Fluoride Action Network

State Reports on Oral Health

Fluoride Action Network | September 25, 2015

The table below lists 119 oral health state reports which were listed in the report, Water Fluoridation and Environmental Justice, by Fluoride Action Network. Many of these reports were funded in part by the Division of Oral Health of the Centers for Disease Control & Prevention (CDC). It is this division that actively promotes the fluoridation of community drinking water.

Over-exposure to fluoride damages teeth as the following photos of the various stages of dental fluorosis, also known as enamel fluorosis, show (see more photos):

Photographs of Dental Fluorosis by Dr. Hardy Limeback and Dr. Iain Pretty, et al.

The National Research Council of the National Academies in 2006 found that severe dental fluorosis was an adverse health effect. This is what the report states:

Enamel fluorosis is a dose-related mottling of enamel that can range from mild discoloration of the tooth surface to severe staining and pitting. The condition is permanent after it develops in children during tooth formation, a period ranging from birth until about the age of 8. Whether to consider enamel fluorosis, particularly the moderate to severe forms, to be an adverse health effect or a cosmetic effect has been the subject of debate for decades…

Severe enamel fluorosis is characterized by dark yellow to brown staining and discrete and confluent pitting, which constitutes enamel loss… Severe enamel fluorosis compromises that health-protective function by causing structural damage to the tooth. The damage to teeth caused by severe enamel fluorosis is a toxic effect that is consistent with prevailing risk assessment definitions of adverse health effects…

Severe enamel fluorosis occurs at an appreciable frequency, approximately 10% on average, among children in U.S. communities with water fluoride concentrations at or near the current MCLG [maximum contaminant level goal] of 4 mg/L. Thus, the MCLG is not adequately protective against this condition…

The committee finds that it is reasonable to assume that some individuals will find moderate enamel fluorosis on front teeth to be detrimental to their appearance and that it could affect their overall sense of well-being. However, the available data are not adequate to categorize moderate enamel fluorosis as an adverse health effect on the basis of structural or psychological effects.

Since 1993, there have been no new studies of enamel fluorosis in U.S. communities with fluoride at 2 mg/L in drinking water. Earlier studies indicated that the prevalence of moderate enamel fluorosis at that concentration could be as high as 15%…

109 of the 119 reports listed below do not mention dental or enamel fluorosis, even after severe dental fluorosis has been found to be an adverse health effect in 2006.

Only 10 reports include a mention of dental fluorosis:

  • 2 reports give limited fluorosis statistics: 2009 California and 2014 Idaho
  • 2 reports cite fluorosis only in a reference citation

Out of the 119 reports, five mention “White Spots” which could be dental fluorosis.

  • The 2007 Georgia report notes: “20% of 2 to 5 year old Georgia Head Start children surveyed have white spot lesions.”
  • The 2011 Washington state report gives the rate for White Spot Lesions in Head Start/ECEAP Preschoolers at 20.5%, with African American children having the highest percent.

State

Oral Health Report

Alabama 2007. Dental Screenings by % W/Decay. In order by Dental District and % W/Decay. 2006-2007.
Note: 7,643 students were screened at 103 schools.
No mention of dental fluorosis.
Alabama 2012. The Oral Health of Alabama’s Children, 2010-2012.
No mention of dental fluorosis.
Alabama 2013. The Oral Health of Alabama’s Kindergarten and Third Grade Children Compared to the General U.S. Population and Healthy People 2020 Targets. Alabama Department of Public Health Data Brief February.
No mention of dental fluorosis.
Alaska Undated. 13. Oral Health. Healthy Alaskans 2010 – Volume I.
A 2 paragraph description of dental fluorosis is given.
Alaska 2007. Alaska Oral Health Plan: 2008-2012. By BJ Whistler. Women’s, Children’s and Family Health, Division of Public Health, Alaska Department of Health and Social Services. Funding for the State Oral Health Plan was provided by the U.S. Centers for Disease Control and Prevention through the Chronic Disease Prevention and Health Promotion Programs Cooperative Agreement (U58/CCU022905).
No mention of dental fluorosis.“White Spot Lesions” is mentioned on page 12:“Develop or identify education materials for parental/caregiver recognition of early enamel caries, ‘white spot lesions’, in relation to early childhood caries and prevention efforts.”
Alaska 2012. Alaska Oral Health Plan 2012-2016. Alaska Department of Health and Social Services. July. Funding for the State Oral Health Plan was provided by the U.S. Centers for Disease Control and Prevention through the Chronic Disease Prevention and Health Promotion Programs Cooperative Agreement (U58/CCU022905).
No mention of dental fluorosis.“White Spot Lesions” is mentioned on page 35 using the same language as above.
Alaska

2013. Alaska Oral Health Surveillance System. Oral Health Program, Department of Health and Social Services. November 1. Supported by a cooperative agreement with the U.S. Centers for Disease Control and Prevention.

