title: Photographic assessment of fluorosis in children from naturally fluoridated Kungsbacka and non-fluoridated Halmstad, Sweden.
abstract: OBJECTIVE
  To assess levels of fluorosis and fluorosis of esthetic concern in children from a naturally fluoridated and a non-fluoridated area of Sweden, and to determine the relative contributions of fluoridated water, parental educational level, and infant oral health-related behaviors.
  
  
  METHODS
  A parental questionnaire collected information concerning child F-supplement and F-dentifrice usage histories, and socio-economic status. Photographic examination of 1336 subjects (F=791; N-F=545) was undertaken. Fluorosis was assessed (blind to F-exposure) in a random sample (n=250) of 35 mm slides by four dental and two lay "jurors" (with 10% random repeat-viewing for inter-observer and intra-observer agreement). Four outcomes were assessed on each slide: fluorosis at any level, fluorosis of esthetic concern, acceptability of appearance, and treatment needs. Ordinal logistic regression models were used to determine significant determinants.
  
  
  RESULTS
  For presence of fluorosis of esthetic concern, majority jury agreements (>3 of 6) were seen in only 2.3% (N-F) and 13.4% (F) pupils (p<0.001), albeit jurors unanimously scored only 13 F and 2 N-F exposed children as having esthetically unacceptable fluorosed teeth (p<0.001). The over-riding significant factor in terms of fluorosis of esthetic concern was exposure to water fluoridation in infancy in both unadjusted and adjusted models.
  
  
  CONCLUSIONS
  The important factor in relation to fluorosis of esthetic concern was explained by exposure to fluoridated water in infancy, and was not explained by age, sex, level of parental education or early childhood oral health behaviors. However, prevalence of this condition was relatively low. These findings should inform policies on appropriate total fluoride exposure levels during infancy.
authors.affiliation: Dental Public Health Unit, University of Glasgow Dental School, Glasgow, UK. l.macpherson@dental.gla.ac.uk
authors.forename: Lorna M D
authors.initials: LM
authors.lastname: Macpherson
authors.forename: David I
authors.initials: DI
authors.lastname: Conway
authors.forename: W Harper
authors.initials: WH
authors.lastname: Gilmour
authors.forename: Lars G
authors.initials: LG
authors.lastname: Petersson
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Stephen
mesh_terms: D002648:Child; D003802:Dentifrices / Q000009:adverse effects; D004955:Esthetics, Dental; D005260:Female; D005457:Fluoridation / Q000009:adverse effects*; D009050:Fluorosis, Dental / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D015438:Health Behavior; D006801:Humans; D007180:Incisor / Q000473:pathology; D008297:Male; D010290:Parents; D023861:Photography, Dental; D015995:Prevalence; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
chemical_list: D003802:Dentifrices