Water fluoridation as a strategy for preventing childhood caries

¶ … Prevention Statistics

Children and young adults often have a much harder time adhering to dental hygiene routines that prevent decay and the progression of caries. Often times, they fail to understand the importance of the routines and the damage that could be caused. In order to strengthen primary prevention strategies, many local municipalities have begun adding fluoride to water sources. This is a great way to augment other prevention strategies because it requires no extra effort on behalf of those benefiting from its treatment. This current research aims to explore whether or not this secondary strategy has been successful in reducing rates of untreated caries in children and young adults, ages 6 to 19. The research used regression, z-Test, and t-Test analysis in order to test the hypothesis that adding fluoride to water does help prevent caries. All three tests suggested that this is true and that ultimately; adding fluoride is an efficient strategy for preventing tooth decay.

Introduction

This current research is exploring rising trends of adding fluoride to water in order to evaluate it as a secondary strategy for preventing caries in children and young adults. Due to the importance of preventing caries, especially in vulnerable populations like children and young adults, understanding what strategies are working is crucial to long-term healthcare efforts. Thus, this research compares increasing rates of water fluoridation with rates of untreated caries within the population in order to test the hypothesis that such increases in the use of fluoridation is successful in decreasing rates of dental health problems.

Objectives

As previously seen, dental health is a major concern, especially in regards to young children. Often times, children do not have the same due diligence as adults to keep up with dental hygiene routines, which can ultimately impact the success of prevention strategies. This research then aims to explore secondary strategies as a way to test whether they are successful in strengthening primary strategies to prevent caries in children and young adults. The objective of this research is to understand how effective evidence-based practice techniques used to help prevent untreated caries in children and young adults.

The research was reviewed to find an appropriate prevention method that has been successful on a large scale in order to demonstrate its importance in actual practice and help provide support for future practice. Ultimately, it was clear that many prevention methods often go without high levels of commitment, given the nature of the child population. Many children do not stick to prevention regiments as diligently as adults, and so the notion of adding fluoride to public water sources was used as a way to suggest that children really rely on unintended prevention methods just as much as they do other, intended methods. Fluoridation in water strengthens prevention strategies without any effort on behalf of the children. This is a strategy that is secondary and aims to augment other, more actively engaging strategies.

This current research aims to test whether this secondary strategy has been successful in recent years for increasing the strength of preventing caries in children and young adults. The hypothesis was that as increasing levels of the population receive fluoride added water from public works, the rate of untreated caries in children and young adults are decreasing because it is an added prevention tool that helps augment what the child is actually intending to do in terms of his or her oral health care. Ultimately, as fluoridation of water sources increases, the hypothesis here is that caries in children and young adults is decreasing across the United States.

Population

The current research used previously recorded data from the United States Centers for Disease Control and Prevention. The CDC has statistical data on statistics of dental health, including incidences of caries for the American population. From such data, the sample population was targeted. The targeted sample population represents children and young adults, ages 6 to 19. This population is often most vulnerable to oral issues, based on a limited understanding of the importance of oral health. The population is often the one that is most often to not be as diligent in their oral care routine. Thus, the study broke the population into three groups, 6-19 to represent the total age group, 6-11, and 12-19. The sample population comes from the target age group from across the United States.

Variables

In order to test the hypothesis, two primary variables will be compared to each other. First, there is the percent of the U.S. population as a whole which is receiving fluoride added water through public works infrastructure systems. This is a variable which represents the increasing use of the practice to illustrate how more and more of the population, including children and young adults, are being exposed to water with fluoridation. It represents increasing trends, where more and more of the United States is turning to the secondary strategy to help increase overall dental health of the population.

This will then be compared to three age groups and the percentage of the population with untreated caries as noted by the CDC in an oral health census over an extensive period of time. Untreated essentially means that they had developed caries within a period of time and have not yet had such cavities filled. It helps represent the state of oral health for the sample population being explored. These variables will be tested for three-year periods, 1989, 2004, and 2008.

Specific Questions

Are unintended prevention methods working?

Has adding fluoride to water sources been successful in reducing untreated caries in the sample population?

Does the additional step of adding fluoride to water augment the success of other oral health care regiments geared towards children and young adults?

