Global trends in dental fluorosis from 1980 to 2000: a systematic review.

AIM: To determine trends in fluorosis prevalence at water fluoride levels <0.3, >0.3 to <0.7, and >0.7 to 1.4 ppm from 1980 to 2000. METHODS: A systematic review of 55 published articles identified in a Medline search for peer-reviewed articles on fluorosis published from 1 January 1980 to 31 December 2000. The prevalence recorded with any fluorosis index was pooled and the trends over time were determined in the three water concentration categories. RESULTS: The fluorosis prevalence for the three fluoride categories were 16.7, 27.4 and 32.2 percent, respectively. A 16-fold and a 2-fold increase in fluorosis prevalence compared with reported rates in the 1940s was seen in non-fluoridated (= 0.3 ppm F) and fluoridated (>0.7 to = 1.4 ppm F) areas, respectively. There has been an increase in fluorosis prevalence over time in the three fluoride water concentration categories but linear regression analysis showed that none are significantly different from zero. CONCLUSION: This systematic review concurs with recent reports of an increase in fluorosis prevalence in fluoridated and non-fluoridated communities.