December 2016

Objective:  To assess the prevalence and severity of dental fluorosis in four city-based populations using a robust photographic method with TF index reporting; and to record the aesthetic satisfaction scores of children in all four cities. Basic research design: Cross sectional epidemiological survey (surveillance). Participants: 1,904 children aged 11-14 years, in four English cities. Interventions: Two cities were served by community water fluoridation schemes supplying water at 1mg/l F. The other two cities did not have water fluoridation schemes and had low levels of fluoride naturally present. Main outcome measures: The prevalence and severity of dental fluorosis. Scoring was undertaken using high quality digital images by a single calibrated examiner. Results: Data suggest that the prevalence of fluorosis at levels greater than TF2 are broadly similar to previous studies (F 10%, NF 2%), with an apparent increase in the total number of TF1 cases across both fluoridated (41%) and non-fluoridated cities (32%) with a commensurate decrease in TF0 (F 39%, NF 63%). Data suggest that the proportion of children expressing dissatisfaction with the appearance of their teeth is the same in fluoridated and non-fluoridated communities although the reasons for this may differ. Conclusions: The levels of fluorosis that might be considered of aesthetic concern are low and stable while the increase in TF1 may be due to an increase in self- and professionally-applied fluoride products or the increased sensitivity afforded by the digital imaging system. It is not however a public health problem or concern. Further monitoring appears justified. Key words: dental fluorosis, TF index, water fluoridation, dental health survey, England