The prevalence of dental fluorosis in relation to water or salt fluoridation and reported use of fluoride toothpaste in school-age children

  • Darius SagheriEmail author
  • J. McLoughlin
  • J. J. Clarkson


Aim: To compare prevalence of dental fluorosis (DF) in permanent teeth in children whose domestic water supply was fluoridated since birth with that in a community where fluoridated salt was available. A second aim was to analyse the relationship between DF prevalence and reported use of fluoride toothpaste in early childhood. Study Design: Cross-sectional study. Methods: A representative, random sample of 12-year-old children was examined in water fluoridated Dublin (Ireland) and non-water fluoridated Freiburg (Germany), where fluoridated salt was available. DF was recorded using the Dean’s Index. The child’s early experience of toothpaste use was recorded using a questionnaire. Results: 377 children in Dublin and 322 children in Freiburg were examined. In Dublin 11.7% of the whole sample had a ‘Questionable’ level of DF, 9.8% had ‘Very Mild’, 3.7% had ‘Mild’ and 0.3% had ‘Moderate’ fluorosis. The corresponding percentages in Freiburg for all children were 10.9%, 4.0%, 3.4% and 0%. The results suggest that children in Dublin started brushing their teeth at an older age than in Freiburg, but no difference in DF levels was found between ‘early’ and ‘late’ users. Statistics: Fisher’s test revealed that the difference in DF levels between the two populations was statistically significant (p=0.03). Conclusions: The prevalence of aesthetically important DF (‘Mild’ and ‘Moderate’) was low and similar in both communities and considerably lower than the expected level at water fluoridation concentrations of 1ppm. However, the prevalence of ‘Very Mild’ fluorosis was twice as frequent in Dublin than in Freiburg.

