Prevalence of Dental Fluorosis and associated Risk Factors in Bagalkot District, Karnataka, India

Study of anaemia in pregnancy and low birth weight in fluoride endemic area of Western Rajasthan: a cohort study

Background

Fluoride is a noxious element known to destroy gastrointestinal mucosa, leading to erythrocytes' destruction and causing anaemia. The birth weight of newborn babies is a significant indicator of a child's vulnerability to the risk of childhood diseases and chances of existence.

Methods

This prospective cohort study was planned to find linkages between fluorosis and the low-birth weight of newborn babies with anaemic mothers. Antenatal mothers until the 20th week of gestation were followed up till delivery in the Antenatal Clinic of a District Hospital in one of the known fluoride-endemic districts (Nagaur) and the other not-so-endemic district (Jodhpur) of Western Rajasthan.

Results

Around 19% of the newborn in Jodhpur and around 22% in Nagaur had low birth weight. Mean fluoride values in water samples were measured to be 0.57 (range from 0.0 to 2.7 PPM) in Jodhpur and 0.7 (range from 0.0 to 3.4 PPM) in Nagaur.

Conclusions

Thus, in fluoride endemic areas, other factors should be included besides iron and folic acid supplementation for improving anaemia in pregnant women. This calls for assessing the effectiveness of de-fluoridation activities along with the area's most common indigenous food practices.

Prevalence and Distribution of Developmental Defects of Enamel in Children Aged 12-15 Years in Fazilka District, Punjab, India, and Their Correlation With Drinking Water Fluoride Level

BACKGROUND AND OBJECTIVES

Dental fluorosis is a developmental disturbance of dental enamels, caused by successive exposures to high concentrations of fluoride during odontogenesis, leading to enamels with lower mineral content and increased porosity. The objective of the present study was to assess the prevalence and severity of developmental defects and their relationship to fluoride levels in drinking water.  Methods: Ten villages were selected from Fazilka district, Punjab, India. A total of 1000 (519 males, 481 females) school children aged 12-15 years formed the study population. Eutech ION 2700 (Thermo Fisher Scientific, Waltham, Massachusetts, United States) was used for the estimation of fluoride levels in water. Developmental defects were screened and assessed using the modified Developmental Defects of Enamel (DDE) Index. Statistical evaluation was done using Karl Pearson's coefficient of correlation and the Chi-square test with IBM SPSS Statistics for Windows, Version 23, (Released 2015; IBM Corp., Armonk, New York, United States).

RESULTS

The fluoride concentration in drinking water ranged from 0.5 to 2.0 ppm. The prevalence of developmental defects among the study population was 73.4% (range 59% to 100%). The most commonly observed type of defect was diffuse opacity (score 4) in 22.8% of the children. The premolars were the most commonly affected teeth. There was a significant positive correlation between the type (r=0.95; p<0.001) and extent (r=0.82; p<0.001) of developmental defects to the fluoride levels in drinking water.  Conclusion: The drinking water from about 50% of the villages had fluoride levels of 1 ppm or >1 ppm. A significant positive correlation between the severity of enamel defects and increased fluoride levels in water was deciphered. Thus, a simple, effective, and inexpensive method of de-fluoridation of drinking water should be prioritized if alternative sources of drinking water are not made available.

Relationships between dental fluorosis and fluoride concentrations in bottled water and groundwater in low-income children in Mexico

Introduction

The aim of the current study was to investigate associations between dental fluorosis in children living in low socioeconomic areas in Mexico, and fluoride concentrations in tap water, fluoride concentrations and in bottled water, and body mass index (BMI).

Methods

A cross-sectional study involving 585 schoolchildren aged 8-12 years was conducted in communities in a southern state of Mexico with >0.7 parts per million (ppm) fluoride in the groundwater. The Thylstrup and Fejerskov index (TFI) was used to evaluate dental fluorosis, and the World Health Organization growth standards were used to calculate age-adjusted and sex-adjusted BMI Z-scores. A BMI Z-score ≤ -1 SD was used as the cut-off point for thinness, and multiple logistic regression models for dental fluorosis (TFI ≥ 4) were constructed.

Results

The mean fluoride concentration in tap water was 1.39 ppm (SD 0.66), and the mean fluoride concentration in bottled water was 0.32 ppm (SD 0.23). Eighty-four children (14.39%) had a BMI Z-score ≤ -1 SD. More than half (56.1%) of the children presented with dental fluorosis in TFI categories ≥ 4. Children living in areas with higher fluoride concentrations in the tap water [odds ratio (OR) 1.57, p = 0.002] and bottled water (OR 3.03, p < .001) were more likely to have dental fluorosis in the severe categories (TFI ≥ 4). BMI Z-score was associated with the probability of dental fluorosis (TFI ≥ 4; OR 2.11, p < 0.001), and the effect size was 29.3%.

