Dental fluorosis in permanent incisor teeth in relation to water fluoridation, social deprivation and toothpaste use in infancy

Objectives To determine the prevalence and severity of fluorosis in permane nt incisor teeth in young children in a fluoridated and a fluoride-deficien t community and to establish what relationship, if any, there was between t he occurrence of dental fluorosis and the reported use of fluoride toothpas te in childhood. Design A prevalence study of children aged 8-9 years who had been continuou s residents in fluoridated Newcastle or fluoride-deficient Northumberland. Method The permanent maxillary central incisor teeth were examined clinical ly and photographically by one examiner using the Thylstrup-Fejerskov index ; the photographs were read blind to child identity and clinical score. A d osed-response questionnaire enquired into the child's early experiences of toothbrushing and use of fluoride toothpastes. Social deprivation was measu red by a Jarman score. The study took place in 1998. Outcome measure Prevalence of dental fluorosis measured by the Thylstrup-Fe jerskov index. Results Complete data were available for 78% (n = 409) and 79% (n = 403) of eligible sampled children in the two areas, respectively. Clinical and pho tographic results agreed closely and had high reproducibility. The prevalen ce of fluorosis was 54% in the fluoridated area and 23% in the fluoride-def icient area when all grades (> 0) of fluorosis were included; percentage pr evalence of mild to moderate fluorosis (greater than or equal to 3) was 3% and 0.5% in the two areas, respectively. Multivariate analysis indicated th at area of residence (odds ratio = 4.5), Jarman score (odds ratio = 0.99 pe r Jarman unit) and type of toothpaste (odds ratio = 1.6) were statistically significantly related to presence or absence of fluorosis: the risk factor s were - fluoridated area, affluence, and use of adult toothpaste. Conclusions and recommendations The prevalence of aesthetically important d ental fluorosis was low, although higher in the fluoridated area. Use of a child's toothpaste (with lower fluoride concentration) could decrease risk in a fluoridated area. Adherence to the guidelines published by the British Society of Paediatric Dentistry is recommended.