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The Association Between Enamel Fluorosis and Dental Caries in U.S. Schoolchildren

  • Author Footnotes
    1 When this article was written, Dr. Iida was a dental public health resident, Bureau of Dental Health, New York State Department of Health, Albany. She now is a senior fellow, Department of Epidemiology, School of Public Health, University of Washington, Seattle.
    Hiroko Iida
    Footnotes
    1 When this article was written, Dr. Iida was a dental public health resident, Bureau of Dental Health, New York State Department of Health, Albany. She now is a senior fellow, Department of Epidemiology, School of Public Health, University of Washington, Seattle.
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  • Author Footnotes
    2 Dr. Kumar is the director, Oral Health Surveillance and Research, Bureau of Dental Health, New York State Department of Health, Albany, and an associate professor, School of Public Health, University at Albany, State University of New York.
    Jayanth V. Kumar
    Correspondence
    Address reprint requests to Dr. Kumar at Bureau of Dental Health, New York State Department of Health, Empire State Plaza, CT #542, Albany, N.Y. 12237
    Footnotes
    2 Dr. Kumar is the director, Oral Health Surveillance and Research, Bureau of Dental Health, New York State Department of Health, Albany, and an associate professor, School of Public Health, University at Albany, State University of New York.
    Search for articles by this author
  • Author Footnotes
    1 When this article was written, Dr. Iida was a dental public health resident, Bureau of Dental Health, New York State Department of Health, Albany. She now is a senior fellow, Department of Epidemiology, School of Public Health, University of Washington, Seattle.
    2 Dr. Kumar is the director, Oral Health Surveillance and Research, Bureau of Dental Health, New York State Department of Health, Albany, and an associate professor, School of Public Health, University at Albany, State University of New York.

      ABSTRACT

      Background

      The authors assessed the association between enamel fluorosis and dental caries to determine if there is any beneficial effect of enamel fluorosis in U.S. schoolchildren.

      Methods

      The authors used data from a National Institute of Dental Research survey of the oral health of U.S. children conducted in 1986 and 1987 to determine the prevalence of caries and mean decayed, missing or filled surfaces on permanent maxillary right first molars in children 7 to 17 years of age who had a history of a single residence. (To date, this is the only national oral health data set in the United States with detailed information on fluoride exposures.) They examined the association between enamel fluorosis and caries using logistic regression analysis, controlling for potential confounders in communities with water at or above optimal fluoridation levels and in communities with nonfluoridated or suboptimally fluoridated water.

      Results

      Permanent maxillary right first molars with fluorosis consistently had lower levels of caries experience than did normal molars. Adjusted odds ratios for caries prevalence in molars with fluorosis were 0.71 (95 percent confidence interval [CI], 0.56–0.89) in communities with nonfluoridated or suboptimally fluoridated water and 0.89 (95 percent CI, 0.74–1.06) in communities with water at or above optimal fluoridation levels.

      Conclusion

      This study's findings suggest that molars with fluorosis are more resistant to caries than are molars without fluorosis.

      Clinical Implications

      The results highlight the need for those considering policies regarding reduction in fluoride exposure to take into consideration the caries-preventive benefits associated with milder forms of enamel fluorosis.

      Key Words

      ABBREVIATION KEY:

      DMFS: (Decayed, missing or filled surfaces), DMFS3 (Decayed, missing and filled surfaces of permanent maxillary right first molars), NIDR: (National Institute of Dental Research), NRC: (National Research Council), ppm: (Parts per million)
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