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ORIGINAL ARTICLE
Year : 2015  |  Volume : 13  |  Issue : 4  |  Page : 405-409

Prevalence of dental fluorosis among 12–15 years school children of Bharatpur city: A cross-sectional study


1 Department of Public Health Dentistry Daswani Dental College and Hospital, Kota, Rajasthan, India
2 Department of Public Health Dentistry, K.D. Dental College and Hospital, Mathura, India
3 Department of Public Health Dentistry, ITS Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
4 Department of Public Health Dentistry, Guardian Dental College, Ambernath, Mumbai, India
5 Department of Oral Medicine and Radiology, Vasantdada Patil Dental College, Sangli, Maharashtra, India
6 Department of Orthodontics and Dentofacial Orthopaedics, Daswani Dental College and Hospital, Kota, Rajasthan, India

Date of Web Publication7-Dec-2015

Correspondence Address:
Harsh Vardhan Dubey
Dahi Wali Gali, Purohit Mohalla, Infront of Jain Temple, Bharatpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.171194

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  Abstract 

Introduction: Healthy teeth are important for any section of society. Dental caries, the product of man's progress toward civilization, has a very high morbidity potential. 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. While fluoride is accepted as an effective method to prevent caries, the excessive consumption of fluoride can put teeth at risk of developing dental fluorosis. Aims and Objectives: To assess the prevalence of dental fluorosis among 12–15 years old government and private school children of Bharatpur city, Rajasthan. Methodology: A cross-sectional study was carried out on total 1400 school children, out of which 700 school children were from government schools and 700 were from private schools. Simple random sampling methodology was used to select the sample. The subjects were examined for dental fluorosis according to WHO 1997 assessment form. Results: The prevalence of dental fluorosis was found higher among government school children, that is, 54.5% when compared to private school children, that is, 45.5% respectively, and this difference was found to be statistically significant (P ≤ 0.05). Conclusion: The study showed the increased prevalence of dental fluorosis among government school children as compared to private school children. Dental fluorosis was found to be the major public health problem among both government and private school children of Bharatpur city which needed immediate attention. Regular dental check-ups and routine oral hygiene practice will enable them to lead a healthier life.

Keywords: Dental fluorosis, government school, private school


How to cite this article:
Dubey HV, Ingle NA, Gupta R, Charania Z, Ingle E, Sharma I. Prevalence of dental fluorosis among 12–15 years school children of Bharatpur city: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:405-9

How to cite this URL:
Dubey HV, Ingle NA, Gupta R, Charania Z, Ingle E, Sharma I. Prevalence of dental fluorosis among 12–15 years school children of Bharatpur city: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Dec 5];13:405-9. Available from: https://www.jiaphd.org/text.asp?2015/13/4/405/171194


  Introduction Top


In the past decade, a substantial decline in dental caries has occurred among children of several developed countries mainly the USA and several European countries.[1],[2] 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. "Fluorine" is the most electronegative of all chemical elements and is largely found in the chemically combined state as "fluoride" and is the largest naturally abundant element in the earth's crust. Fluoride is found in varying concentrations at different geographical locations on the earth.[3] One of the landmark discoveries in the history of preventive dentistry is the charismatic role of "fluoride," which is used in man's battle against dental caries. It is considered as a double-edged sword, because when its level is below optimum level it does not have the caries protective action and when its concentration is above optimum level it causes dental and skeletal fluorosis in various forms. Fluoride at an optimum level does not only decrease the incidence of dental caries but also necessarily maintains the integrity of oral tissues.[4] In industrialized countries, the caries decline has been related due to the use of fluoride in different forms.[4] The therapeutic range of fluoride is narrow, and an association between fluoride and drinking water and the degree of dental fluorosis has been documented worldwide.[4] While fluoride is accepted as an effective method to prevent caries, the excessive consumption of fluoride can put bones and teeth at risk of developing fluorosis. Fluoride ingested during dental development, until the age of 6 years, may promote the development of fluorosis.[3],[5],[6]

