title: Equity in children's dental caries before and after cessation of community water fluoridation: differential impact by dental insurance status and geographic material deprivation.
abstract: BACKGROUND
  One of the main arguments made in favor of community water fluoridation is that it is equitable in its impact on dental caries (i.e., helps to offset inequities in dental caries). Although an equitable effect of fluoridation has been demonstrated in cross-sectional studies, it has not been studied in the context of cessation of community water fluoridation (CWF). The objective of this study was to compare the socio-economic patterns of children's dental caries (tooth decay) in Calgary, Canada, in 2009/10 when CWF was in place, and in 2013/14, after it had been discontinued.
  
  
  METHODS
  We analyzed data from population-based samples of schoolchildren (grade 2) in 2009/10 and 2013/14. Data on dental caries (decayed, missing, and filled primary and permanent teeth) were gathered via open mouth exams conducted in schools by registered dental hygienists. We examined the association between dental caries and 1) presence/absence of dental insurance and 2) small area index of material deprivation, using Poisson (zero-inflated) and logistic regression, for both time points separately. For small-area material deprivation at each time point, we also computed the concentration index of inequality for each outcome variable.
  
  
  RESULTS
  Statistically significant inequities by dental insurance status and by small area material deprivation were more apparent in 2013/14 than in 2009/10.
  
  
  CONCLUSIONS
  Results are consistent with increasing inequities in dental caries following cessation of CWF. However, further research is needed to 1) confirm the effects in a study that includes a comparison community, and 2) explore possible alternative reasons for the findings, including changes in treatment and preventive programming.
authors: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. lmclaren@ucalgary.ca.
authors: Lindsay
authors: L
authors: McLaren
authors: Research and Innovation, Population, Public and Aboriginal Health, Alberta Health Services, Calgary, AB, Canada. Debbie.Mcneil@albertahealthservices.ca.
authors: Deborah A
authors: DA
authors: McNeil
authors: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. Melissa.Potestio@albertahealthservices.ca.|Alberta Cancer Prevention Legacy Fund, Population Public and Aboriginal Health, Alberta Health Services, Calgary, AB, Canada. Melissa.Potestio@albertahealthservices.ca.
authors: Melissa
authors: M
authors: Potestio
authors: Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, AB, Canada. steven.patterson@ualberta.ca.
authors: Steve
authors: S
authors: Patterson
authors: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. sthawer@ucalgary.ca.
authors: Salima
authors: S
authors: Thawer
authors: Research Facilitation, Priorities, and Implementation, Alberta Health Services, Calgary, AB, Canada. Peter.Faris@albertahealthservices.ca.
authors: Peter
authors: P
authors: Faris
authors: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. fiona.congshi@gmail.com.
authors: Congshi
authors: C
authors: Shi
authors: Provincial Oral Health Office, Population, Public and Aboriginal Health, Alberta Health Services, Calgary, AB, Canada.
authors: Luke
authors: L
authors: Shwart
mesh_terms: D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000188:drug therapy / Q000453:epidemiology; D003733:Dental Caries Susceptibility / Q000187:drug effects*; D005260:Female; D005457:Fluoridation / Q000706:statistics & numerical data*; D005459:Fluorides / Q000627:therapeutic use*; D006801:Humans; D007347:Insurance, Dental / Q000706:statistics & numerical data; D008297:Male; D012111:Residence Characteristics
chemical_list: D005459:Fluorides