Fluorosis risk in grade 2 students residing in a rural area with widely varying natural fluoride

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.

Of 1739 students screened during routine health surveillance, 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.

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 prevalence and/or severity of fluorosis. These included: water fluoride concentration, breast-feeding duration, professionally applied topical fluoride, fluoride supplement use, bottle-feeding, fluoridated mouthwash use, and early parental toothbrushing with toothpaste. In logistic regression analysis limited to children living at the current residence for 4 years or more, only four variables had significant independent effects. These were water fluoride concentration, breast-feeding duration, fluoride supplement use, and fluoridated mouthwash use.

These findings indicate that fluorosis is an important concern in non-fluoridated areas. Fluoride supplements should not be recommended unless an independent home water test is performed. Breast-feeding for 6 months or more may protect children from developing dental fluorosis in the permanent incisors.