{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T13:23:03Z","timestamp":1793366583228,"version":"4.5.0"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>While the effects of fluoride on health have been widely researched, fewer high-quality studies examine the association of fluoride levels in water and dental fluorosis.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the association between fluoride exposure from drinking water and dental fluorosis.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study used the 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey (NHANES) data (January 1, 2013, through December 31, 2016). NHANES uses a complex sampling technique to develop nationally representative sample estimates of the US population that consists of interviews and physical assessments. Children and adolescents aged 6 to 15 years were included because NHANES contains their data for all 3 forms of fluoride measures: plasma fluoride levels, water levels of fluoride, and dietary fluoride supplementation. Data were analyzed from January 1 to April 30, 2023.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Water and plasma fluoride levels were measured by laboratory personnel. Dietary fluoride supplement data were self-reported.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The Dean\u2019s Fluorosis Index was used to evaluate fluorosis status for each tooth. The dental fluorosis severity value was based on the second most affected tooth. Independent variables included plasma and water fluoride concentrations and dietary fluoride supplementation. An independent samples t<\/jats:italic> test was used to compare fluoride exposures between groups, and Pearson correlation assessed the association between plasma and water fluoride levels. To assess whether fluoride exposures were associated with dental fluorosis, logistic regression analyses were conducted.<\/jats:p><\/jats:sec>Results<\/jats:title>There were 1543 participants in the 2013-2014 NHANES cycle (weighted proportion male, 51.9%; mean [SD] age, 11.0 [2.7] years) and 1452 in the 2015-2016 cycle (weighted proportion male, 52.6%; mean [SD] age, 11.1 [2.8] years). A weighted 87.3% exhibited some degree of fluorosis in the 2013-2014 cycle and 68.2% in the 2015-2016 cycle. After adjusting for covariates in the 2015-2016 cycle, both higher water and plasma fluoride concentrations were associated with higher odds of dental fluorosis: adjusted odds ratios [AORs],\u20092.378 (95% CI,\u20091.218-5.345]) for water fluoride and 1.568 (95% CI,\u20091.038-2.499) for plasma fluoride. Fluoride supplements were not significantly associated with dental fluorosis: AOR,\u20090.741 (95% CI,\u20090.367-1.408).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this cross-sectional study suggest that exposure to higher concentrations of fluoride in water and having higher plasma levels of fluoride were associated with a greater risk of dental fluorosis. Further research can help policy makers develop policies that balance substantial caries prevention with the risk of dental fluorosis.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.18406","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T16:24:55Z","timestamp":1687623895000},"page":"e2318406","source":"Crossref","is-referenced-by-count":56,"title":["A National Study Exploring the Association Between Fluoride Levels and Dental Fluorosis"],"prefix":"10.1001","volume":"6","author":[{"given":"Man","family":"Hung","sequence":"first","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah"},{"name":"Division of Public Health, University of Utah, Salt Lake City"},{"name":"College of Social Work, University of Utah, Salt Lake City"},{"name":"College of Education, University of Utah, Salt Lake City"},{"name":"George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Hon","sequence":"additional","affiliation":[{"name":"Department of Economics, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Mohajeri","sequence":"additional","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyma","family":"Moparthi","sequence":"additional","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Vu","sequence":"additional","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, South Jordan, 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