Abstract
Background. The inconsistent prevalence of fluorosis for a given level of fluoride in drinking water suggests developmental defects of enamel (DDEs) other than fluorosis were being misdiagnosed as fluorosis. The imprecise definition and subjective perception of fluorosis indices could result in misdiagnosis of dental fluorosis. This study was conducted to distinguish genuine fluorosis from fluorosis-resembling defects that could have adverse health-related events as a cause using Early Childhood Events Life-grid method (ECEL).Methods. A study was conducted on 400 9-year-old children from areas with high, optimal and low levels of fluoride in the drinking water of Fars province, Iran. Fluorosis cases were diagnosed on the standardized one view photographs of the anterior teeth using Dean’s and TF (Thylstrup and Fejerskov) Indices by calibrated dentists. Agreements between examiners were tested. Early childhood health-related data collected retrospectively by ECEL method were matched with the position of enamel defects.Results. Using both Dean and TF indices three out of four dentists diagnosed that 31.3% (115) children had fluorosis, 58.0%, 29.1%, and 10.0% in high (2.12–2.85 ppm), optimal (0.62–1.22 ppm), and low (0.24–0.29 ppm) fluoride areas respectively (p < 0.001). After matching health-related events in the 115 (31.3%) of children diagnosed with fluorosis, 31 (8.4%) of children had fluorosis which could be matched with their adverse health-related events. This suggests that what was diagnosed as fluorosis were non-fluoride related DDEs that resemble fluorosis.Discussion. The frequently used measures of fluorosis appear to overscore fluorosis. Use of ECEL method to consider health related events relevant to DDEs could help to differentiate between genuine fluorosis and fluorosis-resembling defects.
Highlights
Despite the extensive use of well documented indices of dental fluorosis (Dean, 1942; Fejerskov, 1988), there is inconsistency in the reports on the prevalence rates of fluorosis for a given level of fluoride in drinking water
The number of 9-year-old children included in the study was 376; 171 (46%) girls and 196 (53 %) boys
Logistic regression showed that there was a positive relationship between fluorosis and fluoride in the drinking water (p < 0.001)
Summary
Despite the extensive use of well documented indices of dental fluorosis (Dean, 1942; Fejerskov, 1988), there is inconsistency in the reports on the prevalence rates of fluorosis for a given level of fluoride in drinking water. Most probably, this inconsistency in the prevalence of fluorosis occurs due to subjective perception of fluorosis by examiners. The inconsistent prevalence of fluorosis for a given level of fluoride in drinking water suggests developmental defects of enamel (DDEs) other than fluorosis were being misdiagnosed as fluorosis. Use of ECEL method to consider health related events relevant to DDEs could help to differentiate between genuine fluorosis and fluorosis-resembling defects
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