* Dental fluorosis mentioned once on page 12: “Rates of dental fluorosis, a cosmetic condition in tooth enamel, may increase if fluoride levels in the drinking water are chronically in excess of optimal fluoride levels.”

Arizona

2005. The Oral Health of Arizona’s Children. Current status, trends, and disparities. Arizona Department of Health Services – Office of Oral Health. November.

* Dental fluorosis mentioned once on page 18: “Consistent with recommendations developed by the National Institute of Dental and Craniofacial Research, each tooth surface was scored for decay, restorations, sealants, fluorosis, trauma, premature loss, and eruption status. Additional information was gathered to determine treatment urgency and referral needs.”

However, no statistics were given on dental fluorosis even though “More than 13,000 children received dental screenings.” and “each tooth surface was scored for decay, restorations, sealants, fluorosis, trauma, premature loss, and eruption status…”

Arkansas 2002. Too Few Visits to the Dentist? The Impact on Children’s Health. A Special Report from Arkansas Advocates for Children & Families. February.
No mention of dental fluorosis.
Arkansas Undated. Alaska Oral Health Assessment. Summary Report 2004-2005. By the State of Alaska, Department of Health and Social Services, Division of Public Health, Oral Health Program.
No mention of dental fluorosis.
Arkansas 2007. Oral Health in Arkansas. By Mouden LD, Phillips MM, Sledge R, Evans V. Office of Oral Health. August.
No mention of dental fluorosis.
Arkansas 2012. Arkansas Oral Health Plan 2012-2015. Arkansas Department of Health, Office of Oral Health.
“Recommendation 2.8. Provide funding for public health clinic start up and maintenance grants and other safety net programs including community health centers and not-for-profit volunteer programs. Strategy: 1. On an ongoing basis, pursue funding for community health center dental expansion and volunteer community programs through the Tobacco Master Settlement Agreement and other funding mechanisms.”
No mention of dental fluorosis.
Arkansas 2013. Office of Oral Health Surveillance Plan. Prepared by Abby Holt and Brian Whitaker. Arkansas Department of Health.
Community water fluoridation (CWF) is promoted through a CDC cooperative agreement. Activities include presentations on the benefits and costs of CWF internally within the ADH and externally to various governing bodies, community leaders and lay citizens through the distribution of informational packets and campaigns to include print and broadcast media. Internal partners include the ADH Section of Engineering and the Office of Communications and Marketing among others.”
No mention of dental fluorosis.
California

2006. “Mommy, it hurts to chew.” The California Smile Survey. An Oral Health Assessment of California’s Kindergarten and 3rd Grade Children. Dental Health Foundation. February.

“During the 2004-2005 school year we surveyed over 21,000 California children in kindergarten or third grade, in nearly 200 randomly-selected schools spread across the State…”

No mention of dental fluorosis.

California

2009. Research and public policy: dental caries and fluoridation. UCSF Dental Public Health Seminar: Part 1. By Howard Pollick. October 6.

* This is not a report published by the state. However, there is a discussion on dental fluorosis and rates are given for “High Schools” 1993-94. It’s difficult to read the small chart in the report for the percent of severity of dental fluorosis.
Percent of dental fluorosis given for 10th graders teeth 1993-94:
Fluoridated Urban: 9.0%
Other Urban: 16.1%
Rural 7.9%
All Regions (lifetime residents): 11.5%

