Dean's Index Research Articles

Usage of Fluoridated toothpaste in children and Fluorosis of permanent teeth

Objective: To determine the usage of fluoridated toothpaste in children and the presence of fluorosis in permanent teeth. Study Design: Descriptive cross-sectional study. Place and Duration: This study was undertaken in Hayatabad Model School Hayatabad Peshawar, from 1st March, 2022 to 31st October, 2022. Methodology: Eighty (N=80) school going children of both genders from 11-16 years age with healthy and vital teeth were included in this study. Children with chronic diseases were excluded from this study. Ingestion of childhood fluoride toothpaste and degree of fluorosis was recorded by using a questionnaire. Fluorosis was graded on basis of clinical examination by Dean Index. The data was analyzed using statistical package for social sciences (SPSS) version 20. Numerical variables were presented as mean and standard deviation whereas categorical variables were mentioned as numbers and percentages. Results: Mean age of children was 13.15 with 71.25% females (n=57) and 28.75% (n=23) males. 40.6% children (n=65) had dental fluorosis. Majority of children had mild fluorosis 65% (n=52), followed by moderate fluorosis (12.5%, n=10) and severe fluorosis (3.8%, n=3). 36.3% of the children ingested toothpaste in their early childhood (n=29) whereas 63.7% did not ingest tooth paste (n=51). Conclusion: Dental fluorosis is more common in those children who have a history of ingestion of fluoride tooth paste in their childhood. Keywords: Dental Fluorosis, Fluoride, Dental Caries, Dean Index, Childhood, Tooth Paste, Community Water Fluoridation.

Water pollution with fluoride in the Republic of Moldova and its impact on oral health

Water quality, especially drinking water quality, is one of the most essential requirements for the survival of not only mankind but all terrestrial life on Earth. As a determining factor of health, the quality of drinking water must correspond to sanitary regulations, and the violation of the water protection regime results in pollution. Water pollution is one of the major threats to public health in the Republic of Moldova. According to data compiled by the Yale Center for Environmental Law and Policy, globally, the Republic of Moldova was placed 83rd out of 180 countries in terms of drinking water quality, the first place being occupied by the countries with the highest drinking water quality. The „age-standardized life-years lost per 100,000 people due to exposure to unsafe drinking water (Daily rate)” is a measure used to evaluate the quality of water. The Daly score for the Republic of Moldova in 2022 was 50.0. The Republic of Moldova is considered a biogeochemical zone with regard to some chemical elements in the environment, including the content of fluorine in groundwater, soil, and subsequently in food products. The analysis of water samples taken by the National Public Health Center of the Republic of Moldova demonstrated that in 90% of cases, water sources subjected to laboratory investigations for microbiological and chemical parameters (boron, fluorine, and nitrates) do not meet the requirements. The present study was a prospective, observational one, the main objective of which was to evaluate the epidemiological dental characteristics of children from the fluorosis-endemic area of the Republic of Moldova. The study targeted 520 12- and 15-year-old children from Fălești district, where the fluoride concentration in drinking water exceeds 16 times the permissible norm of 16.2 ppm/l. Thus, the prevalence of dental fluorosis in this locality (Dean index ≥1) was 98.7 for 12-year-old children and 100% for 15-year-old adolescents. The prevalence of dental caries was 51.2% with an intensity of 2.1 for 12-year-old children, and for 15-year-old children, the prevalence was 67.1% with an intensity of 3.5. Children’s age and severity of dental fluorosis were independent predictors of dental caries intensity. Thus, a positive correlation was established between the severity of dental fluorosis and the intensity of dental caries in both study groups and in all groups of teeth. The percentage of children with a COAD index (decayed, filled, or absent teeth) ≥1 was higher in those whose Dean index was ≥ 5 in the second molar compared to other groups of teeth. Conclusion. Dental fluorosis remains the most common dental disease in fluorosis-endemic areas, and the severity of fluorosis increases with increasing fluoride concentrations in drinking water. Contrary to the previously established opinion, tooth decay also develops in children from endemic areas of fluorosis, and its frequency and intensity are directly correlated with the concentration of fluoride in drinking water. The higher the concentration of fluoride, the higher the values of the prevalence indices and intensity of dental caries. Republic of Moldova performs suboptimally in the prevention of oral diseases in the pediatric population, and the implementation of dental disease prevention programs would have major implications for improving dental morbidity.

