Eskişehir İlindeki Çocuklarda Diş Çürüğü ve Florozis Görülme Sıklığının Değerlendirilmesi

Amaç: Bu araştırmada, Eskişehir ilindeki çocuklarda diş çürüğü ve dental florozis görülme sıklığının değerlendirilmesi amaçlandı. Ayrıca dental florozisin etiyolojik faktörleri ve dental florozis görülme sıklığının diş çürüğü ile ilişkisi de değerlendirildi. Gereç ve Yöntemler: Araştırmaya, Eskişehir ilindeki 8-12 yaş arasındaki toplam 4936 çocuk dahil edildi. Diş çürüğünün değerlendirilmesinde dft/DMFT indeksi, dental florozisin değerlendirilmesinde ise Thylstrup-Fejerskov İndeksi kullanıldı. Ayrıca çocukların ebeveynleri tarafından dental florozise neden olabileceği öne sürülen etiyolojik faktörleri içeren anamnez formu dolduruldu. Kullanılan içme sularının florür konsantrasyonları iyon kromatografi cihazı kullanılarak tespit edildi. Elde edilen verilerin istatistiksel değerlendirmesinde Mann Whitney-U Testi, Kruskal Wallis Testi ve Spearman Korelasyon testi kullanıldı. Bulgular:Araştırmaya katılan çocukların ortalama DMFT değeri 2.18±2.00, dental florozis görülme sıklığı ise % 1.9 olarak belirlendi. Dental florozis görülme sıklığı ile ilçeler arasında anlamlı bir fark olduğu (p<0.001) ve en yüksek dental florozis görülme oranının sudaki florür konsantrasyonunun optimum dozun üzerinde olan Çifteler ilçesinde (% 15.2) olduğu saptandı. Dental florozis görülmesi ile diş çürüğü arasında negatif korelasyon olduğu tespit edildi (p<0.01). Ayrıca anne/babanın eğitim düzeyi, doğumdan itibaren aynı bölgede yaşaması, anne sütü ile beslenme süresi, içme suyunun tipi, okulda kullanılan suyun tipi, macun tipi ile çocukta dental florozis görülme sıklığı arasında anlamlı bir ilişki olduğu belirlendi (p<0.05). Sonuçlar: Sonuç olarak, dental florozis görülmesinde içme suyundaki florür konsantrasyonunun yanı sıra anne sütü ile beslenme süresi ve kullanılan macun tipi gibi diğer faktörlerin de rol oynadığı ve dental florozis önlenmesinde tüm etiyolojik faktörlerin gözönünde bulundurulması gerektiğini düşünmekteyiz. Anahtar Kelimeler: Çocuk, Dental Florozis, Diş Çürüğü, Eskişehir

Anahtar Kelimeler:

Çocuk, Dental Florozis, Diş Çürüğü, Eskişehir

Evaluation of Dental Caries and Fluorosis Prevalence of Children in Eskisehir

Background:This study aimed to evaluate the prevalence of the dental caries and dental fluorosis in children living in Eskisehir. The etiological factors of the dental fluorosis and the correlation of the prevalence of dental fluorosis between dental caries were also determined. Methods: 4936 children between 8-12 years-old in Eskisehir were included. dft/DMFT and Thylstrup-Fejerskov index were used for the evaluation of the dental caries and fluorosis. Furthermore, the parents of the children were asked to fulfill an anamnesis form including the etiological factors, which were considered as the possible cause of the dental fluorosis. The fluoride concentrations of the drinking water were determined by the ion-chromatography. Statistical analysis was performed using Mann Whitney-U, Kruskal Wallis and the Spearman's Correlation Tests. Results: The mean DMFT score was 2.18±2.00, dental fluorosis prevalence was 1.9 % in the participating children. There was a significant difference between the towns regarding the prevalence of the dental fluorosis (p<0.001). The highest prevalence of dental fluorosis was determined in Cifteler (15.2 %), where the flour concentration in the water was above the optimal dose. A negative correlation was determined between the prevalence of the dental fluorosis and caries (p<0.01). Furthermore, a significant correlation was also determined between the dental fluorosis and the parental education level, living in the same region since birth, duration of the feeding with the mother's milk, the type of the drinking water, the type of the water used in the school and the type of the toothpaste (p<0.05). Conclusions: We conclude that along with the fluoride concentration in the drinking water also other factors such as the duration of the feeding with the mother's milk and the type of the used toothpaste are playing an important role in the prevalence of the dental fluorosis and all etiological factors should be taken into the consideration for the prevention it. Keywords:Child, Dental Fluorosis, Dental Caries, Eskisehir.

