<b>Prevalence and Severity of Dental Fluorosis Among Underprivileged Children in Lahore: A Cross-Sectional Study</b>

Background: Dental fluorosis is a developmental enamel condition associated with excessive fluoride exposure during tooth formation, and its burden may be greater in underserved communities where oral health surveillance and water-quality monitoring are limited. Objective: This study aimed to estimate the prevalence and severity of dental fluorosis among school-aged children from peri-urban underprivileged communities of Lahore and to explore its association with age, sex, and DMFT scores. Methods: A retrospective cross-sectional analysis was conducted using anonymized records from routine community dental outreach screening among children aged 6–15 years in peri-urban Lahore, Pakistan. Dental fluorosis was classified using Dean’s Fluorosis Index, and caries experience was assessed using the DMFT index. Frequencies and percentages were calculated for fluorosis categories, chi-square tests were used for associations with age and sex, and the Kruskal-Wallis test assessed differences in DMFT scores across fluorosis severity categories. Results: Among 292 children, 162 (55.5%) had questionable-to-severe fluorosis and 143 (49.0%) had definite fluorosis. Very mild fluorosis was most frequent (25.7%), followed by mild (18.2%), moderate (4.5%), and severe fluorosis (0.7%). Fluorosis was not significantly associated with sex (p=0.50) but increased across age groups (p=0.03). Mean DMFT scores increased from 1.2±0.8 in children with normal enamel to 3.0±0.8 in severe fluorosis (p=0.02). Conclusion: Dental fluorosis was common among screened peri-urban children and was associated with older age and higher caries experience. The findings support integrated oral health screening and water-quality assessment in underserved communities.