Water fluoridation.
OBJECTIVE
This was to present a summary of the evidence from systematic reviews of the effectiveness and safety of water fluoridation.


METHODS
A search for relevant systematic reviews was conducted using the terms Fluoridation [Mesh] OR "water fluoridation" OR fluoridation OR (water AND fluoride) and was run from 01/01/2000 to 17/10/2008 in Pubmed, Embase, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects in the Cochrane Library. The quality of the systematic reviews was assessed using Scottish Intercollegiate Guideline Network (SIGN) methodology checklists for systematic reviews. Websites of guideline organisations were also searched for relevant evidence-based guidelines, which were appraised using the AGREE instrument.


RESULTS
Of the 59 publications identified, 3 systematic reviews and 3 guidelines were included in this review. While the reviews themselves were of good methodological quality, the studies included in the reviews were generally of moderate to low quality. The results of the three reviews showed that water fluoridation is effective at reducing caries in children and adults. With the exception of dental fluorosis, no association between adverse effects and water fluoridation has been established. Water fluoridation reduces caries for all social classes, and there is some evidence that it may reduce the oral health gap between social classes.


CONCLUSIONS
Water fluoridation, where technically feasible and culturally acceptable, remains a relevant and valid choice as a population measure for the prevention of dental caries.
Parnell
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Oral Health Services Research Centre, University Dental School, Wilton, Cork, Ireland. c.parnell@ucc.ie
Whelton
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O'Mullane
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D000328:Adult; D002648:Child; D003731:Dental Caries / Q000517:prevention & control; D005457:Fluoridation / Q000009:adverse effects; D009050:Fluorosis, Dental / Q000209:etiology; D006801:Humans; D017410:Practice Guidelines as Topic; D012923:Social Class