RESUMEN
OBJECTIVES: Examine the relationship between (1) DMFS and community fluorosis index (CFI) scores, and (2) between individual DMFS and NIDR/Dean Index fluorosis scores. DESIGN: Population-based, cross-sectional study. SETTING: Public and private schools of Puerto Rico. SUBJECTS: 1435, 12-year old students. METHOD: A probabilistic stratified sample was selected from 11 regions of Puerto Rico, according to type of school (public and private), and setting (urban and rural). Children were examined using NIDR criteria for DMFS and fluorosis. Regressions examined the relationship between DMFS means and CFI scores. Individual level DMFS was regressed on NIDR/Dean Index scores to test for linear and deviation from linear trends. RESULTS: (1) There was no statistically significant relationship between regional DMFS and CFI scores, and (2) individual level fluorosis scores when dichotomized as 0-2 as the referent level to level 3-4 demonstrated a statistical significant higher DMFS with the higher fluorosis level. Gender and school setting were statistically significant in all models: females and public school attendance were associated with increased DMFS. CONCLUSION: No ecological relationship between CFI and DMFS scores was found in 12-year-old children in Puerto Rico. Moderate and severe fluorosis were associated with higher DMFS levels relative to lower fluorosis scores, though this finding may be associated with restorations placed for cosmetic reasons. While controlling severe fluorosis is desirable, this will have little impact on overall high caries in Puerto Rican children. These findings suggest caution when interpreting caries experience using the DMFS index in populations with differing fluorosis levels.