India is among the 22 nations around the globe, where health problems have been reported due to excessive fluoride in drinking water.[7] An estimated 66.6 million people in India from 19 states are affected with dental or skeletal fluorosis.[7] In India occurrence of fluoride in ground water has been described in many places of Andhra Pradesh, Haryana, Jharkhand, Tamil Nadu, Karnataka, Gujarat, Rajasthan, Maharashtra, Madhya Pradesh, Chhattisgarh, Punjab, Uttar Pradesh, Kerala, Orissa, Jammu and Kashmir, Bihar, Delhi, West Bengal, and Assam.[7]

Though 19 states in the country have a sizable number of people with high fluoride content in their blood, Rajasthan comes in worst affected areas. All the 32 districts have been declared as fluorosis prone areas.[7] The worst affected areas are Nagaur, Jaipur, Bharatpur, Sikar, Jodhpur, Barmer, Ajmer, Sirohi, Jhunjhunu, Churu, Bikaner, and Ganganagar.[8]

The Bharatpur city comes under Bharatpur block which in turn comes under Bharatpur tehsil of Bharatpur district in the state Rajasthan. The present water supply of Bharatpur is from surface water from Bundh Baretha Irrigation Tank and the ground water sources extracted through 19 tube wells.[9] People who consume groundwater have higher chances of developing dental fluorosis because of a higher level of fluoride in the deep groundwater used for drinking. No study showing the prevalence of dental fluorosis has been done in this region. Keeping this in mind the present study was undertaken to know the prevalence of dental fluorosis among 12–15 years old school children of Bharatpur city.


  Methodology Top


A cross-sectional study was carried out in Bharatpur city to assess the prevalence of dental fluorosis among school children in the age group of 12–15 years. List of schools was obtained from Bharat Shiksha Adhikari Office of Bharatpur which comprised 200 schools present in Bharatpur city, making a population of 105,000. Out of these 105,000 students, 25,000 students (that forms the sampling frame) were of the age group of 12–15 years.[10]

The Bharatpur city had been divided into five zones, that is, central, north, south, east, and west. Areas representing each zone were New Mandi Chauraha, Ranjeet Nagar, Gopalgarh road, Kumher Gate, and Surajpol Gate, respectively. Zone I, that is, New Mandi Chauraha (central zone) had 40 schools, Zone II, that is, Ranjeet Nagar (North) had 52 schools, Zone III, that is, Gopalgarh road (south zone) had 35 schools, Zone IV, that is, Kumher Gate (east zone) had 35 schools, and Zone V, that is, Surajpol (west zone) had 38 schools.

A pilot study was carried out and the sample size of 1400 school children was estimated, to obtain the desired sample size, 280 school children from each of the five zones were randomly selected, out of 280 school children, 140 school children were from government schools and 140 were from private schools. An selection of schools from each zone had been done using simple random sampling (lottery) method (280 × 18 = 1400). The structured proforma was used to assess dental fluorosis in the school children of Bharatpur city that included information related to gender, age, brushing frequency, and source of drinking water. Clinical examination was carried out in the school compound itself, dental fluorosis was examined using WHO standard criteria as mentioned in WHO Oral Health Performa, 1997.[11] The ethical clearance was approved by the Institutional Ethical Committee prior to the start of the study and consent was obtained from school authorities as well as from parents of school children. The inclusion and exclusion criteria were as follows:

Inclusion criteria

  • School children aged 12–15 years
  • School children who were lifelong residents of Bharatpur city (i.e., children residing from 10 to 15 years in the same locality).


Exclusion criteria

  • Individuals consuming any form of tobacco
  • Individuals suffering from systemic illness like hemolytic disease of newborn
  • Individuals with orthodontic brackets and with severe extrinsic stains on their teeth.


Data analysis

  • The statistical analysis was performed using SPSS version 15 (IBM). The mean and standard deviation of scores were calculated, the comparison between government and private school children was done using Chi-square test, P ≤ 0.05 was considered statistically significant.