Discussion

A low BMI Z-score was associated with a higher prevalence of dental fluorosis in the severe category. Awareness of the fluoride concentrations in bottled water may help prevent dental fluorosis, particularly in children exposed to several high fluoride content sources. Children with a low BMI may be more vulnerable to dental fluorosis.

C, Barvaliya MJ, Kirte R, R. S, Ray SK, B. R, Chakma T, Murhekar MV, Roy S. A community-based study of dental fluorosis in rural children (6–12 years) from an aspirational district in Karnataka, India

Objectives

The present study was planned to estimate the prevalence of dental fluorosis in 6–12 years of children and its association with various drinking water sources, water, and urine fluoride levels among the subset of children under the umbrella of a larger study to address iodine deficiency disorders and iron deficiency anemia in 17 villages of Manvi and Devadurga talukas of Raichur district of Karnataka.

Methods

Analysis of subset of data and urine samples of children under the umbrella of a larger cross-sectional community-based study was conducted in 17 villages of Manvi and Devadurga taluks of Raichur district. House to house survey was carried out to collect data using a semi-structured questionnaire in ODK software. Demographic details, source of drinking water, clinical assessment of dental fluorosis, and height and weight measurements were performed by trained staff. Urine and water samples were collected for fluoride level estimation. The overall prevalence of dental fluorosis and its severity-wise prevalence were estimated. Association between dental fluorosis and age, gender, type of diet, source of drinking water, height for age, BMI for age, water fluoride level, and urine fluoride level were carried out using logistic regression analysis.

Results

The prevalence of dental fluorosis was 46.0%. Mild, moderate, and severe dental fluorosis was found in 37.9, 7.8, and 0.3% of children. With the increasing age of participants, the odds of dental fluorosis were found to increase by 2–4 folds. The odds of having dental fluorosis were significantly increased with increasing water fluoride levels of 3 to 5 ppm [AOR = 3.147 (1.585–6.248); P = 0.001] in comparison with water fluoride levels of &lt; 1 ppm. The similar trend was found with urine fluoride level &gt; 4 ppm [AOR = 3.607 (1.861–6.990); P &lt; 0.001]. As compared to river water, other sources of drinking water were significantly associated with higher odds of dental fluorosis.

Conclusions

Prevalence of dental fluorosis was high in 6 to 12 years due to overexposure of fluoride from drinking water. High water and urine fluoride levels in children indicate the chronic exposure to fluoride and suggest that the population is at high risk of developing chronic fluorosis.

Moderate and Severe Dental Fluorosis in the Rural Population of Anantapur, India: Change in Their Biological Susceptibility?

Dental fluorosis affects the quality of life. A cross-sectional, observational study was conducted in a community affected by endemic fluorosis for several generations with a conserved biological and social environment. The study included patients from the rural population of Anantapur, India. The Dean index (DI) and the Thylstrup and Fejerskov Index (TFI) were used for fluorosis classification. Additionally, water samples were collected for fluoride analysis, taken from the patients' living areas. The statistical association between the variables was analyzed. In total, 785 patients between 10 and 60 years old were included in the study (58.7% women and 41.3% men). Fluorosis signs were found in 94.6% of patients examined using the DI and 94.4% using the TFI. Moderate-severe dental fluorosis was observed in 62.8% by DI and 73.1% by TFI consuming untreated water with up to 2.9 ppm of fluoride. Furthermore, moderate-severe dental fluorosis was observed in 33.2% by DI and 39.9% by TFI consuming water with ≤1.5 ppm of fluoride. The high prevalence of moderate-severe dental fluorosis in patients consuming water with a low fluoride concentration suggests that other factors are involved. Biological susceptibility change could play an essential role in the severity of dental fluorosis in populations exposed for several generations, affecting its actual and future quality of life.

Assessment of fluoride levels during pregnancy and its association with early adverse pregnancy outcomes

Background and Aim:

There is sparse data available on human subjects regarding the affect of excessive fluoride exposures on pregnancy. The aim of this study was to examine the association between elevated urinary fluoride levels during early pregnancy and maternal anemia and adverse fetal outcome.

Patients and Methods:

We enrolled 600 pregnant patients with gestational age less than 20 weeks and with a high urinary fluoride levels(>1 mg/L).We also documented the fluoride levels in the tap water and ground water samples collected from the areas where these women resided during pregnancy. These patients were also evaluated for hemoglobin levels and detailed fetal examination by ultrasound. Data was assessed by SSPS version 16.0 software and P < 0.05 was considered to be significant.

