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 The benefits of fluoridated water continue throughout users’ lives, as long as they keep their own teeth. A New Zealand study has attempted to calculate the lifelong benefits on a population basis.
The study report, The Cost-Effectiveness of Fluoridating Water Supplies in New Zealand, by Environmental Science and Research Ltd (ESR) in November 1999, compared the cost of fluoridating water supplies to the savings achieved by health authorities and individuals in the cost of treating decay. The study looked at expected savings over a 30-year period, taken from 2000 to 2030, in an average population consisting of 15 per cent Maori. Savings are significantly higher in areas where Maori make up more than 15 per cent of the population, such as in Rotorua.
The study also set very conservative boundaries, such as assuming no further decay after age 34 and no further savings from averted treatment costs after age 45. If anything, therefore, this study understates the savings offered by water fluoridation.
The “base case” analysis reported by the researchers showed that, for a community of 75,000 people, the net saving over 30 years would be $12.7 million with 111,000 fewer decayed tooth surfaces in permanent teeth only. The study further understated the benefits by ignoring the cost of decay in first or deciduous teeth. Decay in “baby” teeth is a significant cause of hospital treatment for young children in Rotorua.
The researchers conclude that “the economic argument for installation of water fluoridation facilities for presently non-fluoridated water supplies is very strong. The results of our base case analysis and almost all the results of our sensitivity analyses show that the averted dental costs would exceed the water treatment cost for communities greater than 1,000 or so.
“Where a community has a substantial proportion of Maori, a socio-economic status lower than average, or a high proportion of children, the economic argument is particularly persuasive.” (All these factors apply to Rotorua).
“It is our view that one could not ask for more from a public health intervention than from water fluoridation. It is a public health intervention that:
- has well-proven efficacy and is safe
- is extremely cost-effective and doesn’t require heavy capital investment or operating costs
- does not require population behaviour change
- does not require great changes to the status quo, as, for example, would be needed to improve sub-standard housing
- has benefits over a lifetime for those retaining their natural teeth, especially children
- benefits most those whose health is poorest, namely, Maori and others of relatively low socio-economic status.”
The calculations in the research show that water fluoridation is likely to save every resident in a fluoridated area three fillings over a lifetime (approximately 1.5 over 30 years) on average, though the benefits will be heavily skewed towards lower socio-economic groups.
Copies of the ESR paper are available on request from info@goodteeth.org.nz.
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