Fluoride supplements and fluorosis: a meta-analysis

This paper presents a systematic review of the dental literature that was c arried out to investigate whether the regular use of fluoride supplements i n non-fluoridated communities during the period of tooth development increa ses the risk of dental fluorosis. A MEDLINE search was organized for all do cuments published, in English, between January 1966 and September 1997 usin g 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 estim ation of the risk of developing dental fluorosis in users of fluoride suppl ements. The other 10 studies were excluded because they either did not pres ent 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 fluo rosis in users of fluoride supplements compared with non-users ranged betwe en 2.4 and 2.6. The meta-analyses of the follow-up studies estimated that t he relative risk in long-term users was between 5.5 and 12.2. This review c onfirmed that in non-fluoridated communities the use of fluoride supplement s during the first 6 years of life is associated with a significant increas e in the risk of developing dental fluorosis.