Fluoride is an important mineral, especially for children. Our mouths contain bacteria that use sugars in the foods we eat and the beverages we drink to produce an acid that harms our teeth. Fluoride protects our teeth. But too much fluoride can cause something called dental fluorosis.
Dental fluorosis is a slight change in the look of the
teeth, usually in the form of very faint white markings. Typically, the fluorosis seen
in the US is a mild form that does not cause pain and does not affect the
health or function of teeth. Fluorosis only occurs when fluoride is
consumed before the age of 8, while permanent teeth are still forming
the gums. That’s why we teach kids to spit out toothpaste and not to swallow
There are many possible causes of changes in the appearance
of teeth. To understand the extent of fluorosis, the Centers for Disease Control
and Prevention (CDC) periodically set out to measure it. How? Fluorosis is
identified by examiners who “score” the appearance of the teeth based on an
established index (Dean’s Fluorosis Index, or FDI). The scoring process
includes repeat examinations and something called inter-examiner reliability.
But even with these techniques in place, exam results can vary widely, which leaves
the quality of population-level estimates open to question.
Such was the case recently. The CDC National Center for Health Statistics (NCHS) just released an evaluation of the most recent clinical assessment data available. When compared to data from a decade earlier, these numbers seemed to indicate an increase in the prevalence of fluorosis that is “not biologically plausible.” What does that mean? Teeth would have become affected after they were already fully formed under the gums, which has never been observed before and is inconsistent with scientific understanding of how fluorosis occurs.
NCHS therefore had to conclude that the difference “may have
been some change in the way examiners evaluated the level of fluorosis over
time.” They therefore caution that the “quality assessment findings should be
strongly considered” when this information is being used to study the current
extent of fluorosis.
All these nuances can be confusing, making it hard to know what to believe. That’s why you turn to trusted voices to help you determine what you need to know for yourself and your family. Here at the American Academy of Pediatrics Campaign for Dental Health we are proud to stand with the American Association for Dental Research and the American Fluoridation Society, among others, in applauding NCHS for providing both ongoing research and critical analysis that puts the findings in the proper context.
So, what do you need to know about fluorosis today? Children
who consume a typical diet, drink fluoridated water, and use fluoridated dental
products properly will get the fluoride they need for healthy teeth and are no
more at risk of fluorosis now than children were 20 years ago.
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