|Year : 2017 | Volume
| Issue : 2 | Page : 140-144
Dental fluorosis and oral health status of 13–15-Year-Old school children of Chikkaballapur District: A cross-sectional study
Punith Shetty1, A Shamala1, R Murali1, Y Mansi1, Roomani Srivastava2, Arpan Debnath3
1 Department of Public Health Dentistry, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
2 Department of Screening, Indian Cancer Society, Mumbai, Maharashtra, India
3 Department of Public Health Dentistry, KLE Institute of Dental Sciences, Bengaluru, Karnataka, India
|Date of Web Publication||13-Jun-2017|
Department of Public Health Dentistry, Krishnadevaraya College of Dental Sciences and Hospital, International Airport Road, Hunasamaranahalli, Bengaluru - 562 157, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: The high prevalence, severity, and the crippling nature of oral diseases lead to significant absenteeism in schools and economic loss in the working population. Dental fluorosis is endemic in 15 states of India and Chikkaballapur district is one among them. Aim: To assess dental fluorosis and oral health status and in Chikkaballapur district among 13–15 years school going children. Materials and Methods: A cross-sectional study was conducted among 2400 school going children of 13–15-year-old in Chikkaballapur district. The data regarding the dental fluorosis were collected using the Thylstrup and Fejerskov index. The clinical examination for the oral health status was determined using the WHO Oral Assessment Form 1997. Proportions were compared using Chi-square test, and one-way analysis of variance was used to test the differences. Results: It was seen that the mean decayed, missing, and filled teeth was highest among the 13-year-old at 1.39. Bleeding on probing and calculus was highest among 15-year-old with 83.5% and 84.6%, respectively. The prevalence of dental fluorosis in Chikkaballapur district was found to be 41.1%. Conclusion: The oral health status of the individuals was poor, and the prevalence of fluorosis was high. There is a need to create awareness regarding oral health and fluorosis.
Keywords: Dental caries, fluorosis dental, oral health, prevalence
|How to cite this article:|
Shetty P, Shamala A, Murali R, Mansi Y, Srivastava R, Debnath A. Dental fluorosis and oral health status of 13–15-Year-Old school children of Chikkaballapur District: A cross-sectional study. J Indian Assoc Public Health Dent 2017;15:140-4
|How to cite this URL:|
Shetty P, Shamala A, Murali R, Mansi Y, Srivastava R, Debnath A. Dental fluorosis and oral health status of 13–15-Year-Old school children of Chikkaballapur District: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2020 Nov 28];15:140-4. Available from: https://www.jiaphd.org/text.asp?2017/15/2/140/207920
| Introduction|| |
Oral health is a very important component of general health. More than 50 million school hours are lost by children worldwide due to oral health problems. The high prevalence and severity of oral diseases such as dental caries, periodontal disease, oral cancer, and various stages of malocclusion, and the crippling nature of these diseases lead to significant absenteeism in schools and economic loss in the working population. Dental illness thus contributes to considerable reduction in national production and overall national development.
Chikkaballapur district has not been extensively exposed to dental and oral health services. Most of the schools in this region are government schools. Even though government schools have a provision for general health services; oral health component has often been neglected. Moreover, children in the age group of 13–15 years are more vulnerable to oral health problems as newly erupted permanent teeth are more prone to caries, and hormonal changes of puberty may also affect gingival conditions. Dental fluorosis is an endemic oral disease in Karnataka with Chikkaballapur district being one among them. The groundwater dependence of agrarian states like Karnataka is high, and Chikkaballapur district is no different where the source of drinking water is mainly from groundwater, in which more than the permissible limit of fluoride is present. A fluoride concentration of as much as 2.01 mg/l has been reported from Bagepalli taluk. Thus, the present study aims to determine the prevalence and severity of dental fluorosis and oral health status of 13–15-year-old schoolchildren of Chikkaballapur district.
| Materials and Methods|| |
A cross-sectional study was conducted in Chikkaballapur district, an endemic area of Dental Fluorosis12 between, June 2014 and February 2015. The study population consisted of 13–15-year-old government school going children of the various villages of the district. Ethical clearance was obtained from the Institutional Review Board of the institute. The required official permission to examine and to collect the relevant data from selected children was obtained from the District Directorate of Public Instructions, Chikkaballapur district. Informed consent was obtained from each subject and their parents for clinical examination after explaining the nature of the study.
The estimated sample size was 2400 which was obtained by assuming the prevalence of dental caries as 80% as estimated by the previous studies. The variance was estimated to be 2%, and alpha was kept as 0.05, and power of the study was 95%.
 where, N = sample size; Z = 1.96 when is assumed to be 0.05.; ε = 0.02, variance estimated to be 2%.; P = 80%, prevalence of dental caries.
