title: [Prevalence of dental fluorosis and additional sources of exposure to fluoride as risk factors to dental fluorosis in schoolchildren of Campeche, Mexico].
abstract: OBJECTIVE
  To determine the prevalence and severity of dental fluorosis, and to evaluate supplementary fluoride sources as potential risk factors to fluorosis in school children aged 6-9.
  
  
  METHODS
  A cross-sectional study was carried out in 320 children attending elementary schools protected by a public preventive dental program in the city of Campeche, Mexico. A self-administered questionnaire directed to the mothers was delivered through the schools and collected in the same way. The examiners were trained and calibrated (kappa > 0.90) in modified Dean's Index. The fluorosis community index (FCI) was calculated. Bivariate analyses were made with Chi2 test; odds ratios (OR) and 95% confidence intervals were calculated. Logistic regression was used in the final model.
  
  
  RESULTS
  Fluorosis prevalence was 56.3%, with very mild fluorosis present in 45% of children, mild in 10%, and severe in just 1.3%. The FCI was 0.7. The multivariate model showed that the effect of the supplementary fluoride sources was different between children that started brushing with toothpaste before two years of age (OR = 6.15; IC 95% = 2.03-18.67) and after (OR = 2.14; IC 95% = 1.16-3.94).
  
  
  CONCLUSIONS
  Fluorosis prevalence was high for mild modalities, and low for more severe levels. According to FCI the dental fluorosis constitute a public health problem in the studied sample. Exposure to diverse fluoride sources -above and beyond the fluoridated salt program- was a risk factor for dental fluorosis in this community. Results suggest that toothpaste use in children two years of age and younger should be cautious, limited to follow current guidelines, and supervised by parents to minimize the risk of dental fluorosis.
authors.affiliation: Facultad de Odontología de la Universidad Autónoma de Campeche.
authors.forename: Perla Rubí
authors.initials: PR
authors.lastname: Beltrán-Valladares
authors.forename: Héctor
authors.initials: H
authors.lastname: Cocom-Tun
authors.forename: Juan Fernando
authors.initials: JF
authors.lastname: Casanova-Rosado
authors.forename: Ana Alicia
authors.initials: AA
authors.lastname: Vallejos-Sánchez
authors.forename: Carlo Eduardo
authors.initials: CE
authors.lastname: Medina-Solís
authors.forename: Gerardo
authors.initials: G
authors.lastname: Maupomé
mesh_terms: D001294:Attitude to Health; D002648:Child; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D005260:Female; D005459:Fluorides / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis; D005460:Fluorides, Topical / Q000008:administration & dosage / Q000009:adverse effects; D009050:Fluorosis, Dental / Q000453:epidemiology*; D005503:Food Additives; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009035:Mothers / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D012571:School Dentistry; D012720:Severity of Illness Index; D017673:Sodium Chloride, Dietary; D011795:Surveys and Questionnaires; D014100:Toothpastes / Q000032:analysis
chemical_list: D005460:Fluorides, Topical; D005503:Food Additives; D017673:Sodium Chloride, Dietary; D014100:Toothpastes; D005459:Fluorides