Fluoride toothpaste: A risk factor in dental fluorosis.

Abstract

Recent epidemiological studies around the world, particularly in North America and the economically developed countries, show that the prevalence of dental fluorosis has increased since the early part of this century. Fluoridated water and fluoride containing dental products have been postulated to be risk factors in dental fluorosis. Numerous studies have confirmed that fluoridated water, fluoride supplements, and fluoride rinses may increase an individual's risk for fluorosis. Fluoride toothpaste has also been postulated to be a risk factor, but the epidemiological evidence is lacking or at most weak, as most of the studies of risk factors were done in developed countries where an individual is exposed to multiple sources of fluoride. Further over 90 percent of the study population used fluoridated toothpaste. The present study is designed to quantify the risk of fluorosis from fluoride toothpaste, using a population whose only potential source of fluoride is fluoridated toothpaste. Case-control analyses were conducted to test the hypothesis that fluoride toothpaste use before the age of six years increased an individual's risk for fluorosis. Data came from a cross-sectional survey, consisting of a clinical dental examination of the children and a self-administered questionnaire to parents of the children. The study was conducted in Goa, India. The sampling was purposive, and the school system was used to carry out the study. The study group consisted of 1189 seventh grade children with a mean age of 12.23. Results of the crude, stratified, and logistic regression analyses showed that use of fluoride toothpaste before the age of six years was a risk factor for fluorosis (OR 1.83, 95% CI 1.05, 3.15). Beginning brushing before the age of two years did not increase the prevalence of fluorosis but increased the severity of fluorosis significantly. Other factors associated with the use of fluoride toothpaste such as eating or swallowing a fluoride toothpaste, and higher frequency of use, did not show a statistically significant increased risk for prevalence or severity of fluorosis.