Effects of enamel fluorosis and dental caries on quality of life

J Dent Res. 2014 Oct;93(10):972-9. doi: 10.1177/0022034514548705. Epub 2014 Aug 25.


The objectives of this study were to determine the impact of enamel fluorosis and dental caries on oral health-related quality of life (OHRQoL) in North Carolina schoolchildren and their families. Students (n = 7,686) enrolled in 398 classrooms in grades K-12 were recruited for a onetime survey. Parents of students in grades K-3 and 4-12 completed the Early Childhood Oral Health Impact Scale (ECOHIS) and Family Impact Scale (FIS), respectively. Students in grades 4-12 completed the Child Perceptions Questionnaire (CPQ8-10 in grades 4-5; CPQ11-14 in grades 6-12). All students were examined for fluorosis (Dean's index) and caries experience (d2-3fs or D2-3MFS indices). OHRQoL scores (sum response codes) were analyzed for their association with fluorosis categories and sum of d2-3fs and D2-3MFS according to ordinary least squares regression with SAS procedures for multiple imputation and analysis of complex survey data. Differences in OHRQoL scores were evaluated against statistical and minimal important difference (MID) thresholds. Of 5,484 examined students, 71.8% had no fluorosis; 24.4%, questionable to very mild fluorosis; and 3.7%, mild, moderate, or severe fluorosis. Caries categories were as follows: none (43.1%), low (28.6%), and moderate to high (28.2%). No associations between fluorosis and any OHRQoL scales met statistical or MID thresholds. The difference (5.8 points) in unadjusted mean ECOHIS scores for the no-caries and moderate-to-high caries groups exceeded the MID estimate (2.7 points) for that scale. The difference in mean FIS scores (1.5 points) for the no-caries and moderate-to-high groups exceeded the MID value (1.2 points). The sum of d2-3fs and D2-3MFS scores was positively associated with CPQ11-14 (B = 0.240, p < .001), ECOHIS (B = 0.252, p ≤ .001), and FIS (B = 0.096, p ≤ .01) scores in ordinary least squares regression models. A child's caries experience negatively affects OHRQoL, while fluorosis has little impact.

Keywords: adolescents; children; fluoride benefits; fluoride risks; minimal important difference; oral health-related quality of life.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Cariostatic Agents / therapeutic use
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • DMF Index
  • Dental Care
  • Dental Caries / prevention & control
  • Dental Caries / psychology*
  • Educational Status
  • Family Health
  • Fluorides / therapeutic use
  • Fluorosis, Dental / classification
  • Fluorosis, Dental / psychology*
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility
  • Humans
  • North Carolina
  • Oral Health
  • Poverty / statistics & numerical data
  • Quality of Life*
  • Self Concept
  • Socioeconomic Factors


  • Cariostatic Agents
  • Fluorides