|Year : 2022 | Volume
| Issue : 3 | Page : 277-280
Prevalence of dental fluorosis among 12-15-Year-Old schoolchildren in Cheyyur Taluk, Chengalpattu District: A cross-sectional survey
Rajeswary Kumar1, K V Vijay Kumar2, S Veena Dharani3, S Kalaivani1, Vidya Sekhar4
1 Department of Public Health Dentistry, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India
2 Department of Public Health Dentistry, Mallareddy Dental College for Women and Hospital, Hyderabad, Telangana, India
3 Public Health Dentist, Private Practitioner, Perfect 32 Family Dental Solutions, Chennai, Tamil Nadu, India
4 Department of Periodontology and Implantology, I. T. S. Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
|Date of Submission||09-Aug-2021|
|Date of Decision||26-May-2022|
|Date of Acceptance||16-Jun-2022|
|Date of Web Publication||12-Sep-2022|
Department of Public Health Dentistry, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Endemic fluorosis resulting from high fluoride concentration in groundwater is a public health problem in India. The available data suggest that 15 states in India are endemic to fluorosis (fluoride level in drinking water >1.5 mg/l) which includes Tamil Nadu. In Tamil Nadu, almost 19 districts have been reported to be affected by dental fluorosis. Aim and Objectives: This study aimed to assess the prevalence of dental fluorosis among school children in Cheyyur taluk between the age groups of 12 and 15 years. Methods: A cross-sectional survey was conducted among schoolchildren in the age group of 12–15 years. After obtaining ethical clearance and permission from the randomly chosen eight government schools of Cheyyur taluk, demographic data and American Dental Association Type III clinical examination was conducted. The dental fluorosis status of the children was assessed using the Modified Dean's Fluorosis Index (1942) and the data were analyzed using the SPSS software version 16. In descriptive statistics, a Chi-square test was carried out to find the association among dental fluorosis and demographic characteristics such as age and gender and P < 0.05 was considered statistically significant. Results: The study sample comprised of 1089 children of which, 491 (45.1%) were boys and 598 (54.9%) were girls. Overall dental fluorosis prevalence was found to be 28.6%. Conclusion: Mild and very mild form of dental fluorosis was the most common form prevalent among the population, whereas the severe form of dental fluorosis was not found. Statistically significant difference exists between different age groups and no difference exists among gender.
Keywords: Dental fluorosis, enamel defects, fluoride, schoolchildren
|How to cite this article:|
Kumar R, Kumar K V, Dharani S V, Kalaivani S, Sekhar V. Prevalence of dental fluorosis among 12-15-Year-Old schoolchildren in Cheyyur Taluk, Chengalpattu District: A cross-sectional survey. J Indian Assoc Public Health Dent 2022;20:277-80
|How to cite this URL:|
Kumar R, Kumar K V, Dharani S V, Kalaivani S, Sekhar V. Prevalence of dental fluorosis among 12-15-Year-Old schoolchildren in Cheyyur Taluk, Chengalpattu District: A cross-sectional survey. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2022 Sep 28];20:277-80. Available from: https://www.jiaphd.org/text.asp?2022/20/3/277/355886
| Introduction|| |
Fluoride is the 13th most abundant ion present in the earth's crust. Since it is highly electronegative and has a tendency to combine with other soil substances, it is found mostly in combined forms in the earth's crust such as fluorspar (fluorite), cryolite, and apatite.
The Oral Health Report (2003) by World Health Organization stated that fluoride is the most effective agent in dental caries prevention and there is much strong literature evidence to show that the decline in dental caries status in developing countries in the recent times is due to the usage of fluoride in various forms.
