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Original Articles
Impact of water fluoridation on dental caries decline across racial and income subgroups of Brazilian adolescents
Rafael Aiello Bomfim, Paulo Frazão
Epidemiol Health. 2022;44:e2022007.   Published online January 3, 2022
DOI: https://doi.org/10.4178/epih.e2022007
  • 25,732 View
  • 467 Download
  • 7 Web of Science
  • 12 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The aim of this study was to assess the impact of community water fluoridation (CWF) on differences in dental caries decline across racial and socioeconomic subgroups of Brazilian adolescents.
METHODS
Two nationwide Brazilian population-based oral health surveys were used (Brazilian Oral Health Survey 2003 and 2010). In total, 7,198 adolescents from 15 years to 19 years old living in 50 cities investigated in both surveys were included. The mean numbers of untreated decayed teeth (DT) according to racial (Whites vs. Browns/Blacks) and socioeconomic subgroups (at or above the minimum wage per capita vs. under) were analysed. Difference-in-differences negative binomial regressions were adjusted by schooling, age, and sex. Decayed, missing, and filled teeth and DT prevalence, calculated as a categorical variable, were used in sensitivity analyses.
RESULTS
The adjusted difference of reduction in DT was similar across socioeconomic subgroups (β=-0.05; 95% confidence interval [CI], -0.45 to 0.35) and favoured, but not to a significant degree, Whites (β=-0.34; 95% CI, -0.74 to 0.04) compared to Brown/Blacks in fluoridated areas. In non-fluoridated areas, significant differences were observed in the mean number of DT, favouring the higher socioeconomic subgroup (β=-0.26; 95% CI, -0.53 to -0.01) and Whites (β=-0.40; 95% CI, -0.69 to -0.11) in relation to their counterparts. The sensitivity analyses confirmed the findings.
CONCLUSIONS
The similar reduction in DT across income subgroups suggests that CWF has had a beneficial effect on tackling income inequalities in dental caries within a 7-year timeframe.
Summary
Key Message
Community Water Fluoridation tackled income and racial inequalities in dental caries in adolescents aged 15-19 years between 2003 and 2010 in Brazil.