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Referans1. Pinkham JR. The Practical İmportance of Pediatric Dentistry. Pinkham JR, editor. Pediatric Dentistry Infancy Through Adolescence. 2nd ed. W.B. Saunders Company; 1994. p.2-11.
Referans2. Adair SM. Evidence-based use of fluoride in contemporary pediatric dental practice. Pediatr Dent 2006;28:133-42; discussion 92-8.
Referans3. Aoba T, Fejerskov O. Dental fluorosis: chemistry and biology. Crit Rev Oral Biol Med 2002;13:155-70.
Referans4. Whelton H, Crowley E, O'Mullane D, Donaldson M, Kelleher V, Cronin M. Dental caries and enamel fluorosis among the fluoridated and non-fluoridated populations in the Republic of Ireland in 2002. Community Dent Health 2004;21:37-44.
Referans5. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet 2007; 369:51-9.
Referans6. Abanto Alvarez J, Rezende KM, Marocho SM, Alves FB, Celiberti P, Ciamponi AL. Dental fluorosis: exposure, prevention and management. Med Oral Patol Oral Cir Bucal 2009;14:E103-7.
Referans7. Anuradha B, Laxmi GS, Sudhakar P, Malik V, Reddy KA, Reddy SN, et al. Prevalence of dental caries among 13 and 15-year-old school children in an endemic fluorosis area: a cross-sectional study. J Contemp Dent Pract 2011;12:447-50.
Referans8. Narwaria YS, Saksena DN. Prevalence of dental fluorosis among primary school children in rural areas of Karera Block, Madhya Pradesh. Indian J Pediatr 2013;80:718-20.
Referans9. Larsen MJ, Richards A, Fejerskov O. Development of dental fluorosis according to age at start of fluoride administration. Caries Res 1985;19:519-27.
Referans10. Horowitz HS. Indexes for measuring dental fluorosis. J Public Health Dent 1986;46:179-83.
Referans11. Levy SM. An update on fluorides and fluorosis. J Can Dent Assoc 2003;69:286-91.
Referans12. Aguilar-Diaz FC, Irigoyen-Camacho ME, Borges-Yanez SA. Oral-health-related quality of life in schoolchildren in an endemic fluorosis area of Mexico. Qual Life Res 2011;20:1699-706.
Referans13. Ferreira EF, Vargas AM, Castilho LS, Velasquez LN, Fantinel LM, Abreu MH. Factors associated to endemic dental fluorosis in Brazilian rural communities. Int J Environ Res Public Health 2010;7:3115-28.
Referans14. Sharma A. Fluoride and Fluorosis, 1st edn. New Delhi: Jaypee Brothers Medical Publishers, 2014. p.1-98.
Referans15. Grobler SR, van Wyk CW, Kotze D. Relationship between enamel fluoride levels, degree of fluorosis and caries experience in communities with a nearly optimal and a high fluoride level in the drinking water. Caries Res 1986;20:284-8.
Referans16. Ekstrand J, Fejerskov O, Silverstone LM. Fluoride in Dentistry, 1st edn. Copenhagen: Munksgaard, 1988. p.13-28, 171-276.
Referans17. Szpunar SM, Burt BA. Dental caries, fluorosis, and fluoride exposure in Michigan schoolchildren. J Dent Res 1988;67:802-6.
Referans18. DenBesten PK, Thariani H. Biological mechanisms of fluorosis and level and timing of systemic exposure to fluoride with respect to fluorosis. J Dent Res 1992;71:1238-43.
