Development of a Greek Oral health literacy measurement instrument: GROHL.

BACKGROUND: Oral health literacy is an important construct for both clinical and public health outcomes research. The need to quantify and test OHL has led to the development of measurement instruments and has generated a substantial body of recent literature. A commonly used OHL instrument is REALD-30, a word recognition scale that has been adapted for use in several languages. The objective of this study was the development and testing of the Greek language oral health literacy measurement instrument (GROHL). METHODS: Data from 282 adult patients of two private dental clinics in Athens, Greece were collected via in-person interviews. Forty-four words were initially considered and tested for inclusion. Item response theory analysis (IRT) and 2-parameter logistic models assessing difficulty and discriminatory ability were used to identify an optimal scale composition. Internal consistency was examined using Cronbach's alpha and test-retest reliability was measured using intraclass correlation coefficient (ICC) in a subset of 20 participants over a two-week period. Convergent validity was tested against functional health literacy screening (HLS) items, dental knowledge (DK), oral health behaviors (OHBs), oral health-related quality of life (OHRQoL; OHIP-14 index), as well as self-reported oral and general health status. RESULTS: From an initial item pool of 44 items that were carried forward to IRT, 12 were excluded due to no or little variance, 10 were excluded due to low item-test correlation, and 2 due to insignificant contribution to the scale, i.e., difficulty parameter estimate with p > 0.05. The twenty remaining items composed the final index which showed favorable internal consistency (alpha = 0.80) and test-retest reliability (ICC = 0.95). The summary score distribution did not depart from normality (p = 0.32; mean = 11.5; median = 12; range = 1-20). GROHL scores were positively correlated with favorable oral hygiene behaviors and dental attendance, as well as HLS, DK and education level. CONCLUSION: The GROHL demonstrated good psychometric properties and can be used for outcomes research in clinical and public health settings.

Effect of toothpastes containing different NaF concentrations or a SnF2/NaF combination on root dentine erosive lesions, in vitro.

BACKGROUND: Fluoride toothpastes presumably offer some protection against acid erosion. However, uncertainty exists towards fluoride's efficacy relatively to the concentration and the type of chemical compound used. This in vitro study evaluated the relative efficacy of toothpastes containing sodium fluoride in different concentrations or a stabilized stannous fluoride/sodium fluoride system on root dentine erosion. MATERIAL AND METHODS: Bovine dentin specimens were allocated into four groups (n=10): control (no F), 1450ppm F (as NaF), 5000ppm F (as NaF) and 1450ppm F (1100ppm as stabilized SnF2 and 350ppm as NaF)/sodium hexamethaphosphate. The specimens were submitted to 6 daily cycles of erosion (0.3% v/v citric acid, pH=3.2, 20 min) and remineralization (~22h), interspersed by 2-min immersions in 1:3 w/v of dentifrice/distilled water slurries. Subsequently, they were subjected to a 24-h acid resistance test (0.3% v/v citric acid, pH=3.2) without any further treatments. Surface loss was quantified by contact profilometry. Data were analysed through one-way ANOVA and Bonferroni's tests (p≤0.05). RESULTS: In both experiments, all fluoride groups, showed significantly less tissue loss compared to the control (p<0.001-p=0.018). During erosion cycling, no significant differences were found among the fluoride groups. During the acid resistance test, the 5000ppm F toothpaste produced significantly superior effect than both 1450ppm F products (p=0.010, (p<0.001), which performed similarly. CONCLUSIONS: Under less aggressive erosive conditions, fluoride toothpastes did not differ in their ability to protect dentine surfaces. However, in severely erosive environment, the 5000ppm F toothpaste performed superiorly to the other tested products. Key words:Dentine, sodium fluoride, stannous fluoride, tooth erosion, toothpaste, contact profilometry.

The short-term effects of television advertisements of cariogenic foods on children's dietary choices.

