Spencer A John, Do Loc G
Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia.
Community Dent Oral Epidemiol. 2008 Jun;36(3):210-8. doi: 10.1111/j.1600-0528.2007.00389.x.
Research in the last decade has shown changing exposure patterns to discretionary fluorides and declining prevalence of fluorosis among South Australian children, raising the question of how risk factors for fluorosis have changed.
To examine and compare risk factors for fluorosis among representative samples of South Australian children in 1992/1993 and 2002/2003.
Similar sampling strategies and data collection methods were employed in the Child Fluoride Study (CFS) Marks 1 (1992/1993) and 2 (2002/2003). Participants in each CFS round were examined for fluorosis using the Thylstrup and Fejerskov (TF) Index. Exposure history was collected for fluoride in water, toothpaste, fluoride supplements and infant formula, allowing for a fluorosis risk assessment analysis. Data were re-weighted to represent the child population at each time. Changes in prevalence of fluorosis, defined as having a TF score of 1+ on maxillary central incisors, fluoride exposure and risk factors between the two rounds were evaluated.
A total of 375 and 677 children participated in the 1992/1993 and 2002/2003 rounds respectively. Prevalence of fluorosis declined significantly from 45.3% to 25.9%. Reduced use of fluoride supplements and increased use of 400-550-ppm children F toothpaste were the most substantial fluoride exposure changes. Early toothpaste use, residence in fluoridated areas and fluoride supplement use were the risk factors in 1992/1993. Early toothpaste use and fluoride supplement use were not risk factors, leaving fluoridated water as the only risk factor among the common variables in 2002/2003. In an analysis stratified by the type of fluoridated toothpaste in 2002/2003, the large amount of toothpaste used was a risk factor in those who used 1000-ppm fluoridated toothpaste, and eating/licking toothpaste when toothpaste use started was a risk factor among children who used either 1000-ppm or 400-550-ppm fluoridated toothpaste.
Introduction of the 400-550-ppm F toothpaste and use of smaller amount of toothpaste restricted risk associated with early toothpaste use. Less use and possibly a stricter fluoride supplements regimen also restricted fluorosis risk. Periodic monitoring of risk of fluorosis is required to adjust guidelines for fluoride use in caries prevention.
过去十年的研究表明，南澳大利亚儿童接触自由氟化物的模式发生了变化，氟中毒患病率有所下降，这引发了氟中毒风险因素如何变化的问题。
研究并比较1992/1993年和2002/2003年南澳大利亚儿童代表性样本中氟中毒的风险因素。
儿童氟化物研究（CFS）的第1阶段（1992/1993年）和第2阶段（2002/2003年）采用了相似的抽样策略和数据收集方法。每轮CFS的参与者均使用蒂尔斯楚普和费耶斯科夫（TF）指数检查氟中毒情况。收集了饮用水、牙膏、氟补充剂和婴儿配方奶粉中氟化物的接触史，以便进行氟中毒风险评估分析。对数据进行重新加权，以代表每个时期的儿童总体情况。评估了两轮之间氟中毒患病率（定义为上颌中切牙TF评分为1+）、氟化物接触情况和风险因素的变化。
1992/1993年和2002/2003年分别有375名和677名儿童参与。氟中毒患病率从45.3%显著下降至25.9%。氟补充剂使用减少和400 - 550ppm儿童含氟牙膏使用增加是氟化物接触情况最显著的变化。1992/1993年，早期使用牙膏、居住在氟化地区和使用氟补充剂是风险因素。早期使用牙膏和使用氟补充剂在2002/2003年不是风险因素，在常见变量中，氟化水是唯一的风险因素。在按2002/2003年含氟牙膏类型分层的分析中，大量使用牙膏是使用1000ppm含氟牙膏者的风险因素，开始使用牙膏时进食/舔舐牙膏是使用1000ppm或400 - 550ppm含氟牙膏儿童的风险因素。
引入400 - 550ppm含氟牙膏以及减少牙膏使用量限制了与早期使用牙膏相关的风险。减少使用氟补充剂以及可能更严格的氟补充剂使用方案也限制了氟中毒风险。需要定期监测氟中毒风险，以调整预防龋齿的氟化物使用指南。