Referans19. Menon A, Indushekar KR. Prevalence of dental caries and co-relation with fluorosis in low and high fluoride areas. J Indian Soc Pedod Prev Dent 1999;17:15-20.
Referans20. Şaroğlu I, Aras Ş. Florozis. Ankara Üniv Diş Hekim Fak Derg 2001;28:239-50.
Referans21. Hujoel PP, Zina LG, Moimaz SA, Cunha-Cruz J. Infant formula and enamel fluorosis: a systematic review. J Am Dent Assoc 2009;140:841-54.
Referans22. Levy SM, Broffitt B, Marshall TA, Eichenberger-Gilmore JM, Warren JJ. Associations between fluorosis of permanent incisors and fluoride intake from infant formula, other dietary sources and dentifrice during early childhood. J Am Dent Assoc 2010;141:1190-201.
Referans23. Do LG, Levy SM, Spencer AJ. Association between infant formula feeding and dental fluorosis and caries in Australian children. J Public Health Dent 2012;72:112- 21.
Referans24. Şendil Ç , Bayşu N . İnsan ve hayvanlarda Ağrı ili Doğubeyazıt ilçesi köylerinde görülen flor zehirlenmesi ve bunu Van ı̇li Muradiye ilçesi köylerinde de saptamamızla ilgili ilk tebliğ. Ankara Üniv Vet Fak Derg 1973;10:474-89.
Referans25. Oruç N , Alpman N , Karamanderesi İH . Tendürek volkanı çevresindeki yüksek fluorür içerikli kaynak sularının hidrojelojisi. Türkiye Jeoloji Kurumu Bülteni 1976;19:1-8.
Referans26. Usmen E. Isparta il, ilçe ve köylerinde diş fluorosisi. İstanbul Üniv Diş Hekim Fak Derg 1976;10:285-96.
Referans27. Fidanci UR, Salmanoğlu B, Maraşli S, Maraşli N. İç Anadolu bölgesinde doğal ve endüstriyel florozis ve bunun hayvan sağlığı üzerindeki etkileri . Turk J Vet Anim Sci 1998;22:537-44.
Referans28. Altıntaş A, Fidancı UR, Sel T, Duru Ö, Başsatan A. Doğal ve endüstriyel florozisli koyunlarda böbrek fonksiyonu ve serum protein elektroforezi. Ankara Üniv Vet Fak Derg 2000;47:105-14.
Referans29. Fidanci UR, Sel T. The industrial fluorosis caused by a coal-burning powerstation and its effects on sheep. Turk J Vet Anim Sci 2001;25:735-41.
Referans30. Savas S, Cetin M, Akdogan M, Heybeli N. Endemic fluorosis in Turkish patients: relationship with knee osteoarthritis. Rheumatol Int 2001;21:30-5.
Referans31. Oruc N. Occurrence and problems of high fluoride waters in Turkey: an overview. Environ Geochem Health 2008;30:315-23.
Referans32. Çelik EU, Çelik B, Önal S, Örmeci A, Ulutaş H . Isparta ilı̇ndekı̇ 11-12 yaşındakı̇ çocukların diş çürüğü ve florozı̇s prevalansının değerlendirilmesi. Atatürk Üniv Diş Hekim Fak Derg 2010;20:170-5.
Referans33. Jackson RD, Kelly SA, Katz BP, Hull JR, Stookey GK. Dental fluorosis and caries prevalence in children residing in communities with different levels of fluoride in the water. J Public Health Dent 1995;55:79-84.
Referans34. Ibrahim YE, Bjorvatn K, Birkeland JM. Caries and dental fluorosis in a 0.25 and a 2.5 ppm fluoride area in the Sudan. Int J Paediatr Dent 1997;7:161-6.
Referans35. Stephen KW, Macpherson LM, Gilmour WH, Stuart RA, Merrett MC. A blind caries and fluorosis prevalence study of school-children in naturally fluoridated and nonfluoridated townships of Morayshire, Scotland. Community Dent Oral Epidemiol 2002;30:70-9.