OBJECTIVE: To investigate the short-term influence of the advertising of cariogenic foods on children's dietary preferences, and the possible moderating effect of several factors on this influence. METHODS: One-hundred and eighty-three children, 11-12 years of age, were exposed to advertisements showing sugary food and non-food items, in a within-subject counterbalanced design. Their preferences for unhealthy and healthy foods, and their ability to recall or recognise the advertisements, were measured following both sessions. Information on their dietary habits, leisure activities and sociodemographic details were obtained through a questionnaire completed by their parents. Their decayed, missing and filled teeth (DMFT) index, body weight and height were also recorded. A generalised linear mixed model was used to examine the differences in food preferences between experimental conditions, and the associations between children's preferences and the other factors assessed. RESULTS: Exposure to food advertisements significantly decreased the selection of healthy foods. Children with a higher DMFT index chose a higher percentage of unhealthy foods, and children who spent more time watching television chose an increased number of healthy foods, after their exposure to food advertisements. Regardless of condition, girls selected fewer foods than boys. Children with a higher DMFT index selected more unhealthy foods than children with a lower DMFT index. Obese children chose an increased number of healthy foods than those who were overweight and normal weight. CONCLUSIONS: Food advertisements can divert, for a short time, children's preference over healthy food choices, and could lead to changes in their eating habits, which may put them at higher risk of dental diseases and obesity.

Gender differences in oral health status and behavior of Greek dental students: A meta-analysis of 1981, 2000, and 2010 data.

BACKGROUND: The aim of this study was to investigate the oral health status and behavior of Greek dental students over time, and to meta-analyze these findings to test the widely documented hypothesis that women have better oral health behavior, oral hygiene, and periodontal status but higher dental caries rates than men. MATERIALS AND METHODS: A total sample of 385 students was examined using identical indices to assess oral health and behavioral data initially in 1981 while the years 2000 and 2010 were selected due to significant changes that took place in the dental curriculum in the 1990s and 2000s. Data by gender concerning the outcome variables recorded in every one of the three surveys were analyzed using Mantel-Haenszel and continuous outcomes methods. RESULTS: A significant improvement in the oral health status and behavior of students was observed over time. The meta-analysis of data by gender showed that females brushed their teeth significantly more often than males [summary odds ratio (OR): 1.95 and 95% confidence interval (CI): 1.08-3.54]. Males and females were found to have a similar risk of developing dental caries. CONCLUSION: The hypothesis that young women have better oral hygiene habits compared to men was confirmed. However, the hypothesis that women have better oral hygiene and periodontal status but exhibit higher dental caries experience than men was not supported by the findings of the study.

Prevalence of dental caries in 5-year-old Greek children and the use of dental services: evaluation of socioeconomic, behavioural factors and living conditions.

OBJECTIVES: To assess dental caries and use of dental services experience in 5-year-old children attending public kindergartens in Attica, Greece and to examine the influence of certain socioeconomic factors and living conditions as well as dental behaviours and attitudes. METHODS: In this cross-sectional study, a random and stratified sample of 605 Greek children was examined using decayed, missing, filled tooth surfaces and simplified debris indices. The use of dental services was measured by children's dental visits (any dental visit up to the age of 5 years). Care Index was also calculated. Risk indicators were assessed by a questionnaire. Zero-inflated Poisson and Logistic Regression Analysis were generated to test statistical significant associations. RESULTS: The prevalence of dental caries was 16.5%. Care Index was 32% and dental visits were reported for the 84% of the children. Medium Socio-Economic Level (SEL) was associated with no detectable caries. High SEL was related to decreased decayed, missing, filled teeth values, while female gender and rented houses had the opposite effect. The age of the mother (35-39 years) and the higher SEL were related to higher levels of dental services use. CONCLUSIONS: It is suggested that there are differences in the experience of dental caries and use of dental services among preschool children in Attica, which are related to demographic, socioeconomic factors and living conditions. Dental public polices should focus on groups with specific characteristics in order to improve oral health levels of disease-susceptible populations.

Dental erosion prevalence and associated risk indicators among preschool children in Athens, Greece.

OBJECTIVES: The aims of the study were to investigate dental erosion prevalence, distribution and severity in Greek preschool children attending public kindergartens in the prefecture of Attica, Greece and to determine the effect of dental caries, oral hygiene level, socio-economic factors, dental behavior, erosion related medication and chronic illness. MATERIAL AND METHODS: A random and stratified sample of 605 Greek preschool children was clinically examined for dental erosion using the Basic Erosive Wear Examination Index (ΒΕWE). Dental caries (dmfs) and Simplified Debris Index were also recorded. The data concerning possible risk indicators were derived by a questionnaire. Zero-inflated Poisson regression was generated to test the predictive effects of the independent variables on dental erosion. RESULTS: The prevalence of dental erosion was 78.8 %, and the mean and SE of BEWE index was 3.64 ± 0.15. High monthly family income was positively related to ΒΕWE cumulative scores [RR = 1.204 (1.016-1.427)], while high maternal education level [RR = 0.872 (0.771-0.986)] and poor oral hygiene level [DI-s, RR = 0.584 (0.450-0.756)] showed a negative association. CONCLUSIONS: Dental erosion is a common oral disease in Greek preschool children in Attica, related to oral hygiene and socio-economic factors. CLINICAL RELEVANCE: Programs aimed at erosion prevention should begin at an early age for all children.

