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Prevalence of Dental Fluorosis in School Children of Jodhpur City
Jitender Solanki1, Jyothi Dundappa2, Nagendra Babu K3
Assistant professor1 Department of Preventive and Community Dentistry Vyas. Dental College and Hospital, Jodhpur, Rajasthan
Assistant professor2 Department of Periodontics & oral implantology Vyas. Dental College and Hospital, Jodhpur, Rajasthan
Reader3, Department of Periodontics, Dental college, Azamgarh, UP
Aims and objectives: The present study was carried out to know the prevalence of dental fluorosis and the relation of dental fluorosis at varying degree of fluoride concentration in drinking water among the study subjects. Material & methods: The study population was selected by stratified cluster random sampling methodology. A total of 1810 school children were screened for dental fluorosis. Data was entered into computer and analyzed using (SPSS 11.5 version). Chi square test was used for comparison of fluorosis and various levels of fluoride concentration in drinking water. Results: It was observed that number of children affected with dental fluorosis increases with the increase in level of concentration of fluoride in drinking water. The results of the study indicated that dental fluorosis exists irrespective of levels of fluoride concentration in drinking water.
Key words: Dental Caries; Dental Fluorosis; Jodhpur; School Children
Oral diseases are the most prevalent chronic diseases worldwide and are an expensive burden to health care service providers. In most of the developing and under developed countries, the prevalence of dental caries and unmet treatment need is very high. About 5 billion people worldwide experience dental caries which is presented in various forms of discomfort at different stages of its clinical presentation.1 The scenario is different in developed countries where in recent years rapid changes have occurred in the prevalence of oral diseases. In the past decade a substantial decline in dental caries has occurred among children of several developed countries2 mainly USA and several European countries.3 Fluoride has been recognized as one of the most influential factor responsible for the observed decline of caries among children as well as adults of these countries. Fluoride plays a key role in the prevention and control of dental caries. The excellent work of Trendly. H. Dean and his collaborators, showed the association between fluoride in drinking water and the occurrence of disturbances of tooth formation (mottling of enamel or dental fluorosis), they also found association between fluoride in drinking water and reduction in caries experience. Since then the use of fluoride in optimum level has been a central issue in all programs seeking to harness its unique property to control and prevent dental caries. India is among the 23 nations around the globe, where health problems have been reported due to excessive fluoride in drinking water. In India occurrence of fluoride in ground water has been detected in 17 states. The country has a sizable number of people with high fluoride content in their blood; Uttar Pradesh ranks first in this regard. Highest natural fluoride level concentration reported being 38.50 mg/l in Haryana.4 In the Ganga alluvial plain, fluoride contamination has been reported by Indian state and central groundwater departments in a few districts like Unnao, Kanpur, and Agra.5 Jodhpur city comes under Jodhpur Tehsil of Jodhpur district of the state Rajasthan. The city has public water supply but still most of the population depends on ground water for their daily activities. People who consume ground water have higher chances of developing dental fluorosis because of the higher level of fluoride in deep ground water of the city as reported by the water department of Jodhpur district. No study showing the prevalence of dental fluorosis has been carried out in this region, keeping this in mind the study was under taken to know the prevalence of dental fluorosis among school going children in Jodhpur city.
MATERIAL AND METHODS
Study population: Jodhpur is divided into 31 municipal wards according to the Census Report of 2001.The study population was selected by stratified cluster random sampling methodology. Sample size was determined by the formula based on the study population x = 4pqxN e2 (N-1) + 4pq Based on sample size slightly higher sample size of 1810 was selected to compensate for any kind of error during calculating the prevalence or permissible error. Sampling procedure: This study was conducted in Jodhpur city in two phases. In the first phase drinking water samples were collected from various sources from all the 31 wards and taken for estimation of fluoride. Fluoride estimation was done by chemical procedure at the water works department near kudi ka pul pali road, Jodhpur. Rajasthan. Later 31 wards in the city were divided into three groups on basis of varying fluoride concentration in drinking water, ‘below optimum level’ 9 wards, ‘optimum level’ 13 wards, ‘above optimum level’ 9 wards. Among 31 wards in Jodhpur city, there are 121 primary schools and 104 high schools as per the record in the District Education Departments. Schools from each fluoride group were randomly selected. A total of 1810 children of 5-6 years and 12-13 years old were examined out of total study population of 15, 500 children of the specified age groups, 605 from below optimum level, 603 from optimum level and 602 from above optimum level group. Children selected were permanent residents of Jodhpur city (since birth), aged between 5-6 and 12-13 years. Those suffering from any systemic illness, uncooperative or taking any type of oral abuse were excluded from the study. Before scheduling the present survey ethical clearance was obtained from institutional ethical clearance committee to conduct the study, also official permission was obtained from higher authorities at district level. Data collection: The structured Proforma was used to access dental fluorosis in the school children of Jodhpur city. The examination for dental fluorosis was carried out by the investigator who were assisted by a trained assistant during the examination (According to WHO Oral Health Survey Basic Methods 1999). Data was entered into computer and analyzed using (SPSS 11.5 version). Chi square test was used for comparison of fluorosis and various levels of fluoride concentration in drinking water.
