The next stages in researching water fluoridation: Evaluation and surveillance

Objective (1) to provide a commentary on a conference held at the University of Manchester entitled Researching Water Fluoridation: Evaluation and Surveillance; (2) to synthesize from the proceedings of the meeting suggestions for future research and public health surveillance. Method The main points and problematic issues raised by the speakers were documented and, together with information from other sources, used to construct an operational framework for the next stages in developing fluoridation research/ surveillance.

Results Critical areas were identified from the speakers' presentations and plenary discussions for which suggested ways forward were proposed. Important areas needing to be covered in future research/surveillance were then abstracted and tabulated. These included: participants, interventions, outcomes, sampling (sample frame and strategy), stratification, sample size, minimization of bias (blinding, examiner consistency), statistical methods, confounding variables, data requirements for ancillary analyses, and principal measurable adverse events.

Conclusions Covering the full range of criteria for comprehensive evaluation and surveillance would involve a number of complex, logistically demanding and costly procedures, including dietary intake monitoring and medical/dental clinical investigations. These would call for positive consent and compliance of target populations. It is suggested that a piecemeal research strategy, involving pilot studies and a series of separate, though probably linked, projects would be the optimum approach. The extent to which all the identified research/surveillance requirements could be met would depend on the availability of the necessary financial resources.