Dental Fluorosis In Children Research Articles

Endemic fluorosis surveillance in Qinan County of Gansu Province from 2004 to 2007: an outcome analysis

Objective To investigate the prevalence of endemic fluorosis and the progress acchieved through control measures in Taian County of Gansu Province so as to provide basis and technique support for endemic fluorosis control. Methods The survey was carried out according to the National Surveillance Scheme of Endemic Fluorosis. Fulfillment of control measures and the quality of water improving projects were surveyed. Samples of household water and urine in children aged 8-12 years were collected and fluoride content was detected by iron selective electrode method. Children's dental fluorosis were examined with Dean method. Results In Qinan County, water was improved in a rate of 100%. In water-improving and defluoridation projects investigated, 81.15% (99/122) projects worked well, 18.85% (23/122) projects were closed or abandoned. The number of water improvement projects monitored were 24,81,9,8,respectively in the year through 2004 to 2007, revealing 13 projects having water fluorine content(>1.0-2.0 mg/L) in 2004, 15 and 5 projects having water fluorine content higher that 1.0-2.0 and 2.0-4.0 mg/L respectively in 2005, 2 projects having water fluorine content(>1.0-2.0 mg/L) in 2006, and no projects above 4.0 mg/L. In Anfu Village, the fluorine content of source and drinking water were all below 1.0 mg/L in 2006 and 2007. The urinary fluoride content of 8-12 years old children was equal and higher than 1.5 mg/L, dental fluorosis rate was 34.47% (354/1027), and dental fluorosis index was 0.65 in 2004-2007. Conclusions Projects running out of status and excessive levels of water fluorine are frequently seen, dental fluorosis is not controlled in Taian County of Gansu Province Key words: Drinking; Fluoride poisoning; Surveillance

Absorción sistémica de flúor en niños secundaria al cepillado con dentífrico fluorado

The effect of the fluoride in the caries prevention is strongly linked to its topical action. When the fluoride is ingested, its anticaries effect is weak and, in addition, it can cause side effects such as dental fluorosis in children. The toothbrushing with fluoride dentifrice is a suitable procedure to provide the topical fluoride, but in small children there is risk of inadvertent swallowing. The main goal of this study is to quantify the fluoride levels in urine after toothbrushing with fluoride dentifrice. A sample of 115 children between 5 to 8 years was randomly selected. The pH, as well as creatinine and fluoride levels were analyzed in the urine excreted before and two hours after toothbrushing with fluoride dentifrice. The fluoride/creatinine (F/Cr) ratio was used to minimize the variations of the fluoride levels in urine due to the different rates of secretion. For the statistical analysis, the average, the standard deviation and the T test were used for the variables with normal distributions, and nonparametric tests were applied for the variables with non normal distribution. The average amount of dentifrice was 1192 mg (SD: 421). The variables pH and creatinine showed similar values in the two samples of urine analyzed (pH: 6,35 and 6,36; creatinine: 0,76 g/l and 0,81 g/l). Nevertheless, the F/Cr ratio increased significantly after toothbrushing, ranging from 0.61 to 1.25 mg/g. The use of fluoride dentifrice is related to a significant increase of the fluoride concentration in urine in children.

Report on the surveillance results of endemic fluorosis in Qinghai Province in 2007

Objective To investigate the fulfillment of improved water measures for endemic fluomsis and to find out the trend of prevalence in Qinghai Province in order to provide scientific basis and technical support for the government to formulate control strategies for endemic fluorosis.Methods Usage and management of reforming water facilities in Huzhu County were generally surveyed.Yanya Village,Caijiabu Town,Huzhu County was chosen as the surveillance spot.The household drinking water was surveyed.The dental fluorosis and urine fluoride content of children aged 8-12 years and adult above 16 years were examined.Skeletal fluorosis of adult was checked.The fluomsis content in drinking water and urine was determined with F-ion selective electrode method.The dental fluowsis was examined with Dean index.Skeletal fluorosis was diagnosed according to eountry standard(GB 16396-1996.WS 192-1999).Results The rate of water-improving was 60%(36/60)in Huzhu County.The mean of fluoride content in drinking water Was 1.25 mg/L The prevalence rate of dental fluorosis of children aged 8-12 years was 90.20%(46/51);that of adult was 88.89%(48/54).The dental fluorosis index of children was 1.77,that of adult was 2.95.The prevalence rate of skeletal fluorosis was 98.15% indicated by clinical data,18.87% by X-ray.The ufine fluorosis content of children was 2.27 mg/L,that of adult was 2.00 mg/L.Conclusion The disease condition of endemic fluorosis in Qinshai is serious,defluofidation is slow in effect. Key words: Endemic disease; Fhioresis; Epidemioiogieal surveiHance; Outcome assessment

