Association Between Dental Fluorosis and Socioeconomic Status

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Submission ID :
ESPR314
Submission Type
Submission Topic
Abstract: :

Background: Dental fluorosis is a cosmetic condition that is characterized by hypomineralization of the teeth due to excess fluoride ingestion during tooth formation. Fluorosis impacts about one in four Americans between the ages of 6-49, but predominantly between the ages of 12-15. Children living in lower socioeconomic status (SES) households may not have their water supply checked for fluoride content nor receive routine dental care, which can be indicative of lower incidences of fluorosis and high incidence of dental caries. 


Objective: To assess the relationship between the prevalence of dental fluorosis and socioeconomic status among children.  


Design/Methods:  This is a retrospective database study using the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016. Inclusion criteria included subjects ages 6-18 and for whom data on fluorosis was available. Data abstracted included age, sex, race, fluorosis index levels, two year sample weights, and annual household income levels. US Census reported annual incomes were used to define low SES (below median), middle SES (equal to median), and high SES (above median) for each year. Total fluorosis was the average of the dean's fluorosis index value for all 32 teeth, ranging from 0 to 4, higher values indicating more severe fluorosis. Each patient entry was categorized as no fluorosis (average equal to 0) or yes fluorosis (average above 0 and less than or equal to 4) to indicate the incidences of fluorosis. Total fluorosis was compared to SES using a weighted chi-square test. 


Result(s): There were 6,221 children included, 51% male, 74% of whom had fluorosis. Among those who had fluorosis, 56% were lower SES, 8% were middle SES, and 36% were high SES. Chi square analysis for unweighted variables resulted in no significant difference between incidence of fluorosis and SES groups (p>.05).  Chi-square analysis for weighted variables resulted in statistically significant differences between SES and fluorosis incidence (p<.05) (Figure 1). Weighted chi-square analysis showed statistically significant differences in age, sex, SES, and race/ethnicity for those who had fluorosis and those who didn't. 


Conclusion:  With the weighted analysis, there is evidence of SES being associated with the prevalence of dental fluorosis. Future directions for fluorosis studies indicate the need for further examination of geographical location and local county fluoridation levels, tooth brushing frequency, and if SES can be a predictor of fluorosis severity. 

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Connecticut Childrens Medical Center / UConn School of Medicine
University of Connecticut
University of Connecticut
University of Connecticut
University of Connecticut
University of Connecticut
University of Connecticut
University of Connecticut
University of Connecticut
University of Connecticut
University of Connecticut
Connecticut Childrens Medical Center / UConn School of Medicine

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