Abstract

Objectives To determine the prevalence and severity of fluorosis in permanent incisor teeth in young children in a fluoridated and a fluoride-deficient community and to establish what relationship, if any, there was between the occurrence of dental fluorosis and the reported use of fluoride toothpaste in childhood.

Design A prevalence study of children aged 8–9 years who had been continuous residents in fluoridated Newcastle or fluoride-deficient Northumberland.

Method The permanent maxillary central incisor teeth were examined clinically and photographically by one examiner using the Thylstrup-Fejerskov index; the photographs were read blind to child identity and clinical score. A closed-response questionnaire enquired into the child's early experiences of toothbrushing and use of fluoride toothpastes. Social deprivation was measured by a Jarman score. The study took place in 1998.

Outcome measure Prevalence of dental fluorosis measured by the Thylstrup–Fejerskov index.

Results Complete data were available for 78% (n = 409) and 79% (n = 403) of eligible sampled children in the two areas, respectively. Clinical and photographic results agreed closely and had high reproducibility. The prevalence of fluorosis was 54% in the fluoridated area and 23% in the fluoride-deficient area when all grades (> 0) of fluorosis were included; percentage prevalence of mild to moderate fluorosis ( 3) was 3% and 0.5% in the two areas, respectively. Multivariate analysis indicated that area of residence (odds ratio = 4.5), Jarman score (odds ratio = 0.99 per Jarman unit) and type of toothpaste (odds ratio = 1.6) were statistically significantly related to presence or absence of fluorosis: the risk factors were — fluoridated area, affluence, and use of adult toothpaste.

Conclusions and recommendations The prevalence of aesthetically important dental fluorosis was low, although higher in the fluoridated area. Use of a child's toothpaste (with lower fluoride concentration) could decrease risk in a fluoridated area. Adherence to the guidelines published by the British Society of Paediatric Dentistry is recommended.

1. Senior Dental Officer, Newcastle City Health NHS Trust, Walkergate Centre 45 Scrogg Road, Walker, Newcastle upon Tyne NE6 4EY;
2. Technology Manager, Manchester University, Unit 3A Skelton House, Manchester Science Park, Lloyd Street North, Manchester M15 4SH;
3. Professor of Preventive Dentistry, Newcastle University Dental School, Framlington Place, Newcastle upon Tyne NE2 4BW;
4. Consultant in Dental Public Health, Newcastle & North Tyneside and Northumberland Health Authorities, Benfield Road, Newcastle upon Tyne NE6 4PF
5. Director, Dental Health Unit, Manchester University, Unit 3A Skelton House, Manchester Science Park, Lloyd Street North, Manchester M15 4SH;

Correspondence to: E D Tabari¹ e-mail: Tabari@BTinternet.com