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

Consented 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.Data 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).The 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.The use of fluorides in dentistry has been associated with a decline in the prevalence of dental caries through the use of optimally fluoridated community water supplies and fluoridated oral care products. However, the presence of multiple vehicles for fluoride delivery has also been associated with concerns regarding increased prevalence of dental fluorosis in both fluoridated and non-fluoridated communities [1-4].It has been demonstrated that exposure to fluoridated water supplies in addition to the use of fluoridated dentifrices is more effective than the use of fluoridated dentifrice alone in preventing caries [1]. However, the increase in the prevalence of enamel fluorosi