Weaning food and magadi associated with dental fluorosis in Northern Tanzania

Periodontal and dental conditions of a school population in a volcanic region of Tanzania with highly fluoridated community drinking water

Introduction

Dental fluorosis is endemic in the Rift Valley in Africa, especially around volcanic areas, due to the high fluoride content in daily drinking water.

Objective

This study evaluates the oral health status and types of occlusion in a school population, and to assess the possible association between dental fluorosis and other pathologies such as decay, gingivitis and periodontitis.

Material and methods

An observational study of 581 individuals recruited from a public secondary school in Arusha, Northern Tanzania was undertaken. The indices used were: the Silness & Löe Plaque Index, the Community Periodontal Index and the Decayed/Missing/Filled index. Descriptive statistical analyses were performed and a chi-square test was used to assess the associations between independent variables.

Results

Almost all the school children evaluated (96.73%) presented Angle class I dental occlusion, and 75.22% presented some degree of dental fluorosis. Most of the population (511, 87.95%) showed bleeding on probing. A moderate/high degree of some dental pathology (DMF score) was recorded in 14.46%. The association between dental fluorosis, gingival bleeding and tooth decay indicated a higher concentration of pathology in groups with more severe fluorosis (p<0.05).

Conclusion

In this large population sample, both tooth decay and gingivitis were significantly associated with moderate or severe dental fluorosis.

Oral diseases and oral health related behaviors in adolescents living in Maasai population areas of Tanzania: a cross-sectional study

Background

Oral diseases, such as dental caries, tooth wear, dental erosion and periodontal diseases are major health problems in many societies. The study aim was to explore the association between oral health related behaviors and the presence of oral diseases in adolescents living in Maasai population areas in the northern part of Tanzania.

Methods

A cross sectional study was conducted in 2016 using one stage cluster sample design. A total of 989 adolescents were invited and 906 (91.6%; (Maasais n = 721, non Maasais n = 185) accepted the invitation and completed an interview and clinical oral examination in a school setting (mean age 13.4 years, SD 1.2, range 12–17 years). Chi-square test, bivariate analysis and logistic regression were performed to analyze data.

Results

Logistic regression revealed that: adolescents with low frequency of tooth cleaning (OR = 10.0, CI 4.3–20.0) was associated with poor oral hygiene and that more regular tooth cleaning (OR = 0.1, CI 0.04–0.14) and the use of plastic type of tooth brush (OR = 0.7, CI 0.53–0.99) were associated with less gingival bleeding. High consumption of biscuits (OR = 2.5, CI 1.7–3.8) was associated with presence of dental caries and the use of magadi (OR = 24.2, CI 11.6–50.6) as a food additive was the covariate for more severe dental fluorosis (TF grade 5–9). Regular intake of carbonated soft drinks (OR = 1.6, CI 1.1–2.5) and regular tooth cleaning (OR = 1.7, CI 1.1–2.6) were independently associated with dental erosion. Using teeth as a tool for: biting nails (OR = 1.9, CI 1.4–2.4), opening soda (OR = 1.8, CI 1.4–2.4) and holding needles (OR = 1.6, CI 1.3–2.1) were covariates for tooth wear. Adolescents who reported to clench/grind their teeth (OR = 2.3, CI 1.5–3.7) was the only covariate for TMD. In several of the investigated factors, there were significant differences between the Maasai and non Maasai ethnic groups.

Conclusion

Oral health related behaviors have a significant impact on oral diseases/conditions among adolescents attending primary schools in Maasai population areas with obvious differences in behavior between the Maasai and non Maasai ethnic groups. There is a need for addressing oral health and to encourage behaviors that promote good oral health and dental care service utilization in this society.

Oral diseases and socio-demographic factors in adolescents living in Maasai population areas of Tanzania: a cross-sectional study

Background

Oral diseases may cause serious health problems, especially in socially disadvantaged populations and in low-income countries. In populations living in the rural areas of Tanzania there is paucity of reports on oral health. The study aim was to estimate the prevalence, severity and socio-demographic distribution of oral diseases/conditions in adolescents living in Maasai population areas of Tanzania and to compare oral diseases/conditions between Maasai and non-Maasai ethnic groups.