Treatment of dental fluorosis Level: microabrasion with 6% hydrochloric acid. Case report

Dental fluorosis is a malformation of the dental enamel, which is characterized by an increase in its porosity and permeability, and variations in the clinical presentation in relation to the time and amount of fluoride consumed by the patient. The case of a male patient, 22 years old, with no pathological history or allergy to medications or chemical substances, goes to the dental office reporting dissatisfaction with his dental appearance. After clinical radiographic study, the diagnosis of mild fluorosis was established according to the Dean Index, and microabrasion with 6% hydrochloric acid was chosen as treatment. The procedure followed is described and the different management options for dental fluorosis are discussed. Dental fluorosis is widely present both worldwide and in Ecuador. However, many patients are unaware of their condition and do not receive adequate treatment. Microabrasion was the technique of choice for this case, due to the effectiveness and stability of its results already reported. The management of the patient with dental fluorosis must be individualized, the use of a minimally invasive technique, such as microabrasion with 6% hydrochloric acid, turned out to be a safe and effective method of treatment, which provides the patient with adequate dental aesthetics, and improves your quality of life

"Comparative Evaluation of Three Different Microabrasion Techniques in Esthetic Management of Fluorosis": An In Vivo Study.

"Comparative evaluation of three different microabrasion techniques in esthetic management of fluorosis"-an in vivo study. A total of 48 permanent incisors in children between the age-groups of 8-12 years with Dean's fluorosis index modified criteria 1, 2, and 3 were included. The patients were randomly divided into three groups; each group included 16 samples. Group I-phosphoric acid and pumice microabrasion (37% phosphoric acid and pumice as abrasive), group II-opalustre microabrasion [6.6% hydrochloric (HCL) acid and silicon dicarbide (SiC2)], and group III-icon etch microabrasion (15% HCL acid gel as icon etch, pumice, and resin infiltrate). Preoperative sensitivity and pulp vitality of each tooth were evaluated. Standardized preoperative photographs were captured for the evaluation of color parameters L1, a1, and b1 by Adobe Photoshop 7 software and an assessment of color enhancement was carried out. Preoperative surface roughness was evaluated with two methods like, cellulose acetate replicating tape and confocal microscope, and Epoxy resin replica obtained from the preoperative impression of teeth using additional silicone and contact profilometer. Microabrasion was done accordingly. Postoperative values of all the parameters were evaluated. Phosphoric acid and pumice showed the best color change, followed by icon etch resin infiltrate. Opalustre (6.6% HCL acid and SiC2) and was unsuccessful as it had less concentration and was more abrasive. Phosphoric acid and pumice showed the best color enhancement, followed by icon etch resin infiltrate and opalustre. Icon etch resin infiltrate showed minimal surface roughness followed by phosphoric acid and pumice and opaluster group. Reddy VN, Nagar P, Lakhotia R, et al. "Comparative Evaluation of Three Different Microabrasion Techniques in Esthetic Management of Fluorosis": An In Vivo Study. Int J Clin Pediatr Dent 2023;16(4):572-581.

Association of Dental Fluorosis and Urinary Fluoride with Intelligence among Schoolchildren.

