A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects/oral health-related quality of life

Community Dent Oral Epidemiol. 2010 Apr;38(2):97-109. doi: 10.1111/j.1600-0528.2009.00507.x. Epub 2009 Dec 7.


Aesthetic perceptions and oral health-related quality of life concerning dental fluorosis have been assessed in several studies during the past two decades. However, no comprehensive review article summarizing the studies investigating this issue has been published.

Objective: To assess the relationships between perceptions of dental appearance/oral health-related quality of life (OHRQoL) and dental fluorosis.

Methods: The PubMed database was searched using the Medical Subject Headings (MeSH) for English-language studies from 1985 to March 2009. Thirty-five articles qualified for inclusion and then were classified into three categories based on the type of study approach: (i) respondent review of photographs and assessment concerning satisfaction/acceptance, (ii) respondent assessment of study subject's teeth concerning satisfaction/acceptance, and (iii) respondent assessments of the psychosocial/OHRQoL impact.

Results: There were varied results from earlier studies focused on satisfaction/acceptance of very mild to mild fluorosis. More recent studies with methodological improvements to assess impact on quality of life clearly showed that mild fluorosis was not a concern. Furthermore, mild fluorosis was sometimes associated with improved OHRQoL. Severe fluorosis was consistently reported to have negative effects on OHRQoL.

Conclusion: Because dental fluorosis in the United States and other nations without high levels of naturally-occurring fluoride is mild or very mild, with little impact on OHRQoL, dental professionals should emphasize the appropriate use of fluorides for caries prevention and preventing moderate/severe fluorosis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adaptation, Psychological
  • Esthetics, Dental
  • Fluorosis, Dental / psychology*
  • Humans
  • Interpersonal Relations
  • Quality of Life*
  • Self Concept