MICHELY CRISTINA GOEBEL

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UNIVERSIDADE FEDERAL DE SANTA CATARINA 
CAMPUS FLORIANÓPOLIS 
DEPARTAMENTO DE ODONTOLOGIA 
CURSO DE GRADUAÇÃO EM ODONTOLOGIA 
 
 
 
 
 
 
 
MICHELY CRISTINA GOEBEL 
 
 
 
 
 
 
Análise bibliométrica dos 100 artigos mais citados sobre fluorose dentária 
 
 
 
 
 
 
 
 
 
 
 
Florianópolis 
2022 
MICHELY CRISTINA GOEBEL 
 
 
 
 
 
Análise bibliométrica dos 100 artigos mais citados sobre fluorose dentária 
 
 
 
 
 
 
 
 
Trabalho de Conclusão submetido ao curso de 
Graduação em Odontologia do Centro de 
Ciências da Saúde da Universidade Federal de 
Santa Catarina como requisito parcial para a 
obtenção do título de Cirurgiã-Dentista. 
Orientadora: Profa. Mariane Cardoso, Dra 
Coorientador: Aurélio de Oliveira Rocha, Ms 
 
 
 
 
 
 
 
 
 
Florianópolis 
2022 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Michely Cristina Goebel 
 
Análise bibliométrica dos 100 artigos mais citados sobre fluorose dentária 
 
Este trabalho de conclusão de curso foi julgado adequado para a obtenção do título de 
cirurgiã-dentista e aprovado na sua forma final pelo Departamento de Odontologia da 
Universidade Federal de Santa Catarina. 
 
Florianópolis, 23 de novembro de 2022. 
 
 
 
_____________________________________ 
Coordenação do Curso 
 
 Banca examinadora: 
 
 
 
_____________________________________ 
Profª Mariane Cardoso, Dra 
Orientadora 
 
 
_____________________________________ 
Bárbara Suelen Moccelini, Ms 
Universidade Federal de Santa Catarina 
 
 
____________________________________ 
Cirurgiã-Dentista Karina Cardoso 
Universidade Federal de Santa Catarina 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ao meu marido e melhor amigo Marcelo, por com toda a 
paciência e carinho, me apoiar, incentivar e acreditar em 
mim, às vezes mais que eu mesma. 
AGRADECIMENTOS 
 
À Deus, por me dar saúde, motivação e resiliência para seguir com essa rotina alucinante 
de faculdade integral, trabalho e demais responsabilidades da vida adulta. 
À minha mãe, Ester, a quem eu amo demais, por ter me dado a vida, me educado e me 
apoiado à sua maneira. 
 Ao Marcelo, meu marido, parceiro, incentivador e confidente, a quem eu amo 
infinitamente, por me apoiar de várias formas em todos os momentos e ouvir, diariamente, 
minhas histórias super detalhadas sobre como foi o meu dia, e ainda, por ser meu refúgio, meu 
orgulho e motivação. 
 Ao meu chefe Diego Remor, que foi amigo, incentivador e apoiador quando eu mais 
precisei, por permitir que meu sonho se realizasse, pois, sem ele esse projeto não se 
concretizaria. À Vanessa, amiga que o trabalho me deu, por me apoiar, incentivar, ouvir minhas 
angústias e comemorar comigo minhas conquistas. 
 Às minhas amigas, por compreenderem minha ausência nesse período. Em especial à 
Cristiane, que acompanhou boa parte da minha trajetória, por me apoiar, ouvir, incentivar e 
torcer por mim ao longo desses anos; e à Gisela, que através de seu positivismo e entusiasmo, 
sempre me faz ver que posso mais do que imagino. 
À Universidade Federal de Santa Catarina, por me acolher pela segunda vez e por 
proporcionar minha tão sonhada formação em Odontologia. 
À minha orientadora, Mariane Cardoso, inspiração como pessoa e profissional, por 
abrir as portas da Odontopediatria UFSC para mim, pelas oportunidades, por me auxiliar, 
ensinar, incentivar e acreditar em meu potencial. 
Ao meu coorientador Aurélio O. Rocha, super dedicado, de um positivismo e empatia 
contagiantes e com quem aprendi muito, por toda a paciência e suporte independente de horário, 
por não medir esforços pra me ajudar. 
 A todos os professores que compartilharam conhecimento, contribuíram com minha 
formação e de quem certamente levarei os ensinamentos para meu dia a dia profissional, em 
especial ao profº Sylvio Monteiro Junior, que em cada conversa ou orientação fez com que 
aumentasse meu amor pela Odontologia; e à profª Glaucia S. Zimmermann, por acreditar em 
mim, me ensinar, ajudar e incentivar ao longo desses anos. 
Ao Team Odontopediatria da UFSC, professores, pós-graduandos e graduandos, que 
me acolheram tão bem, tanto no grupo de estudos quanto na Liga Acadêmica de 
Odontopediatria (Lacoped). Esses semestres junto à Lacoped fizeram com que aumentasse 
muito meu amor e minha motivação com a Odontopediatria. 
Aos técnicos administrativos e de laboratório, em especial ao Batista e ao Srº Luiz do 
laboratório de procedimentos, por toda a disponibilidade, auxílio, ensinamentos e risadas, que 
não foram poucas, ao longo desses anos. 
 Aos amigos que a faculdade me deu e certamente levarei para a vida, Taynara C. 
Monteiro, Fernanda Bodenmuller, Manoela Veira, Mariana Silva, Gabriel Mafra, Lucas 
Hoffmann e Juan Cassol, por todo o apoio, risadas e boas conversas. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
“Lute com determinação, abrace a vida com paixão, perca com classe e vença com ousadia, 
porque o mundo pertence a quem se atreve e a vida é muito bela para ser insignificante” 
(Charles Chaplin) 
 
