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Dean's criteria were followed to assess enamel fluorosis.
For three quarters of a million people, dental fluorosis is of the " moderate to severe " degree.
So have Japan and India, where fluoride occurs naturally and skeletal fluorosis (thickening of bones) is prevalent.
This mild fluorosis is often undetectable except by a dental expert.
Beside being unsightly, fluorosis can have a psychological impact, and cosmetic dentistry is expensive.