Multistage sampling was used to derive the sample. All the six taluks of Chikkaballapur district was included in this study. Three villages from each taluk were randomly selected. In each village, the government school was selected for the study. The schools in these villages were randomly selected, and stratified random sampling was used thereafter to select the study participants within the selected schools. An average of 134 children was selected from each school. Thus, a total of children subjects from each taluk were obtained, and the sample size of 2400 was achieved [Figure 1]. The study subject who was native of that area since birth and children present on the day of examination were included in this study. Study subjects with mixed dentition and differently abled children were excluded from the study.
The principal examiner was trained and calibrated, to ensure uniform interpretation by the examiner for the various diseases and conditions to be observed and recorded (Kappa = 0.89). The data for oral health status was collected using the WHO Oral Health Assessment form 1997, and the fluorosis was assessed using Thylstrup and Fejerskov (TF) Index.
Proportions were compared using Chi-square test of significance, and one-way analysis of variance was used to test the differences. In all the above test, P< 0.05 was accepted as statistically significant. Data analysis was carried out using Statistical Package for Social Science (SPSS version 10.5).
| Results|| |
Age and gender distribution of the sample is displayed in [Figure 2]. With 80.9% of the sample being males and 19.1% was females. Evaluation of extra oral findings revealed that on 0.7% of the sample showed signs of temporomandibular joint (TMJ) problems. No oral mucosal lesions were seen in the sample, and 1% of the sample had nonfluorotic enamel hypoplasia. Periodontal problems were highly prevalent in the sample where 80.8% of the individuals had bleeding on probing, and 81.5% of the individual had calculus. The differences in the proportion of individuals having bleeding on probing and calculus in each age group were found to be statistically significant (P < 0.05) [Table 1].
Decayed, missing, and filled teeth (DMFT) among 13-year-old were higher at 1.39 when compared to the other age groups. The total mean DMFT was 1.03 which was found to be clinically significant among the three age groups (P < 0.05) [Table 2].
|Table 2: Decayed, missing, and filled teeth scores of the study subjects|
Click here to view
Malocclusion was assessed using the dental esthetic index (DAI). The percentage of participants with no malocclusion in the present study was 38.9 (DAI Score <25). The prevalence of malocclusion was 61.1% in the total sample [Table 3].
It was seen that among 2400 study subjects, 41.1. % had fluorosis. With the highest percentage of fluorosis seen among 15-year-old with 43.6% followed by 13- and 14-year-old, this is 40.8% and 39.1%, respectively. It was seen that the percentage of fluorosis among males was higher at 42% when compared to females it was 37.6% [Figure 3].
Among the total 41.1%, dental fluorosis 97.6% had TF score of <5 and only 2.4% individuals had severe fluorosis (TF score ≥5). Nearly 4.5% of 13-year-old children had severe fluorosis which was followed by 15- and 14-year-old individuals at 2.4 and 2.1, respectively. 97.9% of 14-year-old had fluorosis followed by 15- and 13-year old individuals which at 97.6% and 95.5%, respectively [Figure 4].
Frequency distribution graph of all taluks was plotted to estimate the cumulative frequency of individuals belonging to each score bracket of the TF index. Among the total study sample, i.e., 400, 76.8% of individuals had the score of 0, i.e., no fluorosis. In Gauribidanur taluk, the TF scores ranged between 0 and 6 with 64.5% of individuals had the score of 0. In Gudibande taluk, the TF scores ranged between 0 and 8, and 40.5% of individuals had the score of 0. In Bagepalli taluk, the TF scores ranged between 0 and 6, with 59% of individuals having the score of 0. In Sidlaghatta taluk, the TF scores ranged between 0 and 7and in Chintamani taluk the TF scores ranged between 0 and 4 [Figure 5].
|Figure 5: Taluk wise frequency distribution of Thylstrup and Fejerskov index scores|
Click here to view
| Discussion|| |
Dental fluorosis is recognized as an oral health disease of public health importance by the WHO. Dental fluorosis results in poor esthetic appearance which may have a psychological bearing and lead to low confidence. In today's competitive world, these factors have gained much importance.
Mean DMFT in the present study of all the three age groups combined was 1.03 this was in accordance with the study conducted by Arun Kumar et al. and Mittal et al. The mean DMFT was higher in the study conducted by Mahesh Kumar et al. and a study by Saravanan et al. when compared to the present study. In the current study, the DMFT score of 13, 14, and 15 years old was 1.39, 0.95 and 1.07, respectively, this was higher than the study conducted by Bruce et al. in 2002.
