Prevalence of Fluorosis in a Non-Fluoridated Community

During late 1980s water fluoridation in Puerto Rico was discontinued due to budgetary constraints. In 1998 the government of Puerto Rico mandated water fluoridation of the island drinking water; however, as of today fluoridation has not been implemented.

Objectives:  To estimate the prevalence of fluorosis among twelve-year old Puerto Ricans in 2011 and compare the findings to those from 1997. 

Methods:  A probabilistic stratified sample of 12-year-old schoolchildren was selected from 11 health reform regions of Puerto Rico, according to type of school (public or private). Standardized and calibrated examiners performed visual oral examination using NIDCR guidelines. Modified Dean's index (DI) was used to classify fluorosis lesions into none (DI =0), very mild (DI=1), mild (DI=2), moderate (DI=3) and severe (DI=4). Community fluorosis index was calculated for the overall island of Puerto Rico.

Results: 1,548 schoolchildren were examined for fluorosis, 47% were males and 53% were females. The overall prevalence for fluorosis has increased from 33% in 1997 to 39% in 2011; however, less children had moderate or severe fluorosis in 2011 (1.4%) compared to 1997 (3%). The community fluorosis index did not significantly change from 0.46 in 1997 to 0.47 in 2011, which is considered of borderline public health significance. Public and private school attendees had similar fluorosis prevalence (39% and 38% respectively); fluorosis was more prevalent among females (42%) than males (36%).

Conclusion: The overall prevalence of fluorosis in Puerto Rico had slightly increased over the past 14 years; however, we observed a decrease in occurrence of moderate and severe fluorosis.