However, fluoride is a double-edged sword; if it is taken at optimal levels (0.7–1.2 ppm), it will prevent caries. If it exceeds the optimal limit, it shows disruption of the calcified tissues of the body. Moderate levels of fluoride (1.50–4.60 ppm) in drinking water lead to dental fluorosis, whereas high levels disturb the mineralization of bones, leading to skeletal fluorosis.,,
Dental fluorosis is defined as a sort of enamel hypocalcification that occurs as a result of fluoride over-absorption during tooth calcification and maturation. Its clinical features vary from a thin white line on the enamel to chalky, opaque areas or disfiguring brownish stains. Major factors contributing to these varying prevalence rates are regional temperature, altitude, and nutritional and hygienic trends. The Bureau of Indian Standards has laid down a maximum permissible limit of 1.0 mg/l fluoride in drinking water, with further remarks as “lesser the better.”
About 62 million people in India are at risk of developing fluorosis from drinking high fluoride groundwater (Susheela AK, et al., 1999.). According to National Oral Health Survey and fluoride mapping (2002–2003) reports that 15 States in India are endemic to fluorosis (fluoride level in drinking water >1.5 mg/l) which includes Tamil Nadu.
In Tamil Nadu, dental fluorosis is prevalent in almost 19 districts including Dharmapuri (36%), Krishnagiri (24%) and Salem (33%) with a mean fluoride level of 2.7ppm, 2.2ppm, and 1.2 ppm, respectively in the districts have been reported. In the previous studies done at various blocks of the Kanchipuram district (now districts are separated into Chengalpet and Kanchipuram), fluoride levels in the water samples were within the normal limit and the district was also under the nonendemic zone for dental fluorosis., However, many people residing in the various villages of Chengalpattu district have reported with different grades of dental fluorosis to the outpatient unit and outreach programs of a private dental institution in the district. However, there is sparse literature about the prevalence of dental fluorosis in the Chengalpattu district. Hence, our study aims to assess the prevalence of dental fluorosis among 12–15-year-old school-going children in Chengalpattu district, Tamil Nadu.
| Materials and Methods|| |
A cross-sectional survey was conducted among 12–15-year-old school-going children in Cheyyur taluk, Chengalpattu district (Kanchipuram district then till 2019) from June 2016 to August 2016. The list of schools in Cheyyur taluk was obtained from the educational website of Tamil Nadu and eight government schools were randomly selected from the list to conduct the survey.
Ethical clearance was obtained with a reference number 2015-UG-BrVII-RAJ-02\APDCH from the institutional review board of Adhiparasakthi Dental College and Hospital, Melmaruvathur. Permission was obtained from the school headmasters, and written informed consent was obtained from the parents for performing oral health examinations among the schoolchildren.
From the selected schools, 12–15-year-old children who were present on the day of examination and who gave consent from their parents to participate were included in the study. Demographic data were recorded, and a clinical examination was performed to assess the dental fluorosis status among the students using a mouth mirror and explorer under the natural light source (Type III clinical examination of American Dental Association). Dental fluorosis status was graded by the Modified Dean's Fluorosis Index (1942) which categorized the tooth into six grades ranging from normal, questionable, a very mild, mild, moderate, and severe form of fluorosis based on the color, translucency, and surface area of the tooth affected.
The sample size for the present study was estimated based on the prevalence of dental fluorosis (19.2%) in the previous study conducted by Punita et al. in Kanchipuram district. The sample size was calculated using the following formula N = 4pq/d2
N = sample size
p = 19.2%
q = 1 − P = 80.8%
d = 12.5% allowable error of the prevalence
n = (4 × 19.2 × 80.8)/2.4 × 2.4 = 1077
The estimated sample size was 1077. The collected data were entered in Microsoft Excel and statistical analysis was done using the software Statistical Package for the Social Sciences SPSS Inc. SPSS for windows, version 16.0, (Chicago, Illinois, USA). The data were analyzed for the descriptive statistics and a Chi-square test was carried out to find the association among dental fluorosis and demographic characteristics such as age and gender and P < 0.05 is considered statistically significant.
| Results|| |
A total of 1089 children in the selected eight schools of Cheyyur taluk were examined for dental fluorosis status. Based on age, there were 217 children (19.9%) in the 12-year-old age group, 282 children (25.9%) in the 13-year-old age group, 364 children (33.5%) in the 14-year-old age group, and 136 children (60.2%) in 15-year-old age group. Based on gender, there were 491 (45.1%) were boys and 598 (54.9%) were girls. [Graph 1] shows the distribution of study participants based on gender and age.