The study subjects comprised of a total of 1810 school children aged 5-6 year’s and 12-13 year’s. They include 1003 (55.4%) males and 807 (44.5%) females. There were 856 (47.3%) subjects of age 5-6 year’s and 954 (52.7%) subjects of 12-13 year of age. Age and sex wise distribution of study subjects in relation levels of fluoride concentration in drinking water. Below optimum level (<0.7ppm) consisted of 333 (55%) males and 272 (45%) females. Out of 333 males included in this level 165 (52.7%) were 5-6 year old and 168 (57.7%) were of 12-13 year’s and out of 272 (45%) females in this level 148 (47.3%) were 5-6 year and 124 (42.6%) were 12-13 year old children. (Table 1) Shows prevalence of dental fluorosis according to levels of fluoride concentration in drinking water 29 (4.7%) subjects in below optimum level, 42 (7%) subjects in optimum level and 270 (44.8%) subjects in above optimum level were found to have dental fluorosis respectively. (Table 2) At above optimum level of fluoride concentration there were 110 subjects with dental fluorosis score 2 (very mild) and 77 subjects with fluorosis score 3 (mild). Where as only 3, 18 and 10, 12 subjects in the optimum level and below optimum level were found to have very mild and mild fluorosis score respectively. This difference was found to be highly significant (p<0.05). (Table 3) In 5-6 year old subjects it was found that at above optimum level there were 44 subjects with dental fluorosis. Where as only 4 and 5 subjects in the optimum level and below optimum level were found to have dental fluorosis respectively. This difference was found to be highly significant (p<0.05). (Table 4) In 12-13 year old subjects and it was found that at above optimum level there were 66 subjects with dental fluorosis. Where as only 9 and 25 subjects in the optimum level and below optimum level were found to have dental fluorosis respectively, this difference was found to be highly significant (p<0.05). When age and sex wise relation of dental fluorosis and level of fluoride concentration in drinking water was seen. It was observed that the children affected with dental fluorosis increases with the increase in level of concentration of fluoride in drinking water.
Fluoride plays an important role in caries prevention due to its cariostatic potential, however the excessive uninterrupted intake of fluoride for longer duration can have deleterious effect on teeth and bone’s leading to dental fluorosis or skeletal fluorosis. It is also documented that even at optimal level and below optimum level of fluoride in drinking water, dental fluorosis can be seen (Saravanan et al 2008)6. The prevalence of dental fluorosis in 5-6 and 12-13 year children was 11.44% and 25.47% respectively, irrespective of the level of fluoride concentration in drinking water. It is evident from the study that there is an increase in prevalence of dental fluorosis with increase of age, this finding was consistent with the findings of Larsen et al (1987)7reference missing, National Oral Health Survey and Fluoride Mapping (2002-03)8, Akpata et al (l997)9. This pattern might be due to increase exposure to other sources of fluoride, such as fluoride tooth paste and other fluoride prophylactic measures, consuming more of fluoridated water. However gender wise comparison of prevalence of dental fluorosis showed no statistical difference between male and female. When the dental fluorosis score of the children residing in areas with different level of fluoride concentration in drinking water in this study were compared it was found that children residing in area with the level of fluoride concentration in drinking water above optimum level had more dental fluorosis 270 (44.84%) as compared to children residing in areas with level of fluoride concentration in drinking water below optimum level 29 (4.7%) or optimum level 42 (7%). That might be due to the availability of fluoride to those children from drinking water and other sources of fluoride which exceeds the tolerance dose of fluoride against dental fluorosis. Findings of our study corresponds well with the finding of National Oral Health Survey and Fluoride Mapping (2002-03),8 Akpata et al (l997).9 In the present study, it was found that 37.2% of children residing in areas of above optimum level of fluoride concentration in drinking water had very mild to moderate dental fluorosis, where as only 5.4% of children residing in area with fluoride concentration of optimum fluoride level had very mild to moderate dental fluorosis and 3.9% of children residing in area with below optimum level of fluoride concentration in drinking water had very mild to moderate dental fluorosis. Where as in a study carried out by Grobler et al (1998)10 it was found that children residing in areas with high fluoride concentration in drinking water area had moderate to severe dental fluorosis in comparison to areas with optimum level of fluoride concentration in drinking water and below optimum level of fluoride concentration in drinking water. When the prevalence of dental fluorosis was correlated with the concentration of fluoride in drinking water, it was found that the number of children affected with dental fluorosis increases with the increase in level of concentration of fluoride in drinking water this finding is in correlation with the findings of Budipramana et al (2002)11, Neurath Canton (2005).12 In the present study it was observed that dental fluorosis is existed in very mild to moderate fluorosis form irrespective of the level of fluoride concentration in drinking water.
Dental fluorosis existed in very mild to moderate fluorosis form irrespective of the level of fluoride concentration in drinking water.
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