Referans36. Ekanayake L, van der Hoek W. Prevalence and distribution of enamel defects and dental caries in a region with different concentrations of fluoride in drinking water in Sri Lanka. Int Dent J 2003;53:243-8.
Referans37. Wondwossen F, Astrom AN, Bjorvatn K, Bardsen A. The relationship between dental caries and dental fluorosis in areas with moderate- and high-fluoride drinking water in Ethiopia. Community Dent Oral Epidemiol 2004;32:337-44.
Referans38. Ruan JP, Yang ZQ, Wang ZL, Astrom AN, Bardsen A, Bjorvatn K. Dental fluorosis and dental caries in permanent teeth: rural schoolchildren in high-fluoride areas in the Shaanxi province, China. Acta Odontol Scand 2005;63:258-65.
Referans39. Narbutaité J, Vehkalahti MM, Milciuviené S. Dental fluorosis and dental caries among 12-yr-old children from high- and low-fluoride areas in Lithuania. Eur J Oral Sci 2007;115:137-42.
Referans40. AlDosari AM, Akpata ES, Khan N. Associations among dental caries experience, fluorosis, and fluoride exposure from drinking water sources in Saudi Arabia. J Public Health Dent 2010;70:220-6.
Referans41. Shekar C, Cheluvaiah MB, Namile D. Prevalence of dental caries and dental fluorosis among 12 and 15 years old school children in relation to fluoride concentration in drinking water in an endemic fluoride belt of Andhra Pradesh. Indian J Public Health 2012;56:122-8.
Referans42. Do LG, Miller J, Phelan C, Sivaneswaran S, Spencer AJ, Wright C. Dental caries and fluorosis experience of 8-12-year-old children by early-life exposure to fluoride. Community Dent Oral Epidemiol 2014;42:553-62.
Referans43. Ermis RB, Koray F, Akdeniz BG. Dental caries and fluorosis in low- and high fluoride areas in Turkey. Quintessence Int 2003;34:354-60.
Referans44. World Health Organization, Oral Health Surveys Basic Methods. 5th edn. Geneva: World Health Organization Publications, 2013. p.13-125.
Referans45. Thylstrup A, Fejerskov O. Clinical appearance of dental fluorosis in permanent teeth in relation to histologic changes. Community Dent Oral Epidemiol 1978;6:315-28.
Referans46. Aksit MA, Tel E, Bilir S. Kızılcaören-a health survey in an endemic fluorosis village. Fluoride 1980;13:81-5.
Referans47. Dean HT. Classification of mottled enamel diagnosis. J Am Dent Assoc 1934;21:1421-6.
Referans48. Pendrys DG. The fluorosis risk index: a method for investigating risk factors. J Public Health Dent 1990;50:291-8.
Referans49. Burger P, Cleaton-Jones P, du Plessis J, de Vries J. Comparison of two fluorosis indices in the primary dentition of Tswana children. Community Dent Oral Epidemiol 1987;15:95-7.
Referans50. Rozier RG. Epidemiologic indices for measuring the clinical manifestations of dental fluorosis: overview and critique. Adv Dent Res 1994;8:39-55.
Referans51. Horowitz HS, Driscoll WS, Meyers RJ, Heifetz SB, Kingman A. A new method for assessing the prevalence of dental fluorosis--the Tooth Surface Index of Fluorosis. J Am Dent Assoc 1984;109:37-41.
Referans52. Pereira AC, Moreira BH. Analysis of three dental fluorosis indexes used in epidemiologic trials. Braz Dent J 1999;10:29-37.
Referans53. Evans RW. An epidemiological assessment of the chronological distribution of dental fluorosis in human maxillary central incisors. J Dent Res 1993;72:883-90.
Referans54. Layola-Rodriguez JP, Pozos-Guillen AJ, Hernandez-Guerrero JC, Hernandez-Sierra JE. Fluorosis in primary dentition in a region with endemic water fluoride. Salud Publica Mex 2000;42:194-200.