Fluoride is present naturally in water and has been used worldwide for the prevention of caries. Several studies conducted in high water fluoride or endemic fluorosis areas reported that fluoride adversely affected children's cognitive function, but some studies had negative findings. This study aimed to assess the relationship between urinary fluoride, dental fluorosis, and intelligence among schoolchildren living in communities with non-fluoridated drinking water. This cross-sectional study was conducted on 562 children aged 6-12 years in Taichung, Taiwan. Each child's urinary fluoride level was determined by a fluoride-ion-selective electrode, and the dental fluorosis condition was evaluated according to the criteria of Dean's Index. The Raven's Colored Progressive Matrices-Parallel and Standard Progressive Matrices-Parallel were used to assess children's intelligence. The results showed that the mean (±standard deviation) urinary fluoride concentrations were 0.40 ± 0.27 mg/L (0.43 ± 0.23 mg/g creatinine) among participants. The prevalence of dental fluorosis was 23.67%. After extensive evaluation of potential confounders, dental fluorosis and urinary fluoride were not associated with intelligence quotient (IQ) scores or grades in the regression models. In conclusion, dental fluorosis and urinary fluoride levels were not significantly related to the IQ of schoolchildren living in areas with low drinking water fluoride.

Distribution of Dental Fluorosis in the Southern Zone of Ecuador: An Epidemiological Study.

In recent decades, the increase in fluoride exposure has raised the numbers of dental fluorosis in fluoridated and non-fluoridated communities In Ecuador, but the last national epidemiological study on DF was conducted more than a decade ago. The objective of this cross-sectional descriptive study was to determine the prevalence, distribution and severity of dental fluorosis (DF) using the Dean index in 1606 schoolchildren aged 6 to 12 years from urban and rural environments in provinces that make up the Southern Region of Ecuador. Participants met the inclusion criteria which were age, locality, informed consent document and no legal impediment. The results are presented using percentage frequency measures and chi-square associations. The prevalence of dental fluorosis was 50.1% in the areas of Azuay, Cañar and Morona Santiago, with no significant differences (x2 = 5.83, p = 0.054). The types of DF found most frequently were very mild and mild in all provinces; a moderate degree was more prevalent in Cañar (17%). There was no significant association (p > 0.05) between sex and the presence of dental fluorosis and, with respect to severity, the most frequent degree was moderate at the age of 12 years. The prevalence of dental fluorosis in the area evaluated is high, especially in the light and very light degrees, with a tendency toward moderate levels. It is necessary to carry out studies on the factors that are predisposing to the development of this pathology in the population studied. This research is an update regarding this pathology in Ecuador, so it is concluded that it is necessary to continue developing studies based on the findings obtained, thus contributing to the public health of the country.

Relationship between dental fluorosis, dental caries and salivary levels of Streptococcus mutans.

Worldwide, dental caries is an endemic infection and a significant public health problem. Fluoride reduces caries by helping to prevent demineralisation, by remineralising early carious lesions, and by decreasing the activity and growth of Streptococcus mutans (S. mutans). Fluoride intake above the optimal levels leads to a condition known as dental fluorosis, which causes hypo-mineralisation of the tooth. Some studies have revealed that the severity of fluorosis is directly proportional to caries, but some showed opposite results. Hence, with these contradicting results, this study was undertaken to identify the relationship between different grades of dental fluorosis, dental caries and the most common cariogenic bacteria S. mutans in saliva. A total of 90 subjects within 14- to 16-year age range were selected and categorised depending on the severity of fluorosis into three groups: group I (mild), group II (moderate) and group III (severe) based on modified Dean's fluorosis index criteria (1942). Unstimulated whole saliva samples were collected using the oral rinse technique and processed for quantification of S. mutans using Mitis Salivarius Bacitracin Agar medium. The number of colony-forming units (CFUs) was determined using a colony counter and expressed as ≥102, ≥103, ≥104 and ≥105 CFUs per ml of the sample, in accordance with the scale recommended by the manufacturer (HiMedia Laboratories). The severity of the caries was measured using decayed, missing or filled teeth (DMFT). Observations revealed that the overall DMFT was directly proportional to the level of S. mutans titres. It was observed that 67 to 73% of participants showed fewer colony counts (102 and 103) with minimal DMFT scores and 27 to 33% showed higher counts (104 and 105) with higher DMFT scores in all the groups. 105 CFUs of group III showed the highest mean DMFT scores (2.9) with an increased number of involved subjects than group II (2.3) and group I (1.5). In all, male participants had higher bacterial titres and DMFT scores than females. Fluoride in the drinking water served as anticariogenic agent regardless of the severity of fluorosis. Severe fluorosis with a higher incidence of caries and increased CFUs of S. mutans clearly indicates the importance of preventive measures and early treatment to reduce the severity of fluorosis and prevalence of dental caries.

