Aesthetic concerns of children and parents in relation to different classifications of the Tooth Surface Index of Fluorosis

Abstract

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.

Aesthetically objectionable fluorosis in the United Kingdom

“…Findings from this study suggest that perceptions of unattractiveness, dissatisfaction and treatment need increase with increasing severity of dental fluorosis, a result in line with previous findings [6][7][8][9][10]12,13 and indicating that greater severities of fluorosis have an adverse effect on aesthetics.…”

“…Only 14% of the population were found to perceive mildly fluorosed teeth as aesthetically objectionable, a result which is lower than has been reported previously. 6,[8][9][10]12,13 In past studies the percentage of subjects regarding mild fluorosis as unacceptable has ranged from 19% 9 to 45%. 8 In the current study 45% of the sample also perceived moderate fluorosis as aesthetically objectionable, again a level lower than in previous reports, eg 58% by Clark et Past studies used different methods to assess aesthetically objectionable fluorosis; variations have included differences in the indices used to grade fluorosis and in the way 'aesthetically objectionable' or 'unacceptable' was measured.…”

“…3,5 Severe levels of dental fluorosis are widely perceived as aesthetically objectionable by both professionals and the public. [6][7][8][9][10] However perceptions of mild and moderate levels remain controversial. The findings from studies of perceptions of fluorosis have varied widely.…”

Caries and Fluorosis Prevalence in Communities with Different Concentrations of Fluoride in the Water

“…Unfortunately, current Italian regulations mandate that the high-fluoride area that has been studied is required to defluoridate its water supply or to shift to alternative water sources with lower fluoride concentration. These actions are not supported by our results and, although we did not assess the community acceptance of fluorosis, according to the findings of recent epidemiologic studies, fluorosis is perceived as a minor aesthetic problem and is not a concern for the public at large [Ismail et al, 1990[Ismail et al, , 1993Williams and Zwemer, 1990;Clark et al, 1993;Riordan, 1993]. The benefits of water fluoride, in terms of protection against dental caries, appears to be substantiated, particularly because the availability of dental care, given the high contribution to the DMFT score of active decay, does not appear satisfactory.…”

Comparison of dental esthetic perceptions of young adolescents and their parents

“…In 1992, Clark et al (17) conducted an early study to evaluate how school-aged children and their parents in British Columbia, Canada perceived possible esthetic problems related to fluorosis using the Tooth Surface Index of Fluorosis (TSIF). Among 1,057 children and their parents, there was agreement for over 60% of pairs on the esthetic rating of children's front teeth.…”