Dental Cleaning, Community Water Fluoridation and Preterm Birth, Massachusetts: 2009–2016

  • Xiyuan ZhangEmail author
  • Emily Lu
  • Sarah L. Stone
  • Hafsatou Diop


Objectives Data on the potential effect of dental cleaning and community water fluoridation (CWF) on pregnancy outcomes are scarce. While numerous studies confirm the cost-effectiveness of fluoride in preventing dental caries, the benefit of CWF during pregnancy has not been well established. Methods This cross-sectional study used data from 2009 to 2016 Massachusetts Pregnancy Risk Assessment Monitoring System and restricted to singleton live births (n = 9234, weighted response rate = 64.3%). Our exposures were: (1) dental cleaning alone during pregnancy; (2) CWF alone; and (3) dental cleaning and CWF combined (DC–CWF). Women without dental cleaning during pregnancy and CWF comprised our reference group. The outcome was preterm birth, (birth < 37 weeks gestation). This study used multivariate logistic regression modeling, controlling for maternal sociodemographic characteristics, previous medical risk and behavioral factors, and calculated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results During 2009–2016, the prevalence of preterm birth among women with a singleton live birth was 8.5% in Massachusetts. Overall, 58.7% of women had dental cleaning during pregnancy, and 63.6% lived in CWF. After adjusting for potential confounders, the associations between dental cleaning alone and preterm birth (aRR = 0.74 [95% CI 0.55–0.98]), and DC–CWF and preterm birth (aRR = 0.74 [95% CI 0.57–0.95]) were significant, while the association between CWF alone and preterm birth was not significant (aRR = 0.81 [95% CI 0.63–1.05]), compared to women without dental cleaning and CWF. Conclusions for Practice This study shows that the prevalence of preterm birth was lower among women with DC only and DC–CWF.


Preterm birth Dental cleaning Community water fluoridation PRAMS 



The authors would like to thank the Office of Oral Health, Massachusetts Department of Public Health, for providing community water fluoridation information, and Craig Andrade and Brittany Brown for content review. The authors would also like to thank all of the women who completed the Massachusetts PRAMS questionnaires which made this research possible. This work was supported by the Centers for Disease Control and Prevention Grant #DP006202. The views expressed in this article are those of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention or the Massachusetts Department of Public Health.

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Bureau of Family Health and NutritionMassachusetts Department of Public HealthBostonUSA
  2. 2.Department of Biomedical & Nutritional SciencesUniversity of Massachusetts LowellLowellUSA

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