Citations

Citations to this article as recorded by  
  • Water Fluoridation and Dental Caries Prevention Globally: A Systematic Review and Meta-Analysis
    C.F.D. Nascimento, L.A.D.S. Gindri, M.N. de Oliveira, L.R. Paranhos, F.N. Hugo
    JDR Clinical & Translational Research.2026; 11(2): 107.     CrossRef
  • A vigilância da fluoretação da água de abastecimento público na perspectiva dos técnicos das secretarias municipais de saúde: estudo transversal, Goiás, 2022-2023
    Higor Andrade de Oliveira Gonçalves, Leandro Brambilla Martorell, Maria do Carmo Matias Freire
    Epidemiologia e Serviços de Saúde.2026;[Epub]     CrossRef
  • Surveillance of public water supply fluoridation from the perspective of municipal health department technicians: a cross-sectional study, Goiás, 2022–2023
    Higor Andrade de Oliveira Gonçalves, Leandro Brambilla Martorell, Maria do Carmo Matias Freire
    Epidemiologia e Serviços de Saúde.2026;[Epub]     CrossRef
  • Evolution of income inequalities in the caries experience of 5-year-old children in Brazil between 2010 and 2023
    Armando Cabral de Lira Neto, Isabela Ficagna Oshiro, Luiza De Carli Grieleitow, Maria Letícia Barbosa Raymundo, Amanda Barbosa Oliveira, Yuri Wanderley Cavalcanti, Roger Keller Celeste, Rafael Aiello Bomfim
    Revista Brasileira de Epidemiologia.2026;[Epub]     CrossRef
  • Evolução das desigualdades de renda na experiência de cárie em crianças de 5 anos no Brasil entre 2010 e 2023
    Armando Cabral de Lira Neto, Isabela Ficagna Oshiro, Luiza De Carli Grieleitow, Maria Letícia Barbosa Raymundo, Amanda Barbosa Oliveira, Yuri Wanderley Cavalcanti, Roger Keller Celeste, Rafael Aiello Bomfim
    Revista Brasileira de Epidemiologia.2026;[Epub]     CrossRef
  • Early Childhood Caries and Maternal Education: Systematic Review and Meta‐Analysis
    Roger Keller Celeste, Mariel de Aquino Goulart, Elisa Coelho, Heber Arbildo, Rita Villena, Moréniké Oluwátóyìn Foláyan, Carlos Alberto Feldens
    Community Dentistry and Oral Epidemiology.2026;[Epub]     CrossRef
  • Water fluoridation, functional dentition and tooth loss in Brazilian adults: a multilevel analysis of SB Brasil 2023
    Paulo Roberto Barbato, José Leopoldo Ferreira Antunes, Paulo Frazao, Marco Aurélio Peres
    Revista Brasileira de Epidemiologia.2026;[Epub]     CrossRef
  • Fluoretação da água, dentição funcional e perda dentária em adultos brasileiros: uma análise multinível da Pesquisa Nacional de Saúde Bucal 2023
    Paulo Roberto Barbato, José Leopoldo Ferreira Antunes, Paulo Frazao, Marco Aurélio Peres
    Revista Brasileira de Epidemiologia.2026;[Epub]     CrossRef
  • Differential Exposure and Differential Vulnerability to Unhealthy Food Consumption in Relation to Dental Caries Among Brazilian Children and Adolescents
    Rafael Aiello Bomfim, Luiza De Carli Grieleitow, Hazelelponi Naumann Cerqueira Leite, Amanda Barbosa Oliveira, Andreia Morales Cascaes, Paulo Frazão
    International Journal of Environmental Research and Public Health.2026; 23(9): 1093.     CrossRef
  • Análise do teor de fluoretos nas águas de abastecimento público no Município de Cascavel, Paraná: Vinte quatro meses de heterocontrole
    André Luiz Marçal Terreri, Victor Ferrarezi Nagel, Adilvo Luiz Zancheta, Luiza Wammes, Arthur da Croce da Silva, Celso Huang, Davi Marcon Batista
    Research, Society and Development.2026; 15(8): e6715851572.     CrossRef
  • Unhealthy dietary habits and sedentary behavior drive untreated dental caries among adolescents: A population-based study
    Leticia Pereira de Barros, Luiza De Carli Grieleitow, Rafael Aiello Bomfim
    Scientific Reports.2025;[Epub]     CrossRef
  • Water fluoridation for the prevention of dental caries
    Zipporah Iheozor-Ejiofor, Tanya Walsh, Sharon R Lewis, Philip Riley, Dwayne Boyers, Janet E Clarkson, Helen V Worthington, Anne-Marie Glenny, Lucy O'Malley
    Cochrane Database of Systematic Reviews.2024;[Epub]     CrossRef
Deprived areas and community water fluoridation in Brazil: a multilevel approach for refocusing public policy
Franklin Barbosa da Silva, José Leopoldo Ferreira Antunes, Paulo Frazão
Epidemiol Health. 2021;43:e2021031.   Published online May 1, 2021
DOI: https://doi.org/10.4178/epih.e2021031
  • 22,030 View
  • 336 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The aim of this study was to determine whether geographic location, socioeconomic status, infant mortality, and mortality from diarrheal disease in health regions are associated with the provision of community water fluoridation (CWF) in Brazilian municipalities.
METHODS
A multilevel ecological study was conducted based on data from the National Survey of Basic Sanitation and Human Development Atlas. A multilevel analysis was carried out considering Brazilian municipalities as the first level and health regions as the second level, comprising sanitation, demographic, socioeconomic, and health characteristics.
RESULTS
The observation units comprised 5,565 municipalities clustered in 438 health regions in Brazil. The lack of CWF provision was positively associated with the following municipal characteristics: a below-median proportion of inhabitants covered by the sewage network, medium to very low human development index, below-median per capita gross domestic product, and an above-median percentage of expenditures on sanitation. In relation to the health regions, the likelihood of a lack of CWF provision was greater in the municipalities belonging to the health regions located in the Northern and Northeastern areas of Brazil and in those where child mortality due to acute diarrheal disease and the proportion of people with low income were higher when adjusted by municipal indicators.
CONCLUSIONS
Information on the characteristics associated with CWF provision constitutes important input for refocusing public policy to reduce inequalities among Brazilian municipalities and health regions. These findings may help policy-makers to understand the challenges facing CWF expansion in low-, middle-, and high-income countries.
Summary
Key Message
Just as the challenges for CWF's expansion in Brazil's most vulnerable areas require firm leadership for refocusing public policy, expansion in low- and middle-income countries demands a continued global collaborative effort.

Citations

Citations to this article as recorded by  
  • Trends in Socioeconomic Inequalities of Dental Caries Experience among 12-Year-Olds in Chile: An Ecological Cohort Study
    Mariél de Aquino Goulart, Jorge Celis-Dooner, Fanny Petermann-Rocha, David I. Conway, Andrés Celis, Alex D. McMahon
    Caries Research.2026; : 1.     CrossRef
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