Patterns of dental fluorosis in a European country in relation to the fluoride concentration of drinking water.

Dental fluorosis among 456 14-16-year-old schoolchildren who had resided continuously since birth in their respective study areas was recorded using the Thylstrup and Fejerskov classification system. The children fell into four groups according to fluoride concentration of their drinking water: (1) less than or equal to 0.1 ppm; (2) 0.3-0.5 ppm; (3) 0.5-1.25 ppm; and (4) 1.26-2.0 ppm. It was found that the later in childhood the tooth was formed, the higher was the prevalence of dental fluorosis. The fluoride concentration in the drinking water affected the prevalence of dental fluorosis in all teeth except the lower incisors, which are formed very early in life. Apart from these teeth, the proportionate increase of dental fluorosis with increasing water fluoride concentration was almost the same for all tooth types. However, the actual amount of increase in the prevalence and degree of fluorosis was greatest among those teeth that formed later during childhood. The observed fluorosis is presumed to result from and reflect the drinking water habits in the population as well as the patterns of use of fluoride prophylactics.