A photographic study of developmental defects of enamel in Brazilian school children

The aims of this study were, to record developmental enamel in three areas of Brazil with a range of fluoride concentrations in their drinking water and to consider the association between clinical and photographic methods of recording enamel defects. A total of 457 subjects were examined from areas with less than 0.01, 0.7 and 2-3 ppm F in their drinking water. From the photographs, the prevalences of subjects with TF scores of one or more for the upper permanent central incisors were 7 per cent, 52 per cent and 92 per cent respectively for the three areas. The prevalence of demarcated opacities decreased with increasing fluoride levels in the drinking water (p < 0.008). There was substantial agreement between the Thylstrup Fejerskov (TF) scores using clinical and photographic methods (kappa = 0.63). However, prevalences of TF scores of one or more were higher using the photographic (44.9 percent) than clinical (41.4 percent) method (p < 0.01). The results of this study were compared with one undertaken in the United Kingdom and Ireland which also used the same photographic method. Although the prevalences of TF scores of one or more were similar in the areas with near 'optimal' levels of fluoride in the drinking water, in the groups with levels of fluoride less than 0.1 ppm the prevalence of subjects with TF scores of one or more was higher in the United Kingdom population than in Brazil. This study demonstrates the utility of photographic methods of collecting information on enamel opacities over a wide range of fluoride exposure. Results suggest that for the groups from areas with low levels of fluoride in the drinking water the overall fluoride exposure of the UK children was greater than the Brazilian.