Environmental Impact on Human Health and Sustainable Development : A Comprehensive Study on Drinking Water Quality and Severity of Dental Caries in School Children in South Kalimantan Province, Indonesia

Abstract

Sunstainable development principles suggest that health effects are associated with the result of complex issues affecting air, soil and water. In some areas in Indonesia, such as South Kalimantan province, water quality has been a problem due to both natural environmental hazards and anthropogenic activities. One of the water borne diseases which results as a sign of permanent damage to health is dental decay. Teeth also can provide an excellent record of nutritional status and environmental exposure.The Indonesian Basic Health Research Survey (2008) showed that the prevalence of dental decay was extremely high (83. 6 %). In addition, only 40 % of the people have access to a good quality source of drinking water and much of the drinking water quality was poor (58. 6 %). Tooth decay is a multi-factorial disease, related to socio-behavioural risk: unhealthy diet, poor oral hygiene, individual susceptibility; hereditary factors, and environmental risk factors. The aims of this research are to study the association between drinking water quality and the severity of dental caries in school children as well as investigate the associated environmental risk factors from the perspective of sustainable development principles. In this dissertation, quantitative & Qualitative methods are employed in a cross sectional study, with oral health examinations of 600 school children in 2 age group, 6 and 12 years old, of 300 children each.Study location covered 20 villages, 3 districts, in South Kalimantan Province, Indonesia. Interviewers investigated social risk factors. Drinking water samples were collected from 20 villages and tested through the laboratory analyses. To strengthen the evidence of the environmental exposure, a dental analysis using Laser Ablation Inductively Couple Plasma Mass Spectrometry (LA-ICP-MS) examined trace elements in selected 30 exfoliated deciduous teeth from the sample of 600 children. The study shows the prevalence of tooth decay is 99,7%; on average there are 11 decayed, exfoliated or filled deciduous teeth per person. This finding exceeding the target of oral global health set by WHO is of 50%, and no more than 7 tooth decay. Laboratory findings showed that 30 % of drinking water is outside the normal pH range of 6.5-8.5. Then, 95 % of fluoride concentration is below the optimum level (0.7 ppm) to prevent dental caries. In certain areas, manganese concentration exceeds the safety level of 0.4 ppm. Bivariate analysis showed significant correlations (p<0.05); the more acidic water, the lower the fluoride, the higher the dental caries. Manganese is positively associated with dental caries in deciduous teeth. The potential resource of manganese in this study found is the study site close to mining area. Turbidity and colour shows significant association with permanent teeth decay. Multivariate analysis shows covariate factors positively associated with tooth decay are oral hygiene index and consumption of sweet food, and inversely associated with consumption of milk and fruit. The result of mass Spectrometry through LA-ICP-MS shows that an individual has a unique pattern resulting from different concentration of trace elements in the tooth. Bivariate analysis showed significant (p<0.05) but moderate correlations between the dental caries index and concentrations of tin, mercury and uranium in dentine and inversely with copper in enamel. Concentration of fluoride in water is inversely correlated with selenium, tin, cerium, and lead in enamel, selenium and lanthanum in dentine and positively associated with, samarium, erbium in dentine. Water pH is positively correlated with arsenic and uranium in enamel and with samarium in dentine, and inversely with selenium in enamel and dentine. Socio-behavioural patterns vary among the school children in different villages. The findings support views of people that they have tooth decay due to poor quality water and that many teenagers failed the health examination of Army School entry test, in large part due to teeth decay. Hence, tooth decay also reflects poor environmental conditions and has consequences for future socio-political life, education and employment. A potential approach using local wisdom and applying religious approach in innovative methods in oral health promotion was also identified. Identification of trace elements in the teeth of schoolchildren was undertaken in order to associate levels with caries experience and the quality of local drinking water in communities with distinctive environmental conditions. Tooth decay in school children is highly prevalent and related to poor drinking water quality in certain areas. This needs to be taken into account as a potential indicator of general environmental problems. Interventions are not only treatment of cases and minimizing human exposures but also integrated action from sectors that generate environmental health threats. Environmental risk factors need to be taken into account as the subject of oral health promotion in preventing the high incidence of dental caries in school children.