{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:49:58Z","timestamp":1791452998260,"version":"4.3.3"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Public Health Dent"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine the prevalence of dental fluorosis, and factors associated with its occurrence in two cohorts of children exposed to different fluoride concentrations in the Malaysian water supply.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross\u2010sectional study was conducted among lifelong residents (<jats:italic>n<\/jats:italic>\u00a0=\u00a01,155) aged 9 and 12\u2009years old living in fluoridated and nonfluoridated areas. Malaysian children aged 12\u2009years were born when the level of fluoride in the public water supply was 0.7\u00a0ppm while those aged 9\u2009years were born after the level was reduced to 0.5\u00a0ppm. Fluorosis was blind scored using standardized photographs of maxillary central incisors using Dean's criteria. Fluoride exposures and other factors were assessed by parental questionnaire. Data were analyzed using descriptive statistics, Chi\u2010squared analyses, and logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fluorosis prevalence was lower (31.9\u00a0percent) among the younger children born after the reduction of fluoride concentration in the water, compared to a prevalence of 38.4\u00a0percent in the older cohort. Early tooth brushing practices and fluoridated toothpaste were not statistically associated with fluorosis status. However, the prevalence of fluorosis was significantly associated with parents' education level, parents' income, fluoridated water, type of infant feeding method, age breast feeding ceased, use of formula milk, duration of formula milk intake, and type of water used to reconstitute formula milk via simple logistic regression. Fluoridated water remained a significant risk factor for fluorosis in multiple logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fluorosis was lower among children born after the adjustment of fluoride concentration in the water. Fluoridated water remained as a strong risk factor for fluorosis after downward adjustment of its fluoride concentration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jphd.12448","type":"journal-article","created":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T07:03:59Z","timestamp":1614323039000},"page":"270-279","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Factors associated with dental fluorosis among Malaysian children exposed to different fluoride concentrations in the public water supply"],"prefix":"10.1111","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1282-6585","authenticated-orcid":false,"given":"Nor Azlida","family":"Mohd Nor","sequence":"first","affiliation":[{"name":"Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry University of Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara L.","family":"Chadwick","sequence":"additional","affiliation":[{"name":"Department of Applied Clinical Research and Dental Public Health Cardiff University School of Dentistry  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0662-1927","authenticated-orcid":false,"given":"Damian J. J.","family":"Farnell","sequence":"additional","affiliation":[{"name":"Department of Applied Clinical Research and Dental Public Health Cardiff University School of Dentistry  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivor G.","family":"Chestnutt","sequence":"additional","affiliation":[{"name":"Department of Applied Clinical Research and Dental Public Health Cardiff University School of Dentistry  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12205"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0528.2006.00281.x"},{"issue":"4","key":"e_1_2_8_4_1","first-page":"269","article-title":"Risk factors for dental fluorosis: a review of the recent literature","volume":"22","author":"Mascarenhas AK","year":"2000","journal-title":"Pediatr 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