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. 2020 Apr;99(4):388-394.
doi: 10.1177/0022034520906089. Epub 2020 Feb 24.

Decline in Dental Fluorosis Severity during Adolescence: A Cohort Study

A M Curtis  1 , S M Levy  1 , J E Cavanaugh  1 , J J Warren  1 , J L Kolker  1 , K Weber-Gasparoni  1
Affiliations

Decline in Dental Fluorosis Severity during Adolescence: A Cohort Study

A M Curtis et al. J Dent Res. 2020 Apr.

Abstract

Dental fluorosis occurs from overingestion of fluoride during tooth formation. However, there is little evidence in the literature on whether or how fluorosis prevalence and severity change over time after tooth eruption. Permanent dentition dental examinations were conducted at ages 9, 13, 17, and 23 as part of the Iowa Fluoride Study, which has followed a cohort from birth. Fluorosis was assessed using the Fluorosis Risk Index (FRI) and Russell's criteria for differential diagnosis. Measures of fluorosis severity at the person and tooth level were calculated: second highest FRI score at the person level (the maximum FRI score for each tooth was determined and the tooth with the second highest maximum FRI score was used) and highest FRI score at the tooth level. At both the person and tooth levels, a decline in mild to moderate fluorosis severity was observed across adolescence and young adulthood. Across each pair of adjacent examinations at the person level, for participants with a baseline second highest FRI of 0, most participants stayed at 0 (82% to 91%). Many participants with a baseline second highest FRI of 1 had a follow-up score of 0 (47% to 54%), while about a third had a follow-up score of 1 (34% to 38%), and a lower percentage had an increase to a score of 2 (9% to 15%). For participants with baseline second highest FRI score of 2, between 25% and 44% of participants had follow-up FRI scores each of 0, 1, and 2. Similar patterns were observed at the tooth level. These results were consistent with most of the existing, limited literature. Overall, fluorosis severity, which was initially mild to moderate, tended to decline during adolescence and young adulthood. Additional study of how this trend affects esthetic perceptions of fluorosis is warranted.

Keywords: enamel; epidemiology; fluoride(s); pediatric dentistry; preventive dentistry; tooth wear.

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Conflict of interest statement

The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Cross-tabulations of person level, second highest Fluorosis Risk Index (FRI) scores on maxillary incisors. P values for the Wilcoxon signed-rank test (SR P value) are provided.
Figure 2.
Figure 2.
Cross-tabulations of tooth level maximum Fluorosis Risk Index (FRI) scores on maxillary incisors. P values for the Wilcoxon signed-rank test (SR P value), which adjusts for intraparticipant clustering of teeth, are provided.
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