Australian Research Centre for Population Oral Health (ARCPOH) - IADR 2005 Presentation
Fluoride exposure, dental fluorosis and caries in South Australian children
Do L*, Spencer AJ
Fluoride use among children
involves balancing between protection against caries and risk of fluorosis.
Policy guiding fluoride exposures to reduce fluorosis experience may have an
adverse effect of increasing caries experience. Objective: To identify
appropriate measures to control fluoride exposure by examining associations of
changes in fluoride exposure with fluorosis and caries. Methods: A
random sample of 9-14-year-old South Australian (SA) children enrolled with SA
Dental Service was selected in 2002/2003, stratified by fluoridation status and
urban/rural residence. Fluoride exposure history was collected by parental
questionnaire. Caries data at age six and eight years were collected from
clinic records for 1084 children to calculate deciduous dmfs. One dentist
examined 677 children for fluorosis using the Thylsrup and Fejerskov (TF)
Index. Data were re-weighted to reflect the child population. Fluorosis case
was defined as having a TF score of 2+. Results: Fluorosis and caries
experience by fluoride exposure are:
Prevalence of fluorosis (%)
Caries (dmfs, SD)
Age 6
Age 8
Total
11.8
1.37 (3.03)
2.38 (4.36)
Exposure to water fluoridation
>50% lifetime
†14.2
*0.94 (2.34)
*1.65 (3.16)
>0&<=50% lifetime
13.2
1.71 (3.43)
3.00 (5.18)
0% lifetime
4.1
2.19 (4.06)
3.53 (5.09)
Age when toothbrushing commenced
<19-month
†14.3
*1.03 (2.48)
*1.85 (3.58)
19-30-month
12.5
1.13 (2.60)
2.32 (3.79)
31+month
7.6
2.04 (4.00)
3.20 (5.81)
Toothpaste fluoride concentration
1000-ppm
†16.2
1.44 (3.25)
2.30 (4.86)
<550-ppm
6.4
1.36 (2.92)
2.51 (4.31)
Eating/licking toothpaste
Yes
†15.4
1.36 (2.95)
2.39 (4.01)
No
9.2
1.35 (3.08)
2.37 (4.63)
†Chi-square, p<0.05; *ANOVA, p<0.01
Conclusions: Modifying
lifetime exposure to water fluoridation to reduce fluorosis could significantly
increase caries experience. Use of low concentration fluoride toothpaste and
preventing toothpaste eating/licking could reduce fluorosis prevalence without
a significant increase in caries. Recommendation regarding appropriate age to
commence toothbrushing requires more detailed analyses.
Supported by NHMRC, ADRF, and University of Adelaide.
Presented at the 83rd General Session and Exhibition of the IADR,
9 - 12 March 2005, Baltimore, USA