Referans55. Funmilayo AM, Mojirade AD. Dental Fluorosis and its Indices, what‟s new? IOSR-JDMS 2014;13:55-60.
Referans56. Granath L, Widenheim J, Birkhed D. Diagnosis of mild enamel fluorosis in permanent maxillary incisors using two scoring systems. Community Dent Oral Epidemiol 1985;13:273-6.
Referans57. Demer SA, Memiş Ü. Isparta il merkezinde içme sularının farklı florür içeriklerinin incelenmesi. Ekoloji 2011;20:77-82.
Referans58. Işıklı B, Kalyoncu C, Metintaş S, Demir TA. Eskişehir yöresindeki içme sularında florür düzeyleri. Ekoloji 2009;9:28-30.
Referans59. Brahman KD, Kazi TG, Afridi HI, Naseem S, Arain SS, Ullah N. Evaluation of high levels of fluoride, arsenic species and other physicochemical parameters in underground water of two sub districts of Tharparkar, Pakistan: a multivariate study. Water Res 2013;47:1005-20.
Referans60. Cochrane NJ, Hopcraft MS, Tong AC, Thean H, Thum YS, Tong DE, et al. Fluoride content of tank water in Australia. Aust Dent J 2014;59:180-6.
Referans61. Maraver F, Vitoria I, Almerich-Silla JM, Armijo F. Fluoride content of bottled natural mineral waters in Spain and prevention of dental caries. Aten Primaria 2015;47:15-24.
Referans62. Ley P, Sturm M, Ternes TA, Meermann B. High-resolution continuum source graphite furnace molecular absorption spectrometry compared with ion chromatography for quantitative determination of dissolved fluoride in river water samples. Anal Bioanal Chem 2017;409:6949-58.
Referans63. Singh RP, Smesko SA, Abbas NM. Ion chromatographic characterization of toxic solutions: analysis and ion chemistry of biological liquids. J Chromatogr A 1997;774:21-35.
Referans64. Itota T, Carrick TE, Rusby S, Al-Naimi OT, Yoshiyama M, McCabe JF. Determination of fluoride ions released from resin-based dental materials using ionselective electrode and ion chromatograph. J Dent 2004;32:117-22.
Referans65. Koksal E, Tekcicek M, Yalcin SS, Tugrul B, Yalcin S, Pekcan G. Association between anthropometric measurements and dental caries in Turkish school children. Cent Eur J Public Health 2011;19:147-51.
Referans66. Yılmaz AB, Orbak R, Çanakçı N, Nişli ON, Eminoğlu A. Erzurum ve Düzce'de 6-12 yaş grubu bireylerde CPITN, df, dmf indekslerini kullanarak periodontal hastalıklar ile diş çürüğünün değerlendirilmesi ve iki bölgenin karşılaştırılması. Atatürk Üniv Diş Hekim Fak Derg 1997;7:5-11.
Referans67. Öztunç H, Haytaç MC, Özmeriç N, Uzel İ. Adana ilinde 6-11 yaş grubu çocukların ağız-diş sağlığı durumlarının değerlendirilmesi (Adana DSİ İlköğretim Okulu, 1999). Gazi Üniv Diş Hek Fak Derg 2000;17:1-6.
Referans68. Altun C, Güven G, Başak F, Akbulut E. Altı-onbir yaş grubu çocukların ağız-diş sağlığı yönünden değerlendirilmesi. Gülhane Med J 2005;47:114-8.
Referans69. Akıncı T, Aktören O, Sepet E, Oray H, Sağlam E, Burmabıyıkoğlu S, et al. İstanbul Büyükçekmece ilçesi ilkokul çocuklarında diş çürüğü sıklığı. İstanbul Üniv Diş Hekim Fak Derg 1998;32:16-21.
Referans70. Güler Ç, Eltaş E, Güneş D, Görgen VA, Ersöz M. Malatya ilindeki 7-14 yaş arası çocukların ağız-diş sağlığının değerlendirilmesi. İnönü Üniv Sağlık Bilim Derg 2012;1:19-24.