RESUMO 
Objetivo: Identificar e analisar os 100 artigos mais citados da literatura sobre fluorose dentária 
(FD) através de uma análise bibliométrica. Metodologia: Foi realizada uma busca na base de 
dados Web of Science Core Collection (WoS-CC), com o filtro - Dentistry Oral Surgery 
Medicine, em novembro de 2021. Os artigos foram colocados em ordem decrescente do número 
de citações. Dois pesquisadores independentes fizeram a seleção. Scopus e Google Scholar 
foram utilizados para comparar citações. Foram extraídos dos artigos: título, autores, citações, 
instituição, país, continente, ano de publicação, título do periódico e seu fator de impacto em 
2020, palavras-chave, desenho do estudo e temática. No software VOSviewer foram geradas 
redes colaborativas. A análise dos dados foi realizada no software estatístico SPSS for Windows 
(SPSS, versão 24.0; IBM Corp). Resultados: Os 100 artigos selecionados, publicados entre 
1974 e 2014, foram citados 6.717 vezes (35 a 417 cada). Community Dentistry and Oral 
Epidemiology (24%) e Jornal of Dental Research (21%) publicaram a maioria dos artigos. 
Estudos observacionais (60%) e revisão da literatura (19%) foram os desenhos de estudo mais 
comuns. As temáticas principais foram epidemiologia (44%) e ingestão de flúor (32%). Os 
países com maior número de artigos foram EUA (44%), Canadá (10%) e Brasil (9%). A 
University of Iowa foi a instituição com mais artigos (12%). Levy SM foi o autor de maior 
relevância (12%). O mapa de coautoria revelou clusters na colaboração de pesquisa. Quanto ao 
número de citações, observou-se correlação forte entre WoS-CC e Google Scholar e muito forte 
entre WoS-CC e Scopus. Conclusão: Os 100 artigos mais citados sobre FD foram compostos 
principalmente por estudos observacionais com foco em epidemiologia e originados na 
América do Norte, apontando para a carência de estudos clínicos e demostrando interfaces que 
necessitam ser exploradas para o progresso científico dessa temática. 
Palavras-chave: Fluorose Dentária; Esmalte Dental; Flúor; Intoxicação por Fluoreto; Análise 
Bibliométrica. 
 
 
 
 
 
 
 
 
ABSTRACT 
Objective: To identify and analyze the 100 most cited articles in the literature on dental 
fluorosis (DF) through a bibliometric analysis. Methodology: A search was performed in the 
Web of Science Core Collection (WoS-CC) database, with the filter - Dentistry Oral Surgery 
Medicine, in November 2021. The articles were placed in descending order of the number of 
citations. Two independent researchers made the selection. Scopus and Google Scholar were 
used to compare citations. The following were extracted from the articles: title, authors, 
citations, institution, country, continent, year of publication, journal titleand its impact factor 
in 2020, keywords, study design and theme. In the VOSviewer software, collaborative networks 
were generated. Data analysis was performed using the statistical software SPSS for Windows 
(SPSS, version 24.0; IBM Corp). Results: The 100 selected articles, published between 1974 
and 2014, were cited 6,717 times (35 to 417 each). Community Dentistry and Oral 
Epidemiology (24%) and Journal of Dental Research (21%) published the most articles. 
Observational studies (60%) and literature review (19%) were the most common study designs. 
The main themes were epidemiology (44%) and fluoride intake (32%). The countries with the 
highest number of articles were the USA (44%), Canada (10%) and Brazil (9%). The University 
of Iowa was the institution with the most articles (12%). Levy SM was the most relevant author 
(12%). The co-authorship map revealed clusters in the research collaboration. As for the 
number of citations, there was a strong correlation between WoS-CC and Google Scholar and 
a very strong correlation between WoS-CC and Scopus. Conclusion: The 100 most cited 
articles on DF were composed mainly of observational studies focused on epidemiology and 
originated in North America, pointing to the lack of clinical studies and demonstrating 
interfaces that need to be explored for the scientific progress of this topic. 
Keywords: Dental Fluorosis; Dental Enamel; Fluorine; Fluoride Poisoning; Bibliometric 
Analysis. 
 
 
 
 
 
 
 
LISTA DE ABREVIATURAS E SIGLAS 
 
FD Fluorose Dentária 
HMI Hipomineralização molar-incisivo 
WOS-CC Web of Science Core Collection 
VOSviewer Software Visualization of Similarities Viewer 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SUMÁRIO 
 
1. INTRODUÇÃO........................................................................................................... 12 
2. OBJETIVOS................................................................................................................ 
2.1 OBJETIVO GERAL................................................................................................... 
2.2 OBJETIVOS ESPECÍFICOS...................................................................................... 
14 
14 
14 
3. ARTIGO...................................................................................................................... 15 
4. CONSIDERAÇÕES FINAIS..................................................................................... 42 
 REFERÊNCAS............................................................................................................ 43 
 ANEXO 1 ATA DE APRESENTAÇÃO................................................................... 47 
 ANEXO 2 – NORMAS DA REVISTA...................................................................... 48 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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1. INTRODUCÃO 
A Fluorose Dentária (FD) é considerada uma condição crônica e irreversível 
caracterizada como um defeito de desenvolvimento do esmalte dental. Sua ocorrência está 
relacionada com a alta ingestão de fluoretos durante o período de maturação do esmalte, além 
de poder sofrer influência das características genéticas de cada indivíduo devido a 
polimorfismos em genes da matriz do esmalte, como por exemplo, a ameloblastina (DO; HA, 
2021; FELTRIN-SOUZA et al., 2021; FORERO et al., 2018; KÜCHLER et al., 2017; 
NEVILLE et al., 2016). Os fluoretos podem ser encontrados na água de abastecimento familiar, 
em alimentos e bebidas, em enxaguantes bucais e dentifrícios fluoretados. Apesar desses íons 
serem indicados para a prevenção da cárie dental, em doses excessivas podem ser tóxicos ao 
organismo, podendo comprometer o processo de mineralização do esmalte (DO; HA, 2021; 
FELTRIN-SOUZA et al., 2021;). 
Ainda há discordâncias na literatura acerca da prevalência da FD. Na Índia, Shyan et 
al (2021) encontraram a prevalência de 96,6%, enquanto no Brasil o estudo de Dalledone et al 
(2021) observaram uma redução de 27,7% para 17,2% entre os anos de 2006 e 2016 e, em 
contrapartida, Moura et al (2016), no estado do Piauí encontraram FD em 77,9% da sua amostra. 
Tal divergência se deve às variações dos exames realizados uma vez que dependem, entre 
outros fatores, da calibração de examinadores, do índice utilizado e do local de residência da 
população investigada (DO; HA, 2021; FREITAS et al., 2013; LI et al., 2021; MARTIGNON 
et al., 2021). No México, por exemplo, órgãos de saúde ainda não incluem exames de FD em 
seus levantamentos nacionais de saúde, enquanto no Brasil, a FD foi incluída nos últimos dois 
inquéritos de base populacional da Pesquisa Nacional em Saúde Bucal (SB Brasil) em 2002 e 
2010 (FREITAS et al., 2013; MARTIGNON et al., 2021). 
O esmalte com fluorose compreende uma estrutura hipomineralizada e com vários 
graus de porosidade subsuperficial, que lhe confere menor espessura, dureza e resistência 
conforme a gravidade da condição (DO; HA, 2021; LI et al., 2021; NEVILLE et al., 2016). De 
acordo com Thylstrup et al. (1978), a magnitude do agravo a FD apresenta características 
clínicas distintas, dessa forma, pode ser classificada em leve (linhas brancas e sem brilho ao 
longo das periquimácias com maior evidência em cúspides, bordas incisais e cristas marginais), 
moderada (manchas irregulares com maiores áreas opacas e também turvas/acastanhadas) ou 
severa (presença de áreas acastanhadas mais evidentes, podendo haver perda da arquitetura 
dental, aumento do risco de fraturas e possível sintomatologia dolorosa). 
13 
 
