Enamel Fluorosis in Fluoridated Communities in New South Wales

Objectives: This survey was conducted to the follow-up to the baseline caries experience survey conducted in association with the introduction of water fluoridation in the Blue Mountains region in 1992 and in comparison to the Hawkesbury region, already fluoridated since 1968 as part of Sydney. The water supply in Sydney is fluoridated to a target concentration of 1.0 ppm. Methods: 1,352 randomly selected children aged 6 to 13 years were examined according to Dean's index. Results: (1)The Community Fluorosis Index (CFI) for the combined Blue Mountains and Hawkesbury regions was 0.66. (2) 70% of children started brushing their teeth with toothpaste before the age of 2 years. (3) 70% of the children examined had lifelong exposure to fluoridated water. (4) Children using tank water as the domestic source were 50 percent less likely to have mild or more severe fluorosis. (5) Children using fluoride mouthrinses were three times more likely to have mild or more severe fluorosis - 17 percent of these children commenced rinsing before the age of 5 years. Conclusions: It is concluded that, the higher than expected prevalence and severity of fluorosis was due mainly to the combined risk posed by the fluoridated water and toothpaste, and for a few individuals, contributing risks are exposure to fluoride rinses and tablets. We recommend that policies regarding exposure to fluoride are monitored and that appropriate health promotion in relation to use of fluoride containing products is developed.