Dental fluorosis in the Blue Mountains and Hawkesbury, New South Wales, Australia: policy implications

Abstract

Aim: The aim of the present study was to determine whether the adjustment of the fluoride concentration to 1 ppm in the drinking water supplied to the Blue Mountains, New South Wales, Australia in 1993 was associated with fluorosis incidence.

Methods: In 2003, children attending schools in the Blue Mountains and a control region (fluoridated in 1967) that had been randomly selected at baseline in 1992 were examined for dental fluorosis (maxillary central incisors only) using Dean's index. A fluoride history for each child was obtained by questionnaire. Associations between fluorosis and 58 potential explanatory variables were explored.

Results: The response rate was 63%. A total of 1138 children aged from 7 to 11 years with erupted permanent central incisors were examined for dental fluorosis. Fluorosis prevalence was the same in both regions. The Community Index of Dental Fluorosis values were slightly different, but were both above 0.6, indicative of public health concern.

Conclusions: For the group as a whole, we concluded that: (a) fluorosis prevalence (0.39) in both regions was similar; and (b) the higher-than-expected prevalence and severity of fluorosis was due mainly to two factors: (a) the higher-than-optimal fluoride level in drinking water; and (b) swallowing of fluoride toothpaste in early childhood.

Keywords: caries; fluoridation; fluoride toothpaste; fluorosis; health policy.