Association between dental fluorosis prevalence and inflammation levels in school-aged children with low-to-moderate fluoride exposure

Inflammation mediates the neurological deficits caused by fluoride. Thus, whether inflammation is the underlying mechanism of dental fluorosis (DF) in school-aged children is worth exploring. A cross-sectional study was conducted to investigate the association between inflammation and the prevalence and severity of DF with low-to-moderate fluoride exposure. Fasting morning urine and venous blood samples were collected from 593 children aged 7–14 years. The fluoride content in the water and urine samples was measured using a fluoride ion-selective electrode assay. The levels of interleukin-1β (IL-1β) and C-reactive protein (CRP) were detected using an enzyme-linked immunosorbent assay. The Dean's index was used when performing dental examinations. Regression, stratified, and mediation analyses were performed to analyze the association between fluoride exposure, inflammation, and DF prevalence. In the adjusted regression models, the prevalence of mild DF was 1.723-fold (95% confidence interval [CI]:1.612, 1.841) and 1.594-fold (1.479, 1.717) greater than that of normal DF for each 1 mg/L increase in water and urinary fluoride content, respectively. The prevalence of mild DF increased by 3.3% for each 1 pg/mL increase in the IL-1β level and by 26.0% for each 1 mg/L increase in the CRP level. Stratified analysis indicated a weaker association between fluoride concentration and DF prevalence in boys than in girls, and susceptibility in the boys was reflected by the association of IL-1β with very mild and moderate DF prevalence. For every 1 mg/L increase in water and urinary fluoride levels, the proportion of IL-1β-mediated effects on the prevalence of mild DF was 10.0% (6.1%, 15.8%) and 8.7% (4.8%, 15.2%), respectively, and the proportion of CRP-mediated effects was 9.2% (5.5%, 14.9%) and 6.1% (3.3%, 11.0%), respectively. This study indicates that the DF prevalence may be sex-specific. Inflammatory factors may partially mediate the increased prevalence of mild DF in school-aged children with low-to-moderate fluoride exposure.

Clinical status and assessment of caries on first permanent molars in a group of 6- to 13-year-old Tunisian school children.

The present survey aimed to highlight the clinical status of first permanent molars (FPMs) among a group of children aged between 6 and 13 years in public primary schools in Tunisia and to determine the association between FPMs' dental caries, gingival bleeding, malocclusion, dental fluorosis, and enamel defects. The survey involved a cross-sectional study based on a dental examination conducted in public primary schools in Monastir Tunisia. A dental caries assessment was performed on FPMs using the International Caries Detection and Assessment Systemclassification; the number of carious lesions in permanent and temporary dentition was established using the decayed/missing/filled teeth (DMFT)index. The Gingival Index and the Dental Aesthetic Index were used to determine the occurrence of gingival bleeding and malocclusions. Dean's index and the modified Development Defects of Enamel index were used to define the enamel defects. The χ2 test was used to assess the difference between more than two groups, and the level of statistical significance was set at .05%. A total of 545 children and 2080 FPMs were examined. The prevalence of dental caries in FPMs was recorded to be 35.8%. The overall mean DMFTindex of the study population was 1.62 and the mean DMFT index was 1.41. The proportion of carious FPMs increased significantly with the age of the children (p < .05). The mandibular first permanent molar presented higher caries prevalence than its maxillary counterpart (p < .05). The presence of surfaces affected by molar incisor hypomineralization was recorded in 4.3% and the presence of surfaces affected by fluorosis was recorded in 4.6% of FPMs. No association was reported between FPMs' dental caries, gingival bleeding, malocclusion, and enamel defects (p > .05). Although the prevalence of caries in FPMs was considered moderate, health promotion programs should be implemented on a large scale to decrease the prevalence of dental caries among school children.