Endemic fluorosis:prevalence and prevention in Liaoning Province

Objective To investigate the status of control of endemic fluorosis in Liaoning Province.Methods To investigate the prevalence rate of endemic fluorosis and water fluoride content in regions with different extent of endemic fluorosis,dental fluomsis among 8-12 years old children and clinical fluorosis at adult above 16 years old were extensively surveyed,urinary fluoride among 8-12 years old children was detected.Results We surveyed 842 undefluorided drinking water in endemic fluorosis villages and 1234 projects of improving drinking water in 1829 endemic fluorosis viflages.Water fluoride content was 0.01-7.10 mg/L in unimproved drinking water in endemic fluorosis resions,averaging(0.96±0.64)mg/L;29.2%(246/842)of the endemic fluorosis regions had a fluoride content more than 1.2 mg/L In 1234 projects of improving drinking water.drinking water fluoride content was between 0.06-7.67 mg/L.The project normally operated and having a fluoride content≤1.2 mg/L accounted for 68.31%(843/1234),while 31.69%(391/1234)of the projects did not function well.The prevalence of dental fluomsis in 8-12 years old child ren in endemic fluorosis regions was 24.4%(2960/12 127),the prevalence of clinical fluorosis among adults was 2.22%(1900/85 636).The prevalente of dental fluorosis in slight,moderate and serious fluorosis regions had remarkable statistics differences(X2＝19.25,P＜0.01).The prevalence of dental fluorosis of children in serious fluorosis regions was the highest,reaching 100%,while the prevalence of skeletal fluorosis wns 18.03%(97/538).The median of urinary fluoride was 2.01.2.00mg/L in serious and slight fluomsis regions,respectively.Conclusions Endemic fluorosis is still serious.so we need urgently to improve water in serious fluorosis regions without defluoridaton of drinking water.Endemic fluomsis resions where worn-out and closed defluoriding projects exist need defluoriding management. Key words: Fluoride poisoning; Water; Fluorosis,dental; Osteofluorosis; Data collection

Outcome analysis of endemic fluorosis control in Guangxi in 2006

Objective To investigate the distribution of water fluoride and the status of water-improving defluoridation projects,thus to explore the condition of endemic fluorosis in Guangxi Province.Methods According toThe National Technical Scheme for Endemic Disease Contml in 2005,the fuorine content in water Was determined by F-ion selective electrode,children's dental fluorosis was checked by Dean method.and the skeletal fluorosis was checked by the standard of clinical scale of skeletal fluorosis.Results 305 water samples in 61 villages were examined,among which 71 waters were exceeded the standard,accounting for 23.28%(71/305).The projects of defluoriding drinking water were running well except one was discarded.The prevalence of dental fluorosis was 13.55%(356/2627),the prevalence of skeletal fluorosis was 4.02%(65/1615).Conclusions The situation of endemic fluorosis control is not optimistic in Guangxi,which needs fuaher prevention and controls. Key words: Endemic diseases; Fluoride poisoning; Water

Epidemiological investigation of endemic fluorosis along the Yellow River basin of Shandong Province