In the 1089 schoolchildren, the prevalence of dental fluorosis was present among 312 (28.6%) students and 777 (71.4%) of them were not affected by dental fluorosis [Graph 2].
When considering the severity of dental fluorosis, only 6 (0.6%) and 56 (5.1%) of the children were affected with the severe and moderate types of fluorosis, respectively, whereas 167 (15.3%) of the children were affected by the mild form of fluorosis and 83 (7.6%) were affected by a very mild form of fluorosis. There was a statistically significant difference in the severity of dental fluorosis among different age groups [Table 1].
|Table 1: Severity of dental fluorosis among the study population based on age and gender|
Click here to view
| Discussion|| |
Dental fluorosis which occurs as a result of excess fluoride ingestion during tooth development, particularly in ages between 2 and 8 years affects the permanent teeth of the child. Prolonged ingestion of fluoride through drinking water above the daily requirement is also associated with skeletal fluorosis.
In this study, the prevalence of dental fluorosis was found to be 28.6% among schoolchildren in Cheyyur district, Chengalpattu. This is similar to that reported in the National Oral Health Survey and fluoride mapping-Tamil Nadu conducted in 2003 (25% fluorosis prevalence in rural areas). In the study conducted by Punitha, et al. in 2014 and Prabu and Saravanan in 2013 reported a fluorosis prevalence of 19.2% and 59.6% in the Kanchipuram district, respectively. In the Kanchipuram district, the prevalence was found to be similar in most of the regions. In the study conducted by Saravanan et al. in Cuddalore, Tamil Nadu, nearly one-third of children had experienced dental fluorosis of 31.4% among 11–16 years schoolchildren,
whereas in the study conducted by Maya Ramesh at Salem, Tamil Nadu found a prevalence of 63.1% and in the Andhra Pradesh study conducted by Sukhabhogi JR et al.(2014), the overall prevalence of fluorosis was found to be 76.8% and in a study by Verma et al. in Karnataka, the overall prevalence of fluorosis was found to be 64.3%, whereas a low dental fluorosis prevalence of 16.8% was recorded in the rural schools of Kerala. India shows a varied prevalence of fluorosis status in different geographical locations.
In the present study, 5.1% and 0.6% of the children were affected by a moderate and severe form of fluorosis which was similar to the study conducted by Punitha, et al. and Prabu and Saravanan in 2013.,, This shows that a severe form of fluorosis is not found in the Kanchipuram district in while in a study done by RekhaRaghavan et al. in rural areas of Malappuram district, Kerala it was found that 7.8% of the children were affected by the moderate form of fluorosis this when compared with our present study the prevalence was found to be higher due to excess amounts of fluoride in the water. The main limitation of the study would be the groundwater and source of drinking water samples were not collected for fluoride analysis. This would be the main drawback of the study. However, the groundwater fluoride analysis conducted by Dar et al. in 2011 found that the fluoride range was about 1–3.24 mg/l in the region, and in the study conducted by Pradeep Kumar et al. in 2014 found a fluoride level was 0.05–1.04 mg/L in the Kanchipuram district.
| Conclusion|| |
The present study revealed a dental fluorosis prevalence of 28.6% among the schoolchildren in Cheyyur taluk, in which mild and very mild form was the most common. Further studies can be carried out to obtain a detailed picture of fluorosis-affected regions of Chengalpattu district and analyze the impact on the individual quality of life and self-perception of the problem.
The authors gratefully acknowledge the school authorities who have given permission to conduct the survey, the parents and the schoolchildren who had cooperated for the study and the interns who have helped in data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Fluorides and Oral Health. WHO Technical Report Series No. 846. Geneva: World Health Organization, 1994.