Moderate and Severe Dental Fluorosis in the Rural Population of Anantapur, India: Change in Their Biological Susceptibility?

Dental fluorosis affects the quality of life. A cross-sectional, observational study was conducted in a community affected by endemic fluorosis for several generations with a conserved biological and social environment. The study included patients from the rural population of Anantapur, India. The Dean index (DI) and the Thylstrup and Fejerskov Index (TFI) were used for fluorosis classification. Additionally, water samples were collected for fluoride analysis, taken from the patients’ living areas. The statistical association between the variables was analyzed. In total, 785 patients between 10 and 60 years old were included in the study (58.7% women and 41.3% men). Fluorosis signs were found in 94.6% of patients examined using the DI and 94.4% using the TFI. Moderate–severe dental fluorosis was observed in 62.8% by DI and 73.1% by TFI consuming untreated water with up to 2.9 ppm of fluoride. Furthermore, moderate–severe dental fluorosis was observed in 33.2% by DI and 39.9% by TFI consuming water with ≤1.5 ppm of fluoride. The high prevalence of moderate–severe dental fluorosis in patients consuming water with a low fluoride concentration suggests that other factors are involved. Biological susceptibility change could play an essential role in the severity of dental fluorosis in populations exposed for several generations, affecting its actual and future quality of life.

Effect of Dental Fluorosis on Oral Health-Related Quality of Life and Daily Performances Among 12- and 15-year-old School-going Children Residing in High- and Low-Fluoridated Areas of Meerut District

Introduction: Dental fluorosis is a clinical situation that leads to changes in esthetic appearance in teeth. Oral health problems can cause problems in performing daily activities and social well-being, which may affect individual's quality of life (QOL). Aim: To assess the effect of dental fluorosis on oral health-related QOL and condition-specific oral impact on daily performance (CS-OIDP) among 12- and 15-year-old children residing in high and low fluoridated areas of Meerut district, UP. Methodology: A cross-sectional study was conducted among 200 12- and 15-year-old school-going children residing in high- and low--fluoridated areas of Meerut district. Dean's fluorosis index was used to evaluate dental fluorosis. A pretested questionnaire, CS-OIDP index, was used to assess the dental fluorosis effect on the oral health-related QOL and daily performances. Results: The mean CS-OIDP score among high-fluoridated area was 39.85 and a significant correlation was found between dental fluorosis, CS-OIDP, and oral health-related QOL (P &lt; 0.005). Conclusion: The results of the present study can act as an alarm for dentists to carry out epidemiological investigation at village and district level to evaluate the risk factors and possible treatment and preventive measures.

Prevalence and Causes of Endemic Hydric Fluorosis in a Village in Rural Karnataka, India

Background: Fluorosis is caused because of excessive fluoride intake. Karnataka is one among the states that have reported high fluoride content in the groundwater. This study aimed to determine the prevalence of and clinical manifestations suggestive of fluorosis, along with the causes for fluorosis among the population of Kaiwara village. Methodology: The present cross-sectional survey was performed among 3003 permanent residents of Kaiwara village. Demographic details such as age, occupation, education, economic status, and anthropometric details were recorded. Parameters such as predominant diet, genu valgum, and grades of goiter were studied and recorded to determine their association with fluorosis. Dean's index was used to detect dental fluorosis. The levels of fluoride in urine were estimated using the ELICO-LI-126 Fluoride ion analyzer. Results: The most observed age group among study subjects was 10–49 years (males: 813 and females: 1304). Age, diet, genu valgum, and grade of goiter were significantly (P &lt; 0.001) associated with Dean's index. Of the study subjects, about 11.8% were unable to touch their toes indicating fluorosis. 2.075 mg/dl was the mean baseline fluoride level found in all the four samples from the main water tanks supplying water to the village. Out of 100 urine samples randomly taken, all had fluoride levels above the acceptable levels (&gt;0.1 ppm). Conclusion: Hydric fluorosis is endemic among the general population of Kaiwara village in Karnataka. The main leading cause for fluorosis occurrence in this region might be due to high fluoride levels reported in the groundwater.

