ArticleCommunity dentistry and oral epidemiology2026
Investigation Into the Effectiveness of Community Water Fluoridation and Dental Caries Experience in 4-Year-Old Aotearoa New Zealand Children: A National Repeated Cross-Sectional Study From 2010 to 2022.
Article in Community dentistry and oral epidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo provide contemporary national evidence on the effectiveness of community water fluoridation (CWF) for the prevention of early childhood caries (ECC) among 4-year-old children in Aotearoa New Zealand (NZ), and to examine potential effect modification by ethnicity and other sociodemographic characteristics.
methodsA national repeated cross-sectional study was conducted using routinely collected B4 School Check data (2010-2022). Children aged 4 years were linked to a national spatial dataset of water distribution zones and council-reported fluoridation histories to classify exposure over the assessment year and preceding 3 years. ECC was identified via the 'lift-the-lip' screening. Multilevel mixed-effects modified Poisson regression models, with children nested within meshblocks, estimated incidence rate ratios (IRRs), adjusting for ethnicity, area-level deprivation, age, sex, rurality, and assessment year. Two-factor interactions were examined.
resultsAmong 630 926 children, 14.2% had ECC. In crude analyses, ECC appeared more common in fluoridated areas; however, after adjustment for sociodemographic characteristics, CWF was associated with a lower rate of ECC (IRR = 1.13; 95% CI: 1.11-1.15 for non-fluoridated vs. fluoridated). A significant interaction between CWF and ethnicity was observed. The protective association was strongest among European/Other children (IRR = 1.25; 95% CI: 1.21-1.29) and attenuated among Māori and Asian children, with minimal effect among Pacific children. The ethnicity-weighted population attributable fraction was 4.4%, equating to approximately 282 ECC cases annually.
conclusionFindings are consistent with CWF being an effective population-level oral health intervention. However, its association with caries experience varies by ethnicity, highlighting the importance of addressing structural inequities alongside universal preventive strategies.
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