California 2009. Dental Health Fact Sheet 2009 [for Santa Clara]. By the Santa Clara Public Health Department.
No mention of dental fluorosis.
California 2014. Sonoma County Smile Survey. An Oral Health Assessment of Sonoma County’s Kindergarten and Third Grade Children. Prepared by Jenny Mercado MPH, Epidemiologist, Sonoma County Department of Health Services. November.
No mention of dental fluorosis.
Colorado 2000. Addressing the crisis of oral health access for Colorado’s children. Colorado Commission Children’s Dental Health. A Report to the Honorable Bill Owens Governor, State of Colorado. December 2.
“During the Colorado 2000 General Assembly session, through tobacco settlement legislation, funds were designated for the improvement of the Child Health Plan Plus, including the addition of a dental benefit to begin January 1, 2001, providing an ‘adequate number of dentists are willing to provide services to eligible children.’”
No mention of dental fluorosis.
Colorado 2005. Smart Mouths, Healthy Bodies: An Action Plan to Improve the Oral Health of Coloradans. Prepared for Oral Health Awareness Colorado by the Colorado Department of Public Health and Environment, Oral Health Program. Fall.
No mention of dental fluorosis.
Colorado 2011-2015 Colorado Oral Health Surveillance System Plan. The Colorado Department of Public Health and Environment.
No mention of dental fluorosis.
Colorado 2012. Colorado Oral Health Plan. Developed by Oral Health Colorado.
No mention of dental fluorosis.
Connecticut 2007. Oral Health in Connecticut. Connecticut Department of Public Health.
* A definition of dental fluorosis is given: “However, excessive fluoride consumption can cause mottled enamel or fluorosis (i.e. whitish or brownish spots on teeth). Dental fluorosis results from the ingestion of high levels of fluoride during tooth development in children less than 8 years old.”
Connecticut 2012. The Oral Health of Connecticut’s Children. Connecticut Department of Public Health, Office of Oral Health. October. This publication was supported by the Cooperative Agreement Number 5U58DP001534-04 from The Centers for Disease Control and Prevention
Key findings:
—  Dental decay continues to be a significant public health problem for CT’s children
— There are significant oral health disparities in CT with minority and low-income children having the highest level of dental disease.
No mention of dental fluorosis.
Connecticut 2013. Oral Health Improvement Plan for Connecticut 2013-2018. Connecticut Coalition for Oral Health. This publication was supported by the Cooperative Agreement Number 5U58DP001534-05 from the Centers for Disease Control and Prevention.
No mention of dental fluorosis.
Delaware 2002. Delaware Oral Health Assessment of Third Grade Children. Delaware Health and Social Services, Division of Public Health. May.
No mention of dental fluorosis.
Delaware 2013. KIDS COUNT in Delaware Issue Brief. Oral Health. By the Center for Community Research, University of Delaware (Newark DE). Spring.
This document (oral health issue brief) with funding provided by HRSA # T12HP14660.
No mention of dental fluorosis.
Delaware 2013-b. Delaware Smiles. The Oral Health of Delaware’s Children. Delaware Health and Social Services, Bureau of Oral Health and Dental Services. August.
PROJECT FUNDING. Title V Block Grant, Delaware Division of Public Health, Maternal and Child Health Bureau.
No mention of dental fluorosis.
Delaware 2014. Delaware Oral Health Plan 2014. Goals and Objectives. Delaware Health and Social Services, Bureau of Oral Health and Dental Services. June 5.
No mention of dental fluorosis.
District of Columbia 2006. Behavioral Risk Factor Surveillance System (BRFSS) 2006 Annual Report. Government of the District of Columbia, Department of Health, Center for Policy, Planning and Epidemiology.
“The BRFSS is conducted for the District of Columbia Department of Health, with funding and guidance provided by the CDC of the U.S. Public Health Service.”
No mention of dental fluorosis.
District of Columbia 2007. Issue Brief: Oral Health is Critical to the School Readiness of Children in Washington, DC. By Altarum Institute and funded by Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.
No mention of dental fluorosis.
Florida 2013. Florida Oral Health Metrics. A Florida Public Health Institute Report. Report prepared by the Urban Health Solutions Research and Writing Team (Bello L, Dye M, Garces A, Rovira I, McCabe B). This report was made possible with generous support from the DentaQuest Foundation.
No mention of dental fluorosis.
Florida Undated (after 2012). Statewide Oral Health Surveillance Program: The Third Grade Basic Screening Survey. By D. Solovan-Gleason, Florida Department of Health.
No mention of dental fluorosis.
Georgia 2006. Oral Health of Georgia’s Children. Results from the 2005 Third Grade Oral Health Survey. By the Georgia Department of Human Resources. April. Funding was provided through the Health Resources and Services Administration, States Oral Health Collaborative Systems Grant, Georgia’s Access to Dental Services Grant/GADS III
No mention of dental fluorosis.
Georgia 2007. Status of Oral Health in Georgia, 2007. Summary of Oral Health Data Collected in Georgia. Authors: Levin E, Kanny D, Duval T, Koskela L. Georgia Department of Human Resources. November. Publication Number: DPH07.155WH.
No mention of dental fluorosis.WHITE SPOT LESIONS MENTIONED: “20% of 2 to 5 year old Georgia Head Start children surveyed have white spot lesions.”
“White Spot Lesions (WSL) – Considers only the six maxillary anterior (upper front) teeth and is defined as white spots found only at the cervical 1/3 of the tooth, with or without a break in the enamel surface, and with or without brown staining. The presence of WSL identifies a child as being “at risk for Early Childhood Caries (ECC)”
Georgia 2012. Georgia’s Oral Heath Plan. Georgia Oral Health Coalition, Division of Health Promotion, Maternal and Child Health Section, Oral Health Prevention Program. This effort was made possible in part by funding from Centers for Disease Control and Prevention, Division of Oral Health, Oral Health Prevention Infrastructure Cooperative Agreement.
No mention of dental fluorosis.
Hawaii 2001. Oral Health 2001: A strategic Plan for Oral Health in Hawai’i. Produced by Hawai‘i Primary Care Association. The Frear Eleemosynary Trust, the McInerny Foundation, and the G.N. Wilcox Trust, provided funds to support the planning process and production of this document.
No mention of dental fluorosis.
Hawaii Undated. Hawaii Community Focus Groups Determine Priorities for Oral Health Research. By Harrigan R, DeCambra H, Easa D, Strauss R, Greer M, Beck J.
Acknowledgments: This investigation/manuscript/etc. was supported by a NIDCR R-21 award (DE15020-01) “A Study of Oral Health Disparities in Adult Asian & Pacific Islanders” and a Research Centers in Minority Institutions (NCRR) award, P20 RR11091, from the National Institutes of Health.
No mention of dental fluorosis.
Note from Fluoride Action Network: Hawaii is a series of volcanic islands. On the Big Island volcanic smog (VOG) is a major issue. Off-gassing chemicals of greatest concern include hyrdrogen fluoride, a source for exposure for children to dental fluorosis.
Hawaii 2014. Oral Health Surveillance in Hawaii, 2014. Presented by Donald Hayes, MD, MPH, CDC Assigned Epideniologist, Hawaii Department of Health, Family Services Division. October 2.
No mention of dental fluorosis.
Idaho 2008. Idaho Oral Health Plan 2008-2013. The Idaho Department of Health and Welfare.
No mention of dental fluorosis.
Idaho