World Health Organization. Continuous Improvement of Oral Health in the 21st
Century – The Approach of the WHO Global Oral Health Programme. World Health Organization; 2003.
Kotecha PV, Patel SV, Bhalani KD, Shah D, Shah VS, Mehta KG. Prevalence of dental fluorosis & dental caries in association with high levels of drinking water fluoride content in a district of Gujarat, India. Indian J Med Res 2012;135:873-7.
] [Full text]
Firempong CK, Nsiah K, Vitor DA, Dongsogo J. Soluble fluoride levels in drinking water – A major risk factor of dental fluorosis among children in Bongo community of Ghana. Ghana Med J 2013;47:16-23.
Aminabadi N, Gangi AT, Balayi E, Sadighi M. Prevalence of fluorosis in 5-12-year-old children in the north-western villages of Makoo in 2004. JODDD 2007;1:33-41.
Raghavan R, Bipin N, Abraham A. Prevalence of dental fluorosis and fluoride content of drinking water in rural areas of Malappuram district, Kerala. Int J Med Sci Public Health 2014;3:27-30.
Susheela AK. Fluorosis management programme in India. Curr Sci 1999;77:1250-6.
National Oral Health Survey and Fluoride Mapping – Tamil Nadu. New Delhi: Dental Council of India; 2004.
Harikumar R, Khandare AL, Brahmam GNV, Venkiah K, Reddy G, Sivakumar B. Assessment of Current Status of Fluorosis in North-Western Districts of Tamil Nadu Using Community Index for Dental Fluorosis. J Hum Ecol 2007;21:27-32.
Balakrishnan M, Arul Antony S, Gunasekaran S, Natarajan RK. Impact of dyeing industrial effluents on the groundwater quality in Kancheepuram (India). Indian J Sci Technol 2008;1:1-8.
Punitha VC, Sivaprakasam P, Elango R, Balasubramanian R. Prevalence of dental fluorosis in a non-endemic district of Tamil Nadu, India. Biosci Biotechnol Res ASIA 2014;11:159-63.
Ramesh M, Malathi N, Ramesh K, Aruna RM, Kuruvilla S. Comparative evaluation of dental and skeletal fluorosis in an endemic fluorosed District, Salem, Tamil Nadu. J Pharm Bioallied Sci 2017;9:S88-91.
Sukhabogi JR, Parthasarathi P, Anjum S, Shekar B, Padma CM, Rani AS. Dental fluorosis and dental caries prevalence among 12 and 15-year-old schoolchildren in Nalgonda District, Andhra Pradesh, India. Ann Med Health Sci Res 2014;4:245-52.
] [Full text]
Verma A, Shetty BK, Guddattu V, Chourasia MK, Pundir P. High prevalence of dental fluorosis among adolescents is a growing concern: A school based cross-sectional study from Southern India. Environ Health Prev Med 2017;22:17.
Gopalakrishnan P, Vasan RS, Sarma PS, Nair KS, Thankappan KR. Prevalence of dental fluorosis and associated risk factors in Alappuzha district, Kerala. Natl Med J India 1999;12:99-103.
Saravanan S, Kalyani C, Vijayarani M, Jayakodi P, Felix A, Nagarajan S, et al
. Prevalence of dental fluorosis among primary school children in rural areas of Chidambaram Taluk, Cuddalore district, Tamil Nadu, India. Indian J Community Med 2008;33:146-50.
] [Full text]
Prabu JJ, Saravanan S. Impact of dental caries and dental fluorosis on the quality of life on 12-year-old children in Tamil Nadu, India. Chettinad Health City Med J 2013;2:74-9.
Dar MA, Sankar K, Dar IA. Fluorine contamination in groundwater: A major challenge. Environ Monit Assess 2011;173:955-68.
Pradeep Kumar R, Saiprakash DK. Assessment of fluoride concentration in groundwater in Kanchipuram, Tamil Nadu, India. IOSR J Environ Sci Toxicol Food Technol 2014;8:45-6.