Sampling Methods

The nature of what is being researched is difficult to gather data independently. Getting access to dental hygiene records is difficult, especially on such a large scale as the one being used within the context of this research. Thus, this research turned to already gathered data from reputable government sources in order to ensure the validity of the data. The sample was chosen from data provided by the United States Department of Health and Human Services. Data was collected using the 2010 Health, United States, 2009: With Special Feature on Medical Technology. The sample source provided a multitude of different data from populations of children ages 6 through 19 across a thirty year span. This was an excellent source to test out the chosen variables, as it provided reliable observations from real clinical practice and covered such a long period. All cases of caries were confirmed by a dental professional and had to meet the strict criteria of the CDC sampling process. This ultimately helped secure strong data that was reliable and thus efficient for sampling purposes within the context of this current research.

The next data set to compare these annual rates represented the statistics regarding the adding of fluoride to drinking water around the United States. Again turning to the CDC, statistics of individuals drinking water with fluoride added are recorded every two years since the practice began the middle of the Twentieth Century, starting in Grand Rapids Michigan in 1945 (CDC, 2012). Just as the previous data set, reliability was ensured by the source of the data. Statistics came from individual local and state governments who reported adding fluoride to local water sources. Overall U.S. Statistics from the two-year periods. Data sets representing 1989, 2004, and 2008 will be used in comparison to the rates of untreated tooth decay for the young sample population targeted in this research. Ultimately, these two factors are what made the data source so strong in testing the hypothesis presented here. Once the data was collected, statistical testing could begin. First, the data is presented in descriptive statistics, with the confidence interval presented. Then, a regression analysis was performed that showed correlation between the two variables. This regression analysis is shown in the following section, along with each correlation coefficient. Additionally, two hypothesis tests were conducted in order to determine whether our hypothesis was correct in its assertions. First, a z-test was performed. Then, a t-Test: Paired Two Sample for Means was also performed.

Data Presentation

Data Set: Percent of Population with Untreated Caries

Age

Year

6-19

6-11

12-19

2008

16.2

20.2

13.3

2004

22.9

28.6

18.5

1989

23.6

27.6

20.5

Descriptive Statistics: Percent of Population with Untreated Caries

Ages 6-19

Ages 6-11

Ages 12-19

Mean

20.9

Mean

25.4

Mean

17.4

Standard Error

2.358671943

Standard Error

2.649108865

Standard Error

2.145796925

Median

22.9

Median

27.6

Median

18.5

Mode

#N/A

Mode

#N/A

Mode

#N/A

Standard Deviation

4.085339643

Standard Deviation

4.588391149

Standard Deviation

3.716629297

Sample Variance

16.69

Sample Variance

21.05

Sample Variance

13.81

Kurtosis

#DIV/0!

Kurtosis

#DIV/0!

Kurtosis

#DIV/0!

Skewness

-1.675018571

Skewness

-1.639956635

Skewness

-1.18511502

Range

7.4

Range

8.4

Range

7.2

Minimum

16.2

Minimum

20.2

Minimum

13.3

Maximum

23.6

Maximum

28.6

Maximum

20.5

Sum

62.7

Sum

76.4

Sum

52.3

Count

3

Count

3

Count

3

Largest (1)

23.6

Largest (1)

28.6

Largest (1)

20.5

Smallest (1)

16.2

Smallest (1)

20.2

Smallest (1)

13.3

Confidence Level (95.0%)

10.14854627

Confidence Level (95.0%)

11.39819549

Confidence Level (95.0%)

9.232618998

Data Set: Percent of Population Exposed to Fluoridated Water

Year

Percent

2008

72.4

2004

68.7

1989

60.5

Clearly, more and more of the population have been exposed to water with fluoride added to it. In fact, the percent of the population has increased dramatically over just the past few decades. This ultimately means that more of the population, including children and young adults, are being exposed to this preventative measure.

Descriptive Statistics: Percent of Population Exposed to Fluoridated Water

Column1

Mean

67.2

Standard Error

3.516153201

Median

68.7

Mode

#N/A

Standard Deviation

6.090155991

Sample Variance

37.09

Kurtosis

#DIV/0!