2014. Idaho Smile Survey. 2013 Report. Prepared by Ward Ballard, Research Analyst, Principal. Idaho Department of Health & Welfare.This report was supported by the Maternal and Child Health Block Grant and the Cooperative Agreement 1U58DP004914-01 from the Centers for Disease Control and Prevention.

* FLUOROSIS is mentioned on pages 2, 12, 13, 20
The rate for severe fluorosis (teeth show brown spots or pitting) was 0.1 percent for2013 for all third-grade students
• Percent of Idaho Third-Grade Students with Fluorosis, 2001-2013:
2001: 8.7 %
2005: 11.4%
2009: 7.8%2013: 5.8%

Illinois 2001 or 2002. Proceedings of the Illinois Oral Health Summit and the Illinois Oral Health Plan. Illinois’ response to the U.S. Surgeon General’s report: Oral Health in America. Partial funding to support the Illinois Oral Health Summit was provided by The federal Health Resources and Services Administration and The Association of State and Territorial Dental Directors.
No mention of dental fluorosis.
Illinois 2007. CSHCN Oral Health Report. Illinois IFLOSS Coalition.
No mention of dental fluorosis.
Illinois 2007. Oral Health Care in Illinois. The Illinois Oral Health Plan II. Spring. A compendium of information presented to the Illinois public by IFLOSS.
No mention of dental fluorosis.
Illinois 2007. Illinois Oral Health Surveillance System (IOHSS). By Sangeeta Wadhavan, BDS, MPH, Oral Health Epidemiologist, Illinois Department of Public Health. NOHC 2007.
No mention of dental fluorosis.
Indiana 2009. Indiana Strategic Oral Health Initiative (SOHI). Project Report. 2009. Center for Health Policy (09-C43) School of Public and Environmental Affairs Indiana University–Purdue University Indianapolis; and the Indiana State Department of Health.
No mention of dental fluorosis.
Indiana 2013. The Oral Health of Indiana’s Third Grade Children Compared to the General U.S. Third Grade Population. Indiana State Department of Health Data Brief. December.
No mention of dental fluorosis.
Iowa 2006. Oral Health Survey Report: FY06. Report prepared by Tracy Rogers and Xia Chen. Iowa Department of Public Health, Oral Health Bureau.
No mention of dental fluorosis.
Iowa 2009. Third Grade Open Mouth Survey Report. Iowa Department of Public Health, Oral Health Bureau.
No mention of dental fluorosis.
Kansas 2004. The Oral Health of Kansas Children 2004. By Kimminau KS and Huang CC of the Kansas Health Institute; and McGlasson D and Kim J. of the Kansas Department of Health and the Environment.
No mention of dental fluorosis.
Kansas 2011. Kansas Oral Health Plan 2011-2014. Kansas Department of Health and Environment. January. Funding was provided by the U.S. Centers for Disease Control and Prevention through the Cooperative Agreement ( 1U5 8/ DP002834 – 01 ).
No mention of dental fluorosis.
Kentucky 2006. Statewide Oral Health Strategic Plan – 2006. The Commonwealth of Kentucky.
• PAGE 50: Fluoride Varnish is currently funded through federal tobacco settlement dollars.
• PAGE 4: This program is called KIDS SMILE and is funded from the tobacco settlement funds for children 0 through 5 years of age.
• Early childhood funding through Kentucky’s Federal Tobacco Settlement creates numerous opportunities.
• CHANGE OPPORTUNITIES: 18. Tobacco tax for oral health.
No mention of dental fluorosis.
Kentucky 2007. Kentucky’s Oral Health Poses Challenges. By Michael T. Childress and Michal Smith-Mello. Foresight, No. 50.
No mention of dental fluorosis.
Kentucky 2008. Using Cartograms to Illustrate Disparities in Oral Health in Kentucky. By Saman DM, Arevalo O, Johnson AO. University of Kentucky.
No mention of dental fluorosis.
Louisiana 2006. Oral Health Survey Report: FY06. Report prepared by Tracy Rogers and Xia Chen. Iowa Department of Public Health, Oral Health Bureau.
No mention of dental fluorosis.
Louisiana Undated. Louisiana Statewide Oral Health Coalition. State Plan for 2010-2013. By the Louisiana Statewide Oral Health Coalition.
No mention of dental fluorosis.
Louisiana 2010. Oral Health in Louisiana. A document on the oral health status of Louisiana’s population. By Rishu Garg, Oral Health Program Epidemiologist/Evaluator. Department of Health and Hospitals, Oral Health Program. July.
