Dental fluorosis in populations from Chiang Mai, Thailand with different fluoride exposures - paper 1: assessing fluorosis risk, predictors of fluorosis and the potential role of food preparation.
BACKGROUND
To determine the severity of dental fluorosis in selected populations in Chiang Mai, Thailand with different exposures to fluoride and to explore possible risk indicators for dental fluorosis.


METHODS
Subjects were male and female lifetime residents aged 8-13 years. For each child the fluoride content of drinking and cooking water samples were assessed. Digital images were taken of the maxillary central incisors for later blind scoring for TF index (10% repeat scores). Interview data explored previous cooking and drinking water use, exposure to fluoride, infant feeding patterns and oral hygiene practices.


RESULTS
Data from 560 subjects were available for analysis (298 M, 262 F). A weighted kappa of 0.80 was obtained for repeat photographic scores. The prevalence of fluorosis (TF 3+) for subjects consuming drinking and cooking water with a fluoride concentration of <0.9 ppm was 10.2%. For subjects consuming drinking and cooking water >0.9 ppm F the prevalence of fluorosis (TF 3+) rose to 37.3%. Drinking and cooking water at age 3, water used for infant formula and water used for preparing infant food all demonstrated an increase in fluorosis severity with increase in water fluoride level (p < 0.001). The probability estimate for the presentation of aesthetically significant fluorosis was 0.53 for exposure to high fluoride drinking (≥0.9 ppm) and cooking water (≥1.6 ppm).


CONCLUSIONS
The consumption of drinking water with fluoride content >0.9 ppm and use of cooking water with fluoride content >1.6 ppm were associated with an increased risk of aesthetically significant dental fluorosis. Fluoride levels in the current drinking and cooking water sources were strongly correlated with fluorosis severity. Further work is needed to explore fluorosis risk in relation to total fluoride intake from all sources including food preparation.
School of Dentistry, University of Manchester, Manchester, M13 9PL, England, UK. Michael.mcgrady@postgrad.manchester.ac.uk
Michael G
MG
McGrady
Roger P
RP
Ellwood
Patcharawan
P
Srisilapanan
Narumanas
N
Korwanich
Helen V
HV
Worthington
Iain A
IA
Pretty
D000293:Adolescent; D000367:Age Factors; D002327:Cariostatic Agents / Q000008:administration & dosage* / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003296:Cooking / Q000379:methods*; D003802:Dentifrices / Q000627:therapeutic use; D004955:Esthetics, Dental; D005247:Feeding Behavior; D005260:Female; D005459:Fluorides / Q000008:administration & dosage* / Q000032:analysis; D009050:Fluorosis, Dental / Q000453:epidemiology*; D005544:Forecasting; D006801:Humans; D007180:Incisor / Q000473:pathology; D007223:Infant; D007225:Infant Food / Q000706:statistics & numerical data; D041943:Infant Formula / Q000706:statistics & numerical data; D008297:Male; D009910:Oral Hygiene / Q000706:statistics & numerical data; D023861:Photography, Dental; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D014099:Toothbrushing / Q000706:statistics & numerical data; D014881:Water Supply / Q000032:analysis
D002327:Cariostatic Agents; D003802:Dentifrices; D005459:Fluorides