Prevalence of dental fluorosis and dental caries in fluoride endemic areas of Rohtak district, Haryana.

This study investigates the estimation of the fluoride concentration in drinking water in Rohtak district, Haryana, and quantifies its effect on the prevalence of dental fluorosis and dental caries. A cross-sectional survey was conducted among 1262 school children in endemic fluoride areas of Haryana. Using simple random sampling, thirty villages from five blocks of Rohtak districts were selected, and children 6-12 years of age were examined. A questionnaire survey form was filled out to record the demographic details of the samples. Dental caries was recorded according to DMFT (D = Decayed, M = Missing due to caries only, F = Filled, T = Teeth)/deft index (d = decayed, e = extracted due to caries, f = filled, t = teeth). Assessment of Dental Fluorosis was done according to Dean's Fluorosis index, modified in 1942. The data were analyzed using SPSS version 19, and nonparametric tests were used to assess the significance. The study participants included 615 males and 647 females among which Mean DMFT in the area of study ranged from 0.32 to 1.90. Mean deft in the area of study ranged from 0.34 to 1.91. The fluoride concentrations in groundwater are in the range of 0.532-8.802. Out of 1262 children examined, 655 (51.90%) children were having dental fluorosis. 607 (48.10%) of the subjects were free from fluorosis. 16.09%, 13.39%, 9.11%, and 8.16% and 5.15% were having questionable, very mild, mild, moderate, and severe form of fluorosis, respectively. It can be concluded that in Rohtak district, the fluoride levels in drinking water and the prevalence of dental fluorosis are high, so requiring an urgent need to improve the quality of water and institute de-fluoridation of drinking water in affected areas to lower the burden of dental fluorosis in the community.

Dental caries and its association with increasing water fluoride concentration in district Rudraprayag, Uttarakhand

Background: Evidence from scientific literature confirms both beneficial and detrimental effects of fluoride on human health with only a narrow range between intakes associated with these effects. The limits of this range have been controversial among researchers since the 1930s. Considering this, the World Health Organization (WHO) permissible limit of fluoride in India has been reduced from 1.5 to 1.0 mg/l in 1998. This study aimed to evaluate the association between increasing water fluoride levels and dental caries prevention on permanent teeth.Methods: This cross-sectional study involved 1400 children (aged 6–19 years). Caries experience and dental fluorosis were recorded using DMFT/deft and Dean's index respectively. Also, fluoride concentration in drinking water was analyzed. Around 14.4% of children had dental caries with maximum frequency among 9-10 years of age. A significant negative correlation between caries experience and water fluoride level was found (p&lt;0.05), with the lowest DMFT scores at the fluoride level of 0.61–2 mg/l and the highest at 0.0–0.3 mg/l. Whereas, high prevalence of dental fluorosis was observed above 0.7 mg/l.Results: The study revealed that the presence of 0.3-0.7 mg/l fluoride in drinking water reduces dental caries, without an objectionable rise in dental fluorosis.Conclusions: It can be suggested that fluoride has anticaries property but due to a ‘narrow therapeutic window’ of 0.3-0.7 mg/l, in a country like India where endemic fluorosis is prevalent, its topical application should be encouraged which is almost equally effective with less systemic adverse effects.

