Relationship Between Infant Fluoride Toothpaste Usage and Fluorosis of Aesthetic Concern in Children from Non-water-fluoridated Halmstad, Sweden

Objectives: To undertake a study to determine the prevalence and severity of dental fluorosis of aesthetic concern in children aged 7-9 years, from the non-water-fluoridated city, Halmstad, Sweden, related to their fluoride exposure history during infancy. Methods: In Spring 2002, a questionnaire, distributed to a cluster random sample of 1039 parents, enquired into their child’s early oral health behaviours, and also provided photographs of previously available toothpaste packs to aid brand usage recall. The permanent upper anterior teeth were examined clinically (+10% repeats) using a modified T-F Index, and duplicate photographic records were taken. Subsequently, projected 35mm colour slides were assessed (+10% repeats) for aesthetic impact of dental fluorosis. Results: 757 (73%) returned the questionnaire, albeit full clinical and questionnaire data were available for only 53% (n=555) of the sampled children. The prevalence of fluorosis of aesthetic concern (TF score 3) was 4%, both clinically (95%CI: 3-6%) and photographically (95%CI: 2-6%). Based on repeat observations, clinical reliability was good (Kappa=0.82), as was photographical (Kappa=0.83); and clinical results showed moderate agreement with photographic assessments (Kappa=0.50). There was no increased risk of prevalence or severity of dental fluorosis associated with the many fluoride exposure risk factors examined, including usage of (1000 ppm F) toothpaste. There was a statistically significant relationship between socio-economic background and the presence or absence of fluorosis. However, logistic regression analysis did not find any statistically significant risk factors for the prevalence or severity of dental fluorosis. Conclusions: The prevalence of dental fluorosis of aesthetic concern was low. Early usage of toothpaste containing 1000 ppm F was not significantly associated with dental fluorosis of aesthetic concern.