Perceptions of Dental Fluorosis

Abstract

Mild dental fluorosis has long been accepted as a side-effect of water fluoridation and, more recently, has been recognized as a consequence of the use of other fluoride-based caries-preventive strategies. Traditionally, dental health professionals have not seen this as being of public health importance, but members of the public have not been asked their opinion. The purpose of the present study was to gather the opinions of lay groups concerning the appearance of the teeth of children with various degrees of fluorosis. Twenty-eight children, born in 1978, who had earlier participated in a study of fluorosis in Perth (Western Australia), allowed 110 observers to look at their upper central incisors under good viewing conditions. Fluorosis in these teeth ranged from TF score 0 (no fluorosis) to TF score 3. The observers were university students, parents, public servants, or dentists. They responded to statement items about the appearance of the teeth. The results, based on just over 3000 responses, showed that lay and dental observers could distinguish between different fluorosis levels. In response to a statement that the teeth appeared pleasing, a large majority agreed when the TF score was 0, but agreement declined as the TF score increased; when the TF score was 3, most people disagreed. Similarly, observers felt that the appearance would increasingly embarrass the child as the TF score increased. Observers, except the dentists, tended to feel that higher TF scores indicated neglect on the part of the child. Most observer groups felt that fluorosis would be no greater an esthetic problem for girls than for boys, but for more severe fluorosis, the dentists saw the appearance as being a greater problem for girls. The dentists responded that most fluorosis did not require any treatment, but when the TF score was 3, a majority of them felt that esthetic treatment would be warranted. The results suggest that, for these observers, fluorosis score TF = 2 or greater was easily noticed, and when the TF score was 3, fluorosis aroused concern in most observers. Recent epidemiological studies reported TF scores of 2 or more in 11.3% of 12-year-olds and 17.5% of 7-year-olds in Perth. Strategies to reduce the prevalence of fluorosis with TF score 2 and avoid fluorosis with TF score 3-including reduction of toothpaste ingestion, removal of fluoride from infant formulae, and avoidance of inappropriate supplement use-should be devised and implemented.