Community Dent Oral Epidemiol 1999; 27: 130–6 Copyright C Munksgaard 1999 Printed in Denmark . All rights reserved ISSN 0301-5661 Douglas J. Brothwell 1 and Hardy Limeback 2 Fluorosis risk in grade 2 students 1 Community Dental Services, Wellington- Dufferin-Guelph Health Unit, Guelph, and 2 Department of Preventive Dentistry, residing in a rural area with widely University of Toronto, Toronto, Ontario, Canada varying natural fluoride Brothwell DJ, Limeback H: Fluorosis risk in grade 2 students residing in a rural area with widely varying natural fluoride. Community Dent Oral Epidemiol 1999; 27: 130–6. C Munksgaard, 1999 Abstract – Objectives: This pilot study was performed to determine the prevalence of dental fluorosis and the association between fluorosis and a number of risk factors in a group of second grade students in a rural, non-fluoridated area of Ontario, Canada. Methods: Of 1739 students screened during routine health surveil- lance, 1367 had erupted maxillary central incisors. Fluorosis was scored on these children using the Tooth Surface Index of Fluorosis (TSIF). A fluoride exposure questionnaire and water sample vial was sent home from school with each child. Results: Valid responses were obtained for 752 children (55%). The prevalence of fluorosis in respondents was 23.3%, with 4.9% scoring TSIF of 2 or more. In bivariate analysis, several variables were significantly associated with the preva- lence and/or severity of fluorosis. These included: water fluoride concentration, breast-feeding duration, professionally applied topical fluoride, fluoride supple- Key words: breast-feeding; fluoride ment use, bottle-feeding, fluoridated mouthwash use, and early parental tooth- supplements; prevalence of dental fluorosis; brushing with toothpaste. In logistic regression analysis limited to children living TSIF index at the current residence for 4 years or more, only four variables had significant Douglas J. Brothwell, Community Dental independent effects. These were water fluoride concentration, breast-feeding dura- Services, Wellington-Dufferin-Guelph Health tion, fluoride supplement use, and fluoridated mouthwash use. Conclusions: Unit, 90 Deerglen Terrace, Aurora, Ontario, These findings indicate that fluorosis is an important concern in non-fluoridated Canada L4G 6Y3 Tel: π1(905) 713 6596 areas. Fluoride supplements should not be recommended unless an independent E-mail: dbrothwell/globalserve.net home water test is performed. Breast-feeding for 6 months or more may protect children from developing dental fluorosis in the permanent incisors. Accepted for publication 3 November 1998 Fluoridation of public water supplies has im- proved the dental health status in today’s children (1, 2). Due to its effectiveness in preventing decay, fluoride has also been added to many other prod- ucts including toothpaste, supplements, and mouthwashes. As a result, almost all Canadians in- gest fluoride from numerous sources (3). Dental fluorosis is an undesired side effect of ex- cessive fluoride ingestion. The proportion of the population exhibiting fluorosis and the severity within any individual depend upon the quantity of fluoride ingested. It is believed that both the preva- lence and the severity of fluorosis have increased following the addition of fluoride to water and dental products (4, 5). With increased fluoride 130 ingestion and increased fluorosis prevalence, there is renewed concern about the appropriateness of various fluoride sources. The 1992 Canadian fluo- ride workshop recommended monitoring fluorosis to determine its prevalence and the contribution of various sources of fluoride (5). Many fluoride sources are considered to be im- portant in the development of dental fluorosis. These include water, food, supplements, tooth- paste, mouthwashes, and professionally applied topical fluorides (5, 6). If the direct consumption of fluoride-containing water exceeds the optimum, the prevalence and severity of dental fluorosis are increased (3). Fluoride-containing water can further increase the risk for dental fluorosis when