title: Dental caries and fluorosis in low- and high-fluoride areas in Turkey.
abstract: OBJECTIVE
  The aim of this study was to investigate the caries prevalence of children living in either low- or high-fluoride areas and to relate caries experience to the severity of dental fluorosis.
  
  
  METHODS
  A total of 278 12- to 14-year-old schoolchildren, 149 in a low-fluoride area (LFA) and 129 in a high-fluoride area (HFA), were included in the study. The naturally occurring fluoride concentrations in the drinking water were 0.30 to 0.40 ppm in the LFA, 1.42 to 1.54 ppm in the HFA1, and 1.55 to 1.66 ppm in the HFA2. Dental caries was recorded with the World Health Organization criteria, and dental fluorosis was measured using the Tooth Surface Index of Fluorosis.
  
  
  RESULTS
  The percentages of children who had an average TSIF > or = 1 were 0%, 29%, and 77% in the LFA, HFA1, and HFA2, respectively. The mean decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled permanent surfaces (DMFS) were 0.84 +/- 0.98 and 1.58 +/- 2.24 in LFA, 1.30 +/- 1.46 and 1.78 +/- 2.52 in HFA1, and 1.26 +/- 1.42 and 1.97 +/- 2.60 in HFA2, respectively. There was no significant difference in caries prevalence among children living in low- and high-fluoride areas when evaluated with an analysis of covariance model, including the frequency of toothbrushing. Toothbrushing frequency had a significant effect on the decayed teeth, decayed surfaces, DMFT, and DMFS. In high-fluoride areas, there was no relationship between caries prevalence and severity of fluorosis.
  
  
  CONCLUSIONS
  Increasing water fluoride levels were associated with higher prevalence and severity of dental fluorosis and had no influence on caries experience in children with poor oral hygiene.
authors.affiliation: Department of Restorative Dentistry and Endodontics, School of Dentistry, Süleyman Demirel University, Isparta, Turkey. banu_ermis@yahoo.com
authors.forename: R Banu
authors.initials: RB
authors.lastname: Ermiş
authors.forename: Fatma
authors.initials: F
authors.lastname: Koray
authors.forename: B Güniz
authors.initials: BG
authors.lastname: Akdeniz
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D005260:Female; D009050:Fluorosis, Dental / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015995:Prevalence; D018709:Statistics, Nonparametric; D014099:Toothbrushing / Q000706:statistics & numerical data; D014421:Turkey / Q000453:epidemiology; D014505:Urban Population; D014881:Water Supply / Q000032:analysis*