Adolescents' perceptions of the aesthetic impact of dental fluorosis vs. other dental conditions in areas with and without water fluoridation

Abstract

BackgroundThe use of fluorides for caries prevention is well established but is linked with an increased risk of dental fluorosis, some of which may be considered to be aesthetically objectionable. Patient opinion should be considered when determining impact on aesthetics. The aim of this study was to assess participant rating of dental aesthetics (from photographic images) of 11 to 13 year olds participating in an epidemiological caries and fluorosis survey in a fluoridated and a non-fluoridated community in Northern England.MethodsConsented participants were invited to rank in order of preference (appearance) a collage of 10 computer generated images on a touch-screen laptop. The images comprised an assortment of presentations of teeth that included white teeth, a spectrum of developmental defects of enamel and dental caries. Data were captured directly and exported into SPSS for analysis.ResultsData were available for 1553 participants. In general, there were no significant differences in the rank positions between the fluoridated and non-fluoridated communities, with the exception of teeth with caries and teeth with large demarcated opacities. Very white teeth had the highest rating in both localities. Overall, there was a trend for teeth with fluorosis to be ranked more favourably in the fluoridated community; for TF 1 and TF 2 this preference was significant (p < 0.001).ConclusionsThe results of this study suggest teeth that are uniformly very white have the highest preference. The rankings suggest teeth with a fluorosis score of TF 1 may not be considered aesthetically objectionable to this population and age group. The image depicting a tooth with caries and the image with large demarcated opacities were deemed to be the least favoured. Participant preference of images depicting fluorosis falls with increasing severity of fluorosis.

Patientrs Self-Assessment on Orofacial Aesthetic

“…These findings were different from Kershaw et al, McGrady et al and Browne et al, in which tooth color was associated with the poorest esthetic rating, as these studies did not include missing anterior teeth in their assessment criteria. [8][9][10] It is commonly thought that women were more concerned over their orofacial esthetic and more critical in judging their dental appearance [11]. In this study, both women and men expressed similar levels of satisfaction towards their orofacial esthetic.…”

A comparison of dental fluorosis in adult populations with and without lifetime exposure to water fluoridation

“…The imaging method ensured the blinding of the examiner to participant exposure to water fluoridation, this technique has been tested and calibrated with successful results and has become well established through utilization in other research studies . Using images dictated that only incisors were used for scoring; this was considered acceptable because on an aesthetic level, these are the teeth that are most important …”

“…Many studies report the effects of fluorosis to be purely aesthetic, and that minor presentations of fluorosis are not of great concern to those affected . The links between fluorosis and psychosocial factors are limited; for example, Chankanka et al reported that at mild and moderate levels of fluorosis, there were no negative effects on oral health‐related quality of life in countries with community water fluoridation (USA, UK, Canada and Australia).…”

Water fluoridation: It really is this simple

“…[143] In a recent study, adolescents answered a questionnaire regarding the impact of enamel fluorosis on dental aesthetics, older adolescents rated photographs of mild fluorosis more favorably than younger ones. A fluorosis score indicative of moderate fluorosis was the level considered to have aesthetic significance.…”