Is there also “dental fluorosis”?

FAQ on Salt Fluoridation
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Is there also “dental fluorosis”?

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Is there also “dental fluorosis”?

The incidence of dental fluorosis is said to be less common in areas where salt fluoridation is used which, as Yewe-Dyer states, "might well be because too little salt is eaten at an early age to cause this problem." (Yewe-Dyer, 2002).

If this were indeed true, it would be very disturbing news as it would mean that the most-studied and acknowledged indicator of fluoride over-exposure - dental fluorosis, would no longer be appropriate for exposure investigations. The condition can occur only from fluoride exposure during the critical times of enamel formation - from in utero to approx. 2 1/2 years of age.

In the mind of the dental public health experts - who have long declared dental fluorosis to be of “cosmetic concern” only - this translates into believing that fluoride over-exposure is not a problem for children anymore, while “benefits for caries reduction are striking”. Statements to that effect are already being made (i.e. Yewe-Dyer, 2002).

There are really two issues.

Concerning salt consumption - while while babies and toddlers might not be taking in much salt, 4 to 6 vear olds consume very much salt. Just because they don’t show dental fluorosis in their later years does not mean that their fluoride intake was or is within a “safety limit”, a fact repeatedly alerted to by UNICEF and health organizations in other countries such as India where fluoride poisoning is endemic (see UNICEF, 2001). In India the effects of fluoride poisoning - other than dental defects - are of course clearly acknowledged.

But there is something else. When the papers which claim “only neglible dental fluorosis” are investigated in-depth, a different picture emerges concerning the occurrence, and once again it becomes clear that the science is being manipulated in order to mislead the public. Two examples are given here:

EXAMPLE 1: Jamaica

The World Health Organization (WHO) has a special web page on the salt fluoridation program in Jamaica, because Jamaica was considered a “trial ground” for salt fluoridation. It cites a study which allegedly found that “ninety six percent of the children were fluorosis free, 4% had 'questionable' fluorosis and less than 1% had very mild to mild fluorosis. None of the children showed moderate or severe fluorosis.” (WHO, 2002)

However, upon closer examination one finds that the majority of children investigated were already 4 or 8 years old when the program started - well past the critical stage of enamel formation when dental fluorosis occurs!

When other researchers recently studied the children in Jamaica, they found that almost half of them showed signs of fluorosis (Meyer-Lueckel et al., 2002).

The same findings can be made when other studies proclaiming “no dental fluorosis” are investigated closer.

EXAMPLE 2: France

In France in 1991, Fabien et al, investigated 6 to 16-year-old children, stating that:

“ fluorosis was very uncommon; 96.1% of the 18,786 children examined in 1991 were totally free of any such lesions.”

Salt fluoridation in France started in 1986/1987. As this study was done in 1991 - only four years later - it means, again, that the vast majority of the investigated children (6 to 16 year-olds) had already long surpassed the critical age of enamel formation!

The truth lies somewhere else and will become more apparent as more proper research is conducted. A recent review from Mexico revealed that the prevalence of dental fluorosis ranged from 52% to 82% in areas where fluoridated salt is used (Soto-Rojas et al, 2004).


PFPC Fluoridated Salt FAQ - © 2004 PFPC


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