Severe dental fluorosis and cognitive deficits.

Choi et al. (2014) is a pilot study of the association of exposure to fluoride with cognitive function of children in a Chinese community. Although limited it provides more useful information than almost all the studies included in the earlier review by Choi et al. (2012). Most of the reports considered in that reviewwere very brief with little detail or consideration of confounding factors. Political activists, unfortunately, use Choi et al. (2012) in their campaigns against community water fluoridation (CWF). They claim that it “proves” that CWF damages children's brains (see for exampleMercola, 2013). Although the authors warned this interpretation is unwarranted (Choi andGrandjean, 2012), Grandjean and Landrigan (2014) used Choi et al. (2012) as evidence that fluoride is a neurotoxicant. Ghassemi (2014) also stresses that this current pilot study is also not relevant to CWF. Choi et al. (2012) did highlight the need for further research. Broadbent et al. (2014) showed no effect of fluoride on IQ at the optimum drinking water concentrations used in CWF. However, most of the reports reviewed by Choi et al. (2012) considered data from areas of endemic fluorosis where drinking water fluoride concentrations are higher. The pilot study (Choi et al., 2014) aims to test their hypothesis that increased fluoride exposure is related to impairments in neuro-behavioral development among school children in China where endemic fluorosis is common. This study includes data from several neuropsychological measurements as indicators of IQ. It also includes urine F concentration and the prevalence and severity of dental fluorosis as indicators of fluoride exposure. Most reports have only considered drinking water fluoride concentrations. I believe dental fluorosis could be important to understanding the data for cognitive deficits reported in this study and in the reports reviewed by Choi et al. (2012) and hope its measurement is retained in future studies. Choi et al. (2014) did not find a statistically significant association of drinking water fluoride concentration with any of the neuropsychological measurements. But they did find one for moderate and severe dentalfluorosiswith theWISC-R digit span subtest. Because dentalfluorosis is related to fluoride intake I expect that a studywith a larger number of children might produce a significant relationship of outcome deficits with fluoride water concentration. However, dental fluorosis is known to be influenced by genetic (Everett, 2011) as well as environmental factors besides fluoride (Butler et al., 1985). The strong association with medium/severe dental fluorosis may have significance quite apart from the relationship of dental fluorosis to fluoride uptake. Emotional problems in children have been related to physical anomalies, including obvious oral health problems like severe tooth decay (Hilsheimer and Kurko, 1979). Cognitive deficits can sometimes be related to emotional problems and subsequent learning and