The creation of this document was made possible with funding from the Centers for Disease Control and Prevention, Division of Oral Health by Cooperative Agreement DP08 – 802.
* ENAMEL FLUOROSIS MENTIONED:
Fluoride supplements (page 34): “It is recommended that the risk of tooth decay should be weighted before issuing a prescription for these supplements in children younger than 6 years of age because these supplements also increase the risk of enamel fluorosis.”
Fluoride mouth rinse (page 34)”Children under 6 years old are not recommended to use it without the prescription of a dentist because of the risk of enamel fluorosis as they tend to swallow it more often than adults.”
Fluoride gel and foam (page 34): “These are usually applied in dental offices and pose less of a threat for fluorosis in children younger than six because of the big intervals in between the applications… Fluoride varnish has a fluoride concentration of 22,600 ppm…”
Louisiana 2011. Bright Smiles for Bright Futures. Basic Screening Survey. By Rishu Garg, MD, MPH, A Report of the Oral Health Status of Louisiana’s Third Grade Children.
No mention of dental fluorosis.
Maine 2007. Maine Oral Health Improvement Plan. Published by the Maine Dental Access Coalition. November.
No mention of dental fluorosis.
Maine 2013. Oral Health in Maine. By Feinstein J, Gradie MI, Huston S, Mervis C, Ghouri, F, Nazare S, et al. The Maine Center for Disease Control and Prevention, an office of the Department of Health and Human Service. January.
No mention of dental fluorosis.
Maryland 2007. Survey of the oral health status of Maryland school children 2005-2006. Authors: Richard J. Manski RJ, Chen H, Chenette RR, Coller S. University of Maryland Dental School.
No mention of dental fluorosis.
Maryland 2011. Maryland Oral Health Plan 2011-2015. Holt K., ed. Maryland Dental Action Coalition. This publication was made possible with support from the DentaQuest Foundation and the Division of Oral Health, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.
No mention of dental fluorosis.
Maryland 2012 Annual Oral Health Legislative Report as required by Health-General Article, Sections 13-2504(b) and 13-2506 and HB 70 (Ch. 656 of the Acts of 2009).
No mention of dental fluorosis.
Maryland 2013. Oral Health Survey of Maryland School Children, 2011-2012. By Macek MD, Coller S, Chen H, Manski RJ, Manz M, Altema-Johnson D, Goodman HS. University of Maryland School of Dentistry.
No mention of dental fluorosis.
Massachusetts 2008. The Oral Health of Massachusetts’ Children. By White BA, Monopoli MP, Souza BS. Catalyst Institute. January.
Assessment and report funded in part by Delta Dental of Massachusetts and the Association of State and Territorial Dental Directors (see acknowledgments for all funders).
* ONLY MENTION OF DENTAL FLUOROSIS IS ONE REFERENCE CITATION.
Massachusetts 2010. Oral Health Plan for Massachusetts 2010-2015. Better Oral Health for Massachusetts Coalition.f
No mention of dental fluorosis.
Michigan 2006. Michigan Oral Health Plan. Michigan Department of Community Health; Michigan Oral Health Coalition. September. Funding for the State Oral Health Plan was provided by the Centers for Disease Control and Prevention through the Chronic Disease Prevention and Health Promotion Programs Component 4: Chronic Disease Prevention and Health Promotion Programs (U58/CCU522826).
No mention of dental fluorosis.
Minnesota 2006. Minnesota Oral Health Data Book. Children and Youth. By the Minnesota Department of Health, Community and Family Health Division. October. Funded by the U.S. Department of Health and Human Services Health Resources and Services Administration Grant Number H47MC02019.
* ONLY MENTION OF DENTAL FLUOROSIS IS ONE REFERENCE CITATION.
Minnesota 2013. The Status of Oral Health in Minnesota. By Khan B, Adeniyi A, Thoele MJ. Minnesota Department of Health, Oral Health Program. September. Funding sources: CDC Division of Oral Health Cooperative Agreement funding, DP08-802. Health Resources and Services Administration grants to states to support oral health workforce activities, T12HP14659.
No mention of dental fluorosis.
