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Natural history and long-term impact of dental fluorosis: a prospective cohort study

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Dental fluorosis is a developmental condition of tooth enamel caused by excessive fluoride exposure during periods of enamel formation (the first 3 years of life). Fluorotic enamel is histologically characterised by subsurface porosity. In clinical terms, fluorosis ranges from barely visible white striations to staining and pitting of the enamel.1 Systemic fluoride exposure in childhood is the necessary aetiological factor in the development of dental fluorosis.24

Dental fluorosis is the most common adverse effect of exposure to fluoride used to prevent dental caries.5 The public health importance of dental fluorosis lies in its role as a population indicator of excessive fluoride exposure. Dental fluorosis, once dismissed as a condition without public health significance, is now an important problem in oral health care for a number of reasons:

  • Reports in the scientific literature have recently elevated the prominence of dental fluorosis as an adverse outcome of fluoride use;

  • Public opinion about the safety of fluoride now routinely cites dental fluorosis as a specific concern; and

  • Recommendations about the use of fluoride should be based on evidence regarding the benefit–risk trade-off between preventing dental…