Journal Article

Risk Factors for Enamel Fluorosis in a Nonfluoridated Population

David G. Pendrys, Ralph V. Katz and Douglas E. Morse

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 143, issue 8, pages 808-815
Published in print April 1996 | ISSN: 0002-9262
e-ISSN: 1476-6256 | DOI:
Risk Factors for Enamel Fluorosis in a Nonfluoridated Population

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The purpose of this case-control investigation was to investigate the possible association between mild to moderate enamel fluorosis and exposure during early childhood to fluoride supplements, fluoride toothpaste, and/or infant formula use in nonfluoridated communities. Analysis was performed on 460 10- to 13-year-old children, born after 1979, who were residents of six nonfluoridated communities in Massachusetts and Connecticut. The fluorosis status of the subjects was determined on the basis of a clinical dental examination using the Fluorosis Risk Index (FRI). Risk factor exposure was ascertained via a mailed questionnaire with a response rate of 90% and a questionnaire reliability of 87%. Logistic regression analyses revealed a moderate association between mild-to-moderate enamel fluorosis on early forming (FRI classification l) enamel surfaces and both fluoride supplement use (odds ratio (OR) = 2.25, 95% confidence interval (CI) 1.08–4.69) and early toothbrushing habits (OR = 2.56, 95% CI 1.34–4.88). There was a strong association between mild-to-moderate fluorosis on later forming (FRI classification ll) enamel surfaces and both supplement use (OR = 7.97, 95% CI 2.98–21.33) and early toothbrushing habits (OR = 4.23, 95% CI 1.72–10.41). Infant formula was not found to be associated with fluorosis on either FRI classification I or II surfaces. Am J Epidemiol 1996; 143: 808–15.

Keywords: dental enamel; epidemiologic methods; fluorides; mottled enamel; risk

Journal Article.  0 words. 

Subjects: Public Health and Epidemiology

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