ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Dental Fluorosis In The Primary Dentition Associated with Flouride Exposure
Clinical Question Does dental fluorosis occur in the primary dentition and at what levels does it most readily occur?
Clinical Bottom Line Dental fluorosis does occur in the primary dentition and tends to occur most often in areas with drinking water fluoride levels that are above 1.0 ppm. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16238651Ruan/20057-8 y.o chilidrenComparative study
Key resultsFluorosis prevalence varied from 6.2-96.6% depending on fluoride concentrations. Second primary molars were the most severely affected. Most prevalent in areas with drinking water fluoride concentrations greater than 1.0 mg/L. May be a marker for fluorosis in the permanent dentition.
#2) 16216097Harding/20055 y.o. childrenCross Sectional Study
Key resultsTotal prevalence of primary tooth fluorosis was 23% but was more common in the fluoridated area. Beginning toothbrushing with toothpaste between 12-18 months old is also associated with fluorosis.
#3) 12147170Levy/20024-7 y.o childrenLongitudinal
Key resultsFluorosis occurred most commonly on second primary molars. The middle of the first year of life is most important in fluorosis etiology in primary teeth.
Evidence Search ("Fluorosis, Dental"[Mesh]) AND "Dentition, Primary"[Mesh] ...view in PubMed
Comments on
The Evidence
Fluorosis does occur in the primary dentition although it is not as easily recognized as in the permanent dentition. Fluorosis ocurs in nearly all concentrations of water borne fluoride, but the differences of median TFI scores are significantly higher (P<0.001) in areas of greater fluoride concentration. The study by Ruan found that areas with concentrations greater than 1.0 mg/L were at greater risk for dental fluorosis. The Harding study found the prevalence of fluorosis to be 23% in the highly fluoridated area and also noted that children who were exposed to brushing with toothpaste between 12-18 months were more likely to develop fluorosis. All three studies found the presence of fluorosis to be more common on the primary second molars.
Applicability Detecting fluorosis in the primary dentition may be an indicator to excess fluoride intake that may lead to problems in the permanent dentition. Early detection can lead to appropriate intervention in those patients.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry) (Prosthodontics)
Keywords Dental Fluorosis, Primary dentition
ID# 584
Date of submission: 05/12/2010spacer Revised: 04/30/2012
E-mail hillbk@livemail.uthscsa.edu
Author Brian Hill
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ridley Ross, DDS
Faculty mentor/Co-author e-mail rossr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Caitlyn Ploch, Alexandria Tami & Natalie Garza (San Antonio, TX) on 01/07/2013
The CAT review #584 consisted of comparative, cross-sectional, and longitudinal studies. All found that fluorosis was possible in the primary dentition and more common in areas with higher fluoride concentrations (> 1.0mg/L). One more recent study was found (Ekambaram, 2011, PMID# 22524070) which happens to be a systematic review of older literature. Hence, no new research has been published relating to to topic of fluorosis in the primary dentition.
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