Objective To investigate the current prevailing status of endemic fluorosis in the Yellow River basin of Shandong Province and to provide the scientific evidence for making strategies in prevention and control.Methods Nine counties were chosen to carry out the epidemiological investigation.The content of fluoride in drinking water was determined by F-ion selective electrode and dental fluorosis of children aged 8～12 years old was diagnosed by Deans method.Results Water fluoride content was determined in 1761 fluorosis villages,among which 606 villages had water fluoride content≤1.00 mg/L,accounting for 34.41%(606/1761);1155 villages had water fluoride content＞1.00 mg/L,which accounted for 65.59%(1155/1761).The highest water fluoride content was 11.33 mg/L.Water fluoride content of 618 water-improving and defluoridation projects had been determined,among which 449 projects had water fluoride content≤1.00 mg/L and accounted for 72.65%(449/618),169 projects had water fluoride content＞1.00 mg/L and accounted for 27.35%(169/618),the highest water fluoride content was 5.85 mg/L.The total rate of dental fluorosis of children aged 8～12 years old was 45.03%(25 579/56 804) and the index of dental fluorosis was 0.80. Conclusions In the Yellow River basin in Shandong Province,up to 50.00%in the villages the water fluoride content exceeds the county standard(≤1.00 mg/L).The prevalence of endemic fluorosis in the basin hasn't been effectively controlled.So the counterrneasures for endemic fluorosis should be carried out as soon as possible. Key words: Endemic diseases; Fluoride poisoning; Drinking water; Epidemiology

Assessment of fluoride concentration and daily intake by human from tea and herbal infusions

The fluoride content in infusions of commercially available black, green, oolong, pu-erh and white teas was determined by ion-selective electrode. Herbal infusions as well as instant tea and ready-to-drink tea beverages were also examined. It is found that brewing time (5, 10 and 30 min) does increase the fluoride content, which in infusions of black tea (5 min brewing) was higher than that in the other types of tea, with contents ranging between 0.32 and 4.54 mg/l for black tea to 0.37–0.54 mg/l for white tea and with even lower values for herbal tea infusions of 0.02–0.09 mg/l. On the basis of the results obtained, the daily intake of fluoride provided from tea and herbal beverages was estimated for an adult person and for children in comparison with the Polish SAI (Safe and Adequate Daily Intake) of fluoride which is strictly attributable to ADI (Acceptable Daily Intake). The fluoride intake resulted from the regular consumption of black tea infusions was raised as compared to the other types of teas as well as herbal teas. For adult and children tea drinkers consuming five cups of black tea per day the intake of fluoride will be in the range of 8.0–303% and 12–303% of the SAI, respectively. People are often exposed to multiple sources of fluoride, such as in food, water, air and excessive use of toothpaste. The control of tea quality is important to protect human against too high uptake of this element from black tea, which is the most popular beverage. Excessive intake of fluoride with black tea, especially in the regions with its high level in the drinking water, increases the risk of dental fluorosis in children during the years of tooth development. The long-term exposure to large amounts of fluoride can lead to potentially skeletal fluorosis ( WHO, 1984).

Dental fluorosis in children in areas with fluoride-polluted air, high-fluoride water, and low-fluoride water as well as low-fluoride air: A study of deciduous and permanent teeth in the Shaanxi province, China

Objective. The aim of the study was to assess dental fluorosis (DF) in the deciduous and permanent teeth of children in areas with high-F coal (area A) and high-F water (area C) compared to children from area B, with low-F water and coal. Material and Methods. 596 children were examined. DF was assessed by TF-score. F-content of indoor air, drinking water, coal, tea, rice, and maize was analyzed. Results. F-content of air and coal ranged from 3.2 µg/m3 and 25.8 mg/kg (area B), 3.8 µg/m3 and 36.3 mg/kg (area C) to 56.8 µg/m3 and 713.1 mg/kg (area A). Likewise, mean F-content of water ranged from ∼0.50 mg/l (areas A and B) to 3.64 mg/l (area C). F-content of tea leaves was similar in all three areas. Maize and rice contained <5 mg F/kg. Prevalence of primary teeth with DF was 49.1%, 2.0%, and 66.8% in areas A, B, and C, respectively. Similarly, DF was found in 96.7% (area A), 19.6% (area B), and 94.4% (area C) of the permanent teeth. Severe fluorosis (TF ≥ 5) was found in area A (47.0%) and area C (36.1%) (p<0.01). Early erupting teeth had slightly higher mean TF-scores in area A than in area C. Conclusions. DF was prevalent in both dentitions in areas A and C. Similarity in percentages of DF may indicate that indoor air with ∼60 µg F/m3 and drinking water with 3.6 mg F/L are similarly toxic to developing permanent teeth. The percentage of deciduous teeth with DF was significantly lower in area A compared to area C. Where low-F coal and low-F water were used (area B), ∼20% of permanent teeth had DF, indicating a relatively low tolerance to fluoride in Chinese children brought up under the present living conditions.