Minnesota 2013b. Minnesota Oral Health Plan. 2013-2018. Minnesota Department of Health, Oral Health Program. January. Funding was made possible by grants to support statewide oral health related activities from the Health Resources and Services Administration, Award T12HP1465, and Centers for Disease Control Prevention, Cooperative Agreement Grant Number 5U58DP0011579.
No mention of dental fluorosis.
Mississippi 2006. State of Mississippi Oral Health Plan 2006-2010. By the Mississippi Department of Health.
No mention of dental fluorosis.
Mississippi Undated. Every Smile Counts. The Oral Health of Mississippi’s Third Grade Children 2009-2010 School Year. By the Mississippi State Department of Health, Office of Oral Health.
No mention of dental fluorosis.
Missouri 2005. The Oral Health of Missouri’s Children. Executive Summary. Missouri Department of Health and Senior Services, Oral Health Program.
No mention of dental fluorosis.
Missouri 2014. Oral Health in Missouri 2014: A Burden Report by the Missouri Department of Health and Senior Services.
No mention of dental fluorosis.
Montana 2006. Montana Oral Health Plan. Montana’s response to “A National Call to Action to Promote Oral Health, Healthy People 2010, and the Future of Dentistry”. Montana Department of Public Health and Human Services.
No mention of dental fluorosis.
Montana 2007. Montana 2005-2006 Study of Oral Health Needs: 3rd Graders and Head Start Children. By Rosina Everitte, MPH. June 22.
No mention of dental fluorosis.
Nebraska 2005. Open Mouth Survey of Third Graders Nebraska 2005. Nebraska Department of Health and Human Services Regulation and Licensure. Funding was provided through SSDI, a project of the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, HRSA/MCHB grant number HI8MC00031C0.
No mention of dental fluorosis.
Nevada 2008 Nevada State Oral Health Plan. Department of Health and Human Services, Nevada State Health Division, Bureau of Family Health Services. April.
Funding for the 2008 State Oral Health Summit was provided by: The Department of Health and Human Services Health Resources and Services Administration Centers for Disease Control and Prevention Division of Oral Health
No mention of dental fluorosis.
Nevada 2009. Third Grade Oral Health Survey 2008-2009. Department of Health and Human Services, Nevada State Health Division, Oral Health Program.
No mention of dental fluorosis.
Nevada 2011. Nevada Oral Health Surveiilance Plan. By Pool C, Hansen AC, Cofano L.January. Department of Health and Human Resources. The report is a draft, there is no final available.
No mention of dental fluorosis.
Nevada 2012-2013 Head Start Oral Health Survey. Nevada. Department of Health and Human Services, Nevada State Health Division, Oral Health Program. February 2013.
No mention of dental fluorosis.
New Hampshire 2003. New Hampshire Oral Health Plan: A Framework for Action. Coalition for New Hampshire Oral Health Action.
No mention of dental fluorosis.
New Hampshire 2010. New Hampshire 2008-09 Third Grade Healthy Smiles – Healthy Growth Survey. Oral Health and Body Mass Index Assessment of New Hampshire 3rd Grade Students. By the N.H. Department of Health and Human Services. July. Funded by: HNH foundation, Northeast Delta Dental Foundation, New Hampshire Department of Health and Human Services.
No mention of dental fluorosis.
New Hampshire 2010. New Hampshire Oral Health Data 2010. By the New Hampshire Department of Health and Human Services, Oral Health Program. March.
No mention of dental fluorosis.
New Jersey 2009. Pediatric Oral Health Action Plan for New Jersey’s Children Aged 0-6. Funded by New Jersey Head Start-State Collaboration Grant and The Association of State and Territorial Dental Directors. April.
No mention of dental fluorosis.
New Mexico 2006. New Mexico Oral Health Surveillance System. NMORSS Special Report on Children 2006. Office of Oral Health, Health Systems Bureau, New Mexico Department of Health. Funding was provided by State Oral Health Collaborative Systems Grant, # H47MCO1945, Health Resources Services Administration, US Department of Health and Human Services.
No mention of dental fluorosis.
New Mexico

