Fishing for the evidence on community water fluoridation: a commentary on the CATFISH study.

DATA SOURCE: Goodwin M, Emsley R, Kelly M P et al. Evaluation of water fluoridation scheme in Cumbria: the CATFISH prospective longitudinal cohort study. Southampton: National Institute for Health and Care Research, 2022. METHODS: This longitudinal, prospective cohort study, recruited two populations - a birth cohort and older school cohort - assessing the effects of community water fluoridation (CWF) over a five-year period. The control group received non-fluoridated drinking water in the East of Cumbria, while the intervention group received fluoridated drinking water in the West of Cumbria. The primary outcome measures were the presence or absence of decay into dentine in primary and permanent teeth. Cost effectiveness was assessed by quality-adjusted life-years. RESULTS: Birth Cohort: Modest beneficial effect (17.4% with decay, 21.4% in control). Adjusted Odd Ratios (AOR): 0.74 (95% CI: 0.56 to 0.98). Older Cohort: Insufficient evidence of difference (19.1% with decay and 21.9% in control). AOR: 0.80 (95% CI: 0.58 to 1.09). CONCLUSION: The authors concluded that CWF was effective in the birth cohort and that the modest absolute reduction in caries should be considered in the context of other preventive measures. A longer follow-up period was recommended to fully understand the benefits and risks of CWF in contemporary low-prevalence populations.

Is there an association between prenatal oral healthcare and early childhood caries prevention?

Data sources Database searches included Pubmed, Embase, Scopus, Web of Science, LILACS, Cochrane Library and ClinicalTrials.gov.Study selection This review included studies that assessed the impact of pre-natal oral health care on early childhood caries experience and/or oral carriage of S. mutans. The review included case control studies, retrospective or prospective cohort studies, randomised or non-randomised controlled trials. In vitro studies, animal studies, literature reviews, cross sectional studies and literature reviews were excluded.Data extraction and synthesis Two calibrated and independent reviewers screened the literature using a data extraction form based on defined inclusion and exclusion criteria. A PRISMA flow diagram is presented showing the process of reviewing the literature. The Cochrane Risk of Bias Tool for Randomised Trials and an adapted version of the Downs and Black score were used to assess the quality of the included studies. A qualitative synthesis of five included studies is presented. A Forest Plot then presents quantitative data from four of the studies. A meta analysis did not take place. A generalised linear mixed effects model was applied to results from four of the studies.Results Five studies were included in the qualitative syntheses, three of the studies were randomised controlled trials, one was a prospective cohort study and one was a nested case-control in a cohort study. Two of the studies were assessed as high quality with three assessed as moderate quality. Odds ratios of children experiencing early childhood caries are reported for four studies demonstrating a reduced risk of early childhood caries in intervention groups compared to controls. A generalised linear mixed effects model using combined results from the four studies shows a reduced risk of developing early childhood caries in children up to the age of three years old whose mothers receive pre natal oral care. Above age three years the results of the modelling become non-significant. Based on the results of two studies the authors report a reduction in levels of S. mutans in the oral cavity of children whose mother had prenatal oral care.Conclusions The authors conclude that prenatal oral healthcare has a positive effect on incidence of early childhood caries and S. mutans carriage in children.

Oral care and nursing home-acquired pneumonia.

Data sources Cochrane Oral Health Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Chinese Biomedical Literature Database, China National Infrastructure, US National Institutes of Health Ongoing Trials Registry, WHO Clinical Trials Registry, Sciencepaper Online, 19 Chinese dental and nursing journals. Reference lists of included studies were also screened.Study selection Studies were included if they explored oral care with the purpose of reducing pneumonia compared to no oral care, usual care or other oral care measures. Only randomised controlled trials were included which could be either parallel design or cluster RCTs with randomisation by care facility. No restrictions were placed on language, year of publication or publication status.Data extraction and synthesis Two independent reviewers undertook screening for inclusion, data extraction and assessment of risk of bias. The Cochrane tool for risk of bias was used to assess quality of the studies. Synthesis was mainly narrative, though numerical results were combined where feasible.Results Four studies were included, all of which were parallel RCTs. All were judged to be at high risk of bias due to lack of blinding. One study suggested that oral care may reduce pneumonia associated death, though evidence was low quality and should be treated with caution. There was no high quality evidence available to indicate which oral care methods may be most effective in reducing pneumonia.Conclusions It was not possible to establish the effects of professional oral care on nursing home-acquired pneumonia due to the limited number of studies and low quality evidence. Further trials are needed to draw reliable conclusions.

Oral health literacy, oral health behaviours and dental outcomes.

Data sourcesEight electronic databases were searched: Medline (through PubMed), ISI Web of Science, Scopus, The Cochrane Library, National Institute for Health and Clinical Excellence, Lilacs and the Brazilian Library of Dentistry, Controlled-trials database of Clinical Trials and Clinical Trials-US National Institute of Health. A grey literature search was also conducted and reference lists of included studies were interrogated.Study selectionInclusion criteria were studies which examined the relationship between oral health literacy and one of the pre-defined outcomes including oral health behaviours, perception, knowledge and dental treatment outcomes. Epidemiological studies (such a case-control, cohort, cross-sectional and clinical trials) were included but qualitative studies, systematic reviews and those which examined unrelated outcomes were excluded.Data extraction and synthesisTwo independent reviewers carried out screening, risk of bias assessment and data extraction for all studies against pre-agreed inclusion and exclusion criteria. The Newcastle-Ottawa Scale (a modified version for cross-sectional studies) and the Cochrane Risk of Bias tool were used for quality appraisal. A narrative synthesis was presented, with meta-analysis of a small sub-group of studies relating to one outcome.ResultsTwenty-five studies were included in the final review; 21 cross-sectional, two cohort, one case-control and one clinical trial. Most (17) were considered to be at high risk of bias and there was a high degree of clinical and methodological heterogeneity. No evidence was found of a significant association between oral health literacy and the outcomes considered.ConclusionsThe authors concluded that the current scientific evidence suggests that no association exists between oral health literacy and any of the outcomes investigated. Further prospective studies with high methodological quality are needed.