Archive for September, 2012

Dental Fluorosis

September 14, 2012

Fluoridation opponents have pointed to the rising prevalence of dental fluorosis as a reason to rethink fluoridation, they often present the public with images of brown, pitted teeth as if to say “This is what could happen if your city fluoridates.” Yet, like many tactics used by the anti-fluoridation movement, this is fundamentally misleading.

Dental fluorosis is described by the CDC as,

…a change in the appearance of the tooth’s enamel. These changes can vary from barely noticeable white spots in mild forms to staining and pitting in the more severe forms. Dental fluorosis only occurs when younger children consume too much fluoride, from any source, over long periods when teeth are developing under the gums.

Unlike the pictures of brown and pitted teeth presented by anti-fluoridationists, the vast majority of dental fluorosis in the US is of the mild variety, resulting in little more than slight white streaking on the tooth enamel that is often barley noticeable¹. This form of dental fluorosis is considered a cosmetic condition only, does not negatively affect the health of the teeth, and requires no treatment. In fact, research indicates that people with mild fluorosis get less cavities and are more satisfied with their oral health, in one such study the authors wrote, “mild fluorosis was associated with a lower risk of dental caries and a more acceptable appearance. It is essential that a balanced view of the relative benefits and risks of the use of fluorides is maintained and proven benefits are not overwhelmed by largely unfounded aesthetic concerns.

The fearmongering of anti-fluoridationists over community water fluoridation and severe fluorosis is largely unfounded. Cases of the more severe form of fluorosis are not very common in most developed nations such as the US and can often be linked to known risk factors such as improper supplement usage or drinking water with fluoride levels above the recommended concentration. The Nation Research Council found that, “the prevalence of severe enamel fluorosis is close to zero in communities at all water fluoride concentrations below 2 mg/L.

Prevalence of severe enamel fluorosis at the person level by water fluoride concentration, permanent teeth, age < 20 years, U.S. communities.

While the incidence of dental fluorosis² has risen in the past several decades, it has increased in both fluoridated and unfluoridated communities. In fact, the increase in prevalence is “proportionally greater in non-fluoridated areas than in fluoridated areas.” This fact, along with other research suggests that increased prevalence of sources of fluoride other than municipal water have been central to this increase. Canadian researchers summarized the situation nicely, “water fluoridation has unique advantages from the perspectives of distribution, equity, compliance and cost-effectiveness over other fluoride technologies, it remains as the fundamental base for caries prevention. The increasingly greater contribution that other sources of fluoride make to dental fluorosis suggests that these sources of fluoride, many of which are used on an elective basis, should be more closely examined for needed changes.

Notes:
1. For examples of what fluorosis looks like see, What does dental fluorosis look like?

2. The prevalence of mild fluorosis may be somewhat overestimated as researchers have noted that there are other causes of mild streaking and discoloration.

Further Reading:
The CDC on Dental Fluorosis
Prevalence and Severity of Dental Fluorosis in the United States, 1999–2004
Fluoride & Heart Disease?
Fluoride & Brain Damage
Fluoride & the Brain: Déjà Vu
Fluoride & the Brain: Strike 3, You’re Out!
Fluoride & the Brain: The China Studies
Fluoride & Cancer Quackery
Science by Press Release: Fluoride & IQ


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