The St. Regis environmental health issue: assessment of dental defects

A descriptive epidemiologic study was undertaken to determine the nature, extent, and severity of defects of the dentition alleged to be fluorosis in Native American children. An examination of 520 Native American children living on the St. Regis Reservation, and 248 non-Native American children living in adjacent areas, disclosed a much higher prevalence of generalized pigmentation of the dentition in the former (114, 22%) as compared with the latter group (13, 5.2%). The pattern of enamel pigmentation, opacity, and hypoplasia observed was not typical of fluorosis. After careful consideration of various etiologic factors, use of the antibiotic tetracycline was determined to be the probable causative agent in 112 (21.5%) cases, of which 73 (14%) were classified as esthetically objectionable according to the tetracycline severity index devised. Confirmation of incorporation of the drug into the teeth was made possible in selected cases by histopathologic analysis of extracted teeth.