We welcome academic discussion on all our publications. However, we are aware that some public discourse includes misconceptions about our review on the initiation/cessation of community water fluoridation (CWF), particularly around the study designs included.
We encourage readers to critically read the review based on its review-specific question, eligibility criteria, and risk of bias assessments, rather than assumptions about what a Cochrane review should include.
For many population-level public health interventions, including CWF, randomised controlled trials (RCTs) are often impractical, ethically challenging, and poorly suited to real-world implementation. RCTs were, therefore, not the focus of our eligibility criteria. Study selection was driven by our review question, not by study design. Our question was:
What is the change in dental caries following the initiation or cessation of a community water fluoridation programme?
We included any study capable of answering this question, whether experimental, quasi-experimental, or observational. Rather than relying on a hierarchy of evidence, we focused on whether studies had the features needed to assess change over time. Eligible studies had to:
- compare communities with and without fluoridation and measure before and after initiation or cessation in order to evaluate change over time; and
- be prospective with a concurrent control.
Some commentators have incorrectly suggested that we prioritised RCTs and used a hierarchy of study designs to determine eligibility1. We did not. Eligibility was based solely on whether a study could answer the review question. A detailed response to this criticism is provided here.
1Walmsley, A., Lowry, R., Al Rasheed, A. et al. Critique of the review of ‘Water fluoridation for the prevention of dental caries' published by the Cochrane Collaboration in 2024. Br Dent J 241, 26–30 (2026). https://doi.org/10.1038/s41415-026-9613-y