Factors Associated With Parents’ Esthetic Perceptions of Children’s Mixed Dentition Fluorosis and Demarcated Opacities

Meghan Sullivan Walsh January 23, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Factors Associated With Parents’ Esthetic Perceptions of Children’s Mixed Dentition Fluorosis and Demarcated Opacities

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Factors Associated with Parents’ Esthetic Perceptions of Children’s Mixed Dentition Fluorosis and Demarcated Opacities

Authors: Steven M. Levy, DDS, MPH; John J. Warren, DDS, MS; Barbara Broffitt, MS; Bethany Nielsen, BS

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 27:6, 2005, pages 486-492

Major Topic: To present results concerning parent’s overall satisfaction with their children’s teeth with and without fluorosis and demarcated opacities.

Overview of Method of Research: The Iowa Fluoride Study is an ongoing longitudinal study of a cohort recruited at birth in 1992-1995 from postpartum units of eight Iowa hospitals. At the age of 7.7-11.9 years these subjects were given a dental examination and the parents completed a questionnaire to assess their satisfaction with their child’s dentition. The Fluorosis of these subjects was scored using the Fluoride risk index (FRI) dividing teeth into four sections of zones of teeth: 1) Incisal or occlusal table 2) incisal 1/3 3) Middle 1/3 4) cervical 1/3. The scores were evaluated in six separate categories. 1. 0 - no indication of fluorosis 2) 1-questionable fluorosis 3) 2-50% or more of the zone displayed fluorosis 4) 3- displayed pitting staining or deformity 5) 7- non fluoride opacity 6) 9- the surface zone was excluded due to poor visibility/lack of full eruption. Individuals were then classified into 3 different categories. 1) 2 or more teeth with at least one zone with a FRI score of 2 and 3 were considered to have “definitive fluorosis”; 2) a FRI score of 1 or with only one tooth with a score of 2 or 3 were both considered to have “questionable fluorosis” 3) no scores of 1,2, or 3 were in the “none” category. The questionnaire given to the parents contained three questions 1) Which of the following best describes your thoughts overall about the appearance of your child’s teeth? 2) If not ‘very satisfied’ which of the following are you concerned about? (choices included shape, color, alignment, spacing, crowding, speckled/blotchy, other 3) Which of the following best describes your thoughts overall about the color of your child’s teeth?.

Findings: Of the 577 children examined 37% had definitive fluorosis on one or more permanent incisors. 31% were classified as having definitive fluorosis, 54% had questionable fluorosis and 15% had none. Parent’s overall satisfaction decreased with higher fluorosis scores. Among those children with definitive fluorosis 50% of the parents had concerns about the color, as compared to 32% for those questionable fluorosis subjects and 40% for no fluorosis patients. 44% of the children with definitive fluorosis had parents who were concerned about the ‘blotchy’ appearance of their child’s teeth versus 21% of parents with children of ‘questionable’ fluorosis’ and 9% of parent whose children had no fluorosis. There was no significant relationship between occurrence of opacities and parent’s satisfaction with the overall color of their child’s teeth. In addition 60% of parents were concerned with alignment and 44-51% were concerned with crowding.

Key Points: Summary: Parents of children with dental fluorosis were less likely to be satisfied with the overall appearance of their child’s teeth versus parents with children who had no fluorosis. This study does show that fluoride does contribute to esthetic concerns for parents of children with fluorosis.

Assessment of the Article: The Iowa Fluoride Study is a great tool to study the relationship between fluoride exposure and the risks and benefits of intake. While this study did show that fluorosis does pose many esthetic concerns among parents there were many issues I had with this study. First, the age group selected for examination was that of mixed dentition patient which can result in parents having concerns in their child’s dentition for several reasons not necessarily that of fluorosis. A high percentage of parents had concerns with their child’s dentition who showed questionable of no signs of fluorosis. These numbers, while less than those children with fluorosis, show a questionable assessment of a parent’s view of their child’s dentition. In addition, parents were just as concerned with alignment, spacing, crowding, etc. as they were with dental opacities and fluorosis. The study will pose much more sound when these patients are in full permanent dentition and can take a questionnaire based on the assessment of their own dentition.