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Is community water fluoridation associated with rates of severe caries in the primary dentition of 4-year-old children in New Zealand? In a national cross sectional study of over 275, 000 children, Schulter PJ et al (JAMA Pediatr 2020;174:969–76) have shown that those children living in areas without community water fluoridation had significantly higher odds of severe caries compared with children living in areas with water fluoridation. This is a huge data set and adds to the evidence supporting community water fluoridation continues to be an efficacious upstream population-wide intervention associated with reduced severe caries rates among preschool children. This was a near whole population–level, natural, geospatial cross-sectional study of 4-year-old children. In the eligible sample of 275 843 children, the median age was 4.3 years 141 451 children (51.3%) were boys, and 153 670 children (55.7%) resided within fluoridated areas. In the adjusted analyses, children residing in areas without fluoridation had higher odds of severe caries compared with those within fluoridated areas (OR, 1.21; 95% CI, 1.17 to 1.24). The population attributional fraction associated with unfluoridated community water was 5.6% (95% CI, 4.7% to 6.6%) in a complete case analysis.


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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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  • Provenance and peer review Commissioned; internally peer reviewed.