In the present study, the mean DMFT was 1.06 among males and 0.87 among females, which was in accordance with the study conducted by Mittal et al. The mean DMFT of males and females in the present study was lower than that seen in a study by Saravanan et al. and higher than that reported in a study conducted by Nanak Chand and Abhishek  The DMFT score among females in the present study was higher than the study conducted by Nitin and Vibha. The caries prevalence in the present study was 46.3%. This was in accordance with the study conducted by Mittal et al. However, higher caries prevalence was reported in a study conducted by Chaturdevi et al. and by Jose and Joseph. Chikkaballapur is a fluoride belt, and the caries prevalence is low due to the protective effect of fluoride present in the water.
In the present study, the mean DMFT in females was 0.87 whereas that in males, it was 1.06. However, a number of females were much fewer than males in this study, thus mean DMFT can be considered to be proportionately higher in females.
In the present study, bleeding on probing was seen in 80.8% of the participants, and calculus was seen in 81.5% of the participants: 82.7% and 72.9% of the males and females had BOP, respectively and 83.5% and 72.9% of males and females had calculus, respectively. This was in accordance with the study reported by Mittal et al. A study by Mahesh Kumar et al. reported that 51.3% participants had BOP positive (males 51.7% and females 50.8%) and 57.5% had calculus present (males 40.6% and females 33.9%), which was lower than the present study. Studies by Jose and Joseph  (15% had BOP of which 44% were males, and 56% were females) Arun Kumar et al. (BOP and 18.75% had calculus) and Bruce et al. (67% of the participants had calculus, and 26.8% had BOP) were not in accordance with the present study. The reason for poor oral hygiene seen in the present study could be because Chikkaballapur is a rural area with lack of good preventive and curative services. These villages had no exposure to basic dental screening until this study was conducted.
In the present study, the prevalence of malocclusion was 61.1%. Participants with DAI score ≤25 was 38.9% score of 26–30 was 18.2%. Those with severe malocclusion (DAI Score 31–35) comprised 15.8% of the sample and handicapping malocclusion (DAI Score ≥36) was seen in 27.1% of the sample. This study was in accordance with the study conducted by Tak et al. and Shenoy et al.
Nonfluorotic enamel hypoplasia was 0.8% with females having a higher percentage than males, i.e., 0.9 and 0.8, respectively. The prevalence of TMJ signs such as clicking and tenderness was 0.7%, with the highest prevalence seen among 13-year-olds at 1.3%. TMJ symptoms were not reported in the present study. It was seen that the extraoral lesions were more in females than males. The highest prevalence of extra oral lesions was seen in the 13-year-old individuals followed by15- and 14-year-old at 0.6%, 0.3% and 0.5%, respectively. This study was comparable to the study conducted by the DCI (2002) wherein the total enamel hypoplasia in “Region 2” which includes Chikkaballapur was at 1% among 12- and 15-year-old with females having a higher percentage than males at 1.5%. The prevalence of TMJ signs was 1.3% in 15-year-old and absent among the 12-year-old, and TMJ symptoms were completely absent in the sample, and extraoral lesions were seen in 0.7% of individuals in 15-year-old and 0.3% of individuals in 12-year-old.
The prevalence and severity of dental fluorosis were determined in the present study using TF Index among 13–15-year-old government school children. Median TF score of all teeth examined was used to ascertain the prevalence and severity of dental fluorosis in the current sample. The prevalence of fluorosis was 41.1%, with males having higher prevalence of fluorosis than females. The pattern of prevalence seen in the present study was in accordance with the study conducted by Tekle-Haimanot et al. in Ethiopia where the prevalence of fluorosis in males was higher when compared to females. Studies conducted by Mabelya et al. in Tanzania, and Wondwossen et al. in Ethiopia, the prevalence of dental fluorosis was 72% and 91.8%, respectively, which was at higher level when compared to the present study at 41.1%.
The severity of dental Fluorosis in the present study was assessed using the TF index scores where ≥5 is considered severe. The percentage of people having severe fluorosis was 2.4% in the study sample. Severity was higher among females than males at 3.3% and 2.2%, respectively. Baskaradoss et al. reported the prevalence of dental fluorosis among 11–15-year-old at 15.8% and severity at 6.2%. A study conducted by Mittal et al. among 5- and 12-year-old in Gurgaon had reported the prevalence of dental fluorosis at 15.8% and 23.9% of those had severe fluorosis. In addition, the study conducted by Adelário et al., the severity reported was higher at 53.3%. In all the three studies, the severity was higher than the present study this could probably be due to the factors influencing the prevalence of fluorosis such as diet, type, and amount of dentifrice used, amount of water intake, temperature of the region, and consumption of food formulas.
There were certain limitations in the present study. Data on variables such as diet, oral hygiene habits, and socioeconomic status could have been collected and adjusted to ascertain the extent of dental caries and also the prevalence of dental fluorosis. The study sample was not equally distributed for age and gender; therefore, comparisons in some cases may not be justified.
