Dental caries and dental fluorosis at varying water fluoride concentrations.
OBJECTIVE
The purpose of this study was to investigate the relationships between caries experience and dental fluorosis at different fluoride concentrations in drinking water. The impact of other fluoride products also was assessed.


METHODS
This study used data from the 1986-87 National Survey of US School-children. Fluoride levels of school water were used as an indicator of the children's water fluoride exposure. The use of fluoride drops, tablets, professional fluoride treatments, and school fluoride rinses were ascertained from caregiver questionnaires. Only children with a single continuous residence (n = 18,755) were included in this analysis.


RESULTS
The sharpest declines in dfs and DMFS were associated with increases in water fluoride levels between 0 and 0.7 ppm F, with little additional decline between 0.7 and 1.2 ppm F. Fluorosis prevalence was 13.5 percent, 21.7 percent, 29.9 percent, and 41.4 percent for children who consumed < 0.3, 0.3 to < 0.7, 0.7 to 1.2, and > 1.2 ppm F water. In addition to fluoridated water, the use of fluoride supplements was associated with both lower caries and increased fluorosis.


CONCLUSIONS
A suitable trade-off between caries and fluorosis appears to occur around 0.7 ppm F. Data from this study suggest that a reconsideration of the policies concerning the most appropriate concentrations for water fluoridation might be appropriate for the United States.
Heller
K E
KE
School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA. kheller@umich.edu
Eklund
S A
SA
Burt
B A
BA
D000293:Adolescent; D000367:Age Factors; D002327:Cariostatic Agents / Q000008:administration & dosage / Q000032:analysis* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D004781:Environmental Exposure; D005260:Female; D005457:Fluoridation; D005459:Fluorides / Q000008:administration & dosage / Q000032:analysis* / Q000627:therapeutic use; D005460:Fluorides, Topical / Q000008:administration & dosage / Q000627:therapeutic use; D009050:Fluorosis, Dental / Q000453:epidemiology*; D006291:Health Policy; D006801:Humans; D008297:Male; D009067:Mouthwashes / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012044:Regression Analysis; D012737:Sex Factors; D012996:Solutions; D013607:Tablets; D014481:United States / Q000453:epidemiology; D014881:Water Supply / Q000032:analysis*
D002327:Cariostatic Agents; D005460:Fluorides, Topical; D009067:Mouthwashes; D012996:Solutions; D013607:Tablets; D005459:Fluorides