Dental fluorosis: epidemiological fiction?

Abstract

To review the scientific literature concerning dental fluorosis and to evaluate its occurrence among children attending public schools in the city of Curitiba, which is in the state of Paraná in Brazil. We reviewed the international literature on fluorosis that was published between 1998 and 2001, focusing on systematic critical reviews that were listed in such electronic bibliographical sources as MEDLINE, LILACS, the Cochrane Library, and Sci-ELO Public Health. In addition, in 2000 we carried out a cross-sectional study with 12-year old schoolchildren (n = 1,494) in Curitiba. Our literature review found that there is still much controversy regarding the benefits associated with fluoride supplementation and the impact of fluorosis. In our cross-sectional study with the Curitiba schoolchildren, we found a fluorosis prevalence of 23% for grade 2, 3, 4, or 5 on the Dean index. The observed fluorosis had little impact on the biopsychosocial health of the children studied, as shown by the multivariate logistic regression analysis. The analysis showed that the presence of fluorosis was not significantly associated with dissatisfaction with tooth color. However, there was an association between the independent variable of place of residence (sanitary district within Curitiba) and fluorosis (P = 0.00), in both the bivariate and multivariate analyses. Based on our results, we concluded that dental fluorosis is not now a crucial epidemiological problem for the population studied in Curitiba. Any initiatives to control fluorosis should take into account the population's perception of the problem. Nevertheless, it is still extremely important to monitor the levels of fluoride in drinking water.