Levels Of Fluorosis Research Articles

Perceptions of Dental Fluorosis

Mild dental fluorosis has long been accepted as a side-effect of water fluoridation and, more recently, has been recognized as a consequence of the use of other fluoride-based caries-preventive strategies. Traditionally, dental health professionals have not seen this as being of public health importance, but members of the public have not been asked their opinion. The purpose of the present study was to gather the opinions of lay groups concerning the appearance of the teeth of children with various degrees of fluorosis. Twenty-eight children, born in 1978, who had earlier participated in a study of fluorosis in Perth (Western Australia), allowed 110 observers to look at their upper central incisors under good viewing conditions. Fluorosis in these teeth ranged from TF score 0 (no fluorosis) to TF score 3. The observers were university students, parents, public servants, or dentists. They responded to statement items about the appearance of the teeth. The results, based on just over 3000 responses, showed that lay and dental observers could distinguish between different fluorosis levels. In response to a statement that the teeth appeared pleasing, a large majority agreed when the TF score was 0, but agreement declined as the TF score increased; when the TF score was 3, most people disagreed. Similarly, observers felt that the appearance would increasingly embarrass the child as the TF score increased. Observers, except the dentists, tended to feel that higher TF scores indicated neglect on the part of the child.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Fluorosis Following Downward Adjustment of Fluoride in Drinking Water

The drinking water fluoride concentration in Hong Kong was reduced by about 0.2 ppm in June 1978. This study was undertaken to determine whether the prevailing level of dental fluorosis was affected by such a minor change. Cohorts of children (N = 1,062) aged seven to 12 years, who were born both before and after the fluoride reduction, were examined clinically using Dean's fluorosis index. Based on upper right central incisors, dental fluorosis prevalence decreased from 64 to 47 percent and the community fluorosis index decreased from 1.01 to 0.75 (P less than .01). Thus, dental fluorosis was reduced, although the reduction in water fluoride concentration was not sufficient to achieve the minimal fluorosis level that Dean associated with a fluoride concentration optimal for caries prevention. Variation in dental fluorosis has been reported previously to result from marked sudden changes, during tooth formative years, to drinking water fluoride concentration. This study confirms preliminary findings that variation in dental fluorosis arising from minor changes to the fluoride level in drinking water is also measurable.

Fluorosis and dental caries in 6–8‐year‐old children in a 5 ppm fluoride area

Fluorosis levels and caries prevalence were evaluated in 152 children aged 6-8 yr residing from birth in an area with 5 ppm fluoride in the drinking water. Sixty-two of the subjects had mild fluorosis in both primary and permanent dentition, 31 were defined as moderate, and 4 cases had no signs of fluorosis; 14 cases had a more severe fluorosis level in the primary dentition as compared to 41 cases in which fluorosis was more severe in the permanent dentition. More primary dentitions were free of fluorosis in females than in males (P less than 0.05). No differences between males and females were found in the permanent dentition fluorosis. The decay rate in the permanent dentition gradually increased with increasing fluorosis severity, a finding not observed in the primary dentition. Reasons are discussed for the lower fluorosis level in the primary dentition and the more severe fluorosis in older age groups as well as the fluorosis severity difference by gender.

The Nature and Mechanisms of Dental Fluorosis in Man

Any use of fluorides, whether systemic or topical, in caries prevention and treatment in children results in ingestion and absorption of fluoride into the blood circulation. The mineralization of teeth under formation may be affected so that dental fluorosis may occur. Dental fluorosis reflects an increasing porosity of the surface and subsurface enamel, causing the enamel to appear opaque. The clinical features represent a continuum of changes ranging from fine white opaque lines running across the tooth on all parts of the enamel to entirely chalky white teeth. In the latter cases, the enamel may be so porous (or hypomineralized) that the outer enamel breaks apart posteruptively and the exposed porous subsurface enamel becomes discolored. These changes can be classified clinically by the TF index to reflect, in an ordinal scale, the histopathological changes associated with dental fluorosis. Compared with Dean's and the TSIF index, we consider the TF index to be more precise. Recent studies on human enamel representing the entire spectrum of dental fluorosis have demonstrated a clear association between increasing TF score and increasing fluoride content of the enamel. So far, no useful data on dose (expressed in mg fluoride/kg b.w.)-response (dental fluorosis) relationships are available. In this paper, we have, therefore, re-evaluated the original data by Dean et al. (1941, 1942), Richards et al. (1967), and Butler et al. (1985) from the USA, by applying the equation of Galagan and Vermillion (1957) which permits the calculation of water intake as a function of temperature.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship of dental caries and fluorosis to fluoride supplement history in a non-fluoridated sample of schoolchildren.