Screening high-fluoride and high-arsenic drinking waters and surveying endemic fluorosis and arsenism in Shaanxi province in western China

The objectives of this study were to screen high-fluoride and high-arsenic drinking waters, to evaluate the effectiveness of fluoride-reducing projects and to assess the present condition of endemic fluorosis and arsenism in Shaanxi province in western China. For screening high-fluoride drinking waters, five water samples were collected from each selected village where dental fluorosis patients were detected in 8–12 year-old children. For evaluating the effectiveness of fluoride-reducing projects, four water samples were collected from each project at end-user level. Fluoride concentrations in water samples were measured by fluoride-selective electrode method or spectrophotometry. Dental fluorosis in children aging 8–12 years was examined according to Horowitz's Tooth Surface Index of Fluorosis. Skeletal fluorosis in adults was detected clinically and radiologically according to Chinese Criteria of Clinical Diagnosis of Skeletal Fluorosis. For screening high-arsenic waters, 20 water samples were collected from each village which was selected from areas characterized by the geographic features to induce high-arsenic underground water, i.e., alluvial plains, ore mining or smelting areas, geothermal artesians, and thermal springs. Arsenic concentrations in water samples were determined by spectrophotometry or arsine generation atomic fluorospectrophotometry. Arsenism in adults aging 40–89 years was examined in villages with arsenic concentrations in drinking water above 0.05mg/l according to Chinese Criteria for Classification of Endemic Arsenism Areas and Clinical Diagnoses of Endemic Arsenism. The results showed that the fluoride level of 7144 water samples was 1.17±0.93mg/l. There were 3396 (47.6%) high-fluoride waters (fluoride level was above 1.0mg/l) distributing in 786 (45.1%) villages, where about 0.8 million (50.0%) people inhabited. Additionally, the 1315 fluoride-reducing projects were studied. The fluoride level of the projects was 2.79±1.09 and 0.98±0.47mg/l before and after building the projects, which remained at relatively lower level (1.03±0.47mg/l). But there were still 58.0% of the projects providing drinking waters with fluoride concentrations beyond 1.0mg/l. The rates of dental fluorosis and skeletal fluorosis were 38.2% and 11.8%, respectively. The arsenic level of 1732 water samples was 0.010±0.082mg/l. There were 174 (14.9%) high-arsenic waters (arsenic level was above 0.010mg/l) being detected, distributing in 41 (38.7%) villages. The arsenic level in 53 (4.5%) water samples was beyond 0.025mg/l. There were 3 villages with arsenic level in drinking water beyond Chinese National Permissible Limits (0.050mg/l), and the prevalence rate of arsenism reached 37.0% in these three villages, 3.7%, 22.2%, and 11.1% of subjects suffering from mild, moderate, and severe arsenism, respectively. Conclusively, the wide distribution of high-fluoride drinking waters contributes to the prevalence of dental and skeletal fluorosis in Shaanxi province and the quality of fluoride-reducing projects should be further improved. Ore mining and smelting induces high-arsenic drinking waters, resulting in arsenism prevalence in Shang-luo city. Proper measures should be taken to deal with water pollution in the ore mining and smelting areas in order to solve the high-arsenic water problem in Shaanxi province.

