Resident’s Name: Semantha Charles Date: 08/31/2016 Article Mentor: Dr. Mindy Sapir
Title: The association between enamel fluorosis and dental caries in U.S. schoolchildren.
Authors: Lida, H. and Kumar, J. V.
Journal: J Am Dent Assoc
Topic: Caries, Fluorosis
Type of Article: Review of surveys
Main Purpose: Association between enamel fluorosis and dental caries to determine if there is any beneficial effect of enamel fluorosis in U.S. schoolchildren.
Milder forms of enamel fluorosis are usually not noticeable by lay people.
Analyses of only children 7 to 17 years old who had a history of single residence was used.
Examiners, examined mouth of children and assigned each tooth very mild, mild, moderate, severe fluorosis index.
Water sample was obtained.
Analysis was focused on the permanent maxillary right first molar.
Permanent first molar is one of the most susceptible teeth to dental caries and fluorosis. There is no preceding primary tooth and therefore no chance that a primary tooth could affect the eruption and formation of the 1st molar.
Permanent first molars presented similar pattern of caries and enamel fluorosis according to preliminary analysis.
Mean DMFS of permanent teeth was consistently lower in children with enamel fluorosis when compared with that in children without enamel fluorosis.
An estimated 35 percent of permanent maxillary right first molars had caries experience, and an average of 0.6 surfaces per tooth were affected by caries.
Molars without fluorosis had a higher count of DMFS and a higher prevalence of caries than did molars with fluorosis.
The degree of fluorosis exhibited an inverse dose-response relation to both mean DMFS and the prevalence of caries.
Fluoride concentration of (<0.7ppm) had decreased odds of having caries as compared with molars without fluorosis, in communities with higher ppms the protective effect of enamel fluorosis was not statistically significant.
Conclusions: The results of this study suggest that teeth with fluorosis were more resistant to caries in U.S. schoolchildren than were teeth without fluorosis and consideration of these effects in regards to reduction of fluoride exposure.
Level of Evidence/Comments: Good article that addresses pros and cons of the rationale for fluoride exposure.
My comments on the article are as follows:
Flouride prevents proximal (smooth surface lesions) better than occlusal caries. This study did not take bitewings only clinical assessment , therefore it did not rule out proximal lesions unless they were already filled.
First molars have a higher tendency for developmental defects like MIH and it is not easy to differentiate hyperplasia from fluorosis on a molar, from that aspect incisors are easier to examine. A molar with hypoplasia will be more susceptible to caries, and not taking DDE into account can bias the results.
Enjoy the rest of your weekend,