Study Links End of Water Fluoridation in Israel to Rise in Children's Cavity Treatments

A recent Israeli study has linked the cessation of water fluoridation in Israel to a significant increase in cavity treatments among children, particularly exacerbating disparities between socioeconomically strong and weak populations. The research, published in the Israel Journal of Health Policy Research, analyzed the dental records of 12-year-olds treated by Maccabi Dent between 2014 and 2022.

The most striking finding pertained to children from low socioeconomic status (SES) communities. In areas without fluoridation, the rate of cavity treatments was more than double that of children from high SES areas. Even within weaker communities, the rate of cavity treatments was approximately 24% higher in areas without fluoridation compared to those with it. This figure represents a difference in treatment rates, not necessarily a 24% increase in the number of children developing cavities.

Researchers examined over 61,000 restorative treatments, including fillings and crowns, and 3,327 permanent tooth extractions due to cavities among nearly 28,000 children. The study focused on the DMFT index, which measures decayed, missing, and filled teeth, adapted here to reflect treatments for cavities. Children were categorized into three groups based on their community's SES: low, medium, and high. The exposure to fluoridation was classified by locality and treatment year.

In low SES communities, the average DMFT index was 0.817 without fluoridation, compared to 0.660 with it. While differences were less pronounced in medium and high SES groups, the study found a statistically significant disparity in low SES areas. The researchers suggest that water fluoridation provides a protection that is less dependent on a family's economic ability or proactive pursuit of preventive care, as affluent families may better compensate for its absence.

The study also noted a 25% gap between girls and boys, with girls showing a higher average index. This could be attributed to earlier eruption of permanent teeth in girls and differences in dental service utilization. Despite limitations, including its observational nature and lack of data on untreated cavities and individual fluoride exposure, the researchers advocate for reinstating water fluoridation, prioritizing weaker communities with dedicated government funding. They also recommend expanding preventive measures like school fluoride applications and oral health education, alongside a national monitoring program.