Prevalence of dental fluorosis in children from non-water-fluoridated Halmstad, Sweden: fluoride toothpaste use in infancy

Objectives. To determine the prevalence and severity of dental fluorosis in children aged 7–9 years from non-water-fluoridated Halmstad, Sweden, and to relate the results to their reported fluoride exposure history during infancy. Material and Methods. In Spring 2002, a questionnaire distributed to a cluster random sample of 1039 parents enquired into their child's early oral health behaviors and included a “photographic toothpaste menu”. The permanent upper anterior teeth (13–23) were examined clinically (+10% repeats) using a modified Thylstrup-Fejerskov Index. Results. Complete data were available for 53% (n=548) of the sampled children. The prevalence of fluorosis at any level was 49% (95% CI: 45–54%), and of fluorosis with esthetic concern (TF score ≥3) 4% (95% CI: 3–6%). Based on repeat observations, reliability was good (kappa=0.82). There was no statistically significant increased risk of dental fluorosis prevalence associated with any of the fluoride exposure risk factors examined, including reported usage of (1000 ppm) fluoride toothpaste from time of first deciduous tooth eruption. Conclusions. While there were low levels of dental fluorosis of esthetic concern, half the children had some degree of dental fluorosis. The prevalence of dental fluorosis was not explained by the risk factors, including fluoride toothpaste usage as explored in this study.

Dental fluorosis in children attending basic health units

The purpose of this study was to determine the prevalence and severity of dental fluorosis among patients attending basic health units in Londrina. Five basic health units of the urban area were randomly selected and 434 children attending these units, born between 1986 and 1989 (9 to 12 years of age), were examined. Diagnosis of dental fluorosis was performed by means of the Thylstrup and Fejerskov (TF) Index. Oral examinations were carried out by 5 previously trained dentists with the patients lying in the dental chair, under artificial light, preceded by prophylaxis, isolation with cotton rolls and air-drying of the teeth. Ten percent of the sample was reexamined and an almost perfect agreement on diagnostic criteria was obtained either on the intra-examiner or inter-examiner evaluation (K=1.00, p<0.0001). The observed prevalence of dental fluorosis was 91.0%, and 87.8% of the individuals were classified as TF grade 2 or less. Despite of the low severity, the high prevalence observed shows the need for regular screening of dental fluorosis in Londrina; establishment of procedures to prevent the overutilization of fluoride both by the professionals and the population; sanitary surveillance of fluoride levels in water supply and also in all sources of fluoride available; besides the need for further studies to understand the factors associated to dental fluorosis among children living in Londrina.

Self-perception of fluorosis due to fluoride exposure to drinking water and dentifrice

The impact of dental fluorosis in children exposed to fluoride in drinking water and dentifrice was evaluated. Dental fluorosis was found in 72% of the children, but the children's well-being was not affected. It was concluded that although dental fluorosis due to the intake of optimally fluoridated drinking water and dentifrice did not affect the dental aesthetics of this studied population sample, there is a need of further studies on the subject.

Varied Ecological Environment and Fluorosis in Tibetan Children in the Nature Reserve of Mount Qomolangma

To determine the extent of brick tea consumption fluorosis in children living at elevations of 2000 and 4300 m, 519 children aged 8–15 years living in Xiege'er Town at 4300 m and Zhangmu Town at 2000 m were examined for dental fluorosis, their urinary fluoride concentration was determined, their dietary structure investigated, and the fluoride concentrations of various foods, freshwaters, soils, and fuels determined. Fifteen Tibetan families living in these two areas of the nature reserve of Mount Qomolangma were studied according to UNEP, FAO, and WHO guidelines for the study of dietary intake of chemical contaminants, Horowitz's classification and examination of dental fluorosis, and Dean's dental fluorosis index. The results demonstrated that dental fluorosis in Tibetan children living at an elevation of 2000 m was significantly lower than that of children at 4300 m (P<0.01). Higher elevation can worsen the extent of fluorosis, leading to retention of fluoride in tissues as a result of hypoxia, but fluorosis can also be associated with the deterioration of the ecological environment at high elevation and a low-level economy. Beverages and foods mixed with brick tea water are responsible for the dental fluorosis in the children.