Key words

Children Dental Fluorosis Fluoridated Salt Toothpaste Water Fluoridation 


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  1. Ast DB, Smith DJ, Wachs B, Cantwell KT. Newburgh-Kingston caries-fluorine study. XIV. Combined clinical and roentgenographic dental findings after ten years of fluoride experience. J Am Dent Assoc 1956;52:314–325.PubMedGoogle Scholar
  2. Arnold FA and Russell AL. Fifteenth year of the Grand Rapids fluoridation study. J Am Dent Assoc 1962;65:780–785.Google Scholar
  3. Black GV, McKay FS. Mottled teeth. Dental Cosmos 1916;58:129.Google Scholar
  4. Brown HK and Poplove M. Brantford-Sarnia-Stratford fluoridation study: final survey 1963. J Can Dent Assoc. 1965;31:505–511.PubMedGoogle Scholar
  5. Brunelle JA, Carlos JP. Recent trends in dental caries in US children and the effect of water fluoridation. J Dent Res 1990;69:723–7.PubMedGoogle Scholar
  6. Clarkson J. Review of terminology, classifications, and indices of developmental defects of enamel. Adv Dent Res 1989;3:104–9.PubMedGoogle Scholar
  7. Dean HT. Endemic fluorosis and its relation to dental caries. Public Health Rep 1938;53:1443–52.CrossRefGoogle Scholar
  8. Dean HT. The investigation of physiological effects by the epidemiological method; in: Moulton, F.R. (ed.): Fluorine and dental health. Washington: AAAS; 1942. p 23.Google Scholar
  9. Eastern Health Board. Children’s Dental Health in the Eastern Health Board region, 1993. Dublin: Eastern Health Board; 1993.Google Scholar
  10. Eastern Health Board. Oral Health of Children, 1997. Dublin: Eastern Health Board; 1997.Google Scholar
  11. Eklund SA, Moller IJ, Leclercq MH. Calibration of Examiners for Oral Health Epidemiological Surveys. Geneva: World Health Organization, ORH/EIS/EPID; 1993.Google Scholar
  12. Ericsson Y. Urinary estimation of optimal fluoride dosage with domestic salt. Acta Odontol Scand 1971;29:43–51.PubMedCrossRefGoogle Scholar
  13. Evans RW, Darvell BW. Refining the estimate of the critical period for susceptibility to enamel fluorosis in human maxillary central incisors. J Public Health Dent 1995;55:238–249.PubMedCrossRefGoogle Scholar
  14. Fleiss JL, Chilton NW. The Measurement of Interexaminer Agreement on Periodontal Disease. Periodont Res 1983;18:601–606.CrossRefGoogle Scholar
  15. Forum on Fluoridation. Forum on Fluoridation Report. Dublin: Stationery Office; 2002.Google Scholar
  16. Freeman VE. A longitudinal study of growth, feeding practices and iron status in healthy children from birth to 2 years of age (PhD thesis). Dublin: Trinity College; 1996.Google Scholar
  17. Hawley GM, Ellwood RP, Davies RM. Dental caries, fluorosis and the cosmetic implications of different TF scores in 14-year-old adolescents. Community Dent Health 1996;13:189–192.PubMedGoogle Scholar
  18. Horowitz HS. The effectiveness of community water fluoridation in the United States. J Public Health Dent 1996;56:253–8.PubMedCrossRefGoogle Scholar
  19. Johnson H, Dack P, Boyle E, Doyle D. Census 1996 by District Electoral Division for the Northern Area Health Board. Dublin: Eastern Regional Health Authority, Department of Public Health, Health Information Unit; 2001.Google Scholar
  20. Khan A, Moola MH, Cleaton-Jones P. Global trends in dental fluorosis from 1980 to 2000: a systematic review. SADJ 2005;60:418–21.PubMedGoogle Scholar
  21. Lennon MA. Dental Health in Europe: A problem for the disadvantaged groups. Brussels: European Parliament; 1998.Google Scholar
  22. Levy SM, Kiritsy MC, Warren JJ. Sources of fluoride intake in children. J Public Health Dent 1995;55:39–52.PubMedCrossRefGoogle Scholar
  23. Moller IJ, Schait A, Muhlemann HR. The fluorine content of the surface of fluoride-treated and non-fluoride-treated teeth. I. Tandlaegebladet 1965;69:849–862.Google Scholar
  24. McDonagh M, Whiting P, Bradley M, et al. A Systematic Review of Public Water Fluoridation. York: University of York, NHS Centre for Reviews and Dissemination; 2000.Google Scholar
  25. O’Mullane D, Clarkson J, Holland T, O’Hickey S, Whelton H. Children’s Dental Health in Ireland 1984. A survey conducted on behalf of the Minister of Health by University College Cork. Dublin: The Stationery Office; 1986.Google Scholar
  26. O’Mullane D, Whelton H. Oral Health of Irish Adults 1989–1990. A survey conducted on behalf of the Minister of Health by University College Cork. Dublin: The Stationery Office, 1992.Google Scholar
  27. O’Mullane DM, Ketley CE, Cochran JA, et al. Fuoride ingestion from toothpaste: conclusions of European Union-funded multicentre project. Community Dent Oral Epidemiol. 2004 Apr;32 Suppl 1:74–6.PubMedCrossRefGoogle Scholar
  28. Osuji OO, Leake JL, Chipman ML, et al. Risk factors for dental fluorosis in a fluoridated community. J Dent Res 1988;67:1488–1492.PubMedCrossRefGoogle Scholar
  29. Rolla G, Ekstrand J: Fluoride in Oral Fluids and Dental Plaque. In: Fejerskov O, Ekstrand J, Burt B. (eds). Fluoride in Dentistry, 2nd Edition. Copenhagen: Munksgaard; 1996. 215.Google Scholar
  30. Stadt Freiburg. Amtliche Bevölkerungszahl seit 1950. Freiburg: Amt für Bürgerservice und Informationsverarbeitung; 2006.Google Scholar
  31. U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville: U.S. Department of Health and Human Services, 2000.Google Scholar
  32. Whelton H, Crowley, O’Mullane D, Cronin M, Kelleher V. North South Survey of Children’s Oral Health 2002, Preliminary Report. Dublin: Department of Health and Children; 2003.Google Scholar
  33. World Health Organization. Expert Committee on Oral Health Status and Fluoride Use: Fluorides and Oral Health. WHO Technical Report Series 846. Geneva: World Health Organization; 1994.Google Scholar
  34. World Health Organization. Oral Health Surveys, basic methods. 4th edn. Geneva: World Health Organization; 1997.Google Scholar

Copyright information

© European Archives of Paediatric Dentistry 2007

Authors and Affiliations

  • Darius Sagheri
    • 1
    Email author
  • J. McLoughlin
    • 1
  • J. J. Clarkson
    • 1
  1. 1.Department of Public and Child Dental Health, Dublin Dental School and HospitalTrinity CollegeDublin 2Republic of Ireland

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