FAN Science Watch
August 25, 2005

Issue #24: Fluorosis on the Rise according to new U.S. Survey
By Michael Connett

Today, the CDC released the findings of a new national survey of oral health in the United States. The survey found a 9% higher prevalence of dental fluorosis in American children than was found in a similar survey 20 years ago. In addition, the survey provides further evidence that black Americans suffer from higher rates of fluorosis than whites. See CDC’s report at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5403a1.htm

The new survey being referred to is ‘The National Health and Nutrition Examination Survey’ (NHANES). It was conducted during the years 1999-2002.

The NHANES survey found an overall dental fluorosis rate of 32% among U.S. school children aged 6 to 19 years old. This compares to an incidence of 22.8% reported in the last national survey of fluorosis, conducted by the National Institute of Dental Research (NIDR) in 1986-87.

The NHANES survey also found that black Americans are more affected by fluorosis than whites. According to CDC:

In sum, the new survey data released today by CDC confirms that total fluoride exposure among U.S. children A) remains too high, B) may be increasing, and C) needs to be lowered.

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UPDATE (March 2007): CDC Releases New Fluorosis Data

In March of 2007, the CDC provided updated information on the rate of dental fluorosis among US schoolchildren. According to this latest information, 41% of children aged 12-15 now have some form of fluorosis, whereas 36% of children 16-19 have fluorosis. The CDC provided this information at a conference of the International Association of Dental Research (IADR). A summary of CDC's presentation can be found online at: http://iadr.confex.com/iadr/2007orleans/techprogram/abstract_92598.htm

The following is an excerpt:

Prevalence of Enamel Fluorosis Among 12-19 Year-Olds, U.S., 1999-2004

E. BELTRAN, Centers for Disease Control and Prevention, Atlanta, GA, USA, and L. BARKER, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA

Objective: To describe the prevalence of enamel fluorosis among adolescents aged 12 to 15 and 16 to 19 years using data from the three most recent cycles of the National Health and Nutrition Examination Surveys (NHANES) in the U.S: 1999-2000, 2001-2002, and 2003-2004. Methods: NHANES is an ongoing survey of representative samples of the civilian non institutionalized U.S. population. Intraoral examinations were conducted by seven trained dentists using standardized criteria, with no examiner serving in all three cycles. Enamel fluorosis was assessed in all permanent teeth using Dean's Fluorosis Index (DFI). Data were analyzed in SAS and SUDAAN to account for the complex sample design. Results: Table below presents percentages (standard errors) and prevalence of fluorosis, including very mild or higher severity. Conclusions: Between 1999 and 2004, approximately 41% of adolescents aged 12 to 15 and 36% aged 16 to 19 years had enamel fluorosis. Moderate and severe fluorosis was observed in less than 4% in both age groups. Considering the little historical change in fluoride sources and practices at the age these adolescents were at risk for fluorosis, differences among data cycles suggest inter-examiner variability.