title: Fluorosis risk in grade 2 students residing in a rural area with widely varying natural fluoride.
abstract: OBJECTIVE
  This pilot study was performed to determine the prevalence of dental fluorosis and the association between fluorosis and a number of risk factors in a group of second grade students in a rural, non-fluoridated area of Ontario, Canada.
  
  
  METHODS
  Of 1739 students screened during routine health surveillance, 1367 had erupted maxillary central incisors. Fluorosis was scored on these children using the Tooth Surface Index of Fluorosis (TSIF). A fluoride exposure questionnaire and water sample vial was sent home from school with each child.
  
  
  RESULTS
  Valid responses were obtained for 752 children (55%). The prevalence of fluorosis in respondents was 23.3%, with 4.9% scoring TSIF of 2 or more. In bivariate analysis, several variables were significantly associated with the prevalence and/or severity of fluorosis. These included: water fluoride concentration, breast-feeding duration, professionally applied topical fluoride, fluoride supplement use, bottle-feeding, fluoridated mouthwash use, and early parental toothbrushing with toothpaste. In logistic regression analysis limited to children living at the current residence for 4 years or more, only four variables had significant independent effects. These were water fluoride concentration, breast-feeding duration, fluoride supplement use, and fluoridated mouthwash use.
  
  
  CONCLUSIONS
  These findings indicate that fluorosis is an important concern in non-fluoridated areas. Fluoride supplements should not be recommended unless an independent home water test is performed. Breast-feeding for 6 months or more may protect children from developing dental fluorosis in the permanent incisors.
authors.affiliation: Community Dental Services, Wellington-Dufferin-Guelph Health Unit, Guelph, Ontario, Canada. dbrothwell@globalserve.net
authors.forename: D J
authors.initials: DJ
authors.lastname: Brothwell
authors.forename: H
authors.initials: H
authors.lastname: Limeback
mesh_terms: D000704:Analysis of Variance; D001903:Bottle Feeding / Q000009:adverse effects; D001942:Breast Feeding / Q000706:statistics & numerical data; D002327:Cariostatic Agents / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D019587:Dietary Supplements / Q000009:adverse effects; D005457:Fluoridation / Q000009:adverse effects; D005459:Fluorides / Q000009:adverse effects*; D009050:Fluorosis, Dental / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007180:Incisor; D016015:Logistic Models; D009067:Mouthwashes / Q000009:adverse effects; D009864:Ontario / Q000453:epidemiology; D010865:Pilot Projects; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health; D011795:Surveys and Questionnaires
chemical_list: D002327:Cariostatic Agents; D009067:Mouthwashes; D005459:Fluorides