Tooth loss and oral rehabilitation in Greek middle-aged adults and senior citizens.

PURPOSE: The aims of this study were to investigate the prevalence of tooth loss in Greek individuals aged 35 to 44 and 65 to 74 years in relation to sociodemographic parameters and to describe their prosthetic status and needs. MATERIALS AND METHODS: A stratified cluster sample of 1,188 middle-aged adults and 1,093 senior citizens was selected according to World Health Organization (WHO) guidelines for national pathfinder surveys. Tooth loss and prosthetic status and needs were recorded according to WHO criteria. Sociodemographic data were collected through face-to-face interviews. RESULTS: Complete edentulism affected 0.3% of individuals aged 35 to 44 years and 31.5% of those aged 65 to 74 years. Most middle-aged adults (92.1%) had ≥ 21 natural teeth, while the corresponding percentage for the senior citizens was 23.1%. The mean number of missing teeth was 5.2 in middle-aged adults and 21.6 in senior citizens. The multivariate analysis showed that education level was the only predictor of tooth loss in both age groups. Approximately 38% of those aged 35 to 44 years and 80% of those aged 65 to 74 years had dental prostheses, while 47.6% of middle-aged adults and 66.3% of senior citizens did not need any prosthetic treatment. The need for complete dentures was relatively low in both age groups. Comparisons of the present results with those of 1985 indicate that the dentate status of Greek adults aged 35 to 44 years has not improved. Furthermore, the prevalence of tooth loss in the elderly population was high compared with internationally reported findings. CONCLUSION: The replacement of missing teeth with fixed or removable prostheses will continue to be common in Greece for the foreseeable future.

Adhesion of Porphyromonas gingivalis and Biofilm Formation on Different Types of Orthodontic Brackets.

Objectives. To examine the interaction between Porphyromonas gingivalis and 3 different orthodontic brackets in vitro, focusing on the effect of an early salivary pellicle and other bacteria on the formation of biofilms. Material and Methods. Mono- and multi-species P. gingivalis biofilms were allowed to form in vitro, on 3 different bracket types (stainless steel, ceramic and plastic) with and without an early salivary pellicle. The brackets were anaerobically incubated for 3 days in Brain Heart Infusion Broth to form biofilms. Bacteria were quantified by trypsin treatment and enumeration of the total viable counts of bacteria recovered. Results. Saliva was found to significantly affect (P < 0.001) adhesion and biofilm formation of P. gingivalis, with higher numbers for the coated brackets. No significant effect was detected for the impact of the type of biofilm, although on stainless steel and plastic brackets there was a tendency for higher numbers of the pathogen in multi-species biofilms. Bracket material alone was not found to affect the number of bacteria. Conclusions. The salivary pellicle seems to facilitate the adhesion of P. gingivalis and biofilm formation on orthodontic brackets, while the material comprising the brackets does not significantly impact on the number of bacteria.

An in vitro study of the effect of aluminum and the combined effect of strontium, aluminum, and fluoride elements on early enamel carious lesions.

