DOES FLUORIDATION REDUCE THE USE OF DENTAL SERVICES AMONG ADULTS

OBJECTIVES. The authors determine whether prevention influences the us e of health services. Fluoridation's effect on restorative dental dema nd among 972 Washington state employees and spouses, aged 20 to 34 yea rs, in two fluoridated communities and a nonfluoridated community was examined. METHODS. At baseline, adults were interviewed by telephone, and oral assessments were conducted to measure personal characteristic s, lifetime exposure to fluoridated water, oral disease, and the quali ty of restorations. Adults were followed for 2 years to measure dental demand from dental claims, Each adult's baseline and claims data were linked with provider and practice variables collected from the dentis t who provided treatment. RESULTS. Relative to adults with no lifetime exposure to fluoridated water, adults drinking fluoridated water for half or more of their lives had less disease at baseline and a lower b ut nonsignificant probability of receiving a restoration in the follow -up period. In the 2-year follow-up period, however, more than half of the restorations were performed to replace fillings of satisfactory o r ideal qualify at baseline. When only teeth with decay and unsatisfac tory fillings at baseline were considered, adults with high fluoridati on exposure had a lower probability of receiving a restoration than ad ults with no exposure. Market effects also were detected in demand equ ations; relative to adults in the nonfluoridated community, adults res iding in the fluoridated community with a large dentist supply receive d a greater number of restorations, suggesting potential supplier-indu ced demand from less disease and fewer patients, CONCLUSIONS. Among ad ults aged 20 to 34 years with private dental insurance, fluoridation r educes oral disease but may or may not reduce use of restorative servi ces, depending on dentists' clinical decisions.