No abstract

This review of the literature was undertaken to demonstrate the changing trends in the prevalence of dental fluorosis in North America. Using Dean's early work to establish a baseline for the prevalence of dental fluorosis, results of more recent prevalence surveys were used to establish a range for the occurrence of dental fluorosis today. These results suggest that the prevalence of dental fluorosis now ranges somewhere between 35% and 60% in fluoridated communities and between 20% and 45% in nonfluoridated areas, depending on the influence of different local conditions. While the increase has occurred primarily in the very mild and mild categories of dental fluorosis, there is also some evidence that the prevalence is increasing in the moderate and severe classifications as well.

Increasing prevalence of dental fluorosis for children both from fluoridated and non-fluoridated communities are now well documented. Along with recent studies purporting possible adverse health effects from fluorides, this proven public health intervention is again being challenged. This study was undertaken to determine the prevalence of dental fluorosis for children from fluoridated and non-fluoridated areas in British Columbia. In addition, children and parents were provided with an opportunity to express concerns about the aesthetics of the child's anterior teeth. Children from representative schools in two communities were surveyed using the Tooth Surface Index of Fluorosis (TSIF). Questionnaires were sent home to parents to detail their child's use of various fluoride preventive practices and residence histories. Completed questionnaires were returned and exams were performed on 1131 children. Of those examined, 60% had dental fluorosis on at least two tooth surfaces, only 8% had scores ranging from "2" to "6", and 52% were classified with a score of "1". Parental and child ratings on the aesthetics or color of the child's teeth suggests that there are few children with aesthetic problems in the TSIF category of "1". While concerns of parents were more common, the actual source of those concerns was not assessed in the questionnaire. Not unexpectedly, children with fluorosis on anterior teeth ranging between TSIF scores of "2" to "6" appear to have increased concerns about tooth color. Data from children with confirmed residence histories from fluoridated communities suggest that the occurrence of aesthetic problems in these children is rare.

The difference between the 10% chlorhexidine varnish and placebo treatments is considered to be highly clinically significant for root caries increment (41% reduction) and for total caries increment (25% reduction) but only for coronal caries increment (14%).

Results suggest that the prevalence of esthetic problems is low in the communities surveyed, and that exposure to any number of fluoride technologies in the third year of life can increase a child's risk for this problem.

Repeated measurements of attachment level appear to be important assessments in periodontal clinical trials, yet the lack of reliability for this assessment creates measurement error which in turn demands increased sample sizes or reduces the power of the test. A plastic occlusal stent has been developed as a fixed reference point to assess changes in probing depths over time and thus reflect differences in attachment levels. The advantages of this system over traditional methods have not been measured. The purpose of this study was to determine intra- and interexaminer reliability for probing depths from the stent and the CEJ. Paired measurements of attachment level using the stent produced correlation coefficients for inter- and intraexaminer readings of 0.84 and 0.76, respectively. For subgingival cementoenamel (CEJ) measurements, lower coefficients of 0.71 and 0.59 were found for inter- and intraexaminer paired readings, respectively. Thus, measurements using the stent appear to be more reliable than subgingival CEJ readings.

The prevalence of dental fluorosis for children both from fluoridated and non-fluoridated communities has increased dramatically in some regions of North America. This study evaluated the aesthetics of dental fluorosis for school-aged children from a reference population of 1131 children. The methodology from the Social Acceptability Scale of Occlusal Conditions (SASOC), part of the Dental Aesthetics Index (DAI), was used to assess fluorosis-related aesthetics. Pairs of semantic differentiated adjectives adapted from SASOC were used to rate fifty 35 mm slides of anterior teeth. Sampling of children from the different categories of the Tooth Surface Index of Fluorosis (TSIF) on anterior permanent teeth was weighted to permit sufficient numbers of slides for the different classifications of the TSIF. Each slide was presented to a stratified random sample of pairs of parents and children who were participants in the original study. A convenience sample of dental professionals was also included. Analysis compared different classifications of "affected" slides (non-zero TSIF scores), with the mean aesthetic score computed from all "non-affected" slides (TSIF = 0). Results from children, parents, and professionals showed that there were highly significant differences between ratings of low and high TSIF scores. The only non-significant differences were between TSIF 4 and TSIF 5 & 6, which all three groups did not distinguish, as well as TSIF 1 versus TSIF 2 & 3, which children could not distinguish.

Our results suggest a complicated pattern of disease following cessation of fluoridation. Multiple sources of fluoride besides water fluoridation have made it more difficult to detect changes in the epidemiological profile of a population with generally low caries experience, and living in an affluent setting with widely accessible dental services. There are, however, subtle differences in caries and caries treatment experience between children living in fluoridated and fluoridation-ended areas.