Risk factors for dental fluorosis prevalence and severity in United States school children, 1986--1987.

Abstract

The purpose of this study was to investigate the risk factors for fluorosis prevalence and severity. The dataset used in this study was the 1986-87 National Survey of Oral Health in U.S. School Children, conducted by the National Institute for Dental Research. Children ages 7 to 18 years of age who lived continuously in one residence were the study sample subset used in this investigation. Fluorosis prevalence and severity were found to be significantly inversely associated with the age of the children. Region of residence, rural or urban status, racial/ethnic group, gender, gingival bleeding status, and sealant status were neither strongly nor consistently associated with fluorosis. The use of fluoride drops or tablets in sub-optimally fluoridated areas was positively associated with fluorosis prevalence and severity. The associations with fluorosis when used in optimally or above-optimally fluoridated areas, however, were inconsistent. The use of professional topical fluoride treatments were not consistently associated with fluorosis prevalence or severity. School fluoride rinses, when used in areas with above-optimal water fluoridation, were positively associated with fluorosis prevalence, whereas the associations with fluorosis when used in sub-optimally or optimally fluoridated areas were inconsistent. Water fluoride level was strongly and consistently positively associated with fluorosis prevalence and severity. There was a clear increase in fluorosis prevalence and severity with increasing duration of exposure to fluoridated water. Public policy on fluoride use seeks to balance the benefits of cariostasis against the risks of unacceptable fluorosis. This research demonstrated the increased risk of dental fluorosis from the consumption of fluoridated water. The next step will be to evaluate the effect of fluoride in water and dental products on caries. With these findings, it will be possible to re-evaluate the optimal levels of fluoride used in public water fluoridation and in fluoride products.