 
O tratamento da FD depende do grau de comprometimento da estrutura dental, 
podendo ser realizados procedimentos como microabrasão, clareamento e tratamento 
restaurador, assim como a combinação entre as modalidades. Contudo, sua prevenção é a 
conduta mais indicada, sendo realizada com o controle no consumo e ingestão de íons flúor 
durante o período de formação e maturação do esmalte dental (LI et al., 2021; MARTIGNON 
et al., 2021). 
As análises bibliométricas tem sido utilizadas em diversas áreas da pesquisa com a 
finalidade de examinar a literatura de forma qualitativa e estatística. Esse tipo de análise tem o 
intuito de apontar as principais lacunas da ciência. Evidenciando, assim, a relevância de 
publicações através do número de citações, a evolução e a necessidade científica, bem como, a 
influência de pesquisadores e periódicos na disseminação do conhecimento (KAROBARI et 
al., 2021; KODONAS et al., 2020; ROCHA et al., 2022). 
Em Odontologia, a literatura evidencia análises bibliométricas envolvendo diversas 
alterações dentais incluindo cárie e erosão (BALDIOTTI et al., 2021; ROCHA et al., 2022). No 
entanto, não foi identificado até o presente momento estudos bibliométricos que tenham FD 
como foco principal a nível global, apenas estudos em que a FD aparece como temática 
secundária ou com análise restrita a determinado país (FORERO et al., 2018; WAGHMARE et 
al, 2021). Preencher essa lacuna sobre FD, permitirá uma avaliação do histórico científico dessa 
patologia e evidenciará limitações sobre essa temática, auxiliando pesquisadores na 
identificação de tendências de pesquisas futuras, que resultará no conhecimento adequado para 
decisões clínicas e prevenção baseada em evidências, uma vez que se trata de uma condição 
que pode comprometer função e estética e assim, afetar em variados níveis a qualidade de vida 
dos pacientes. 
Com isso, o presente estudo tem por objetivo elencar e analisar os 100 artigos mais 
citados da literatura sobre FD através de uma análise bibliométrica. 
 
 
 
 
 
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2. OBJETIVOS 
 
2.1 OBJETIVO GERAL 
Avaliar os 100 artigos mais citados da literatura sobre fluorose dentária através de uma 
análise bibliométrica. 
 
2.2 OBJETIVOS ESPECÍFICOS 
• Avaliar e comparar o número de citações entre os artigos e as bases selecionadas;• Determinar os autores mais recorrentes entre o top 100; 
• Avaliar as instituições que mais pesquisaram sobre FD dentre os artigos; 
• Avaliar os países e continentes mais relacionados ao top 100; 
• Observar as palavras-chave mais recorrentes; 
• Analisar as revistas que mais publicaram entre o top 100; 
• Analisar desenho de estudo e temática de maior frequência. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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3 ARTIGO 
Este trabalho encontra-se nas normas da revista “Caries Research”. 
Disponível em: https://www.karger.com/Journal/Guidelines/224219 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Review Article 
A bibliometric analysis of the top 100 most-cited papers concerning 
dental fluorosis 
Michely Cristina Goebela, Aurélio de Oliveira Rochab, Pablo Silveira Santosb, Michele Bolanc, Paulo 
Antônio Martins-Júniord, Carla Miranda Santanac, Mariane Cardosoc 
aSchool of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, (Santa Catarina), Brazil. 
bPostgraduate Program of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, (Santa 
Catarina), Brazil. 
cDepartment of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, (Santa Catarina), 
Brazil. 
dDepartment of Paediatric Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, 
(Minas Gerais), Brazil. 
 
Short Title: Bibliometric analysis concerning dental fluorosis 
 
Corresponding Author 
Pablo Silveira Santos 
Postgraduate Program of Dentistry 
Federal University of Santa Catarina 
Campus Universitário - Bloco H - Trindade 
Florianopolis, Santa Catarina, 88040-900, Brazil 
Tel: +55 55 9616-4544 
E-mail: pablossant@gmail.com 
 
Number of Tables: Four supplementary tables. 
Number of Figures: Three figures (two in the main text and 1 supplementary). 
Word count: 3,168 words 
about:blank
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Keywords: Dental Fluorosis; Dental Enamel; Fluoride; Bibliometric Analysis.
18 
 
 
Abstract 1 
The most-cited papers help to understand the main characteristics of the certain area of knowledge. 2 
The present study aimed to analyze the 100 most-cited papers about dental fluorosis (DF) through a 3 
bibliometric review. A search was performed in the Web of Science Core Collection database (WoS-4 
CC). The papers were ranked in descending order of number of citations. Two independent researchers 5 
performed the selection. Scopus and Google Scholar were used to compare citations with WoS-CC. 6 
The following data were extracted from the papers: title, authors, number and density of citations, 7 
institution, country, continent, year of publication, journal title, keywords, study design and theme. 8 
Collaborative networks were generated using the VOSviewer software. The top 100 selected papers, 9 
published between 1974 and 2014, were cited 6,717 times (ranging from 35 to 417). Community 10 
Dentistry and Oral Epidemiology (24%), Journal of dental Research (21%), Journal of Public Health 11 
dentistry (7%) and the Caries Research (13%) published the majority of papers. Observational studies 12 
(60%) and literature reviews (19%) were the most common study designs. The main topics were 13 
epidemiology (44%) and fluoride intake (32%). The countries with the highest number of papers were 14 
the United States of America (USA) (44%) and Canada (10%). The University of Iowa (USA) was the 15 
institution with the most papers (12%). Levy SM was the author with the highest number of papers 16 
(12%). The 100 most-cited papers on DF mainly were composed of observational studies focused on 17 
epidemiology and originated in North America. There is a need for interventional studies and 18 
systematic reviews among the most-cited papers on this topic. 19 
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 31 
Introduction 32 
Dental Fluorosis (DF) has its first records in the literature dating from the beginning of the 20th century, 33 
known as “mottled enamels”, when its etiology was not yet [Fejerskov et al., 1994]. Only 30 years after 34 
the first reports, the condition was then related to high levels of fluoride intake during the period of 35 
amelogenesis, being called DF [Churchill, 1931]. Enamel with DF presents lower hardness and elastic 36 
modulus due to hypomineralization, being less resistant to wear and fracture [Li et al., 2021]. Clinically, 37 
mild DF appears as white lines in isolated areas, in more severe cases it affects larger areas with 38 
frequent brownish areas, while in very severe cases there is a possibility of loss of dental enamel [Dean, 39 
1934; Forero et al., 2018]. 40 
After one hundred years of research on DF, the current literature still shows a substantial prevalence 41 
of individuals affected by this condition in several countries [Martignon et al., 2021; Shyam et al., 42 
2021]. The prevalence of DF in the United States of America, for example, increased from 22% (1986–43 
1987) to 65% (2011–2012) according to the National Health and Nutrition Examination Survey [Li et 44 
al., 2021; Neurath et al., 2019]. According to the Canadian Health Measures Survey, the prevalence of 45 
DF in schoolchildren under 12 years of age was 37.1% (2010) [Martignon et al., 2021]. 46 
In dentistry, non-carious dental conditions, including DF, are the subject of extensive research and 47 
growing concern for dentists worldwide [Martignon et al., 2021]. The literature has bibliometric 48 
studies involving other non-carious dental alterations such as Erosive Tooth Wear (ETW) and Molar 49 
Incisor Hypomineralization (MIH) [Rocha et al., 2022; Da Costa et al., 2021]. However, bibliometric 50 
analyses directed specifically to DF were not identified, only in studies where it appears as a secondary 51 
theme or with an analysis restricted to a particular country [Forero et al., 2018; Waghmare et al., 2021]. 52 
Thus, the present bibliometric analysis has the potential to assess the scientific “state of art” of DF, 53 
presenting a perspective of the researchers’ impact and identifying the most-cited references in the 54 
area. Such information could assist researchers in the perception of knowledge gaps and delimitation 55 
of trends for future research, which could ultimately contribute to a reduction in new cases and 56 
adequate management of existing cases. 57 
The present study aims to identify and analyze the 100 most-cited papers in the literature on DF 58 
through a bibliometric review. 59 
Methods 60 
20 
 
