Effect of community water fluoridation cessation on dental caries in 12-year-old Israeli children: a retrospective analysis of socioeconomic disparities (2014–2022)

Abstract

Background Israel’s community water fluoridation policy, mandatory from 2002 until its halt in 2014, provides a natural experiment to assess fluoridation’s impact on pediatric oral health. This retrospective study analyzed digital dental records of 12-year-old children (2014-2022) to assess changes in caries experience following community water fluoridation cessation. Methods We examined the Decayed, Missing, and Filled Teeth index, focusing on its Missing-and-Filled (MF) component, across socioeconomic status groups, gender, and fluoridation status (fluoridated vs. non-fluoridated). Differences were assessed using one-way Welch ANOVA and post-hoc Games-Howell tests. Results The MF index increased significantly after fluoridation ended, especially in low-SES populations. Twelve-year-olds in low-SES communities without fluoridated water had more than double the caries experience of those in high-SES communities (mean MF 0.82 vs. 0.40; p < 0.05). Fluoridated communities showed a considerably narrower SES gap. SES had a large effect on caries outcomes (partial η²≈0.34), and the absence of fluoridation was associated with a modest but significant increase in MF (partial η²≈0.01). Females exhibited higher MF rates than males, with gender disparities more pronounced in non-fluoridated groups. Cessation of CWF was associated with a rise in caries and widened SES and gender disparities, underscoring fluoridation’s value in promoting oral health equity. Conclusion CWF remains a foundational public health measure, one that is unequaled in its ability to deliver effective, safe, equitable, and cost-saving caries prevention to entire populations. Practical implications Reinstating mandatory community water fluoridation is essential to reverse the widening oral health disparities that disproportionately affect low-SES children and females. Policymakers must prioritize this measure to restore health equity and protect vulnerable populations who rely on this passive preventive intervention. Supplementary Information The online version contains supplementary material available at [https://doi.org/10.1186/s13584-026-00782-z]().