Results:

Urinary fluoride averaged 2.65 mg/L and ranged from 1.0 to 4.3 mg/L while all the water samples revealed fluoride levels greater than WHO prescribed the limit of 1.5 mg/L. A total of 402 patients (67%) were found to be anemic with hemoglobin levels ranging from 6.2 to 11.9 g/dl (9.28 ± 1.29). Eighty one patients (13.5%) had adverse fetal outcomes that comprised abortions, congenital abnormalities, and intrauterine deaths (IUDs). There was a negative correlation between urinary fluoride and hemoglobin levels (P = 0.031, r= -0.59) and females with elevated urinary fluoride levels were found to have a strong association with the pregnancy complications, i.e., anemia, miscarriage, abortion, and still birth (χ² = 9.23, P < 0.05).

Conclusions:

Excess fluoride exposures can have deleterious effects on the expecting mother and fetus and is associated with adverse pregnancy outcomes.

Factors associated with dental fluorosis in three zones of Ecuador

Background

To determine the prevalence of dental fluorosis in 10-12 year-old school children, in three provinces of the inter-andean Region of Ecuador: Imbabura, Pichincha and Chimborazo, as well as the relationship between certain factors, considering that the latest studies go back to the year 2009.

Material and Methods

A cross-sectional and observational study was proposed. A sample of 599 was calculated at 95% of confidence considering population projections for children between 10 and 12 old of three zones of Ecuador. However, 608 school children, who had the acceptance and informed consent of their parents to participate, completed a survey about factors associated with dental fluorosis. Once the survey was completed, the vestibular surfaces of the upper and lower anterior teeth of the infant were photographed, following standardized distance and light procedures. Three evaluators, trained in the detection of fluorosis using the Thylstrup and Fejerskov index, analyzed the photographs. The Stata 13.0 software was used for the statistical analysis, with a level of significance of 5% and with a confidence interval of 95%. To relate the risk factor of fluorosis, a multinomial logistic model was used.

Results

The prevalence of dental fluorosis was of 89.96%, with a greater presence of grade 2 TF. A positive statistical relationship and statistical significance was detected between dental fluorosis and consumption of bottled beverages. Also the amount of toothpaste used and its ingestion during brushing (p = 0.000) were analyzed.

Conclusions

The populations evaluated, that are related to the consumption of bottled beverages and involuntary toothpaste ingestion, and have a high prevalence of a mild level of fluorosis. Key words:Fluorosis, dental, risk factors, epidemiology.

Aesthetic treatment of dental fluorosis in a 9-year-old girl: Case report

Background/Aim: Dental fluorosis is a specific disturbance of tooth formation caused by excessive intake of fluoride. The discoloration of teeth is the most common reason for parents to seek treatment. The purpose of this paper is to describe the therapeutic management performed in a 9-year-old girl with fluorosis. Case report: A clinical case of a 9-year-old girl diagnosed with fluorosis is reported. The treatment of this clinical case was achieved using microabrasion, which is a minimally invasive method. This technique improves the aesthetics of the teeth without causing significant loss of dental tissue; a characteristic making microabrasion applicable to children as well. Its implementation involved the combined use of 18% hydrochloric acid and pumice on the enamel surface of upper incisors. The improved appearance of the teeth was aesthetically pleasing and, consequently, the patient gained in self-confidence. Conclusions: In the literature, several treatment choices are proposed, depending on the severity of the fluorosis. In our case, microabrasion was applied and the aesthetic outcome satisfied both the patient and the dentist.

A comparative study of dental fluorosis and non-skeletal manifestations of fluorosis in areas with different water fluoride concentrations in rural Kolar

Background:

Fluorosis is an endemic disease which results due to excess exposure to high fluoride from different sources. The climatic factors and dependency on ground water add to the risk of fluorosis in Kolar. In addition to it, the epidemiological studies conducted on fluorosis in Kolar are very few.

Aims:

(1) To estimate age-specific prevalence of dental fluorosis in the study population. (2) To determine the proportion of study subjects with non-skeletal manifestations of fluorosis (3) To assess and compare the influence of various socio-epidemiological factors in the occurrence of dental fluorosis among the study population in areas with high and normal fluoride.

Methodology:

A cross-sectional study was conducted among the residents of three randomly selected villages, Thimmasandra and Batwarahalli (high fluoride) and Maddinayakanahalli (normal fluoride) belonging to Bangarpet taluk, Kolar for 1 year. Dental fluorosis was assessed by the Dean's grading. Non-skeletal manifestations were elicited based on clinical features. Fluoride levels of drinking water sources were estimated by ion-electrode method. The Chi-square and Fisher's exact tests were used to see the difference in proportions and a P value of <0.05 was considered for statistical significance.

Results:

The prevalence of dental and non-skeletal fluorosis in the study groups with high and normal fluoride groups were 13.17%, 5.5%, 3.84%, 1.9%, respectively. The prevalence of dental fluorosis was significantly higher among the children and adolescents compared to adults (P < 0.05).

Conclusion:

Dental fluorosis is a public health problem mainly affecting children and adolescents in Bangarpet.