 
The present bibliometric study was conducted on November 2021, in the Web of Science Core 61 
Collection (WoS-CC) database. The following search strategy was developed: (TS = [“Dental Fluorosis” 62 
OR “Mottled Enamel” OR “Dental Fluoroses” OR “Adverse Effects of Fluoride” OR “Enamel Defective” 63 
OR “Dentin Defective” OR “Fluoride Poisoning”]). The WoS-CC “Dentistry, Oral Surgery & Medicine” 64 
category filter was used. No limitations to the language or year of publication were applied. Papers not 65 
addressing topics related to DF, conference papers and editorials were excluded. 66 
All papers found were organized in descending order by the number of citations according to the WoS-67 
CC. Two researchers (MCG and AOR) selected the 100 most-cited papers by reading titles, abstracts 68 
and full texts, when necessary. Disagreements in the selection of papers were resolved by consensus 69 
with a third researcher (MC). Subsequently, a cross-reference was performed with the number of 70 
citations of each selected paper in the Scopus and Google Scholar databases. 71 
The following parameters were collected from each paper: title, authors, number of authors, number 72 
and density of citations, institution, countries and continent (based on the affiliation of the 73 
corresponding author), year of publication, journal, keywords, study design and theme. Study designs 74 
were classifiedinto systematic reviews, literature reviews, laboratory, observational, and 75 
interventional studies. The papers were grouped according to the most prevalent themes: fluoride 76 
intake, epidemiology, diagnosis, pathogenesis and clinical presentation of DF. The themes that 77 
appeared only once were classified as “others”. 78 
The journals’ impact factor in 2020 was verified in the Journal Citation Reports and the VOSviewer 79 
software was used to generate a graphical representation of bibliometric networks between authors 80 
and keywords. In the co-authorship map, the authors' names were entered into the software and were 81 
linked together based on the number of co-authored papers. The software analyzed the collaboration 82 
relationship between authors forming clusters. Each cluster was represented by a color. The most 83 
important terms had larger circles and the strongly related terms were closer together. Lines between 84 
terms indicate relationships, and thicker lines represent stronger connections. 85 
Data analysis was performed using the statistical software SPSS for Windows (SPSS, version 24.0; IBM 86 
Corp) to assess possible correlations of the number of citations among the databases The Kolmogorov-87 
Smirnov test was used to verify the normality of the data distribution. Spearman's correlation 88 
coefficient test was used since the data did not present a normal distribution. 89 
Results 90 
The initial search resulted in 1,977 documents. After applying the filter “Dentistry, Oral Surgery & 91 
Medicine”, 810 results were obtained and listed in descending order based on the number of citations, 92 
21 
 
 
of which 26 papers were excluded - 19 conference and editorial and 7 that were not directly related 93 
to the topic, resulting in the top 100 most-cited papers (suppl. online Table 1). 94 
The top 100 papers were cited 6,717 times in WoS-CC, including 523 self-citations (7.8%), that is, 95 
references that the author makes to his own work [Mattos et al., 2021]. The number of citations ranged 96 
from 35 to 417, with 58 papers cited at least 50 times and 9 more than 100 times. In comparison, a 97 
greater number of citations were observed in Scopus, with 7,442 (ranging from 37 to 450), and in 98 
Google Scholar with 15,202 (ranging from 51 to 829). There was a strong positive correlation between 99 
the number of citations in WoS-CC and Google Scholar (rho = 0.758) and Google Scholar and Scopus 100 
(rho = 0.854), as well as a very strong correlation in WoS-CC and Scopus (rho = 0.935). 101 
The most-cited paper in WoS-CC was “Clinical appearance of dental fluorosis in permanent teeth in 102 
relation to histologic changes”, an observational study written by Thylstrup A and Fejerskov O, 103 
published in 1978, accumulating an average of 9.47 citations per year. It was also the most-cited in 104 
Scopus (450 citations) and Google Scholar (829 citations). The oldest paper was published in 1974 – 105 
“Dental fluorosis and caries in high-fluoride districts in Sweden” – written by Forsman B; while the 106 
most recent was published in 2014 – “Barrier formation: potential molecular mechanism of enamel 107 
fluorosis” – written by Lyaruu DM et al. The largest number of publications among the 100 most-cited 108 
papers were concentrated between 1995 and 2004 (40%), followed by the periods between 1985-1994 109 
(27%), 2005-2014 (25%) and 1975-1984 (8%). 110 
Based on data obtained from WoS-CC, presented in online suppl. Table 2, Community Dentistry and 111 
Oral Epidemiology appears as the most prominent journal in terms of the number of publications in 112 
this top 100 (24 papers; 7,242 citations), followed by the Journal of Dental Research (21 papers; 6,218 113 
citations), Journal of Public Health Dentistry (17 papers; 5,073 citations) and the Caries Research (13 114 
papers; 2,893 citations). The vast majority of papers are observational studies (60 papers; 16,430 115 
citations), followed by literature reviews (19 papers; 8,108 citations), laboratory studies (16 papers; 116 
3,323 citations), systematic reviews (4 papers; 1,235 citations) and interventional studies (1 paper; 265 117 
citations). The most studies addressed topics related to the epidemiology (44 papers; 12,083 citations), 118 
followed by fluoride ingestion (32 papers; 7,931 citations), DF pathogenesis (12 papers; 4,782 119 
citations), clinical presentation of DF (8 papers; 3,664 citations) and other topics (4 papers; 724 120 
citations). 121 
Among the continents with the most papers, as seen in Figure 1, North America (54 papers) stood out, 122 
with the highest number of citations in WoS-CC (3,482), Scopus (3,984) and Google Scholar (8,045), 123 
followed by Europe (21 papers; 6,420 citations) and South America (9 papers; 2,097 citations). 124 
Considering the number of publications by country, the United States of America led with 44 papers, 125 
22 
 
