Does water fluoridation affect the prevalence of enamel fluorosis differently among racial and ethnic groups?

J Public Health Dent. 2018 Mar;78(2):95-99. doi: 10.1111/jphd.12258. Epub 2017 Nov 24.


Objectives: There are reports showing higher prevalence of enamel fluorosis among African-American children. This study was conducted to assess whether the effect of water fluoride level on enamel fluorosis is different among different race/ethnicity groups among US school children.

Methods: Data from the National Survey of Oral Health of US School Children 1986-1987 were analyzed to determine the prevalence of enamel fluorosis among 7-17 year-old children. The association between race/ethnicity and enamel fluorosis was examined using logistic regression modeling after controlling for potential confounders age, gender, water fluoridation, other sources of fluoride, and region of residence.

Results: The prevalence of very mild to severe enamel fluorosis was 20.8 (95% CI, 15.4, 26.3) and 25.7 (95% CI, 15.0, 36.5) percent among non-Hispanic White and non-Hispanic Black children, respectively. Neither the adjusted odds ratio of 1.3 (0.8, 2.0) for the non-Hispanic Black group nor the interaction effect between non-Hispanic Black and water fluoridation were statistically significant.

Conclusions: Enamel fluorosis was not associated with race/ethnicity. Our analysis suggests that exposure to similar levels of fluoride in the water does not appear to place certain race/ethnic groups at a higher risk for developing enamel fluorosis, and lowering the optimal range of drinking water fluoride to a single value of 0.7 ppm will provide a level of protection against enamel fluorosis that will benefit all race/ethnicity groups.

Keywords: enamel fluorosis; prevalence; race and ethnicity.

MeSH terms

  • Adolescent
  • Child
  • Dental Enamel
  • Ethnicity
  • Fluoridation*
  • Fluorides
  • Fluorosis, Dental*
  • Humans
  • Prevalence


  • Fluorides