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<p>Most dental fluorosis in England is mild and unlikely to be of any concern from
a cosmetic perspective. When discussing the public health impact of this condition,
it is useful to distinguish between mild to moderate dental fluorosis and more severe
fluorosis which is likely to be of concern from a cosmetic perspective, rather than
overall levels.</p><p> </p><p>The study described in the paper by McGrady et al in
2012 photographed teeth in order to reducing potential examiner bias, a key recommendation
of the York Review. The results might therefore not be directly comparable to the
results of studies using older methodology.</p><p> </p><p>Public Health England’s
2014 water fluoridation health monitoring report was published subsequent to the responses
given on 28 October 2013 and 5 December 2013 and included a section on dental fluorosis,
drawing upon the 2012 report by McGrady et al. A copy of <em>Water Fluoridation Health
Monitoring Report for England 2014</em> is attached.</p><p> </p><p>The report displayed
the individual categories of dental fluorosis that were used in the 2012 report by
McGrady et al, including the proportion who showed no signs of dental fluorosis in
the two cities studied. This is shown in the following table.</p><p> </p><p> </p><p>
</p><p> </p><p>Descriptive data for fluorosis total-fluorosis (TF) scores by city</p><p>
</p><table><tbody><tr><td><p> </p></td><td colspan="4"><p>City</p></td><td rowspan="3"><p>p-value
(probability value)</p></td></tr><tr><td><p> </p></td><td colspan="2"><p>Newcastle
(fluoridated)</p></td><td colspan="2"><p>Manchester (non-fluoridated)</p></td></tr><tr><td><p>
</p></td><td><p>Number</p></td><td><p>%</p></td><td><p>Number</p></td><td><p>%</p></td></tr><tr><td><p>Fluorosis
TF Score</p></td><td><p> </p></td><td><p> </p></td><td><p> </p></td><td><p> </p></td><td><p>
</p></td></tr><tr><td><p>0</p></td><td><p>410</p></td><td><p>45%</p></td><td><p>638</p></td><td><p>73%</p></td><td
rowspan="7"><p>P <del class="ministerial">></del> <ins class="ministerial">less
than</ins><ins class="ministerial"> </ins>0.0001</p></td></tr><tr><td><p>1</p></td><td><p>355</p></td><td><p>39%</p></td><td><p>209</p></td><td><p>24%</p></td></tr><tr><td><p>2</p></td><td><p>79</p></td><td><p>9%</p></td><td><p>16</p></td><td><p>2%</p></td></tr><tr><td><p>3</p></td><td><p>53</p></td><td><p>6%</p></td><td><p>4</p></td><td><p>1%</p></td></tr><tr><td><p>4</p></td><td><p>8</p></td><td><p>1%</p></td><td><p>0</p></td><td><p>0%</p></td></tr><tr><td><p>5</p></td><td><p>1</p></td><td><p>0.1%</p></td><td><p>2</p></td><td><p>0.2%</p></td></tr><tr><td><p>Total</p></td><td><p>906</p></td><td><p>
</p></td><td><p>869</p></td><td><p> </p></td></tr></tbody></table><p> </p><p>The probability
values show that levels of dental fluorosis overall in fluoridated Newcastle were
higher than in non-fluoridated Manchester. The proportion of children with dental
fluorosis (TF score >0) was 55% in Newcastle compared to 27% in Manchester. Fluorosis
recorded at a level of TF3, considered to be mild or mild to moderate, was 6% in Newcastle
and 1% in Manchester. The prevalence of higher scores (TF4 or greater) was very low
in both cities.</p><p> </p><p>The methodology described in the 2012 paper by McGrady
et al may give higher estimates of dental fluorosis compared to the direct examination
by a dentist used in other surveys. The results give further assurance that there
are low levels of dental fluorosis which might be of concern from a cosmetic perspective
in both fluoridated and non-fluoridated areas.</p><p> </p>
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