Risk-benefit balance in the use of fluoride among young children

This study aimed to evaluate the risk-benefit balance of several fluoride exposures. Fluoride exposure history of randomly selected children was collected for calculation of exposure to fluoridated water, toothpaste, and other fluoride sources. We evaluated the risk-benefit balance of fluoride exposure by comparing dental fluorosis on maxillary central incisors, recorded at the time of the study with the use of the Thylstrup and Fejerskov Index, and deciduous caries experience, recorded at age six years, of the same group of South Australian children who were from 8 to 13 years old in 2002-03. Population Attributable Risk for fluorosis and Population Prevented Fraction for caries were estimated. Fluorosis prevalence was found to be 11.3%; caries prevalence, 32.3%; mean dmfs, 1.57 (SD 3.3). Exposure to fluoridated water was positively associated with fluorosis, but was negatively associated with caries. Using 1000-ppm-F toothpaste (compared with 400- to 550-ppm-F toothpaste) and eating/licking toothpaste were associated with higher risk of fluorosis without additional benefit in caries protection. Evaluation of the risk-benefit balance of fluoride exposure provides evidence to assist in the formulation of appropriate guidelines for fluoride use.