title: The CATFISH study protocol: an evaluation of a water fluoridation scheme.
abstract: BACKGROUND
  Tooth decay is the commonest disease of childhood. We have known for over 90 years that fluoride can prevent tooth decay; it is present in nearly all toothpastes and can be provided in mouthwashes, gels and varnishes. The oldest method of applying fluoride is via the water supply at a concentration of 1 part per million. The two most important reviews of water fluoridation in the United Kingdom (the York Review and MRC Report on water fluoridation and health) concluded that whilst there was evidence to suggest water fluoridation provided a benefit in caries reduction, there was a need to improve the evidence base in several areas.
  
  
  METHODS
  This study will use a natural experiment to assess the incidence of caries in two geographical areas, one in which the water supply is returned to being fluoridated following a discontinuation of fluoridation and one that continues to have a non-fluoridated water supply. The oral health of two discrete study populations will be evaluated - those born 9 months after the water fluoridation was introduced, and those who were in their 1st year of school after the introduction of fluoridated water. Both populations will be followed prospectively for 5 years using a census approach in the exposed group along with matched numbers recruitment in a non-exposed control. Parents of the younger cohort will complete questionnaires every 6 months with child clinical examination at ages 3 and 5, whilst the older cohort will have clinical examinations only, at approximately 5, 7 and 11 years old.
  
  
  CONCLUSIONS
  This project provides a unique opportunity to conduct a high quality evaluation of the reintroduction of a water fluoridation scheme, which satisfies the inclusion criteria stipulated by the York systematic review and can address the design issues identified in the MRC report. The research will make a major contribution to the understanding of the costs and effects of water fluoridation in the UK in the 21st Century. Its findings will help inform UK policy on this important public health intervention and may have a significant impact on public health policy in other developed countries. There is currently true equipoise in relation to the effectiveness of water fluoridation in contemporary populations and while the biological plausibility is well established, there is a need to examine impact on the changing epidemiological status of dental decay.
authors.affiliation: The Dental Health Unit, School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK. michaela.goodwin@manchester.ac.uk.
authors.forename: Michaela
authors.initials: M
authors.lastname: Goodwin
authors.affiliation: Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 1.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. Richard.Emsley@manchester.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Emsley
authors.affiliation: Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 OSR, UK. mk744@medschl.cam.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Kelly
authors.affiliation: Dental Observatory, NHS Central Lancashire, Preston Business Centre, Watling Street Road, Fulwood, PR2 8DY, UK. Eric.Rooney@phe.gov.uk.
authors.forename: Eric
authors.initials: E
authors.lastname: Rooney
authors.affiliation: Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. Matt.Sutton@manchester.ac.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sutton
authors.affiliation: , Coupland 3 Building, Oxford Road, Manchester, M15 6FH, UK. Martin.Tickle@manchester.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Tickle
authors.affiliation: Public Health England, North West, 1st Floor, York House, Ackhurst Business Park, Foxhole Road, Chorley, PR7 1NY, UK. Rebecca.Wagstaff@phe.gov.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wagstaff
authors.affiliation: , Coupland 3 Building, Oxford Road, Manchester, M15 6FH, UK. tanya.walsh@manchester.ac.uk.
authors.forename: Tanya
authors.initials: T
authors.lastname: Walsh
authors.affiliation: Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. William.Whittaker@manchester.ac.uk.
authors.forename: William
authors.initials: W
authors.lastname: Whittaker
authors.affiliation: The Dental Health Unit, School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK. Iain.A.Pretty@manchester.ac.uk.
authors.forename: Iain A
authors.initials: IA
authors.lastname: Pretty
mesh_terms: D003731:Dental Caries / Q000453:epidemiology* / Q000517:prevention & control*; D005457:Fluoridation; D006801:Humans; D009909:Oral Health; D006113:United Kingdom / Q000453:epidemiology
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