Referans71. Gökalp S, Güçiz Doğan B, Tekçiçek M, Berberoğlu A, Ünlüer Ş. Beş, on iki ve on beş yaş çocukların ağız diş sağlığı profili, Türkiye-2004. Hacettepe Diş Hek Fak Derg 2007;31:3-10.
Referans72. Kambek Taşveren S, Yalçın Yeler D, Sözen A, Taşveren S. 12 yaş grubu çocukların diş fırçalama sıklığı-dmf-t ilişkisi. Atatürk Üniv Diş Hekim Fak Derg 2005;15:11-4.
Referans73. Bodur H, Bodur A, Yücesoy V, Baloş K. İki farklı yaş grubunda diş çürüğü prevelansı ve periodontal durumun değerlendirilmesi. Gazi Üniv Diş Hek Fak Derg 2004;21:35-9.
Referans74. Mann J, Tibi M, Sgan-Cohen HD. Fluorosis and caries prevalence in a community drinking above-optimal fluoridated water. Community Dent Oral Epidemiol 1987;15:293-5.
Referans75. Cochran JA, Ketley CE, Arnadottir IB, Fernandes B, Koletsi-Kounari H, Oila AM, et al. A comparison of the prevalence of fluorosis in 8-year-old children from seven European study sites using a standardized methodology. Community Dent Oral Epidemiol 2004;32:28-33.
Referans76. Molina-Frechero N, Gaona E, Angulo M, Sanchez Perez L, Gonzalez Gonzalez R, Nevarez Rascon M, et al. Fluoride exposure effects and dental fluorosis in children in Mexico City. Med Sci Monit 2015;21:3664-70.
Referans77. Pontigo-Loyola AP, Islas-Marquez A, Loyola-Rodriguez JP, Maupome G, Marquez-Corona ML, Medina-Solis CE. Dental fluorosis in 12- and 15-year-olds at high altitudes in above-optimal fluoridated communities in Mexico. J Public Health Dent 2008;68:163-6.
Referans78. Antonijevic E, Mandinic Z, Curcic M, Djukic-Cosic D, Milicevic N, Ivanovic M, et al. "Borderline" fluorotic region in Serbia: correlations among fluoride in drinking water, biomarkers of exposure and dental fluorosis in schoolchildren. Environ Geochem Health 2016;38:885-96.
Referans79. Azevedo MS, Goettems ML, Torriani DD, Demarco FF. Factors associated with dental fluorosis in school children in southern Brazil: a cross-sectional study. Braz Oral Res 2014;28:1-7.
Referans80. Garcia-Perez A, Irigoyen-Camacho ME, Borges-Yanez SA, Zepeda-Zepeda MA, Bolona-Gallardo I, Maupome G. Impact of caries and dental fluorosis on oral health related quality of life: a cross-sectional study in schoolchildren receiving water naturally fluoridated at above-optimal levels. Clin Oral Investig 2017;21:2771-80.
Referans81. Irigoyen-Camacho ME, Garcia Perez A, Mejia Gonzalez A, Huizar Alvarez R. Nutritional status and dental fluorosis among schoolchildren in communities with different drinking water fluoride concentrations in a central region in Mexico. Sci Total Environ 2016;541:512-9.
Referans82. Jordão LM, Vasconcelos DN, Moreira Rda S, Freire Mdo C. Dental fluorosis: prevalence and associated factors in 12-year-old schoolchildren in Goiânia, Goiás. Rev Bras Epidemiol 2015;18:568-77.
Referans83. Moimaz SA, Saliba O, Marques LB, Garbin CA, Saliba NA. Dental fluorosis and its influence on children's life. Braz Oral Res 2015;29:1-7.
Referans84. Costa Sde M, Abreu MH, Vargas AM, Vasconcelos M, Ferreira e Ferreira E, Castilho LS. Dental caries and endemic dental fluorosis in rural communities, Minas Gerais, Brazil. Rev Bras Epidemiol 2013;16:1021-8.
