Dental Fluorosis = Increase in Caries
©1996 - 2008 PFPC

There are many studies found in the international literature which have documented that an increase in dental fluorosis leads to an increase in tooth decay (caries) - the very thing it (fluoride) is proclaimed to
prevent...

A short list of 20+ studies is provided below, arranged in alphabetical
order.

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Azpeitia-Valadez Mde L, Rodríguez-Frausto M, Sánchez-Hernández MA - "Prevalence of dental fluorosis in children between 6 to 15 years old" Rev Med Inst Mex Seguro Soc 46(1):67-72 (2008)

"Dental fluorosis is a defect in the formation of the enamel by high fluoride concentrations during tooth development. It produces hypomineralization of the enamel by increasing the porosity, thus exposing the tooth to decay....The severity was mild and very mild in 90 % of cases. Tooth decay appeared in 55 % of children with fluorosis and in 43 % of children without fluorosis....The prevalence of dental fluorosis is rapidly increasing. Tooth decay affected more often children with fluorosis."

Awadia AK, Birkeland JM, Haugejorden O, Bjorvatn K - "Caries experience and caries predictors - a study of Tanzanian children consuming drinking water with different fluoride concentrations" Clin Oral Investig. 6(2):98-103 (2002)

"Logistic regression analyses indicated that subjects in the high-F and urban Arusha municipality were at a significantly higher risk of dental caries than children in the low-F areas."

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Birkeland JM, Ibrahim YE, Ghandour IA, Haugejorden O - "Severity of dental caries among 12-year-old Sudanese children with different fluoride exposure" Clin Oral Investig 9(1):46-51 (2005)

"Children . . . drinking water with 1.0-2.0 mg fluoride/L (median = 1.8), had significantly higher caries prevalence (21% versus 8%) than in a 0.4 mg fluoride area."

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Budipramana ES, Hapsoro A, Irmawati ES, Kuntari S - "Dental fluorosis and caries prevalence in the fluorosis endemic area of Asembagus, Indonesia"  Int J Paediatr Dent 12(6):415-22 (2002)

"In this study, DT (Decayed Permanent Teeth) increased with an increase in the fluoride content."

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Carlsson A - "Current problems relating to the pharmacology and toxicology of fluorides" Lakartidningen 75: 1388-1392 (1978)

"More severe degrees of enamel fluorosis are associated with an abnormally high incidence of caries... There is thus no doubt that a high degree of enamel fluorosis causes an increased tendency to caries."

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Chibole O - "Dental caries among children in high fluoride regions of Kenya" J R Soc Health 108(1):32-3 (1988)

"When the non-fluorosis group was compared to the fluorosis group, there was a significant difference in caries experience; the fluorosis group having higher DMFT and dft... It appears that with increased severity of fluorosis there is increased susceptibility for dental caries."

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Cortes DF, Ellwood RP, O'Mullane DM, Bastos JR - "Drinking water fluoride levels, dental fluorosis, and caries experience in Brazil" J Public Health Dent 56(4):226-8 (1996)

"The children in the high-fluoride area who had dental fluorosis at or above a TF score of 3 had higher levels of dental caries than those with milder degrees of fluorosis present. This finding suggests that if fluoride intake is too high, severe enamel hypomineralization may result in increased caries risk."

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Cunha-Cruz J, Nadanovsky P - "Dental fluorosis increases caries risk" Journal of Evidence Based Dental Practice 5: 170-171 (2005)

"The reviewed study suggests an increased risk of caries among children with fluorosis. The results are reinforced by the observed dose-response relationship: the higher the fluorosis, the higher the caries prevalence. However this was not a linear relationship; the threshold at which fluorosis appears to start increasing the risk of caries was at TF score 3."

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Driscoll WS, Horowitz HS, Meyers RJ, Heifetz SB, Kingman A, Zimmerman ER - "Prevalence of dental caries and dental fluorosis in areas with negligible, optimal, and above-optimal fluoride concentrations in drinking water" J Am Dent Assoc 113(3):370 (1986)

"Children with severe fluorosis have a significantly higher caries experience than do children with lesser degrees of fluososis."

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Ekanayake L, Van Der Hoek W - "Dental caries and developmental defects of enamel in relation to fluoride levels in drinking water in an arid area of Sri Lanka" Caries Research 36: 398-404 (2002)

"Both the caries prevalence and the mean caries experience were significantly higher in children with diffuse opacities (dental
fluorosis) than in those without..."

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Elias-Boneta AR, Psoter W, Elias-Viera AE, Jimenez P, Toro C - "Relationship between dental caries experience (DMFS) and dental fluorosis in 12-year-old Puerto Ricans" Community Dent Health 23(4):244-50 (2006)

"....individual level fluorosis scores when dichotomized as 0-2 as the referent level to level 3-4 demonstrated a statistical significant higher DMFS with the higher fluorosis level."

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Grobleri SR, van Wyk CW, Kotze D - "Relationship between enamel fluoride levels, degree of fluorosis and caries experience in communities with a nearly optimal and a high fluoride level in the drinking water" Caries Research 20 (3):284-8 (1986)

"Very interestingly and in agreement with Retief et al. [1979a] and Schamschula et al. [1979], a significant (p < 0.02) positive association was found between the caries experience (DMFS) and the enamel fluoride level of children from the high fluoride area (3.70)."

