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Fluoride May Mottle Children's Teeth

CDC suggests increase in cosmetic condition linked to increased availability of mineral

TUESDAY, Feb. 26, 2002 (HealthDayNews) -- First introduced into the public water system in 1945, fluoride is considered one of the 20th century's greatest public health achievements.

HealthDay recently reported the Centers for Disease Control and Prevention's (CDC) announcement that two-thirds of Americans who drink public water are now getting enough of the mineral, which protects against cavities and other dental problems. That's an increase of 3.7 percent from 1992.

However, this success doesn't come without a cost.

A new CDC study in the February issue of the Journal of the American Dental Association finds that children in the 1980s had a higher incidence of enamel fluorosis than children in the 1930s did.

Enamel fluorosis is a disruption in the formation of tooth enamel that occurs during early childhood. The condition is a cosmetic one and, according to most experts, has no known health effects. More severe fluorosis may give teeth a mottled appearance.

"Many of the mild and moderate cases you wouldn't even know people had," says Dr. Raymond Cohlmia, president of the Oklahoma Dental Association. "We are talking about a cosmetic situation. It doesn't cause anybody to die."

In this study, researchers reviewed enamel fluorosis data for U.S. schoolchildren collected by the National Institute of Dental Research in 1986 and 1987, as well as data from the 1930s. The children were all 8 years old or younger.

Geographic regions were categorized, depending on how much fluoride was present in the water system.

Not surprisingly, the prevalence of enamel fluorosis varied, depending on the level of the mineral present in the water. The highest prevalence (37.8 percent) occurred among children in areas with public systems that had naturally fluoridated water, followed by children living in "optimally" fluoridated areas (25.8 percent) and, finally, children in "suboptimal" areas (15.5 percent).

Overall, 22.3 percent of all schoolchildren had enamel fluorosis in the 1986 to 1987 period. The prevalence in the 1930s ranged from 7 percent to 20 percent.

The study authors speculate the increase in enamel fluorosis was due to the wider availability of sources of fluoride as the years wore on.

"The main difference between the 1930s to 1940s and the 1980s is the availability of all those other sources of fluoride," says Eugenio D. Beltran-Aguilar, lead author of the study. "Unfortunately, we have not developed a practical and reliable way to measure current total fluoride exposure, [but] when you see more fluorosis-like lesions in the 1980s that parallel the increase in the sources of fluoride available, you infer that both should be connected."

After the 1930s, fluoride became available to the public from a variety of sources, including toothpaste, mouth rinse and even some baby foods. Dentists also applied gels and solutions during annual check-ups. "Because not all community water was fluoridated, dental researchers searched for other ways to provide fluoride," Beltran-Aguilar says.

In the late 1970s and early 1980s, manufacturers started removing fluoride from most of these products but the move was too late to affect the results of this study.

For future generations, Beltran-Aguilar and his colleagues recommend children under the age of 8 only receive fluoride according to their needs, rather than some predetermined, universal schedule. In addition, they suggest a low-fluoride toothpaste, such as is sold in other countries, be made available in this country.

They stop short of recommending a reduction in water fluoride concentrations, but do suggest this avenue be investigated.

What To Do

The study authors recommend children be supervised while brushing their teeth and that only a pea-sized amount of toothpaste be used or, alternatively, that the toothpaste be squeezed across the width of the brush rather than length-wise.

You can also visit the American Dental Association or the CDC.

SOURCES: Interviews with Eugenio D. Beltran-Aguilar, DMD, MPH, MS, DrPH, oral epidemiologist, Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta; Raymond Cohlmia, DDS, president, Oklahoma Dental Association, Oklahoma City; February 2002 Journal of the American Dental Association
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