Methods

A total of 23 schools were randomly selected from 66 rural public primary schools in Monduli and Longido districts, Tanzania. All pupils in the selected classes, 6th grade, were invited to participate in the study. A total of 989 were invited and 906 (91.6%) accepted the invitation and completed an interview and a clinical oral examination.

Results

Out of 906 study participants (age range 12–17 years), 721(79.6%) were from Maasai and 185 (20.4%) from non-Maasai ethnic groups. Prevalence of poor oral hygiene, gingival bleeding, dental caries experience (DMFT> 0), dental fluorosis TF grade 5–9, dental erosion (into dentin), tooth wear (into dentin) and TMD was 65.6, 40.9, 8.8, 48.6, 1.9, 16.5 and 11.8%, respectively. Multiple variable logistic regression analysis revealed that, girls (OR = 2.0) and participants from Longido (OR = 2.6) were more likely to present with good oral hygiene (p < 0.05). Adolescents from Monduli (OR = 1.7), males (OR = 2.1), being born within Arusha region (OR = 1.9) and Maasai (OR = 1.7) were more likely to present with gingival bleeding (p < 0.05). DMFT> 0 increased by age (OR = 2.0) and was associated with non-Maasai ethnic group (OR = 2.2), (p < 0.05). Adolescents from Monduli district (OR = 10.0) and those born in Arusha region (OR = 3.2) were more likely to present with dental fluorosis (p < 0.05). Dental erosion was more common among non-Maasais (OR = 2.0) as well as having mother with high education (OR = 2.3), (p < 0.05).

Conclusions

Oral diseases like dental caries and dental erosion were less common, but gingival bleeding, dental fluorosis, tooth wear and TMD were common findings in adolescents attending primary schools in the Maasai population areas of Tanzania. Notable differences between Maasai and non-Maasai ethnic groups and certain correlations to sociodemographic factors were detected. Our findings can be utilized by policy makers in the planning of oral health programs in public primary schools of Maasai population areas of Tanzania.

Dental fluorosis and associated risk factors in early adolescents in India

Background Dental fluorosis has a negative impact on the facial esthetics of adolescents and is a worldwide oral health concern. Objective To assess the prevalence and associated risk factors for dental fluorosis in early adolescents in India. Methods This was a cross-sectional study carried out on 800 adolescent school children selected from the Jhabua and Dhar districts of Madhya Pradesh, India. The children were in the of 12-15-year age group. A total of eight schools from both Jhabua and Dhar districts were included in the study. A self-administered questionnaire collected information on demographic characteristics, oral hygiene practices and various risk factors for dental fluorosis. Water samples were collected from each zone and sent to a laboratory for water fluoride estimation. Dental fluorosis was assessed using the Dean index. Chi-squared (χ2) and logistic regression analysis were performed. Results The overall prevalence of dental fluorosis was found to be 40.5% in early adolescents. The prevalence of dental fluorosis was found to be 45% in the Jhabua district and 36% in the Dhar district. The water fluoride content was found to be the strongest predictor for dental fluorosis followed by the method of water storage. Conclusion Dental fluorosis affects a large number of adolescents in both the Jhabua and Dhar districts of Madhya Pradesh. Effective policies focusing on oral health education and prevention of dental fluorosis need to be drafted.

Groundwater quality and its health impact: An assessment of dental fluorosis in rural inhabitants of the Main Ethiopian Rift

This study aims to assess the link between fluoride content in groundwater and its impact on dental health in rural communities of the Ethiopian Rift. A total of 148 water samples were collected from two drainage basins within the Main Ethiopian Rift (MER). In the Ziway-Shala basin in particular, wells had high fluoride levels (mean: 9.4±10.5mg/L; range: 1.1 to 68 mg/L), with 48 of 50 exceeding the WHO drinking water guideline limit of 1.5mg/L. Total average daily intake of fluoride from drinking groundwater (calculated per weight unit) was also found to be six times higher than the No-Observed-Adverse-Effects-Level (NOAEL) value of 0.06 mg/kg/day. The highest fluoride levels were found in highly-alkaline (pH of 7 to 8.9) groundwater characterized by high salinity; high concentrations of sodium (Na⁺), bicarbonate (HCO₃⁻), and silica (SiO₂); and low concentrations of calcium (Ca²⁺). A progressive Ca²⁺ decrease along the groundwater flow path is associated with an increase of fluoride in the groundwater. The groundwater quality problem is also coupled with the presence of other toxic elements, such as arsenic (As) and uranium (U). The health impact of fluoride was evaluated based on clinical examination of dental fluorosis (DF) among local residents using the Thylstrup and Fejerskov index (TFI). In total, 200 rural inhabitants between the ages of 7 and 40 years old using water from 12 wells of fluoride range of 7.8-18 mg/L were examined. Signs of DF (TF score of ≥ 1) were observed in all individuals. Most of the teeth (52%) recorded TF scores of 5 and 6, followed by TF scores of 3 and 4 (30%), and 8.4% had TF scores of 7 or higher. Sixty percent of the teeth exhibited loss of the outermost enamel. Within the range of fluoride contents, we did not find any correlation between fluoride content and DF. Finally, preliminary data suggest that milk intake has contributed to reducing the severity of DF. The study highlights the apparent positive role of milk on DF, and emphasizes the importance of nutrition in management efforts to mitigate DF in the MER and other parts of the world.