Age as a determinant of severity of dental fluorosis in children residing in areas with 0.5 and 2.5 mg fluoride per liter in drinking water.

The purpose of this study was to investigate the influence of age on the severity of dental fluorosis in children exposed to drinking water with either low or high fluoride concentrations. The children selected for this study were aged 10-14 years, with 28 permanent teeth and at least 1 tooth pair with fluorosis. The children were permanent residents of districts in western Uganda with either 0.5 mg (n = 33) or 2.5 mg fluoride/l in drinking water (n = 186). All vestibular tooth surfaces were examined for fluorosis using the modified Thylstrup and Fejerskov (TF) index. In the high fluoride community, the proportion of teeth per child with TF scores > or = 4, and > or = 5 was significantly higher among children aged 13-14 years compared to those aged 10-12 years. Children's chronological age correlated positively and significantly with the median TF scores for all teeth, including early erupting (first molars and incisors) and late erupting teeth (canines, premolars and second molars). In linear regression analyses, the median TF score for all teeth, as well as for early erupting and late erupting teeth, increased significantly with age. On the other hand, in the low fluoride community there was no significant association between age and the severity of fluorosis. This study showed a significant increase in the severity of fluorosis with increasing age in a high fluoride community, whereas no change in severity with age was observed in a low fluoride community.

Fluoride supplements useful but increase the risk of mild fluorosis

Objectives To investigate whether the regular use of fluoride supplements in non-fluoridated communities during the period of tooth development increases the risk of dental fluorosis.Data sources Medline search 1966–Sept 1997 (English only papers) using following key words: fluorosis, dental, fluoride, fluoride supplement or supplements, drop or drops, and tablet or tablets.Study selection Twenty-four studies that assessed the development of dental fluorosis in children who had used fluoride supplements were identified. Ten cross-sectional/case control studies and four follow-up studies had data that allowed a quantitative estimation of the risk of developing dental fluorosis in users of fluoride supplements. Ten studies were excluded.Results A consistent and strong association between the use of fluoride supplements and dental fluorosis was found. Meta-analyses of the cross-sectional/case-control studies estimated the odds ratio of dental fluorosis in users of fluoride supplements between 2.1 and 2.3 (95% C.I. 1.5–3.4).Conclusions In non-fluoridated communities, the use of fluoride supplements during the first 6 years of life is associated with a significant increase in the risk of developing a very mild to mild type of dental fluorosis.

Chronic fluoride intoxication (fluorosis) in tribes and their domestic animals

A chronic fluoride intoxication in the form of dental and skeletal fluorosis has been observed in tribal subjects and domestic animals (cattle and buffalo) of twelve villages; Badoda, Bhavanpura, Devala, Dhunda, Ghanta, Katisor, Khalil, Bhagela, Masona, Munged, Pindawal and Ramgarh of Dungarpur district of Rajasthan (India), where mean fluoride concentration in drinking water sources varied between 1.5 to 5.0 mg/L. The greatest prevalence of dental fluorosis in children and adult subjects was found at 3.5 and 3.7 mg/L fluoride concentration, whereas in calves and mature animals at 2.9 and 3.5 mg/L, respectively. The highest prevalence of skeletal fluorosis, 57.0% in tribes and 58.6% in animals, has been observed at 5.0 and 4.8 mg/L fluoride concentrations, respectively. Some observations pertaining to other deformities and radiological in fluorotic cases have also been focussed.

Fluoride exposure and dental fluorosis in Newburgh and Kingston, New York: policy implications.