Defluoridation of areas with high fluoride levels must be one of the goals in public health programs. The health-care workers at village level must be educated regarding small-scale methods of defluoridation so that they in turn can conduct it in the village. Dental services in these areas must be improved with the help of village health workers and public–private partnerships to improve the provision of services may be considered as a long-term goal.
| Conclusion|| |
The oral health status was found to be very poor with the high levels of fluorosis in the present population. School teachers should be empowered to take up the mantle of creating awareness among the children.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits. Am J Public Health 1992;82:1663-8.
Jackson SL, Vann WF Jr., Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children's school attendance and performance. Am J Public Health 2011;101:1900-6.
Güncü GN, Tözüm TF, Caglayan F. Effects of endogenous sex hormones on the periodontium – Review of literature. Aust Dent J 2005;50:138-45.
Shruthi N, Anil NS. Prevalence of dental fluorosis in school children of Bangarpet taluk, Kolar district. J Orofac Sci 2013;5:105-8.
Bali R, Mathur V. Talwar P. National Oral Health Survey and Fluoride Mapping 2002-2003. New Delhi: Dental Council of India; 2004.
Fox N, Hunn A, Mathers N. Sampling and Sample Size Calculation. Yorkshire and the Humber: The NIHR RDS for the East Midlands; 2007.
World Health Organization. Oral Health Surveys Basic Methods. 4th
ed. India: A.I.T.B.S. Publishers; 1997.
Thylstrup A, Fejerskov O. Clinical appearance of dental fluorosis in permanent teeth in relation to histologic changes. Community Dent Oral Epidemiol 1978;6:315-28.
World Health Organization. WHO. Bull World Health Organ 2015;93:594-5.
Arun Kumar S, Madan Kumar PD, Sivasamy S, Balan N. Oral health status of 5 and 12-year-old rural school going children with limited access to oral health care – A cross sectional survey. Carib J Scitech 2014;2:336-9.
Mittal M, Chaudhary P, Chopra R, Khattar V. Oral health status of 5 years and 12 years old school going children in rural Gurgaon, India: An epidemiological study. J Indian Soc Pedod Prev Dent 2014;32:3-8.
] [Full text]
Mahesh Kumar P, Joseph T, Varma RB, Jayanthi M. Oral health status of 5 years and 12 years school going children in Chennai city – An epidemiological study. J Indian Soc Pedod Prev Dent 2005;23:17-22.
Saravanan S, Kalyani V, Vijayarani MP, Jayakodi P, Felix J, Arunmozhi P, et al.
Caries prevalence and treatment needs of rural school children in Chidambaram Taluk, Tamil Nadu, South India. Indian J Dent Res 2008;19:186-90.
] [Full text]
Bruce I, Addo ME, Ndanu T. Oral health status of peri-urban schoolchildren in Accra, Ghana. Int Dent J 2002;52:278-82.
Nanak Chand R, Abhishek M. Dentition status and treatment needs of 12-year-old rural school children of Panchkula district, Haryana, India. J Indian Dent Assoc 2010;4:303-5.
Nitin J, Vibha J. Assessment of oral health status of school going adolescent girls in Jodhpur City, Rajasthan. J Med Dent Sci 2015;2:16-8.
Chaturdevi TP, Rajat S, Rajul V, Ankitha S, Mishra CP. Prevalence of caries and treatment needs among school children in urban and suburban areas of Varanasi District, U.P. Indian J Prev Soc Med 2012;43:31-4.
Jose A, Joseph MR. Prevalence of dental health problems among school going children in rural Kerala. J Indian Soc Pedod Prev Dent 2003;21:147-51.
] [Full text]
Tak M, Nagarajappa R, Sharda AJ, Asawa K, Tak A, Jalihal S, et al.
Prevalence of malocclusion and orthodontic treatment needs among 12-15 years old school children of Udaipur, India. Eur J Dent 2013;7 Suppl 1:S45-53.
Shenoy RP, Panchamal GS, Shenai KP, Kotian MS, Abdul Salam TA. Malocclusion and orthodontic treatment needs among high school students in Mangalore city. J Med Res 2014;2014:1-6.
Tekle-Haimanot R, Fekadu A, Bushera B, Mekonnen Y. Fluoride Levels in Water and Endemic Fluorosis in Ethiopian Rift Valley. 1st
International Workshop on Fluorosis Prevention and Defluoridation of Water; 2000.
Mabelya L, van't Hof MA, van Palenstein Helderman WH, Knig KG. Suitability of the TF-dental Fluorosis Index for Detection of Fluoride Sources. 1st
International Workshop on Fluorosis Prevention and Defluoridation of Water; 1995.
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.
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.
] [Full text]
Adelário AK, Vilas-Novas LF, Castilho LS, Vargas AM, Ferreira EF, Abreu MH. Accuracy of the simplified Thylstrup & Fejerskov index in rural communities with endemic fluorosis. Int J Environ Res Public Health 2010;7:927-37.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3]