The purpose of this in vitro study was to evaluate the effect of aluminum and of combined strontium, aluminum, and fluoride treatments on enamel demineralization and remineralization. During a 6-day pH-cycling protocol, pre-softened bovine enamel slabs were immersed twice daily for 1 min in the following experimental solutions: (a) distilled water [W] (negative control); (b) 1,000 ppm F [F] (positive control); (c) 1,000 ppm Al [Al]; (d) 1,000 ppm Al,1,000 ppm F applied interchangeably [Al-F]; (e) 1,000 ppm Al, 1,000 ppm F, applied in sequential order [Al+F]; (f) combined 1,000 ppm Al and 150 ppm Sr [Al+Sr]; and (g) combined 150 ppm Sr and 1,000 ppm F [Sr+F]. Subsequently, the specimens were subjected to a 5-day acid resistance test. Lesions were evaluated quantitatively by performing surface microhardness and qualitatively by using polarized light microscopy. According to the results, solutions [Sr+F] and [Al-F] enhanced remineralization and inhibited demineralization as effectively as the [F] solution and significantly superiorly compared to [Al+Sr] and [Al] solutions. All tested solution groups, except for the [Al+Sr] group, presented significantly increased resistance to acidic attack, compared to [W]. PLM examination revealed that all solution groups, except for the [W] group, developed an acid-resistant zone at lesion surfaces. In conclusion, under the present experimental conditions, the combined strontium-fluoride and aluminum-fluoride treatments presented similar anti-caries efficacy compared to fluoride treatment alone, but they did not show evidence of synergistic activity on pre-softened enamel.

Greece's high dentist to population ratio: comparisons, causes, and effects.

Reaching the optimal dentist to population ratio is a common health policy challenge around the world, but while many countries have too few dentists for their populations, Greece is facing the opposite problem. This study was designed to describe and analyze trends in the number and distribution of dentists in Greece over the last thirty years and compare the Greek dentist to population ratio with that of the other twenty-six European Union (EU) countries. Demographic data for Greece were obtained from the Hellenic Dental Association and the National Statistical Service of Greece and were analyzed using nonparametric statistical tests. Data for the other EU countries were derived from various authoritative sources. In Greece, the number of dentists per 10,000 inhabitants increased significantly (p<0.05) from 1982 (7.7) to 2007 (13.0), ranking Greece first (in 2008) among the EU countries. The proportional increase in the number of dentists during the decade 1979-88 (30.4 percent) was significant (p<0.05), compared to the decade 1989-98 (22.3 percent) and the nine-year period 1999-2007 (23.6 percent). In 1982 and 1992, the majority of dentists practiced in the Attica Prefecture (Athens) (55.2 percent and 52.6 percent, respectively), but this situation changed significantly in 2007 (p<0.05) (40.1 percent for Attica). The percentage of female dentists remained almost the same from 1982 until 2007, but female dentists' location of practice changed significantly (p<0.05) between 1992 and 2007. After reporting the data, we examine some of the reasons for and effects of the situation and consider the problem that, even with a high dentist to population ratio, Greece has significant oral health access problems.

Penalties for academic dishonesty in a Greek dental school environment.

The aim of this study was to investigate the opinions of the faculty and students of the University of Athens Dental School in Greece regarding the appropriate penalty for specific academic offenses. In addition, faculty and student opinions were compared. A questionnaire was distributed to officially registered seniors and full-time faculty members, and 177 individuals responded anonymously and voluntarily. The respondents were asked to select one from a set of nine penalties for each of fifteen hypothetical academic offenses and three cases with extenuating circumstances. Non-parametric Mann-Whitney U tests and a Wilcoxon signed-rank test, depending on the nature of variables, were used to detect significant differences in penalty scores between faculty and students. A p-value of <0.05 was considered statistically significant. The penalty scores for the fifteen offenses ranged from a mean of 2.23±1.55 to 7.25±2.64. Faculty respondents gave more severe penalties than students did for all offenses, and the finding was statistically significant (p<0.05) for eleven of the fifteen offenses. Where extenuating circumstances were added, the penalty selection altered in two of the three cases. A significantly more lenient penalty was selected by both faculty and students in these two cases. The results of this study suggest that faculty members are harsher than students for the same offenses and that extenuating circumstances can sometimes significantly change recommended penalties.

In vitro evaluation of fluoride and calcium sodium phosphosilicate toothpastes, on root dentine caries lesions.

OBJECTIVES: The aim of this in vitro study was to assess the effect of toothpastes containing three different sodium fluoride concentrations and a calcium sodium phosphosilicate system, on root dentine demineralization and remineralization. METHODS: During a fourteen-day pH-cycling protocol, pre-softened bovine root dentine specimens were immersed twice daily, before and after the demineralization periods, for 2 min, in the following toothpaste slurries: (a) non-fluoridated (control), (b) 7.5% calcium sodium phosphosilicate, (c) 1450 ppm F, (d) 2800 ppm F, and (e) 5000 ppm F. Subsequently, the slabs were subjected to a fifty-hour acid resistance test. Knoop microhardness at different lesion depths was assessed in specimen cross-sections and KHN values were converted to vol.% mineral. Comparisons between the groups were performed at each lesion depth through ANOVA-based tests and furthermore, regression analysis of the derived statistic of "integrated vol.% mineral loss" was carried out. Also, lesions were evaluated qualitatively using transmission and polarized light microscopy. RESULTS: The 5000 ppm F toothpaste group, during pH-cycling, presented significantly less total vol.% mineral loss and subsequently exhibited considerably increased surface acid resistance, compared to all the other tested groups. The calcium sodium phosphosilicate toothpaste, during pH-cycling, inhibited demineralization and/or promoted remineralization of the surface layers significantly more effectively than the control group nevertheless, subsequently, the acid resistance of the calcium sodium phosphosilicate dentifrice group was similar to that of the control group. These observations were confirmed by microscopic examination of the lesions. CONCLUSIONS: Under the present experimental conditions, the 5000ppm F toothpaste, promoted remineralization and inhibited demineralization more effectively, than the other tested toothpastes.

Dental caries prevalence and treatment needs of 5- to 12-year-old children in relation to area-based income and immigrant background in Greece.

OBJECTIVES: To investigate the association between certain socio-demographic characteristics and dental health status of 5- to 12-year-old children attending public kindergarten and primary schools in Piraeus, Greece. METHODS: Gender, age, place of residence, immigrant background and area-based income were associated with dental caries prevalence, treatment needs and oral hygiene level in 5,116 children. RESULTS: The mean number of decayed, missing and filled deciduous teeth (dmft) and Unmet Restorative Treatment Needs Index (UTN) at 6-year-olds were 1.54 and 84.6% respectively, and the DMFT and UTN at 12-year-olds were 1.35 and 71.8%. Caries experience/severity significantly increased with age, whereas treatment needs and oral hygiene level decreased (P<0.001). Immigrant background and low area-based income was associated with poorer oral health outcomes. The above associations retained statistical significance after multivariate analysis. Children who live in areas with lower average income present 1.20 to 2.14 greater risk of having higher caries severity and poorer oral hygiene in comparison to those living in more affluent areas, and children with an immigrant background have 1.68 to 4.34 higher likelihood to present higher dmft and DMFT values, higher unmet treatment needs, and poorer oral hygiene levels compared to their Greek counterparts above and beyond the effect of the other risk factors assessed. CONCLUSIONS: The present study revealed a socio-demographic gradient in oral health status and treatment needs of children in Piraeus, Greece.

Novel methods of balancing covariates for the assessment of dental erosion: a contribution to validation of a synthetic scoring system for erosive wear.

OBJECTIVES: The purpose of the study was to balance several potential erosive covariates, using traditional and novel epidemiological approaches, in order to assess the relative risks of dental erosion more precisely. METHODS: Traditional (univariate and logistic regression analysis) and novel techniques (propensity scores and Inverse Probability Weighting-IPW) were applied for evaluating the effect of twenty covariates on dental erosion among 502 adolescents. RESULTS: Different approaches gave different estimates of the relative risks of dental erosion. The increased consumption of carbonated soft drinks had the major erosive effect, when traditional analyses were used (unadjusted: OR=3.475 and CI: 1.499-8.052, logistic regression: OR=3.219 and CI: 1.373-7.547). On the other hand, IPW method indicated that the consumption of erosion drinks immediately after intense physical exercise had the highest odds ratio (OR=1.363 and CI: 0.963-1.929), followed by the increased consumption of citrus fruit juice (OR=1.326 and CI: 1.004-1.752). This method also demonstrated a marked improvement in balance, with the 95% CIs for each OR being considerably narrower than those reported in the initial analysis. CONCLUSIONS: Standardization of the potential aetiological criteria of erosive wear is a considerably difficult process. Nevertheless, novel methods revealed that the increased consumption of carbonated soft drinks and citrus fruit juices could be included as aetiologic factors in a synthetic scoring system for erosion. Parameters which are related to salivary protective mechanisms (e.g. consumption of erosion drinks immediately after intense physical exercise) could also be a part of such an index. Further research is required in order to achieve the maximum validation of the potential erosive risk factors.

Evaluation of three different scoring systems for dental erosion: a comparative study in adolescents.

OBJECTIVES: The purpose of the study was to evaluate and compare three scoring systems for dental erosion representing different approaches: the recently proposed Basic Erosive Wear Examination (B.E.W.E.), the Simplified Tooth Wear Index (S-T.W.I.), and the Evaluating Index of Dental Erosion (EV.I.D.E.), which are introduced and calibrated in the present study, in order to contribute to the development of a standardised and validated erosion index. METHODS: A cross-sectional study was conducted, in which a random and stratified sample of 502 adolescents aged 14-16 years was examined using the aforementioned scoring systems. RESULTS: A significant number of Greek adolescents had experienced dental erosion: 58%, 51.6% and 45.2%, according to the B.E.W.E., S-T.W.I. and EV.I.D.E. scores, respectively. Additionally, 22.7-24.3% of the subjects had lesions into dentine (according to the EV.I.D.E. and S-T.W.I. scores respectively), whereas the B.E.W.E. classified all subjects with erosion in the "none" and "low" risk level categories. However, the use of the B.E.W.E. cumulative scores was important for avoiding the overestimation of the prevalence of erosion. The aetiological criteria of the EV.I.D.E. seemed to reduce the false positive cases. CONCLUSIONS: The S-T.W.I. appeared to have the lowest content validity, while the B.E.W.E. was a convenient to use index, with sufficient sensitivity and specificity. Nevertheless, the B.E.W.E. cut-off values have to be reconsidered in order to reflect the severity of the erosive lesions. The B.E.W.E. could also be supplemented with a group of sufficient validated aetiological criteria, which are necessary to establish a more accurate differential diagnosis of dental erosion.

Self-reported and clinically-diagnosed dental needs: determining the factors that affect subjective assessment.

PURPOSE: The role of demographic, socioeconomic and psychological factors that influence the subjective assessment of dental needs has been the subject of contemporary dental research. The aim of this study was to determine the relationship between self-reported and clinically diagnosed dental needs, with the view of understanding the factors that affect subjective assessments of dental problems. MATERIALS AND METHODS: A random sample of 130 subjects, aged 21 to 63 years, was selected from the non-academic staff members of the Athens University of Economics and Business. Data were obtained for 92% (120 participants) of the sample by a questionnaire-based interview and a clinical examination. The questions concentrated on the demographic and socioeconomic characteristics and the ratings of oral health, the perceived need, oral functional impacts and the level of satisfaction with the appearance. In the clinical examination, the oral health status of the participants was thoroughly recorded. RESULTS: A strong relationship was detected with the presence of caries, badly broken and missing teeth, and self-reported need for care. Embarrassment due to one's dental health was also associated with the perceived need, although satisfaction with the appearance was not. Neither demographic and socioeconomic status nor self-rated oral health was significantly associated with a currently perceived dental problem. CONCLUSION: Perceived need for dental care is affected by parameters other than demographic and socioeconomic status (i.e. parameters that are associated with the presence of symptoms and/or impacts on everyday life). Therefore, functional and psychological impacts of the disease seem to be as important, if not more, as the clinical indicators while estimating the dental needs.

A comparison of the prevalence of fluorosis in 8-year-old children from seven European study sites using a standardized methodology.

OBJECTIVES: The objectives of this study were to report on the prevalence of enamel opacities from seven European study sites using a standardized photographic method, and to investigate the importance of variables responsible for enamel fluorosis. METHODS: The sample comprised a randomly selected group of 300 8-year-old children in each of the study areas. One examiner from each area was trained and calibrated in the use of a standardized photographic technique. Two transparencies were taken of each child's permanent maxillary central incisor teeth; one to represent the teeth 'wet' and one when the teeth had been allowed to dry out naturally for 105 s. The transparencies were viewed 'blind' by the author (JAC) and scored using the DDE and TF indices. Data relating to variables considered to be associated with enamel fluorosis were also collected. RESULTS: The prevalence of diffuse opacities ranged from 61% in fluoridated Cork (Ireland) to 28% in Athens (Greece). The percentage of subjects with a TF score of three or more ranged from 4% in Cork and nonfluoridated Haarlem (the Netherlands) to zero in Oulu (Finland) and Athens. Fluoridated water and the prolonged use of fluoride tablets were found to be significant contributory factors to fluorosis. CONCLUSIONS: The prevalence of fluorosis was found to be highest in fluoridated Cork. The prolonged use of fluoride supplements was also found to be a significant risk indicator associated with fluorosis.