This analysis was conducted to determine the changes in the effect of exposure to fluoridation and other sources of fluoride on dental fluorosis in children attending Newburgh and Kingston school districts in New York State. Data for this analysis were obtained from two surveys conducted in the 1986 and 1995 school years. Analyses were limited to 3500, 7-14-year-old lifelong residents of a fluoridated or a nonfluoridated community. Dean's classification and DMFS index were used for recording dental fluorosis and caries, respectively. A questionnaire was used to collect fluoride exposure data. Regression procedures were used to estimate the effect of fluoridation, fluoride supplements, and brushing before the age of 2 years on dental fluorosis. Children examined in 1996 were at higher risk for both questionable and very mild to severe dental fluorosis if they received fluoride from water or daily tablet use, or started brushing before the age of 2 years. The increase in risk from 1986 to 1995 was greater for African-American children. This analysis showed that the risk of developing dental fluorosis did not decline over time in these communities. Continuous exposure to water fluoridation had an observable effect on dental fluorosis. However, implementation of fluoridation in Newburgh Town did not result in an increase in dental fluorosis prevalence.

Fluoride supplements and fluorosis: a meta-analysis.

This paper presents a systematic review of the dental literature that was carried out to investigate whether the regular use of fluoride supplements in non-fluoridated communities during the period of tooth development increases the risk of dental fluorosis. A MEDLINE search was organized for all documents published, in English, between January 1966 and September 1997 using the following key words: fluorosis, dental, fluoride, fluoride supplement or supplements, drop or drops, and tablet or tablets. Twenty-four studies that assessed the development of dental fluorosis in children who had used fluoride supplements earlier in their life were included in this review. Of the 24 studies, 10 were cross-sectional/case control studies and four were follow-up studies. These studies had data that allowed a quantitative estimation of the risk of developing dental fluorosis in users of fluoride supplements. The other 10 studies were excluded because they either did not present enough data or had other methodological problems. A qualitative review of the studies found a consistent and strong association between the use of fluoride supplements and dental fluorosis. The meta-analyses of the cross-sectional/case-control studies estimated that the odds ratio of dental fluorosis in users of fluoride supplements compared with non-users ranged between 2.4 and 2.6. The meta-analyses of the follow-up studies estimated that the relative risk in long-term users was between 5.5 and 12.2. This review confirmed that in non-fluoridated communities the use of fluoride supplements during the first 6 years of life is associated with a significant increase in the risk of developing dental fluorosis.

"Risk periods" associated with the development of dental fluorosis in maxillary permanent central incisors: a meta-analysis

This systematic review of the dental literature (1966-98) concerns risk periods associated with dental fluorosis in the maxillary permanent central incisors. A literature search was organized through the MedLine and the ISI databases. In addition, one unpublished paper (in manuscript) was obtained, as well as one paper published before 1966. However, out of 143 catches, only 10 studies were included in this review. The main reason for exclusions was that the data presented did not meet the criteria given for the present meta-analysis. Among the included papers, 7 pertained to subjects whose exposure to fluoride started at different ages during the enamel formation (Group 1), and 3 were based on subjects who had been exposed from birth and then experienced an abrupt reduction in daily fluoride exposure at different ages during the amelogenesis period (Group 2). The meta-analysis for Group 1 found the odds ratio (OR) for dental fluorosis in children exposed to fluoride early in life (before 2 years of age) to be 7.24 (95% CI; 4.71-11.13) as compared to children exposed later in life (after 2 years of age). The meta-analysis for the studies in Group 2 found the overall OR to be 1.88 (95% CI; 1.35-2.61) for children who had a reduction in fluoride intake after 2 years of age, as compared to individuals who experienced reduction earlier (during the first 2 years). The studies from both groups were pooled and the duration of exposure to fluoride during the first 4 years of life was the independent variable. The meta-analysis now revealed an overall OR of 5.83 (95% CI; 2.83-11.94) for long periods of fluoride exposure (>2 out of the first 4 years) versus shorter periods of exposure (<2 out of the first 4 years of life) during the enamel formation in the maxillary central incisors. Based on the findings of the meta-analysis, no specific period of enamel formation is singled out as being the most critical for the development of dental fluorosis. The duration of fluoride exposure during the amelogenesis, rather than specific risk periods, would seem to explain the development of dental fluorosis in the maxillary permanent central incisor.

Severe dental fluorosis in children consuming fluoride containing magadi salt

Severe dental fluorosis in children consuming fluoride containing magadi salt