  Results Top


A cross-sectional study was carried out in Bharatpur city to assess the prevalence of dental fluorosis among school children in the age group of 12–15 years. The distribution of study population according to gender, age, brushing frequency, and source of drinking water are given in [Table 1],[Table 2],[Table 3],[Table 4]. In the present study, a maximum number of school children, that is, 861 (61.5%) were without dental fluorosis. Among school children with dental fluorosis, mild form of dental fluorosis was the most common found among 189 (13.5%) school children and questionable form of dental fluorosis was least common found only among 35 (2.5%) school children. Among both government and private schools, maximum number of children, that is, 406 (58%) and 455 (65%) respectively, were without dental fluorosis whereas, a minimum number of children, that is, 14 (2%) and 21 (3%) respectively, were having questionable form of dental fluorosis. A statistically significant difference, that is, P ≤ 0.05 was observed when the comparison of dental fluorosis was made among government and private school children [Table 5].
Table 1: Distribution of study population according to gender among government and private school children

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Table 2: Distribution of study population according to age among government and private school children

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Table 3: Distribution of study population according to frequency of cleaning teeth among government and private school children

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Table 4: Distribution of study population according to drinking water source among government and private school children

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Table 5: Distribution of study population according to the prevalence of dental fluorosis among government and private school children

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  Discussion Top


Healthy teeth and the need for oral health care are important for any section of society. Oral disorders can have a profound impact on the quality of life. Good oral health has real health gains, in that it can improve general health and quality of life and contribute to self-image and social interaction.[12] Epidemiologic studies may be of value in assessing the prevalence of diseases, in disclosing trends in disease development, and in analyzing possible factors influencing the disease pattern.[12] Dental fluorosis is a hypomineralization of tooth enamel or dentin produced by the chronic ingestion of excessive amounts of fluoride during the period of tooth development.[13] In the present study, the prevalence of dental fluorosis was found higher among government school children, that is, 54.5% when compared to private school children, that is, 45.5% respectively, and this difference was found to be statistically significant (P ≤ 0.05). Similar results have been found in the previous studies that proved a direct association between the degree of dental fluorosis and amount of fluoride in drinking water.[2],[3],[4],[5],[14],[15]

In the present study among the total 1400 (100%) study subjects, 745 (53.2%) were boys and 655 (46.8%) were girls. Among both government and private schools maximum school children were boys, that is, 360 (51.4%) and 385 (55%), respectively. It has been found that maximum number of school children, that is, 387 (27.6%) were from the age group of 15 years which is in accordance with the study conducted by Pontigo-Loyola et al.[14] in which a maximum number of school children belonged to the age group of 15 years, that is, 850 (55.3%).

In the present study, a maximum number of children, that is, 1176 (84%) brushed once in a day whereas, a minimum number of children, that is, 112 (8%) brushed twice daily and similar number, that is, 112 (8%) did not clean their teeth at all. It was also observed that maximum number of school children, that is, 644 (46%) consumed water through public water supply, followed by 581 (41.5%) who consumed water from bore well and 175 (12.5%) of school children used pump as a source of water supply which is in contrast to the study conducted by Bårdsen et al.[16] in which maximum number of school children, that is, 113 (51.8%) consumed ground water and a minimum number of children, that is, 105 (48.2%) consumed surface water.

In the present study, it was found that a maximum number of school children, that is, 861 (61.5%) were without dental fluorosis. Among school children with dental fluorosis, mild form of dental fluorosis was most common which was among 189 (13.5%) school children and questionable form of dental fluorosis was least common found only among 35 (2.5%) of school children. In the study conducted by Mann et al.[15] prevalence of dental fluorosis was found in 100% of the study population with 53 subjects demonstrating mild dental fluorosis, 83 demonstrating moderate dental fluorosis, and severe dental fluorosis diagnosed in 46 subjects.


  Conclusion Top


The results of the study showed the increased prevalence of dental fluorosis among government school children as compared to private school children. Dental fluorosis was found to be the major public health problem among both the government and private school children of Bharatpur city which need immediate attention. Regular dental check-ups and practice of routine oral hygiene procedures will enable them to lead a healthier life. Increased exposure to dental health education through dental professionals will help them to improve their knowledge on oral health care.