2006b. New Mexico Oral Health Surveillance System. NMOHSS Special Report on the Border Counties 2006. Office of Oral Health, Health Systems Bureau, New Mexico Department of Health. Funding was provided by State Oral Health Collaborative Systems Grant, # H47MCO1945, Health Resources Services Administration, US Department of Health and Human Services.

* Dental fluorosis is mentioned on page 5. “The EPA- established Maximum Contaminant Level Goal (MCLG) for fluoride is currently 4 mg/L; higher levels increase the risk of severe enamel fluorosis (discoloration, enamel loss, and pitting of the teeth during tooth development in children).

New York 2005. Oral Health Plan for New York State. By the New York State Department of Health. August. This effort was made possible in part by funding from Centers for Disease Control and Prevention, Division of Oral Health, Cooperative Agreement 03022.
No mention of dental fluorosis.
New York 2005. Oral Health Status of Third Grade Children. By Kumar JV, Altshul DL, Cooke TL, Green EL. New York State Oral Health Surveillance System. December 15.
No mention of dental fluorosis.
New York 2005. Children’s Oral Health. By the Schuyler Center for Analysis and Advocacy (Albany NY).
No mention of dental fluorosis.
New York 2012. Oral Health in New York City. A data report from the New York City Department of Health. NYC Vital Signs, Volume 11, No. 5, June.
No mention of dental fluorosis.
New York 2014. Oral Health Plan for New York State. December 2014. By the New York State Department of Health. December. This effort was made possible in part by funding from Centers for Disease Control and Prevention, Division of Oral Health, Cooperative Agreement 03022.
No mention of dental fluorosis.
North Carolina 2013. North Carolina Oral Health Section. Kindergarten and Fifth Grade Oral Health Status. County Level Summary 2012-2013. North Carolina Division of Public Health, Dental Health Section.
No mention of dental fluorosis.
North Carolina 2014. Revised Statewide Oral Health Strategic Plan: Collaboration for Integrated and Comprehensive Oral Health. North Carolina Department of Health and Human Services. February 1.
No mention of dental fluorosis.“WHITE SPOT LESIONS’is mentioned on page 22.
North Dakota 2005. North Dakota Oral Health Survey 2004-2005 School Year. Prepared by Kathy Phipps, DrPH, ASTDD Data Coordinator, Morrow Bay, CA.
No mention of dental fluorosis.
North Dakota 2012. Oral Health in North Dakota. Burden of Disease and Plan for the Future 2012-2017. North Dakota Oral Health Department, North Dakota Department of Health. Funding for this publication was obtained through cooperative agreement #DP08-802 between the U.S. Centers for Disease Control and Prevention (CDC) and the North Dakota Department of Health (NDDoH).
No mention of dental fluorosis.
Ohio 2013. Oral Health Section 2013 Plan. Ohio Department of Health.
No mention of dental fluorosis.
Ohio 2014. Ohio Oral Health Surveillance Plan, 2014-2018. Ohio Department of Health. February 1.
No mention of dental fluorosis.
Oklahoma 2009. Governors Task Force on Children and Oral Health. August.
No mention of dental fluorosis.
Oklahoma 2013. Oklahoma Oral Health Needs Assessment 2013. Third Grade Children. By the Oklahoma State Department of Health, Dental Health Service.
No mention of dental fluorosis.
Oregon 2014. Oregon Oral Health Surveillance System 2002-2014. By the Oregon Health Authority, Public Health Division, Oral Health Program.
No mention of dental fluorosis.
Oregon 2014. Strategic Plan for Oral Health in Oregon: 2014-2020. Oregon Oral Health Coalition, Oregon Health Authority, Oregon Health Funders Collaborative.
No mention of dental fluorosis.
Pennsylvania 2002. Oral Health Strategic Plan for Pennsylvania. Commonwealth of Pennsylvania Department of Health. November 2002.
No mention of dental fluorosis.
Rhode Island 2011. Rhode Island Oral Health Plan, 2011-2016. Rhode Island Oral Health Commission, Rhode Island Department of Health. January. This publication was made possible in part by funding from the Centers for Disease Control and Prevention, Division of Oral Health, Cooperative Agreement 08802 and the Health Resources and Services Administration, Division of Medicine and Dentistry, Grant #T12HP14663.
No mention of dental fluorosis.
Rhode Island 2012. Oral Health of Rhode Island’s Children. By the Rhode Island Department of Health, Oral Health Program. February. Authored by Junhie Oh, BDS, MPH, Oral Health Epidemiologist/Evaluator; Deborah Fuller, DMD, MS, Dental Sealant Program Coordinator/Public Health Dentist, Oral Health Program.
No mention of dental fluorosis.
South Carolina 2008. South Carolina State Oral Health Plan. Update May 26.
No mention of dental fluorosis.
South Dakota 2014. The Oral Health of South Dakota’s Third Grade Children Compared to the General U.S. Third Grade Population. South Dakota Department of Health Data Brief June 2014.
No mention of dental fluorosis.
South Dakota 2015. Oral Health Plan for South Dakota, 2015-2020. South Dakota Oral Health Coalition. Spring.
No mention of dental fluorosis.
Tennessee 2010. Tennessee Smiles: The UT Grassroots Oral Health Outreach Initiative. By Lewis MW, Wasson W, Scarbecz M, Aubertin MA, Woods M, Himel VT. Journal of the Tennessee Dental Association. 91-4.
• See reference 67
No mention of dental fluorosis.
Texas 2008. Oral Health in Texas 2008. By the Texas Department of State Health Service, the Centers for Disease Control and Prevention, and the U.S. Department of Health and Human Services. DSHS OHP acknowledges the funding and technical support received from the Division of Oral Health at the Centers for Disease Control and Prevention, Atlanta, Georgia, in making this document available to the citizens of Texas as provided through Cooperative Agreement No. U58/CCU622789-0.
No mention of dental fluorosis.
Utah 2012. Utah’s Plan of Action to Promote Oral Health. A Public-Private Partnership, Utah Oral Health Coalition. December 20.
No mention of dental fluorosis.
Vermont 2014. Vermont Oral Health Plan 2014. By the Vermont Department of Health.
No mention of dental fluorosis.
Virginia 2011. Oral Health in Northern Virginia. A report commissioned by the Northern Virginia Health Foundation. September.
No mention of dental fluorosis.
Washington 2009. Washington State Collaborative Oral Health Improvement Plan 2009-2014. Washington State Oral Health Coalition. November. Acknowledgment: Federal funding from HRSA Grant T12HP10687, CFDA 93.236.
No mention of dental fluorosis.
Washington 2011. Smile Survey 2010. The Oral Health of Washington’s Children. By the Washington State Department of Health; Delta Dental Washington Dental Service Foundation; Washington State Department of Early Learning. March.
No mention of dental fluorosis.WHITE SPOT Lesions mentioned in Tables 7,8,9,10.
WHITE SPOT LESIONS in Head Start/ECEAP Preschoolers is 20.5%

