The relationship between reported toothpaste usage in infancy and fluorosis of permanent incisors

To examine a possible relationship between reported toothbrushing habits in infancy and fluorosis of permanent maxillary incisors at age 8-9 years.

Comparison of clinical findings with retrospective survey data.

Five primary schools in the City of Birmingham where the water is fluoridated at 1.0 mg F/l.

Results of clinical examinations were compared with historical data collected via parental questionnaires. Maxillary central incisors of 325 consecutive children were examined for fluorosis clinically and photographically according to the criteria of the Modified Thylstrup and Fejerskov Index. 112 children had fluorosis and 213 did not. Information concerning toothbrushing habits in infancy was obtained via a questionnaire to parents who were also asked to add paste to a brush in a similar way to when the children were small. From a combination of questionnaire replies and paste weights the amount of fluoride that each child may have ingested from toothpaste each day was then estimated.

Highly significant associations were found between estimated fluoride ingestion from toothpaste and fluorosis. The mean DMF score of the fluorosis group was half that of the fluorosis-free children. The prevalence of fluorosis among children in ACORN group A-C was significantly greater than in groups D-F.

The results of the study suggest that toothpaste swallowing may be a factor in the production of fluorosis.