Abstract
BackgroundDental fluorosis can be a disease of social inequity in access to safe drinking water. This dental public health issue becomes prominent in socially disadvantaged agrarian communities in fluoride endemic areas where the standard irrigation system is unavailable and groundwater containing natural fluoride is the major drinking water source. This study aimed to determine the prevalence and severity of dental fluorosis in children and to evaluate its association with fluoride in groundwater in the aforementioned setting in Thailand.MethodsA cross-sectional survey of 289 children in Nakhon Pathom Province was conducted in 2015. Children with very mild to severe fluorosis were regarded as ‘cases’ while their counterparts were ‘controls’ for a subsequent case–control study. Records of fluoride concentrations in groundwater used for household supply corresponding to resident and number of years by age of each child during 2008–2015 were retrieved. Other exposure variables were measured using a questionnaire. Prevalence ratio (PR), a measure indicating the relative effect of different levels of fluoride on dental fluorosis, was obtained from Poisson regression with robust standard error.ResultThere were 157 children with very mild to moderate dental fluorosis (54.3% prevalence). The univariable analysis revealed that the prevalence of dental fluorosis among children with fluoride concentrations in water sources of 0.7–1.49 (index category 1) and ≥ 1.5 ppm (index category 2) was 1.62 (95% CI; 0.78, 3.34) and 2.75 (95% CI; 1.42, 5.31) times the prevalence among those with fluoride < 0.7 ppm (referent category). After adjusting for all covariates, the adjusted prevalence ratios in both index categories were 1.64 (95% CI; 0.24, 11.24) and 2.85 (95% CI; 0.44, 18.52) which were close to their corresponding crude estimates. Since the magnitude of confounding, measured by (PRcrude–PRadjusted)/PRadjusted, were less than 10% for both index categories; this indicated the limited confounding effect of all covariates.ConclusionsIn fluoride endemic areas, groundwater containing natural fluoride utilized for household consumption resulted in high dental fluorosis prevalence, particularly in the groundwater with fluoride concentrations of ≥ 1.5 ppm.
Highlights
Dental fluorosis can be a disease of social inequity in access to safe drinking water
In fluoride endemic areas, groundwater containing natural fluoride utilized for household consumption resulted in high dental fluorosis prevalence, in the groundwater with fluoride concentrations of ≥ 1.5 ppm
Study design This study comprises two phases of investigation: a crosssectional survey to determine the prevalence and severity of dental fluorosis and a case–control study to examine the plausible association between environmental fluoride in groundwater used for household consumption and dental fluorosis occurrence
Summary
Dental fluorosis can be a disease of social inequity in access to safe drinking water. This dental public health issue becomes prominent in socially disadvantaged agrarian communities in fluoride endemic areas where the standard irrigation system is unavailable and groundwater containing natural fluoride is the major drinking water source. In a unique setting of socially disadvantaged rural agrarian communities, social determinants of health, including the low socioeconomic status and social inequity in access to a safe drinking water source, can increase the likelihood of excessive environmental fluoride exposure through the use of natural water sources [9]
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