Referans85. Tsutsui A, Yagi M, Horowitz AM. The prevalence of dental caries and fluorosis in Japanese communities with up to 1.4 ppm of naturally occurring fluoride. J Public Health Dent 2000;60:147-53.
Referans86. Machiulskiene V, Baelum V, Fejerskov O, Nyvad B. Prevalence and extent of dental caries, dental fluorosis, and developmental enamel defects in Lithuanian teenage populations with different fluoride exposures. Eur J Oral Sci 2009;117:154-60.
Referans87. Kotecha PV, Patel SV, Bhalani KD, Shah D, Shah VS, Mehta KG. Prevalence of dental fluorosis & dental caries in association with high levels of drinking water fluoride content in a district of Gujarat, India. Indian J Med Res 2012;135:873-7.
Referans88. McGrady MG, Ellwood RP, Maguire A, Goodwin M, Boothman N, Pretty IA. The association between social deprivation and the prevalence and severity of dental caries and fluorosis in populations with and without water fluoridation. BMC Public Health 2012;12:1122.
Referans89. Shanthi M, Reddy BV, Venkataramana V, Gowrisankar S, Reddy BV, Chennupati S. Relationship between drinking water fluoride levels, dental fluorosis, dental caries and associated risk factors in 9-12 years old school children of Nelakondapally Mandal of Khammam District, Andhra Pradesh, India: a cross-sectional survey. J Int Oral Health 2014;6:106-10.
Referans90. Sukhabogi Jr, Parthasarathi P, Anjum S, Shekar B, Padma C, Rani A. Dental fluorosis and dental caries prevalence among 12 and 15-year-old school children in Nalgonda District, Andhra Pradesh, India. Ann Med Health Sci Res 2014;4:S245-52.
Referans91. Narbutaitė J, Virtanen JI, Vehkalahti MM. Variation in fluorosis and caries experience among Lithuanian 12 year olds exposed to more than 1 ppm F in tap water. J Investig Clin Dent 2016;7:187-92.
Referans92. Oruç N, Akşit MA. A health survey in a village with endemic fluorisis, 1978-1988. Çevre’89, Çevre Genel Müdürlüğü, Çukurova Üni, Adana 7-9 Haziran 1989.
Referans93. Bardal PA, Olympio KP, Buzalaf MA, Bastos JR. Dental caries and dental fluorosis in 7-12-year-old schoolchildren in Catalao, Goias, Brazil. J Appl Oral Sci 2005;13:35-40.
Referans94. Rigo L, Caldas Junior AF, de Souza EH. Factors associated with dental fluorosis. Rev Odonto Ciênc 2010;25:8-14.
Referans95. Angelillo IF, Romano F, Fortunato L, Montanaro D. Prevalence of dental caries and enamel defects in children living in areas with different water fluoride concentrations. Community Dent Health 1990;7:229-36.
Referans96. Tuli A, Rehani U, Aggrawal A. Caries experience evidenced in children having dental fluorosis. Int J Clin Pediatr Dent 2009;2:25-31.
Referans97. Wong MC, Glenny AM, Tsang BW, Lo EC, Worthington HV, Marinho VC. Topical fluoride as a cause of dental fluorosis in children. Cochrane Database Syst Rev 2010; 20;(1):CD007693.
Referans98. Atabey E. Türkiye‟de İçme Suyunda Flor ve Etkileri. 1. Baskı. Ankara: Ares Basım Reklam Prodüksiyon Hizmetleri San Tic Ltd Şti, 2010. p.1-88.
Referans99. Ergin E, Eden E. Florun insan sağlığına olumsuz etkisi var mı? Ege Üniv Diş Hek Fak Derg 2017;38:13-20.
Referans100. American Academy of Pediatric Dentistry. Guideline on fluoride therapy. Pediatr Dent 2014;36:171-4.
Referans101. Indermitte E, Saava A, Karro E. Exposure to high fluoride drinking water and risk of dental fluorosis in Estonia. Int J Environ Res Public Health 2009;6:710-21.