Contribution of trona (magadi) into excessive fluorosis--a case study in Maji ya Chai ward, northern Tanzania

Excessive fluoride ingestion predominantly comes from drinking water sources. However, prevalence and severity of dental and skeletal fluorosis in northern Tanzania have been reported to be higher than would be expected from ingestion of fluoride through drinking water alone. This study aimed at investigating the contribution of "trona" (also locally known as magadi) a food additive, to the prevalence and severity of fluorosis in northern Tanzania. The study was carried out in four villages (Embaseni, Kitefu and Ngurdoto) in Maji ya Chai ward; and Nkoanekoli in Poli ward, in Arusha region, Tanzania. Analysis of fluoride concentrations was carried out in drinking water sources as well as in magadi samples. Assessment of the prevalence of dental fluorosis using Dean's Index Method was carried out for a population of 2217 pupils in four primary schools located in the case study area. Fluoride concentration in drinking water sources was found to range from 1.7 to 11.3 mg/l, while the concentration in magadi samples in case study villages were in the range of 0.21 to 0.9 mg/g. Total fluoride ingestion through magadi and water were established to be 11.74 mg/person/day in Embaseni, 36.1 mg/person/day in Ngurdoto, 10.88 mg/person/day in Kitefu and 5.7 mg/person/day in Nkoanekoli villages. Levels of total fluoride ingestion were directly correlated with Community Fluorosis Index (CFI) values, which were found to be 3.32 (in Embaseni), 3.67 (in Ngurdoto), 2.2 (in Kitefu) and 1.47 (in Nkoanekoli). The village with the highest fluoride consumption rate showed the highest CFI as well. High levels of fluoride concentrations in magadi suggest that excessive fluorosis in northern Tanzania may be due to the use of magadi in food preparations.

Sociodemographic and behavioural correlates of severe dental fluorosis

OBJECTIVES

The aim of this study was to identify sociodemographic and behavioural factors associated with the prevalence of severe dental fluorosis in moderate- and high-fluoride areas of the Ethiopian Rift Valley.

METHODS

Three hundred and six adolescents (12-15 years) and 233 mothers participated in the study. The children were examined for dental fluorosis according to the Thylstrup-Fejerskov Index (TFI). The children and their mothers were subsequently interviewed. Sixty mothers had more than one participating child. In order to perform a paired parent/child analysis, a total of 73 younger siblings had to be excluded.

RESULTS

Among the remaining 233 children, the prevalence of severe dental fluorosis (TFI >or= 5) was 24.1% and 75.9% in the moderate- and high-fluoride areas, respectively. According to bivariate as well as multivariate analyses, a number of sociodemographic and behavioural factors were related to severe fluorosis. The odds for having severe fluorosis varied according to the fluoride concentration of the drinking water, age, consumption of tea, length of breastfeeding and method of storing water. The adjusted odds ratios ranged from 2.6 to 26.1. Breastfeeding for > 18 months and the use of clay pots for storing drinking water helped protect against severe dental fluorosis. Bivariate analyses indicated that being male and consuming fish might be associated with higher TFI scores.

CONCLUSION

In order to avoid dental fluorosis, low-fluoride drinking water should be provided in the relevant villages. A prolonged period of breastfeeding, the use of clay pots for storing water, and possibly a reduced intake of tea and whole fish in infants might also help to avoid severe fluorosis in children growing up in traditionally fluoride-endemic areas.