title: An alternative marker for the effectiveness of water fluoridation: hospital extraction rates for dental decay, a two-region study.
abstract: BACKGROUND
  Contemporary evidence for the effectiveness of water fluoridation schemes in the U.K. is sparse. The utility of routinely collected data in providing evidence warrants further research.
  
  
  OBJECTIVE
  To examine inpatient hospital episodes statistics for dental extractions as an alternative population marker for the effectiveness of water fluoridation by comparing hospital admissions between two major strategic health authority (SHA) areas, the West Midlands SHA-largely fluoridated--and the North West SHA--largely unfluoridated.
  
  
  METHODS
  Hospital episodes statistics (HES) were interrogated to provide data on admissions for simple and surgical dental extractions, which had a primary diagnostic code of either dental caries or diseases of pulp and periapical tissues for financial years 2006/7, 2007/8 and 2008/9. Data was aggregated by SHA area and quinary age group. Directly standardised rates (DSR) of admissions purchased for each primary care trust (PCT) were calculated and ranked by index of multiple deprivation (IMD).
  
  
  RESULTS
  A significant difference in DSRs of admission between PCTs in the West Midlands and North West was observed (Mann-Whitney U test [p <0.0001]) irrespective of IMD ranking. The difference in rates between the two most deprived PCTs was 27-fold.
  
  
  CONCLUSIONS
  After ranking by IMD, DSRs of hospital admissions for the extraction of decayed or pulpally/periapically involved teeth is lower in areas with a fluoridated water supply. The analysis of routinely collected HES data may help identify the impact of water fluoridation schemes.
authors.affiliation: SpR Dental Public Health, South Staffordshire Primary Care Trust, Anglesey House, Rugeley, WS15 1UL.
authors.forename: T B
authors.initials: TB
authors.lastname: Elmer
authors.affiliation: Specialist in Dental Public Health, Birmingham, B30 1EG.
authors.forename: J W
authors.initials: JW
authors.lastname: Langford
authors.affiliation: Consultant in Dental Public Health, South Staffordshire Primary Care Trust, Anglesey House, Rugeley, Stafford-shire, WS15 1UL.
authors.forename: A J
authors.initials: AJ
authors.lastname: Morris
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003731:Dental Caries / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery*; D005457:Fluoridation; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011204:Poverty Areas; D015397:Program Evaluation; D014081:Tooth Extraction / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult