Background: The use of fluorides for caries prevention is well established but is linked with an increased risk of\r\ndental fluorosis, some of which may be considered to be aesthetically objectionable. Patient opinion should be\r\nconsidered when determining impact on aesthetics. The aim of this study was to assess participant rating of dental\r\naesthetics (from photographic images) of 11 to 13 year olds participating in an epidemiological caries and fluorosis\r\nsurvey in a fluoridated and a non-fluoridated community in Northern England.\r\nMethods: Consented participants were invited to rank in order of preference (appearance) a collage of 10\r\ncomputer generated images on a touch-screen laptop. The images comprised an assortment of presentations of\r\nteeth that included white teeth, a spectrum of developmental defects of enamel and dental caries. Data were\r\ncaptured directly and exported into SPSS for analysis.\r\nResults: Data were available for 1553 participants. In general, there were no significant differences in the rank\r\npositions between the fluoridated and non-fluoridated communities, with the exception of teeth with caries and\r\nteeth with large demarcated opacities. Very white teeth had the highest rating in both localities. Overall, there was\r\na trend for teeth with fluorosis to be ranked more favourably in the fluoridated community; for TF 1 and TF 2 this\r\npreference was significant (p < 0.001).\r\nConclusions: The results of this study suggest teeth that are uniformly very white have the highest preference.\r\nThe rankings suggest teeth with a fluorosis score of TF 1 may not be considered aesthetically objectionable to this\r\npopulation and age group. The image depicting a tooth with caries and the image with large demarcated\r\nopacities were deemed to be the least favoured. Participant preference of images depicting fluorosis falls with\r\nincreasing severity of fluorosis.
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