ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Risk of Flourosis in Children from Water Fluoridation is Dose Dependent
Clinical Question What is the dose-response relationship between public water fluoridation and the risk of fluorosis in children?
Clinical Bottom Line There is a dose-dependent increase between concentration of fluoride in the public water and dental fluorosis. (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) 11021861McDonagh/2000 88 StudiesSystematic Review
Key resultsThe review found that there is a dose-response relationship with dental fluorosis. There is a 48% prevalence of dental fluorosis at a water fluoride concentration of 1.0 ppm with a 95% confidence interval 40% to 57%. At a water fluoride concentration level of 1.0 ppm, the prevalence of dental fluorosis that is of aesthetic concern is 12.5% with a 95% confidence interval 7.0% to 21.5%.
#2) 19772843Parnell/20092 StudiesReview of Systematic Reviews
Key resultsA dose-response relationship was found between the water fluoride level and the occurrence of dental fluorosis in the York Review. The proportion of the population with dental fluorosis at different water fluoride concentration levels varied from 15% (95% confidence interval 10 – 22) at a 0.1-ppm level of fluoride to 72% (95% confidence interval 62-80) at a 4-ppm fluoride level. The review found that at a level of 1 ppm of Fluoride the occurrence of dental fluorosis was 48% with a 95% confidence interval 40-57. Dental fluorosis of aesthetic concern prevalence was 12.5% with a 95% confidence interval 7.0 – 21.5%. The Australian review found that there is an increase in dental fluorosis when water fluoride levels are increased. They found a 17% prevalence of dental fluorosis at a concentration of 0 to 0.3 Fluoride, there is a 27% prevalence of dental fluorosis at a water fluoride level ranging from 0.3 to 0.7 ppm, and a 32% prevalence of dental fluorosis at a 0.7 to 1.4 ppm of Fluoride. They found that the overall absolute increase in prevalence is small even though there is a 4-fold increase of developing dental fluorosis of aesthetic concern.
Evidence Search Search "Fluorosis, Dental"[Mesh] Limits: Humans, Systematic Reviews ...view in PubMed
Comments on
The Evidence
The McDonagh study is not a systematic review of randomized controlled trials. They used a comprehensive, detailed search for relevant trials. The individual studies were not assessed for validity. The systematic review included 88 studies with 4 controlled before-after designs and 84 cross sectional designs. Meta-analysis was not done. The Parnell study was not a systematic review of randomized controlled trials. They used a comprehensive, detailed search for relevant trials. The individual studies were not assessed for validity. Two systematic review studies were used. Meta-analysis was not done.
Applicability These patients with dental fluorosis are highly likely to be seen in private practice and treatment is feasible within this setting. Potential harms of higher levels of fluoride is increasing the risk of dental fluorosis. A potential benefit of higher levels of fluoride is prevention in caries.
Specialty/Discipline (Public Health) (General Dentistry)
Keywords Dental fluorosis, water fluoridation
ID# 836
Date of submission: 04/28/2011spacer Revised: 11/09/2011
E-mail pateld5@livemail.uthscsa.edu
Author Dipali Patel
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Suman Challa, BDS, MS
Faculty mentor/Co-author e-mail challas@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?)
post a rationale
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 Amanda G. Hughart (San Antonio, TX) on 10/03/2014
A PubMed search was conducted in September 2014. A new observational cross-sectional survey based on a convenience sample population (McGrady, 2012, PMID: 22720834) assessed levels of fluoride consumed from drinking and cooking water in populations from Chiang Mai, Thailand with different fluoride exposures and found similar results to prior studies in that the higher levels of fluoride concentration in drinking water resulted in increased risk of dental fluorosis. A recent Canadian review (Stoneman, 2014, Trip Database) happens to be a review of older literature including the Systematic Review (McDonagh/2000) used for this CAT demonstrating no new relevant research findings.
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