 
which together added up to 3,047 citations in WoS-CC, followed by Canada (10 papers; 2,576 citations) 126 
and Brazil (9 papers; 2,097 citations). 127 
According to the affiliation of the corresponding author, 51 institutions were identified within the 128 
studies. The online suppl. Table 3 shows the 10 institutions involved with the highest number of 129 
publications. The University of Iowa/USA (12 papers; 3,730 citations), the Royal Dental 130 
College/Denmark (6 papers; 3,202 citations) and the University of North Carolina/USA (6 papers; 2,223 131 
citations) could be highlighted. 132 
A total of 341 different keywords were found among the 100 most-cited papers, with emphasis on 133 
“dental fluorosis” (62 occurrences), followed by “fluoride”, “prevalence” and “children” (32 134 
occurrences each). Figure 2 presents the most frequent keywords (with five or more occurrences), as 135 
well as the relationship between them. The words that correspond to the biggest circles are the ones 136 
with the highest occurrence. On the other hand, the words that appear in the smallest circles had a 137 
lower occurrence. Circles with the same color indicate greater interactions among the associated 138 
keywords. The largest circle, in the central part of the figure, in red, demonstrates that "dental 139 
fluorosis" was the most common keyword used in the papers. 140 
Among the 100 most-cited papers, 254 authors were identified. Authors with three or more roles and 141 
the co-authorship relationships among them are represented in online suppl. Figure 3. The names 142 
corresponding to the red/orange coloration were associated with the most frequent authors. Levy SM 143 
and Warren JJ lead the main DF research clauster and Fejerskov O leads another important clauster 144 
represented in the figure 3. In online suppl. Table 4, the 10 authors with the highest number of 145 
publications among the 100 most-cited papers on DF were listed. Levy SM (12 papers; 813 citations) 146 
was the most prominent author, followed by Fejerskov O (8 papers; 1,124 citations) and Warren JJ (8 147 
papers; 572 citations). 148 
Discussion 149 
The present study identified and analyzed the main characteristics of the 100 most-cited papers on DF 150 
in the WoS-CC database. Such knowledge provides a perspective on the DF research field. In addition, 151 
mapping the most-influential papers may help researchers to identify trends, as well as gaps in the 152 
literature. 153 
Citations are indicators of the relevance of studies and are commonly used to assess the impact of 154 
teeth on the scientific community [Nightingale and Marshall, 2012]. To consider a paper a classic, it 155 
has been said that it needs to be cited at least 400 times [Garfield, 2013]. However, a paper with over 156 
23 
 
 
100 citations can also be considered a classic in some smaller fields of research. Thus, nine papers had 157 
over 100 citations in WoS-CC, 14 in Scopus, and 73 in Google Scholar. 158 
In the bibliometricfield, WoS-CC, designed with an emphasis on citation analysis, is considered one of 159 
the most prestigious databases for examining scientific quality and impact [Ionescu et al., 2021]. 160 
Therefore, studies involving bibliometric analysis often use WoS as the main database [Baldiotti et al., 161 
2021; Rocha et al., 2022]. Scopus has the limitation of measuring citations in a shorter period, starting 162 
from 1996. In addition, Google Scholar provides results only organized by relevance or publication date 163 
and includes citations from documents such as books and dissertations, which can be considered a 164 
limitation, as they are not peer-reviewed blindly [Ionescu et al., 2021]. 165 
The objective of the most-cited article was to determine an index for the clinical diagnosis of DF that 166 
until then was performed with the Dean's index, developed in 1934 [Dean, 1934]. The Thylstrup and 167 
Fejerskov Index is considered a sensitive method, as it allows a careful classification of the affected 168 
teeth; although it was defined more than 40 years ago, it is still the most indicated [Burger et al., 1987; 169 
Shyam et al., 2021]. 170 
Despite the existence of two bibliometric studies in which the DF appears as a secondary outcome and 171 
one with an analysis of publications restricted to a particular country, no global bibliometric analysis 172 
specifically focused on the DF were identified. A bibliometric analysis [Forero et al., 2018] evaluated 173 
the relationship of fluoride with dental structures, between the years 2012 and 2017. Another study 174 
[Ullah et al., 2019] described fluoride in the context of oral health, between the years 1997 and 2017. 175 
Finally, one study [Waghmare et al., 2021] evaluated Indian publications about dental caries and DF, 176 
between the years 1999 and 2020. Restricting the years to perform the search in a bibliometric review 177 
may represent a considerable limitation [Brandt et al., 2019]. Thus, the present study, without time 178 
restrictions, increases the comprehensiveness of the obtained data. 179 
The highest concentration of publications occurred between 1995 and 2004. This episode may be 180 
related to the increase in the prevalence of DF in some countries during this period [Martignon et al., 181 
2021; Neurath et al., 2019; Wondwossen et al., 2004]. Corroborating these findings, Levy SM, who had 182 
the highest number of papers in the top 100, publishing most of his studies, as lead author and co-183 
author, in this period. 184 
Seven authors published five or more papers in the 100 most-cited list. These authors worked mainly 185 
on three themes: fluoride intake, epidemiology and appearance of DF, demonstrating their 186 
fundamental contributions to the consolidation of the knowledge of this condition. In 1977 and 1978, 187 
Fejerskov O published studies on the clinical presentation of DF [Martignon et al., 2021]. In the mid-188 
1980s and 1990s Fejerskov O published studies on the epidemiology of DF, at the same time Levy SM, 189 
24 
 