Effect of Sodium Hypochlorite in Ground Fluorotic Enamel: Shear Bond Strength and Surface Analysis

Evaluate the effect on the shear bond strength (SBS) of 5% NaOCl applied after acid etching on ground anterior teeth with fluorosis and analyze the surface with scanning electron microscopy (SEM), also compare fluorotic and healthy ground enamel by atomic force microscopy (AFM) and Vickers microhardness (VM). For the SBS test 30 anterior teeth with moderate and severe fluorosis according Dean index were selected by an examiner previously calibrated with an expert in fluorosis by using the intraclass correlation coefficient (ICC). With the help of a calibrated high speed diamond bur for veneer preparation and a parallel chamfer high speed diamond bur the vestibular face was prepared with a uniform reduction of .3 mm under water cooling. In one half of the vestibular face of the teeth the conventional adhesive procedure was carried out while in the other half was added an additional step with 5% NaOCl applied for 1 minute and washing after acid etchant. A resin post was adhered in each half and load was applied until fracture. The failure mode was evaluated and a SEM analysis was made. Posteriorly 10 samples of fluorotic and healthy ground enamel were used to measure the nanostructural characteristics by AFM (roughness average and absolute depth profile) and the VM in three operative steps (after ground, after etchant and after deproteinization). The Shapiro-Wilks and Brown-Forsythe methods were used to test the distribution of variables. The Paired Student's t-test was used to compare the differences between mean bond strength (MPa) in the two groups for SBS test. Chi-square analyzes were performed to compare the failure modes between groups. One-way ANOVA analysis and Tukey-Kramer post hoc test were used to compare groups for roughness average, absolute depth profile and Vickers microhardness. A greater SBS (32.17±4.20 MPa) and a surface more homogeneous and less contaminated were observed in the deproteinization subgruoup compared to the conventional subgroup (27.74±4.88 MPa). AFM parameters were greater in fluorosis subgroup than in healthy enamel subgroup. VM was lower in the fluorotic enamel in each operative step in comparation with healthy enamel. The use of 5% NaOCl as a deproteinizing agent after acid etchant in ground fluorotic enamel results in better adhesion, which may imply greater success in adhesive treatments. The ground surface of fluorotic enamel shows higher values of roughness and depth and lower values of VM which proves that there is a more irregular and less hard surface.

Associations of low level of fluoride exposure with dental fluorosis among U.S. children and adolescents, NHANES 2015–2016

Drinking water fluoridation was a mid-twentieth century innovation based on the medical hypothesis that consuming low doses of fluoride at the teeth forming years provided protection against dental decays. Numerous studies showed that high level exposure to fluoride could cause dental and skeleton fluorosis. However, there was limited study focusing on the fluorosis effect of low levels of exposure to fluoride. Therefore, our study aimed to examine whether the low level of fluoride exposure (measured in blood plasma and household tap water) was associated with the risk of dental fluorosis based on data of the National Health and Nutrition Examination Survey (NHANES) 2015–2016. We analyzed data in 2098 children and adolescents who had Dean's Index scores, and water and plasma fluoride measures. The Dean's Index score was measured by calibrated dental examiners using the modified Dean's fluorosis classification system. Fluoride was measured in plasma and household tap water. In this study, we found that the rate of fluoride concentration in water above the recommended level of 0.7 mg/L was 25%, but the prevalence of dental fluorosis was 70%. Binary logistic regression adjusted for covariates showed that higher water fluoride concentrations (0.31–0.50, 0.51–0.70, > 0.70 compared 0.00–0.30) were associated with higher odds of dental fluorosis (OR = 1.48, 95% CI: 1.13–1.96, p = 0.005; OR = 1.92, 95% CI: 1.44–2.58, p < 0.001, and OR = 2.30, 95% CI: 1.75–3.07, p < 0.001, respectively). The pattern of regression between plasma fluoride and dental fluorosis was similar. Inclusion, our study showed that even low level of water or plasma fluoride exposure was associated with increased the risk of dental fluorosis. The safety of public health approach of drinking water fluoridation for global dental caries reduction are urgently needed further research.

