Severe Dental Fluorosis and the 2006 NRC Review
© 2006 PFPC

Here is what the NRC wrote concerning the prevalence of severe dental fluorosis:

    Despite the wide range of research methods, fluorosis indexes, water fluoride measurement methods, and population characteristics in these studies conducted over a period spanning half a century, a clear trend is evident. The prevalence of severe enamel fluorosis is close to zero in communities at all water fluoride concentrations below 2 mg/L. (NRC 2006; Page 113/114)


This is entirely untrue, and the Review itself lists numerous studies documenting exactly the opposite (i.e. Yoder et al, 1998). Already in 1993, the NRC wrote the following concerning severe dental fluorosis in Augusta, Georgia:

    "More recently, a prevalence of 80.9 was reported in children 12-14 years old in Augusta, Georgia, the highest prevalence yet reported in an optimally fluoridated community in the United States (Williams and Zwemer, 1990)....moderate-to-severe fluorosis was found in 14% of the children"-  (1993 NRC Report, Page 37).

A basic overview of the literature indicates that the NRC Committee engaged in "selective use of data".

A recent review about the prevalence of dental fluorosis in Mexico (Soto-Royas et al., 2004) provides detailed figures from various studies conducted in Mexico:

Fluoride in water

Severe dental fluorosis

0.50 ppm

6.4 %

0.70 ppm

18.5 %

0.90 ppm

28 %

1.69 ppm

57 %

1.03 ppm

4.5 %

According to the NRC’s own inclusion criteria, many of these studies should have been included in the NRC Review.

Why weren’t they?


Forrest JR - "Caries incidence and enamel defects in areas with different levels of fluoride in the drinking water" Brit Dental J 100:195-200 (1956)

Ibrahim YE, Affan AA, Bjorvatn K - “Prevalence of dental fluorosis in Sudanese children from two villages with 0.25 and 2.56 ppm fluoride in the drinking water” Int J Paediatr Dent  5:223-9 (1995)

Soto-Rojas AE, Urena-Cirett JL, Martinez-Mier Ede L - “A review of the prevalence of dental fluorosis in Mexico” Rev Panam Salud Publica. 15

Yoder KM, Mabelya L, Robison VA, Dunipace AJ, Brizendine EJ, Stookey GK “Severe dental fluorosis in a Tanzanian population consuming water with negligible fluoride concentration” Community Dent Oral Epidemiol 26(6):382-93

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