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Grobleri SR, Louw AJ, van Kotze TJ - "Dental fluorosis and caries experience in relation to three different drinking water fluoride levels in South Africa" Int J Paediatr Dent 11(5):372-9 (2001)

"Significantly (P < 0.01) more children had decayed teeth in the high F area than in the other two areas. The results suggest a positive association between high F levels in the drinking water and dental caries."

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Ibrahim YE, Bjorvatn K, Birkeland JM - "Caries and dental fluorosis in a 0.25 and a 2.5 ppm fluoride area in the Sudan" Int J Paediatr Dent 7(3):161-6 (1997)

"Analyses based on children in the 2.5 ppm area alone, showed significantly higher DMFT (Decayed, Missing, and Filled Teeth) by increased severity of dental fluorosis."

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Levy SM - "An update on fluorides and fluorosis" Journal of the Canadian Dental Association 69: 286-91 (2001)

"With more severe forms of fluorosis, caries risk increases because of pitting and loss of the outer enamel."

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Manji F, Kapila S - "Fluorides and fluorosis in Kenya. Part III: Fluorides, fluorosis and dental caries" Odontostomatol Trop 9(3):135-9 (1986)

"The WHO/FAO/UNICEF study (Bohdal, Gibbs and Simmons 1968) in which some 19,000 individuals were examined, a strong positive relationship between the presence of fluorosis and the occurence of dental caries were reported, though the degree of severity of fluorosis was found not to be associated with the incidence of caries."

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Mann J, Mahmoud W, Ernest M, Sgan-Cohen H, Shoshan N, Gedalia I - "Fluorosis and dental caries in 6-8-year-old children in a 5 ppm fluoride area" Community Dent Oral Epidemiol 18(2):77-9 (1990)

"The decay rate in the permanent dentition gradually increased with increasing fluorosis severity..."

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Mann J, Tibi M, Sgan-Cohen HD - "Fluorosis and caries prevalence in a community drinking above-optimal fluoridated water" Community Dent Oral Epidemiol 15(5):293-5 (1987)

"A statistically significant positive association was found between caries prevalence and fluorosis; the more caries experienced, the more severe the fluorosis level. Boys experienced significantly higher fluorosis levels than girls."

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Nanayakkara D, et al. - "Dental fluorosis and caries incidence in rural children residing in a high fluoride area in the dry zone of Sri Lanka" Ceylon J Med Sci 42:13-17 (1999)

"The prevalence of caries increased as the degree of fluorosis increased. The mean DMFT was 0.43 in children showing no fluorosis but increased up to 1.65 in children showing a fluorosis score of 3."

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Olsson B - "Dental findings in high-fluoride areas in Ethiopia" Community Dent Oral Epidemiol 7(1):51-6 (1979)

"Teeth with moderate and severe fluorosis more frequently had dental caries than teeth with no or very mild and mild fluorosis.... Gingivitis was seen in 97% of the children..."

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Ramezani GH, Valaei N, Eikani H- "Prevalence of DMFT and fluorosis in the students of Dayer city (Iran)" J Indian Soc Pedod Prev Dent 22(2):49-53 (2004)

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Wondwossen F, Astrom AN, Bjorvatn K, Bardsen A - "The relationship between dental caries and dental fluorosis in areas with moderate- and high-fluoride drinking water in Ethiopia" Community Dent Oral Epidemiol 32(5):337-44 (2004)

"Independent of the fluoride concentration in drinking water, caries prevalence increased consistently with increasing severity of dental fluorosis in the second molars, first molars, premolars and canines."

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Wozniak K - "Developmental abnormalities of mineralization in populations with varyingexposure to fluorine compounds" Ann Acad Med Stetin 46:305-15 (2000)

"Children with developmental defects of dental enamel had a significantly higher incidence of caries and elevated mean DMF, as compared to children without any abnormalities of mineralization."

Teotia SPS, Teotia M - "Dental Caries: A Disorder of High Fluoride and Low Dietary Calcium Interactions (30 Years of Personal Experience" Fluoride 27: 59-66 (1994)

"Our findings indicate that dental caries was caused by high fluoride and low dietary calcium intakes, separately and through their interactions. Dental caries was most severe and complex in calcium-deficient children exposed to high intakes of endemic fluoride in drinking water."

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In Vitro:

Waidyasekera PG, Nikaido T, Weerasinghe DD, Wettasinghe KA, Tagami J - "Caries susceptibility of human fluorosed enamel and dentine" J Dent. 2006 Nov 30

Other recent studies involving topical applications:

Cunha-Cruz J - "Teacher-supervised toothbrushing with fluoride has little effect on dental caries prevention" J Evid Based Dent Pract 5(4):202-4 (2005)

Bretz W - "No benefit from regular 6-month fluoride gel applications in low-risk caries individuals" J Evid Based Dent Pract 6(2):183-4 (2006)

SEE ALSO: DF = Increase in Caries

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