Evidence suggests that water fluoridation has an effect over and above that of fluoridated toothpaste

Objective If water fluoridation is shown to have beneficial effects, what is the effect over and above that offered by the use of alternative interventions and strategies? Data sources See page 37. Study selection Studies were included that were carried out after 1974 in industrialised countries because, in those, any modifying effect of fluoride toothpaste and other sources of dental fluoride (eg, mouthrinses, tablets) should be apparent. Of the 24 studies that met the inclusion criteria for Objective 1, 10 were completed after 1974 (1978–1997). The mean validity score of these 10 studies was 5.0 (range, 3.5–6.8 out of 8). Data extraction and synthesis See page 37. Results Only 10 studies qualified to address this issue, although none of these identified this objective as the purpose of the investigation. The study with the highest validity score showed a statistically-significant difference in caries increment between fluoridated and nonfluoridated areas. Those in the nonfluoridated area had the greatest increment, in spite of fluoridated toothpaste being used by both groups (94% versus 95% used fluoride toothpaste only in the fluoridated and nonfluoridated groups, respectively). Conclusions The evidence suggests that water fluoridation has an effect over and above that of fluoridated toothpaste (and other sources of fluoride). McDonagh M, Whiting P, Bradley M, Cooper J, Sutton A, Chestnutt I, et al. A Systematic Review of Public Water Fluoridation. York: Publications Office, NHS Centre for Reviews and Dissemination, University of York. ISBN 1 900640 16 3; 2000