WHITE SPOT: Head Start/ECEAP Preschoolers by race:
25.3%, African-American
20.7%, Minority
20.6%, White, Non-Hispanic
17.5%, Hispanic
West Virginia 2010. West Virginia Oral Health Plan 2010-2015. By the West Virginia Department of Health & Human Resources. March 2010.
No mention of dental fluorosis.
Wisconsin 2010. The Health of Dane County. The Oral Health Crisis. Produced by the Public Health Madison & Dane County and the Oral Health Coalition of Dane County. May.
No mention of dental fluorosis.
Wisconsin 2013. Healthy Smiles / Healthy Growth. Wisconsin’s Third Grade Students. By Olson M, Chaffin J, Chudy N, Yang A.
The publication was made possible in part by funding from two grants from the Centers for Disease Control and Prevention. The Division of Oral Health, Cooperative Agreement DP08-802 and the Division of Nutrition, Physical Activity and Obesity Cooperative Agreement 5U58DP001494-05.
No mention of dental fluorosis.
Wisconsin 2013b. Wisconsin’s Roadmap to Improving Oral Health 2013-2018. Wisconsin Oral Health Coalition. This publication was made possible in part by funding from the Centers for Disease Control and Prevention, Division of Oral Health, Cooperative Agreement DP08-802.
No mention of dental fluorosis.
Wyoming 2010. Oral Health in Wyoming. Final Report. Wyoming Department of Health.
No mention of dental fluorosis.

 

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Table 3