title: Fluorosis and dental caries in Mexican schoolchildren residing in areas with different water fluoride concentrations and receiving fluoridated salt.
abstract: OBJECTIVE
  To explore the association between fluoride in drinking water and the prevalence and severity of fluorosis and dental caries in children living in communities receiving fluoridated salt.
  
  
  METHODS
  Participants were schoolchildren (n = 457) living in two rural areas of the State of Morelos, Mexico, where the water fluoride concentration was 0.70 or 1.50 ppm. Dental caries status was assessed using Pitts' criteria. Lesions that were classified as D3 (decayed) were identified to determine the decayed, missing, and filled teeth index (D3MFT). Fluorosis was assessed using the Thylstrup-Fejerskov Index (TFI). Information regarding drinking water source and oral hygiene practices (tooth brushing frequency, dentifrice use, and oral hygiene index) was obtained.
  
  
  RESULTS
  The prevalence of fluorosis (TFI ≥1) in communities with 0.70 and 1.50 ppm water fluoride was 39.4 and 60.5% (p = 0.014), respectively, while the prevalence of more severe forms (TFI ≥4) was 7.9 and 25.5% (p < 0.001), respectively. The mean D3MFT was 0.49 (±1.01) in the 0.70 ppm community and 0.61 (±1.47) in the 1.50 ppm community (p = 0.349). A logistic regression model for caries (D3 >1) showed that higher fluorosis categories (TFI 5-6 OR = 6.81, p = 0.001) were associated with higher caries experience, adjusted by age, number of teeth present, tooth brushing frequency, bottled water use, and natural water fluoride concentration.
  
  
  CONCLUSIONS
  The prevalence of fluorosis was associated with the water fluoride concentration. Fluorosis at moderate and severe levels was associated with a higher prevalence of dental caries, compared with lesser degrees of fluorosis. The impact of dental fluorosis should be considered in dental public health programs.
authors: Postgraduate Unit, Dental College, National Autonomous University of Mexico, Mexico, Mexico.
authors: A
authors: A
authors: García-Pérez
authors: M E
authors: ME
authors: Irigoyen-Camacho
authors: A
authors: A
authors: Borges-Yáñez
mesh_terms: D002648:Child; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology* / Q000473:pathology; D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D005459:Fluorides / Q000008:administration & dosage* / Q000009:adverse effects; D009050:Fluorosis, Dental / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D006801:Humans; D017736:Ion-Selective Electrodes; D016015:Logistic Models; D008297:Male; D008800:Mexico / Q000453:epidemiology; D015995:Prevalence; D012965:Sodium Chloride / Q000737:chemistry*; D017673:Sodium Chloride, Dietary; D014099:Toothbrushing / Q000706:statistics & numerical data
chemical_list: D060766:Drinking Water; D017673:Sodium Chloride, Dietary; D012965:Sodium Chloride; D005459:Fluorides