 
Warren JJ, Horowitz H, Wefel JS, Kiritsy M and Stookey G were engaged in publishing on the 190 
epidemiology and fluoride intake levels in research that lasted until the 2000s. As it is a condition that 191 
affects the general population, epidemiological studies were essential to determine the prevalence 192 
and causal factors for DF. In addition, the determination of fluoride intake levels was essential for the 193 
control of severe cases of this condition. 194 
Papers that introduce techniques or methods lead to a high number of citations [Silva and Bianchi, 195 
2001]. In this context, the most-cited studies in this review consequently address the development of 196 
a new criterion for clinical classification and the pathophysiology of DF that was the Thylstrup and 197 
Fejerskov index [Thylstrup and Fejerskov, 1978]. 198 
In this study, the citation count included self-citations. Although they can be seen as a means to 199 
increase bibliometric indicators, self-citations may reflect the cumulative effect of studies in a given 200 
area by a given author [Costas et al., 2010]. 201 
DF is a major public health problem in many countries [Martignon et al., 2021; Freitas et al., 2013]. 202 
Fluoridation of community water began in the USA in 1945 and is currently practiced in several 203 
countries around the world. Health authorities consider it a fundamental strategy for the prevention 204 
of dental caries. On the other hand, the risk of DF increased with this action, requiring epidemiological 205 
studies for a real understanding of the effects and causal factors to support strategies to prevent this 206 
condition in populations. However, mild presentations of fluorosis are preferable to dental caries 207 
[Iheozor-Ejiofor et al., 2015]. This fact justifies much of the evidence on the subject being based on 208 
epidemiological studies. 209 
It is known that randomized clinical trials (RCTs) are considered the “gold standard” for the evaluation 210 
of treatments and serve as a reference for decision-making by health professionals [Moher et al., 211 
2001]. With only one RCT among the 100 most cited, this analysis showed that the literature lacks 212 
more clinical intervention studies to improve the level of scientific evidence on DF. This fact can be 213 
explained, in part, by the difficulty of gathering a representative sample, in addition to the different 214 
forms of clinical presentation of this condition, which makes the homogeneity of the groups difficult. 215 
Corroborating these data, only four systematic reviews developed on DF was identified, with only six 216 
clinical trials [Di Giovanni et al., 2018]. The RCT in question was published 25 years ago, which brought 217 
an important finding, as it showed no support for the hypothesis that prenatal fluoride would have a 218 
strong preventive effect on caries and DF [Leverett et al., 1997]. 219 
This bibliometric study among the top 100 on DF showed that the USA was the country with the highest 220 
number of publications, which corroborates other bibliometrics in the area of oral health [Jafarzadeh 221 
et al., 2015; Mattos et al., 2021]. In addition, the USA was the location of the most prominent 222 
25 
 
 
institution and was linked to the authors with the highest number of publications. This is likely due to 223 
the existence of institutes that actively provide funding to the private and public sectors for dental 224 
research in that country [Alshammari et al., 2021]. Concerning the continents, Africa and Asia were 225 
the ones with the lowest number of papers, according to the corresponding author affiliation. 226 
However, they are continents with a significant DF prevalence rates. The prevalence of DF in 227 
schoolchildren aged 11-14 years in Haryana (India) reached 96,6% [Shyam et al., 2021]. This situation 228 
exemplifies the difficult to homogenize groups for clinical studies even in areas with high prevalence 229 
rates. Thus, the need to develop relevant studies on DF in these locations is evident. 230 
In conclusion, the analysis of the 100 most-cited papers on DF revealed a large number of 231 
epidemiological and literature review studies, originating mainly in North America, mainly addressing 232 
the epidemiology of DF and fluoride intake. These findings demonstrate the scarcity of interventional 233 
studies and systematic reviews among the most-cited papers. Therefore, researchers should seek 234 
alternatives for the development of randomized clinical trials, ensuring research with a higher level of 235 
scientific evidence on DF. 236 
 237 
 238 
Statements 239 
Statement of Ethics 240 
Ethical approval was not required because the study was not conducted directly with humans but 241 
analyzed data from previous studies. 242 
Conflict of Interest Statement 243 
The authors have no conflicts of interestto declare. 244 
Data Availability Statement 245 
All data generated or analyzed during this study are included in this article and its supplementary 246 
material files. Further enquiries can be directed to the corresponding author. 247 
Funding Sources 248 
This study was supported in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior 249 
– Brasil (CAPES) – Finance Code 001. 250 
26 
 
 
Author Contributions 251 
Michely Cristina Goebel: Conception; acquisition, analysis and interpretation of data; original drafting. 252 
Aurélio de Oliveira Rocha: Conception; acquisition, analysis and interpretation of data; original 253 
drafting. Pablo Silveira Santos: Conception; interpretation of data; critical revision; final approval. 254 
Michele Bolan: Analysis and interpretation of data; critical revision; final approval. Paulo Antônio 255 
Martins-Júnior: Conception; analysis and interpretation of data; critical revision; final approval. Carla 256 
Miranda Santana: Analysis and interpretation of data; critical revision; final approval. Mariane 257 
Cardoso: Conception; analysis and interpretation of data; critical revision; final approval. All authors 258 
gave their final approval and agreed to be accountable for all aspects of the work.259 
27 
 
 
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29 
 
 
Figure Legends 
 
Figure 1. Worldwide distribution of the 100 most-cited papers in dental fluorosis. 
Figure 2. Bibliometric coupling among the most used keywords in the 100 most-cited papers. The 
biggest circles indicate that the associated keywords had greater occurrence, the lines that connect 
the circles indicate interaction among the keywords, circles and lines with the same color indicate 
greater interactions among the linked terms. 
Online Suppl. Figure 3. Density map of authors and collaborative co-authorship among them in the 
100 most-cited papers. Names linked to the colors closest to red, indicate a greater number of 
publications and closer to yellow, a lower number of publications. Authors who share the same clusters 
indicate articles together. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
30 
 
 
 
Figure 1. Worldwide distribution of the 100 most-cited papers in dental fluorosis. 
 
 
 
Figure 2. Bibliometric coupling among the most used keywords in the 100 most-cited papers. The 
biggest circles indicate that the associated keywords had greater occurrence, the lines that connect 
the circles indicate interaction among the keywords, circles and lineswith the same color indicate 
greater interactions among the linked terms. 
 
 
 
31 
 
 
 
 
Online Suppl. Figure 3. Density map of authors and collaborative co-authorship among them in the 
100 most-cited papers. Names linked to the colors closest to red, indicate a greater number of 
publications and closer to yellow, a lower number of publications. Authors who share the same clusters 
indicate articles together. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
32 
 
