title: The risk of enamel fluorosis and caries among Norwegian children: implications for Norway and the United States.
abstract: BACKGROUND
  The authors investigated the associations between enamel fluorosis, caries and early fluoride use among Norwegian children who received fluoride supplementation under a protocol similar to the current U.S. protocol.
  
  
  METHODS
  Two examiners whose techniques were calibrated examined randomly selected middle-school-aged children living in Bergen, Norway-where the water supply contains less than 0.10 milligrams of fluoride per liter-for both enamel fluorosis and caries by using the Fluorosis Risk Index and modified National Institute of Dental and Craniofacial Research criteria. The authors ascertained past fluoride exposure via a follow-up questionnaire mailed to parents.
  
  
  RESULTS
  The questionnaire had an 88 percent response rate and 87 percent reliability. Adjusted analyses revealed a strong association between regular supplementation (given in the form of lozenges) and mild to moderate enamel fluorosis (odds ratio [OR], 6.85; P < .05), as well as fluorosis of lesser severity (OR, 3.07; P < .05). No children who had exclusively used only a pea-sized amount of toothpaste (0.1 percent fluoride) had mild to moderate fluorosis. The authors found a 40 percent reduction in caries risk associated with early use of pea-sized amounts of fluoridated toothpaste and a 46 percent reduction associated with regular use of fluoride supplement lozenges.
  
  
  CONCLUSIONS
  These findings suggest that both risk of fluorosis development and caries-preventive benefit are associated with regular use of fluoride supplements, and caries prevention was associated with early use of a pea-sized amount of toothpaste.
  
  
  CONCLUSIONS
  These findings underscore the need for clinicians to consider thoroughly-and discuss with a child's parent or guardian-both the benefit and the potential risk of fluorosis development associated with preventive fluoride agents before introducing them. Clinicians also should emphasize the proper use of such agents.
authors.affiliation: Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, Conn. 06030, USA. pendrys@nso1.uchc.edu
authors.forename: David G
authors.initials: DG
authors.lastname: Pendrys
authors.forename: Ola
authors.initials: O
authors.lastname: Haugejorden
authors.forename: Asgeir
authors.initials: A
authors.lastname: Bårdsen
authors.forename: Nina J
authors.initials: NJ
authors.lastname: Wang
authors.forename: Finn
authors.initials: F
authors.lastname: Gustavsen
mesh_terms: D000293:Adolescent; D002327:Cariostatic Agents / Q000009:adverse effects; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology* / Q000517:prevention & control; D005459:Fluorides / Q000009:adverse effects; D009050:Fluorosis, Dental / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D012306:Risk; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D002327:Cariostatic Agents; D005459:Fluorides