Posteruptive tooth age and severity of dental fluorosis in Kenya

The purpose of the present study was to assess whether the degree of severity of enamel changes in a population exhibiting rather severe dental fluorosis may be related to posteruptive tooth age and to describe the clinical manifestations of the enamel destructions. All permanent teeth in 102 children aged 10-15 yr who were born and reared in a 2 ppm fluoride area of Kenya were examined for dental fluorosis using the TF-Index. Clinically, at time of eruption all teeth appeared chalky white, but already prior to coming into occlusion discrete pits had formed. A variety of more extensive damages to the surface enamel was found in teeth already in occlusion. In particular, the maxillary incisors exhibited extensive artificial attrition for cosmetic reasons, which make these teeth unreliable for accurate scoring of severity in the present population. An analysis of the proportion of teeth exhibiting TFI-scores 4+, 5+ and 6+ showed that children aged 13-15 yr had a significantly greater proportion of teeth with TFI-scores greater than or equal to 6 compared to children aged 10-12 yr (Wilcoxon, P less than 0.0001). This finding is unlikely to be a result of different fluoride exposures in the two age groups and indicates that even several years after eruption there is a trend towards an increasing severity of enamel surface destructions in children exhibiting pronounced degrees of subsurface enamel hypomineralization at time of eruption.