School-Based Fluoride Mouth-Rinse Program Dissemination Associated With Decreasing Dental Caries Inequalities Between Japanese Prefectures: An Ecological Study

• Published in: Journal of epidemiology Vol. 26; no. 11; pp. 563 - 571
• Main Authors: Matsuyama, Yusuke, Aida, Jun, Taura, Katsuhiko, Kimoto, Kazunari, Ando, Yuichi, Aoyama, Hitoshi, Morita, Manabu, Ito, Kanade, Koyama, Shihoko, Hase, Akihiro, Tsuboya, Toru, Osaka, Ken
• Format: Journal Article
• Language: English
• Published: Japan Japan Epidemiological Association 2016
• Subjects: Age; Child; Child, Preschool; Children; Cohort Studies; Confidence intervals; Dental caries; Dental Caries - epidemiology; Dental Caries - prevention & control; Dentifrices; Ecological monitoring; Ecological studies; Fluoridation; Fluoride treatments; fluoride; dental caries; population approach; health inequalities; Fluorides; Fluorides - administration & dosage; Health Status Disparities; Humans; Incidence; Inequalities; Japan - epidemiology; Mouthwashes - administration & dosage; Original; Program Evaluation; Regression analysis; School Health; School Health Services; Socioeconomic Factors; Teeth; Utilization; Japan
• ISSN: 0917-5040; 1349-9092
• DOI: 10.2188/jea.je20150255

Dental caries inequalities still severely burden individuals' and society's health, even in countries where fluoride toothpastes are widely used and the incidence of dental caries has been decreasing. School-based fluoride mouth-rinse (S-FMR) programs, a population strategy for dental caries prevention, might decrease dental caries inequalities. This study investigated the association between S-FMR and decreasing dental caries prevalence and caries-related inequalities in 12-year-olds by Japanese prefecture. We conducted an ecological study using multi-year prefecture-level aggregated data of children born between 1994 and 2000 in all 47 Japanese prefectures. Using two-level linear regression analyses (birth year nested within prefecture), the association between S-FMR utilization in each prefecture and 12-year-olds' decayed, missing, or filled permanent teeth (DMFT), which indicates dental caries experience in their permanent teeth, were examined. Variables that could explain DMFT inequalities between prefectures, such as dental caries experience at age 3 years, dentist density, and prefectural socioeconomic circumstances, were also considered. High S-FMR utilization was significantly associated with low DMFT at age 12 (coefficient -0.011; 95% confidence interval, -0.018 to -0.005). S-FMR utilization explained 25.2% of the DMFT variance between prefectures after considering other variables. Interaction between S-FMR and dental caries experience at age 3 years showed that S-FMR was significantly more effective in prefectures where the 3-year-olds had high levels of dental caries experience. S-FMR, administered to children of all socioeconomic statuses, was associated with lower DMFT. Utilization of S-FMR reduced dental caries inequalities via proportionate universalism.