Efficacy
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The available evidence shows that water fluoridation is effective in reducing cavities (see effectiveness section of the main article). The most comprehensive systematic review found that fluoridation was statistically associated with a decreased proportion of children with cavities (the median of mean decreases was 14.6%, the range −5 to 64%), and with a decrease in decayed, missing, and filled primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5 to 4.4 teeth), which is roughly equivalent to preventing 40% of cavities. The review found that the evidence was of moderate quality: many studies did not attempt to reduce observer bias, control for confounding factors, report variance measures, or use appropriate analysis. The effect is largely due to the topical effect of fluoride ions in the mouth rather than the systemic effect of ingestion.
Fluoridation opponents have challenged the efficacy of fluoridation,although their arguments have been accused of bias. A large study of water fluoridation's efficacy was conducted by the National Institute of Dental Research in 1988, which officially found "20 percent fewer decayed tooth surfaces" corresponding to "less than one cavity per child". Arguing that the study had errors, the data was reanalyzed by fluoridation opponent John A. Yiamouyiannis, whose results indicated no statistically significant difference in tooth decay rates among children in fluoridated and nonfluoridated communities. Conversely, fluoridation proponents argued that Yiamouyiannis' work had errors.
In 1986 fluoridation opponent Mark Diesendorf pointed out the substantial declines in tooth decay in nonfluoridated European countries. This failed to account for the fluoride added to table salt in continental Europe. Although fluoridation may still be a relevant public health measure among the poor and disadvantaged, it may be unnecessary for preventing tooth decay, particularly in industrialized countries where tooth decay is rare.
Read more about this topic: Water Fluoridation Controversy
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