Root Canal Treatment Rate in Deciduous Teeth Among 6-Year-Olds in the Era of Discontinuing Water Fluoridation - Historical Cohort Study

Abstract Background: Fluoride protects teeth by replacing the hydroxyl group in hydroxyapatite, creating fluoroapatite that is more resistant to acids from food and bacteria. In this way fluoride helps prevent tooth decay. Untreated caries may progress to the nerve of the tooth located in the pulp chamber and canals in the root, and then the tooth will require root canal treatment. In 1998, Israel mandated fluoridation in cities with a population of over 5,000. However, in 2014, a new directive, banned the fluoridation of drinking water. This study aimed to explore the impact of community water fluoridation on socio-economic disparities by examining the differences in the prevalence of root canal treatments in deciduous teeth among 6-year-old children with and without community water fluoridation. Methods: For this retrospective study, computerized dental treatment codes were collected for checkups and root canal treatments in deciduous teeth between 2014-2015 and between 2016-2022 in 6-year-old children. Statistical significance was set as p<0.05. Results: Children with a low socio-economic status tended to undergo more root canal treatments on deciduous teeth than those with higher socio-economic status. This discrepancy was more prominent in areas without fluoride i.e. the population most affected by the absence of community water fluoridation had a lower socio-economic level. Those with higher economic status had relatively stable rates of root canal treatments regardless of fluoridation. Moreover, across all socio-economic levels, males had more root canal treatments than females. Conclusion: Water fluoridation is important to reduce caries incidence and the need for root canal treatment and has the potential to reduce the disparity between different socio-economic levels.