A random sample of 206 Michigan children, aged from 9 to 13, were examined for fluorosis from a larger group of 2038 children participating in a dental project. Clinical examinations included caries data (DMFS) and assessment of fluorosis by use of the Tooth Surface Index of Fluorosis (TSIF). Separate examiners were used for each index. The response rate of a questionnaire mailed to parents to gather information on residence histories, use of fluoride supplements, and antibiotics was 78%. The prevalence of fluorosis was about 20% among the respondents. Of the 4868 tooth surfaces examined, 9.2% were affected by fluorosis. In all cases, dental fluorosis was judged as mild, with most occurrences on the posterior teeth. No instances of moderate or severe fluorosis were found. The caries experience of respondents was 1.69 +/- 2.73 DMFS. Caries experience does not appear to be significantly related to income, education, or fluoride supplement use. Approximately 52% of respondents were reported to have taken fluoride supplements with various degrees of consistency. Parents' education was positively related to both prevalence of fluorosis (odds ratio = 2.2) and use of fluoride supplements (odds ratio = 2.7). No significant relation was revealed with evidence of fluorosis and use of supplements. This study shows a relatively mild level of dental fluorosis in a sample of children from a non-fluoridated area. Dental fluorosis in this group does not appear to be related to use of fluoride supplements or differences in caries experience.

Fluorosis and caries prevalence in a community drinking above-optimal fluoridated water.

Fluorosis levels and caries prevalence were evaluated in 182 adolescents aged 15-16 yr residing from birth in an area with 5 ppm fluoride in the drinking water. The mean number of surfaces affected by caries in the total study population was 5.46 DMFS. The teeth most susceptible to caries were the first molars. The prevalence of fluorosis was 100% with 53 subjects demonstrating mild fluorosis (according to Dean's index), 83 demonstrating moderate fluorosis, and severe fluorosis diagnosed in 46 subjects. A statistically significant positive association was found between caries prevalence and fluorosis; the more caries experienced, the more severe the fluorosis level. Boys experienced significantly higher fluorosis levels than girls. Further research will investigate the possible variables which may explain this difference in fluorosis by sex.

High-fluoride drinking water, fluorosis, and dental caries in adults

This study measures the prevalence and distribution of dental fluorosis and coronal caries in lifelong adult residents of two New Mexico communities. One community has a natural fluoride concentration of approximately 0.7 mg/L in its drinking water, optimum for the climate, and the water of the other community is naturally fluoridated at approximately 3.5 mg/L, five times optimum. The differences between the communities in amounts of dental fluorosis and any reduced susceptibility to dental caries associated with higher levels of fluorosis, particularly in molars, the teeth most susceptible to decay, are discussed.

Enamel defects in fluoridated and non-fluoridated areas of South Australia.

AbstractThe optimum level of fluoride in the water supply represents a balance between the maximum prevention of dental caries and the maintenance of an “acceptable” level of dental fluorosis. For temperate climates it has been accepted generally that a concentration of one part per million of fluoride is associated with a near maximum reduction in dental caries with only a small proportion experiencing the mildest level of dental fluorosis.In 1982,577 South Australian primary school children with near lifelong exposure to artificially fluoridated water and 277 primary school children, who had never resided in an area with a significant level of fluoride in its water, were examined by a single examiner to assess the prevalence and severity of the enamel defects.While alternative explanations are possible, the results suggest that South Australian children with life‐long or near life‐long exposure to water borne fluoride at a level of 1ppm show increased levels of enamel defects.

Gingivitis and dental plaque in relation to dental fluorosis in man in Morocco

A survey of 254 boys aged 12–14 yr from a fluorosis area (Khouribga) and a nonfluorosis area (Beni Mellal) in Morocco demonstrated no differences in level of gingival inflammation. The level of plaque accumulation was consistently lower in the fluorosis area compared to the non-fluorosis area. This difference was less pronounced on teeth with a relatively low level of dental fluorosis (lower incisors) than on teeth with a relatively high level of dental fluorosis (canines and premolars).