Limitations and recommendations

Although the present study had comprehensively assessed the prevalence of dental fluorosis among government and private school children of Bharatpur city, there is the need for the further epidemiological study with wider geographical base and greater number of study subjects. It is indeed high time that adequate health education measures, as well as other preventive measures, are taken to inform the school children about the prevention of common oral diseases. By providing suitable education materials and by engaging them in health promotion activities, dental public health professionals can interact with children in a mutually beneficial manner. Moreover, there is a need for inclusion of oral health promotion in the curriculum of the school children.

Acknowledgment

This study was conducted independently and not sponsored by a research grant from any outside body. The author would like to thank all participants for their valuable help and enthusiasm.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Meyer-Lueckel H, Paris S, Shirkhani B, Hopfenmuller W, Kielbassa AM. Caries and fluorosis in 6- and 9-year-old children residing in three communities in Iran. Community Dent Oral Epidemiol 2006;34:63-70.  Back to cited text no. 1
    
2.
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;32:337-44.  Back to cited text no. 2
    
3.
Jiménez-Farfán MD, Hernández-Guerrero JC, Juárez-López LA, Jacinto-Alemán LF, de la Fuente-Hernández J. Fluoride consumption and its impact on oral health. Int J Environ Res Public Health 2011;8:148-60.  Back to cited text no. 3
    
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Shekar C, Cheluvaiah MB, Namile D. Prevalence of dental caries and dental fluorosis among 12 and 15 years old school children in relation to fluoride concentration in drinking water in an endemic fluoride belt of Andhra Pradesh. Indian J Public Health 2012;56:122-8.  Back to cited text no. 4
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Baskaradoss JK, Clement RB, Narayanan A. Prevalence of dental fluorosis and associated risk factors in 11-15 year old school children of Kanyakumari District, Tamilnadu, India: A cross sectional survey. Indian J Dent Res 2008;19:297-303.  Back to cited text no. 5
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Bronckers AL, Lyaruu DM, DenBesten PK. The impact of fluoride on ameloblasts and the mechanisms of enamel fluorosis. J Dent Res 2009;88:877-93.  Back to cited text no. 6
    
7.
Fluorosis State Institute of Health and Family Welfare, Jaipur. Available from: http://www.sihfwrajasthan.com/ppts/full/Fluorosis.pdf. [Last accessed on 2013 Sep 15].  Back to cited text no. 7
    
8.
Districts Endemic for Fluorosis. Available from: http://www.fluorideandfluorosis.com/fluorosis/districts.html. [Last accessed on 2013 Sep 15].  Back to cited text no. 8
    
9.
Initial Environmental Examination: Bharatpur Water Supply. Available from: http://www.ruidp.rajasthan.gov.in/Water%20 Supply%20Sub-project,%20Bharatpur%20pdf. [Last accessed on 2013 Sep 15].  Back to cited text no. 9
    
10.
Basic Shiksha Adhikaari. Department of Education, Kila Road, Bharatpur, Rajasthan.  Back to cited text no. 10
    
11.
WHO. Oral Health Surveys: Basic Methods. 4th ed. Geneva: WHO; 1997.  Back to cited text no. 11
    
12.
Olsson B. Dental caries and fluorosis in Arussi province, Ethiopia. Community Dent Oral Epidemiol 1978;6:338-43.  Back to cited text no. 12
    
13.
Almerich-Silla JM, Montiel-Company JM, Ruiz-Miravet A. Caries and dental fluorosis in a western Saharan population of refugee children. Eur J Oral Sci 2008;116:512-7.  Back to cited text no. 13
    
14.
Pontigo-Loyola AP, Medina-Solis CE, Borges-Yañez SA, Patiño-Marín N, Islas-Márquez A, Maupome G. Prevalence and severity of dental caries in adolescents aged 12 and 15 living in communities with various fluoride concentrations. J Public Health Dent 2007;67:8-13.  Back to cited text no. 14
    
15.
Mann J, Tibi M, Sgan-Cohen HD. Fluorosis and caries prevalence in a community drinking above-optimal fluoridated water. Community Dent Oral Epidemiol 1987;15:293-5.  Back to cited text no. 15
    
16.
Bårdsen A, Klock KS, Bjorvatn K. Dental fluorosis among persons exposed to high- and low-fluoride drinking water in western Norway. Community Dent Oral Epidemiol 1999;27:259-67.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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