 
Supplementary Tables 
 
Suppl. Table 1. The 100 most-cited papers concerning dental fluorosis 
Rank Paper Number of citations 
(Citation density) 
WoS Core 
Collection 
Scopus Google 
Scholar 
1 Thylstrup A, Fejerskov O. Clinical appearance of dental 
fluorosis in permanent teeth in relation to histologic 
changes. Community Dent Oral Epidemiol. 1978 
Nov;6(6):315-28. 
417 
(9,70) 
450 
(10,47) 
829 
(19,28) 
2 Aoba T, Fejerskov O. Dental fluorosis: chemistry and 
biology. Crit Rev Oral Biol Med. 2002;13(2):155-70. 
273 
(10,37) 
317 
(16,68) 
680 
(35,79) 
3 Everett ET. Fluoride's effects on the formation of teeth and 
bones, and the influence of genetics. J Dent Res. 2011 
May;90(5):552-60. 
221 
(22,10) 
231 
(23,10) 
358 
(35,80) 
4 Fejerskov O, Thylstrup A, Larsen MJ. Clinical and structural 
features and possible pathogenic mechanisms of dental 
fluorosis. Scand J Dent Res. 1977 Nov;85(7):510-34. 
157 
(3,57) 
149 
(3,39) 
248 
(5,64) 
5 Horowitz HS, Driscoll WS, Meyers RJ, Heifetz SB, Kingman 
A. A new method for assessing the prevalence of dental 
fluorosis--the Tooth Surface Index of Fluorosis. J Am Dent 
Assoc. 1984 Jul;109(1):37-41. 
146 
 (3,95) 
180 
(4,86) 
307 
(8,30) 
6 Bronckers AL, Lyaruu DM, DenBesten PK. The impact of 
fluoride on ameloblasts and the mechanisms of enamel 
fluorosis. J Dent Res. 2009 Oct;88(10):877-93. 
134 
(11,17) 
143 
(11,92) 
272 
(22,67) 
7 Osuji OO, Leake JL, Chipman ML, Nikiforuk G, Locker D, 
Levine N. Risk factors for dental fluorosis in a fluoridated 
community. J Dent Res. 1988 Dec;67(12):1488-92. 
134 
(4,06) 
146 
(4,42) 
273 
(8,27) 
8 Levy SM, Warren JJ, Davis CS, Kirchner HL, Kanellis MJ, 
Wefel JS. Patterns of fluoride intake from birth to 36 
months. J Public Health Dent. 2001 Spring;61(2):70-7. 
122 
(6,10) 
129 
(6,45) 
198 
(9,90) 
9 Wong MC, Clarkson J, Glenny AM, Lo EC, Marinho VC, 
Tsang BW, Walsh T, Worthington HV. Cochrane reviews on 
the benefits/risks of fluoride toothpastes. J Dent Res. 2011 
May;90(5):573-9. 
118 
 (11,80) 
132 
(13,20) 
270 
(27,00) 
10 Evans RW, Stamm JW. An epidemiologic estimate of the 
critical period during which human maxillary central 
incisors are most susceptible to fluorosis. J Public Health 
Dent. 1991 Fall;51(4):251-9. 
99 
(3,30) 
103 
(3,43) 
207 
(6,90) 
11 Everett ET, McHenry MA, Reynolds N, Eggertsson H, 
Sullivan J, Kantmann C, Martinez-Mier EA, Warrick JM, 
94 
(4,95) 
100 
(5,26) 
161 
(8,47) 
33 
 
 
Stookey GK. Dental fluorosis: variability among different 
inbred mouse strains. J Dent Res. 2002 Nov;81(11):794-8. 
12 Leverett D. Prevalence of dental fluorosis in fluoridated 
and nonfluoridated communities--a preliminary 
investigation. J Public Health Dent. 1986 Fall;46(4):184-7. 
93 
 (2,66) 
84 
(2,40) 
185 
(5,29) 
13 Szpunar SM, Burt BA. Trends in the prevalence of dental 
fluorosis in the United States: a review. J Public Health 
Dent. 1987 Spring;47(2):71-9. 
91 
(2,68) 
86 
(2,53) 
175 
(5,15) 
14 Clark DC. Trends in prevalence of dental fluorosis in North 
America. Community Dent Oral Epidemiol. 1994 
Jun;22(3):148-52. 
88 
(3,26) 
100 
(3,70) 
216 
(8,00) 
15 Driscoll WS, Horowitz HS, Meyers RJ, Heifetz SB, Kingman 
A, Zimmerman ER. Prevalence of dental caries and dental 
fluorosis in areas with optimal and above-optimal water 
fluoride concentrations. J Am Dent Assoc. 1983 
Jul;107(1):42-7. 
88 
(2,32) 
73 
(1,92) 
160 
(4,21) 
16 Heller KE, Eklund SA, Burt BA. Dental caries and dental 
fluorosis at varying water fluoride concentrations. J Public 
Health Dent. 1997 Summer;57(3):136-43. 
84 
(3,50) 
96 
(4,00) 
257 
(10,71) 
17 Ismail AI, Hasson H. Fluoride supplements, dental caries 
and fluorosis: a systematic review. J Am Dent Assoc. 2008 
Nov;139(11):1457-68. 
83 
(6,38) 
102 
(7,85) 
223 
(17,15) 
18 Levy SM, Kiritsy MC, Warren JJ. Sources of fluoride intake 
in children. J Public Health Dent. 1995 Winter;55(1):39-52. 
83 
(3,19) 
97 
(3,73) 
237 
(9,12) 
19 Evans RW, Darvell BW. Refining the estimate of the critical 
period for susceptibility to enamel fluorosis in human 
maxillary central incisors. J Public Health Dent. 1995 
Fall;55(4):238-49. 
83 
(3,19) 
92 
(3,54) 
198 
(7,62) 
20 Fomon SJ, Ekstrand J, Ziegler EE. Fluoride intake and 
prevalence of dental fluorosis: trends in fluoride intake 
with special attention to infants. J Public Health Dent. 
2000 Summer;60(3):131-9. 
81 
(3,86) 
102 
(4,86) 
263 
(12,52) 
21 Riordan PJ. Perceptions of dental fluorosis. Journal of 
dental research. 1993; 72(9), 1268-1274. 
77 
(2,75) 
90 
(3,21) 
158 
(5,64) 
22 Levy SM. Review of fluoride exposures and ingestion. 
Community Dent Oral Epidemiol. 1994 Jun;22(3):173-80. 
75 
(2,78) 
80 
(2,96) 
176 
(6,52) 
23 Richards A, Kragstrup J, Josephsen K, Fejerskov O. Dental 
fluorosis developed in post-secretory enamel. J Dent Res. 
1986 Dec;65(12):1406-9. 
75 
(2,14) 
77 
(2,20) 
145 
(4,14) 
24 Chankanka O, Levy SM, Warren JJ, Chalmers JM. A 
literature review of aesthetic perceptions of dental 
fluorosis and relationships with psychosocial aspects/oral 
74 
(6,73) 
85 
(7,73) 
184 
(16,73) 
34 
 
