08/13/2010 The prevalence and risk factors of fluorosis among patients in a pediatric dental practice

Resident: J. Hencler
Date: 08/13/2010

Article title:
The prevalence and risk factors of fluorosis among patients in a pediatric dental practice

Author(s): Lalumandier, DDS, MPH and Rozier, DDS, MPH
Journal: Pediatric Dentistry-17: 1, 1995

Major topic: Fluorosis

Main Purpose:
To determine the prevalence and severity of enamel fluorosis occurring in patients of a pediatric dental practice in a fluoridated community and to identify those factors contributing to the fluorosis.

Overview of method of research:
780 patients aged 5-19 y.o. were selected using a random start, systematic sampling procedure, and enrolled in a case control study to determine risks for fluorosis. Examinations for enamel fluorosis were performed using the Tooth Surface Index of Fluorosis (TSIF). Information on fluoride exposure was obtained through parent interviews and mail questionnaires. Fluoride exposure was confirmed by fluoride assay of community drinking water samples. MHX2 statistics and logistic regression was used to analyze the data.

Findings: See tables and results section

Key points in the article discussion:
Understanding of F exposures has increased over the last 5 decades and the ADA has made exposure recommendations. A number of studies have implicated F supplements; other’s have pointed to F varnish, rinses, and swallowing toothpaste. Certain food and drinks are also a major source of F. Soy-based formulas can cause fluorosis b/c of their F binding properties. In this study, F supplementation use was the most consistent risk factor for fluorosis. More frequent use and within the first 2 years of life were most associated with fluorosis. PCPs in NC comprised 65.7% of providers prescribing F supplements. PCPs need to be educated to prevent inappropriate dietary F supplementation prescriptions if needed.

Summary of conclusions:
For children drinking fluoride deficient water, fluorosis was associated with fluoride supplementation frequency and the age of the child when brushing was initiated. For children drinking fluoridated water throughout their lives, fluorosis was associated with the age of the child when toothbrushing was initiated. These findings suggest that supplements and brushing at an early age place children at an increased risk for enamel fluorosis. Dietary fluoride supplements increase the risk of fluorosis for those in nonfluoridated areas by more than 6 fold. Children who begin using toothpaste before age 2, regardless of whether their drinking water is fluoridated, increase their chance of fluorosis by 3 times.

Assessment of article:
Article was okay, lots of statistics. At 15 years old it is a little dated and the conclusion and F recommendations have been established for some time now.