The prevalence of fluorosis-like lesions associated with topical and systemic fluoride usage in an area of optimal water fluoridation

The frequency of using self-applied (over-the-counter) fluoride products and prescribed supplemental fluorides, and the prevalence of fluorosis-like enamel lesions in the permanent dentitions of children living in an optimally fluoridated urban community were investigated. Subjects were selected randomly, and consent forms and questionnaires concerning fluoride usage and residency status were provided to guardians prior to examination. After a supervised tooth brushing event, 300 consenting subjects were examined by the principal investigator using Dean’s index to assess levels of fluorosis-like lesions. The principal investigator was standardized with another investigator prior to the examinations to obtain an interexaminer agreement level of 97%, and an intraexaminer agreement level of 96%. Portable dental equipment was used during all examinations. Chi-square analysis indicated no statistically significant difference between the frequency of tooth brushing with a fluoridated den tifrice at an early age and the prevalence of fluorosis-like enamel lesions. However, there was a significant difference (P < 0.05) between the prevalence of fluorosis-like lesions, and the frequency of using prescribed fluoride supplements and gels, and over-the-counter rinses. Water fluoridation has been recognized as one of the major public health accomplishments during this century (Butler et al. 1985), and today more than one-half the population of the United States, including children, receive fluoride systemically by drinking water that contains fluoride in optimal concentrations (Ripa et al. 1986). Although some recent reports have indicated that there is no clear epidemiologic evidence indicating an increase in the prevalence of fluorosis (Heifetz and Horowitz 1986), other studies (Leverett 1982,1986) have suggested that indeed the prevalence of dental fluorosis in children has increased when compared to levels reported by Dean et al. (1942). Current theories seem suggest that the increase in fluorosis may be due to the ingestion of fluorides additional to that obtained from fluoridated water supplies (Taves 1977). It is postulated by some, that the additional fluoride may be obtained from the wide variety of fluoride-containing products such as prescribed supplements and gels, and over-thecounter rinses and dentifrices, which are readily available in the marketplace (Levy 1986). Consequently, when these products are used by children who are already consuming optimally fluoridated water, the additional fluoride consumed during the calcification stages of tooth development may contribute to the presence of some level of enamel fluorosis in these children. This study was designed to determine the relationship between the frequency of the use of self-applied (over-the-counter) and prescribed supplemental fluorides and the prevalence of fluorosis-like lesions of enamel in the dentitions of children residing in an optimally fluoridated urban community.