When only teeth with decay and unsatisfactory fillings at baseline were considered, adults with high fluoridation exposure had a lower probability of receiving a restoration than adults with no exposure. Market effects also were detected in demand equations; relative to adults in the nonfluoridated community, adults residing in the fluoridated community with a large dentist supply received a greater number of restorations, suggesting potential supplier-induced demand from less disease and fewer patients.


CONCLUSIONS
Among adults aged 20 to 34 years with private dental insurance, fluoridation reduces oral disease but may or may not reduce use of restorative services, depending on dentists' clinical decisions.
Grembowski
D
D
Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle 98195, USA.
Fiset
L
L
Milgrom
P
P
Conrad
D
D
Spadafora
A
A
D000328:Adult; D003753:Dental Health Surveys; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data*; D005260:Female; D005457:Fluoridation; D006301:Health Services Needs and Demand; D006801:Humans; D007344:Insurance Claim Reporting; D007347:Insurance, Dental; D008297:Male; D008389:Marketing of Health Services; D015999:Multivariate Analysis; D014861:Washington