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JADA Continuing Education

Background. The National Survey of Dental Caries in U.S. School Children: 1986–1987 conducted by the National Institute of Dental Research, or NIDR, remains the only source of national data about the prevalence of enamel fluorosis. The authors analyze these data and describe changes in the prevalence of enamel fluorosis since the 1930s, as reported by H. Trendley Dean.

Methods. A sample of children comparable to those described in the 1930s was selected from the NIDR data set among children living in households served by public water systems during the child’s first eight years of life. The type of water system (that is, natural, optimal and suboptimal) for each household had been recorded in the NIDR data set using data from the 1985 U.S. Fluoridation Census. The NIDR data set included information about the children’s history of fluoride exposure obtained from parents.

Results. In the 1986–1987 period, the prevalence of enamel fluorosis (ranging from very mild to severe) was 37.8 percent among children living in residences with natural fluoride (0.7 to 4.0 parts per million fluoride ions, or F ^–), 25.8 percent in the optimal fluoride group (0.7 to 1.2 ppm F ^–) and 15.5 percent in the suboptimal fluoride group (< 0.7 ppm F ^–). The largest increase in fluorosis prevalence from the 1930s to the 1980s was in the suboptimal fluoride group (6.5 to 15.5 percent).

Conclusions and Clinical Implications. Exposure to multiple sources of fluoride may explain the increase in enamel fluorosis from the 1930s to the 1980s. The exposure to fluoride from sources such as dietary supplements has decreased since the 1980s because of reductions in the recommended dosage, but these changes occurred too late to have an effect on the study cohort. Evidence of simultaneous use of systemic fluorides indicates the need to reinforce guidelines for the appropriate use of fluorides and promote research on measuring total fluoride exposure.

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