Background <p>Dental fluorosis is a significant public health issue in many parts of the world, including Sudan, where its prevalence and associated factors among adolescents are not well-documented. Thus, this study aimed to determine the prevalence and factors associated with dental fluorosis among adolescents in Central Sudan.</p> Methods <p>This community-based cross-sectional study was conducted from April to June 2025 in Elrikieb, East Gezira, Central Sudan. Adolescents aged 10–19 years were enrolled using a multistage, stratified random sampling approach to achieve the required sample size (343). Data on socio-demographics, anthropometrics, and environmental factors were collected using a structured questionnaire. Dental fluorosis was assessed using the Thylstrup-Fejerskov Index (TFI). Participants with a TFI score of 4 or more were classified as having dental fluorosis. Univariate binary analysis was performed, with odds ratios and 95% confidence intervals; <i>P</i> values &lt; 0.05 were considered statistically significant.</p> Results <p>A total of 343 adolescents [177 (51.6%) males and 166 (48.4%) females] were enrolled in the study. The median (interquartile, IQR) age and body mass index (BMI) were 14 (12–16) years and 16.3 (14.8–18.2) kg/m², respectively. The distribution of fluorosis was as follows: questionable (0.6%), very mild (16.9%), mild (21.0%), moderate (26.2%), severe (5.5%), and 29.7% were normal. Of the total, nearly one-third (31.8%) of enrolled adolescents had moderate to severe (TF score ≥ 4) dental fluorosis, giving the overall prevalence of dental fluorosis of 31.8% (109 adolescents).</p> <p>Univariate analysis revealed no significant association between dental fluorosis and any of the investigated factors, including age, gender, BMI, tobacco use, parental education, parental occupation, or the presence of a smoker in the family (all <i>p</i> &gt; 0.05).</p>