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Clark DC, Shulman JD et al. Community Dent Oral Epidemiol 2006; 34: 197–204

Recent studies have suggested that fluorosis has increased in both fluoridated and non-fluoridated communities, and also that parents are more critical of children's tooth colour than dentists or the children themselves. This study compares results from epidemiological surveys in 1993-4, 1996-7 and 2002-3, of children aged up to 9 yrs who were lifelong residents in 3 Canadian communities which ceased fluoridation in 1992.

Respective zero fluorosis scores for the surveys were 55%, rising to 67% and then 78%. Over the period of the surveys, fluoride supplement use decreased from nearly 50% to almost nothing, and fluoride dentifrice use increased from 92% to 99% in 2-3 year-olds. In the 3 surveys, overall parental assessment of tooth colour in their offspring remained constant with 90-96% expressing no dissatisfaction. The authors consider that fluorosis-related aesthetic problems are rare.