Skewness

-1.041110123

Range

11.9

Minimum

60.5

Maximum

72.4

Sum

Count

3

Largest (1)

72.4

Smallest (1)

60.5

Confidence Level (95.0%)

15.12878617

Regression Testing

As the regression clearly shows, there is a statistically significant relationship between the rising levels of population being exposed to fluoride in their water and a decrease in the occurrence of untreated caries in children and young adults. Ultimately, the hypothesis was correct in assuming that fluoridation of water can help augment holes in children and young adults' oral care regiment, which can lead to a decrease in the occurrence of cavities and other oral health concerns. Such conclusions can be used to suggest that fluoridation practices are successful and should continue to increase on a localized basis, as they are clearly showing strong positive results within the sample population.

Data Analysis

For each of the two hypothesis tests performed, there is the hypothesis (H1: p >< p0) that increasing use of fluoridation in water is reducing the numbers of untreated caries in all age groups. Thus, the null hypothesis (H0: p = p0 ) is that increasing fluoridation of water has no affect on untreated caries in children and young adults.

Z Test

Age

2008

2004

1989

Variance

6 to 19

16.2

22.9

23.6

16.69

6 to 11

20.2

28.6

27.6

21.05333

12 to 19

13.3

18.5

20.5

13.81333

Year

Percent

2008

72.4

2004

68.7

1989

60.5

Variance

37.09

Ages 6-19

z-Test: Two Sample for Means

72.4

16.2

Mean

64.6

23.25

Known Variance

37.09

16.69

Observations

2

2

Hypothesized Mean Difference

0

z

7.974071267

P (Z

7.77156E-16

z Critical one-tail

1.644853627

P (Z

1.55431E-15

z Critical two-tail

1.959963985

Ages 6-11

z-Test: Two Sample for Means

72.4

20.2

Mean

64.6

28.1

Known Variance

37.09

21.05333

Observations

2

2

Hypothesized Mean Difference

0

z

6.769520562

P (Z

6.4605E-12

z Critical one-tail

1.644853627

P (Z

1.2921E-11

z Critical two-tail

1.959963985

Ages 12-19

z-Test: Two Sample for Means

72.4

13.3

Mean

64.6

19.5

Known Variance

37.09

13.81333

Observations

2

2

Hypothesized Mean Difference

0

z

8.939607325

P (Z

0

z Critical one-tail

1.644853627

P (Z

0

z Critical two-tail

1.959963985

For all age groups, the P. value is greater that 0, indicating that the alternative hypothesis is correct. This can be seen when examining the test with all age groups considered especially. Here, the one tail P. value is 7.77156 and the two tail P. value is 1.55431, both greater than 0. Ultimately, the null hypothesis is rejected. This means that there is enough of a statistical significance to show that the alternative hypothesis is confirmed, meaning that as the levels of fluoridation increase, and the rates of untreated caries within the age group decrease. As seen in the individual age group categories, this result is repeated as well, making the alternative hypothesis confirmed for all age groups.

T-Test

t-Test: Paired Two Sample for Means

Ages 6-19 with Caries

Percent Fluoridated

Mean

20.9

67.2

Variance

16.69

37.09

Observations

3

3

Pearson Correlation

-0.794401826

Hypothesized Mean Difference

0

df

2

t Stat

-8.301900494

P (T

0.00710046

t Critical one-tail

2.91998558

P (T

0.014200919

t Critical two-tail

4.30265273

Using the t-Test for paired sample for means, the alternative hypothesis is again confirmed and the null hypothesis is rejected. Here, the P. value is slightly greater than 0, being 0.00710046 and 0.014200919 for the two-tail test. Ultimately, that suggests that the alternative hypothesis is confirmed, meaning again that as the levels of fluoridation increase, the levels of untreated caries for children and young adults ages 6 to 19 decreases.

Conclusions

Clearly, adding fluoride to the water is having an impact on the numbers of untreated caries in children and young adults, ages 6 to 19. Using regression, z-Test, and t-Test statistical analysis, it is clear that the numbers of untreated caries for children ages 6 to 19 are decreasing alongside increasing use of fluoride in drinking water sources. This shows that the secondary prevention strategy is working alongside all other primary prevention strategies. Ultimately, adding fluoride to water sources is a good way to augment all other primary prevention strategies, especially in cases with children who may not be as adamant about following strict dental hygiene routines.

Still, there were some limitations to this study that can be improved in future research. Obviously, there are a number of other variables that can be included here, and future testing might want to focus on levels of education and improving health care conditions. This would provide a much clearer picture in regards to the results. Yet, with the data sets available to this current research, it is clear that the hypothesis was confirmed.