 
health-related quality of life. Community Dent Oral 
Epidemiol. 2010 Apr;38(2):97-109. 
25 Driscoll WS, Horowitz HS, Meyers RJ, Heifetz SB, Kingman 
A, Zimmerman ER. Prevalence of dental caries and dental 
fluorosis in areas with negligible, optimal, and above-
optimal fluoride concentrations in drinking water. J Am 
Dent Assoc. 1986 Jul;113(1):29-33. 
73 
 (2,09) 
71 
(2,03) 
130 
(3,71) 
26 Kiritsy MC, Levy SM, Warren JJ, Guha-Chowdhury N, 
Heilman JR, Marshall T. Assessing fluoride concentrations 
of juices and juice-flavored drinks. J Am Dent Assoc. 1996 
Jul;127(7):895-902. 
72 
(2,88) 
84 
(3,36) 
148 
(5,92) 
27 Karube H, Nishitai G, Inageda K, Kurosu H, Matsuoka M. 
NaF activates MAPKs and induces apoptosis in 
odontoblast-like cells. J Dent Res. 2009 May;88(5):461-5. 
70 
(5,83) 
81 
(6,75) 
106 
(8,83) 
28 Hong L, Levy SM, Broffitt B, Warren JJ, Kanellis MJ, Wefel 
JS, Dawson DV. Timing of fluoride intake in relation to 
development of fluorosis on maxillary central incisors. 
Community Dent Oral Epidemiol. 2006 Aug;34(4):299-309. 
70 
(4,67) 
75 
(5,00) 
167 
(11,13) 
29 Wondwossen F, Astrøm AN, Bjorvatn K, Bårdsen A. The 
relationship between dental caries and dental fluorosis in 
areas with moderate- and high-fluoride drinking water in 
Ethiopia. Community Dent Oral Epidemiol. 2004 
Oct;32(5):337-44. 
70 
(4,12) 
85 
(5,00) 
155 
(9,12) 
30 Yoder KM, Mabelya L, Robison VA, Dunipace AJ, 
Brizendine EJ, Stookey GK. Severe dental fluorosis in a 
Tanzanian population consuming water with negligible 
fluoride concentration. Community Dent Oral Epidemiol. 
1998 Dec;26(6):382-93. 
69 
(3,00) 
73 
(3,17) 
119 
(5,17) 
31 Guha-Chowdhury N, Drummond BK, Smillie AC. Total 
fluoride intake in children aged 3 to 4 years--a longitudinal 
study. J Dent Res. 1996 Jul;75(7):1451-7. 
69 
(2,76) 
79 
(3,16) 
141 
(5,64) 
32 Wright JT, Hanson N, Ristic H, Whall CW, Estrich CG, Zentz 
RR. Fluoride toothpaste efficacy and safety in children 
younger than 6 years: a systematic review. J Am Dent 
Assoc. 2014 Feb;145(2):182-9. 
68 
(9,71) 
91 
(13,00) 
228 
(32,57)33 Ismail AI, Brodeur JM, Kavanagh M, Boisclair G, Tessier C, 
Picotte L. Prevalence of dental caries and dental fluorosis 
in students, 11-17 years of age, in fluoridated and non-
fluoridated cities in Quebec. Caries Res. 1990;24(4):290-7. 
66 
(2,13) 
63 
(2,03) 
135 
(4,35) 
34 Larsen MJ, Richards A, Fejerskov O. Development of dental 
fluorosis according to age at start of fluoride 
administration. Caries Res. 1985;19(6):519-27. 
66 
(1,83) 
73 
(2,03) 
119 
(3,31) 
35 
 
 
35 Whelton HP, Ketley CE, McSweeney F, O'Mullane DM. A 
review of fluorosis in the European Union: prevalence, risk 
factors and aesthetic issues. Community Dent Oral 
Epidemiol. 2004 Apr;32 Suppl 1:9-18. 
63 
 (3,71) 
75 
(4,41) 
162 
(9,53) 
36 Riordan PJ. Dental fluorosis, dental caries and fluoride 
exposure among 7-year-olds. Caries Res. 1993;27(1):71-7. 
60 
(2,14) 
70 
(2,50) 
165 
(5,89) 
37 Rojas-Sanchez F, Kelly SA, Drake KM, Eckert GJ, Stookey 
GK, Dunipace AJ. Fluoride intake from foods, beverages 
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40 
 
 
potential molecular mechanism of enamel fluorosis. J Dent 
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Suppl. Table 2. Top 10 journals with the most papers in the 100 most-cited list. 
Source Title Number of 
papers 
Number of 
citations 
Impact 
Factor 
Community Dentistry and Oral Epidemiology 24 7,242 3,383 
Journal of Dental Research 21 6,218 6,116 
Journal of Public Health Dentistry 17 5,073 1,821 
Caries Research 13 2,893 4,056 
Journal of The American Dental Association 11 3,361 3,634 
British Dental Journal 2 494 1,626 
InternationalDental Journal 2 453 2,512 
Archives of Oral Biology 2 343 2,635 
Critical Reviews in Oral Biology & Medicine 1 273 - 
Scandinavian Journal of Dental Research 1 157 - 
 
 
 
 
 
 
41 
 
 
Suppl. Table 3. Top 10 institutions with the highest number of papers among the 100 most-cited. 
Institution Country Number of 
papers 
Number of 
citations 
University of Iowa USA 12 3,730 
Royal Dental College Denmark 6 3,202 
University of North Carolina USA 6 2,223 
University of Michigan USA 5 1,557 
University of Toronto Canada 4 1,159 
University of São Paulo Brazil 4 993 
Indiana University School of Dentistry USA 4 967 
University of British Columbia Canada 4 940 
University of Western Australia Australia 3 861 
University of Bergen Norway 3 676 
 
 
Suppl. Table 4. Top 10 authors with the most papers among the 100 most-cited. 
Authors Number of 
papers among 
100 most-cited 
Number of 
citations among 
the 100 most-
cited papers 
Number of 
papers 
published in 
WoS-CC 
Number of 
citations in 
WoS-CC 
H-Index 
Levy SM 12 813 268 6,408 49 
Fejerskov O 8 1,124 304 7,665 47 
Warren JJ 8 572 164 4,645 38 
Horowitz H 5 406 197 3,120 30 
Wefel JS 5 358 167 2,279 29 
Kiritsy M 5 321 29 739 11 
Stookey G 5 201 381 3,781 33 
Driscoll W 4 359 62 1,117 21 
Heifetz S 4 359 78 1,213 21 
Kingman A 4 359 70 927 14 
The h-index is a proposal to quantify the production and impact of researchers based on their most 
cited papers. 
 
 
 
 
 
 
 
 
 
 
 
42 
 
 
4 CONSIDERAÇÕES FINAIS 
 
A análise dos 100 artigos mais citados sobre FD revelou principalmente tendências na 
temática epidemiologia, com publicações originadas em grande parte nos EUA. Dessa forma, 
esses achados podem auxiliar pesquisadores e formuladores de políticas públicas, pois essa 
análise também revelou as principais limitações científicas sobre FD, evidenciando a escassez 
de estudos clínicos, revisões sistemáticas, além da carência de publicações com essa perspectiva 
em diversos países da África, Ásia, América do Sul e Oceania. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
43 
 
 
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