Health implications among school children due to fluoride in underground aquifers of Haryana state, India

AbstractPotable water requirements for 98% of people in Haryana (India) are accomplished by groundwater resources. Considering the presence of high fluoride content in ground aquifers, and the subsequent problem of dental fluorosis, this study was conducted in the central region of Haryana state. Underground water samples at eight sites at three depths were examined during premonsoon and postmonsoon (2018–2020) to differentiate the impact of water recharging and its interaction with rocks. The SPADANS‐zirconyl oxychloride method (UV–vis spectrophotometer – Systronics 118) was adopted for fluoride‐level detection. The fluoride level in sampling sites varied from 0.19 to 2.87 ppm with a mean of 1.06 ppm in water samples. More than 38% of samples did not meet the optimum permissible limit (1 ppm) of fluoride in potable water. The fluoride level intensifies in postmonsoon samples with the maximum concentration at 40 m bgl depth. Estimated marginal mean statistics illustrate a significant impact of locations, depth of water sample, and monsoon season on fluoride levels. Fluorosis prevalence among school‐going children (N = 1600) was also assessed (Dean's index) to gain implications of fluoride concentration on health. Forty‐nine percent of children suffer from various levels of dental fluorosis with male children had high occurrences. Public health authorities must ensure safe drinking water availability and preventive measures for fluorosis prevalence in this region through defluoridation of water resources and distribution of calcium/ascorbic acid food supplement to school children.

The occurrence, severity degree, and associated risk factors of dental fluorosis among the 12-year-old schoolchildren in Jilin, China.

This study aims to describe the occurrence, severity degree, and correlated risk factors of dental fluorosis among the 12-year-old schoolchildren of Jilin, China.We conducted a cross-sectional, observational, and descriptive study among 960 12-year-old schoolchildren in Jilin. The Dean index was utilized to evaluate the severity degree of dental fluorosis. A questionnaire was sent to the guardians of children. Community fluorosis index was measured to estimate the importance of enamel fluorosis for the whole population's public health. The logistic regression analysis was also utilized to identify the correlation between fluorotic teeth and the independent variables.Nine hundred sixty children were assessed. Among them, 480 (50%) were female. 30.5% of subjects had dental fluorosis, 7.19% had very mild dental fluorosis, 10.73% experienced mild dental fluorosis, 9.58% suffered moderate dental fluorosis, and 3.02% encountered severe dental fluorosis. The overall community fluorosis index was 0.73. The results of logistic regression showed that schoolchildren who brushed teeth more frequently (OR: 2.012, 95% CI 1.767–2.342), deficiency of parental supervision (OR: 4.219, 95% CI 3.887–4.573), and lived in rural areas (OR: 2.776, 95% CI 2.163–3.489) were more correlated with enamel fluorosis. Moreover, schoolchildren whose mothers or fathers were of high education level (OR: 0.336, 95% CI 0.217–0.413 and 0.346, 95% CI 0.113–0.512) and only child (OR: 0.378, 95% CI 0.213–0.415) were protective factors for dental fluorosis.In the Jilin province of China, the risk indicators for dental fluorosis include rural areas, more frequency of brushing, low educational background of parents, and deficiency of parental supervision.

Objective comparison of three different treatment modalities in the esthetic improvement of mild-to-moderate dental fluorosis: A randomized clinical trial

Objective: To compare and evaluate esthetic improvement following resin infiltration, vital bleaching, and diode laser bleaching in mild-to-moderate fluorosis conditions immediately after treatment, 1 month, and 6 months postoperatively. Study Design: Sixteen patients with Central and lateral incisors showing mild-to-moderate fluorosis according to modified Dean's fluorosis index were selected and simple randomization was done to allocate the teeth to resin infiltration group, vital bleaching group, diode laser bleaching group, and control group. Esthetic improvement posttreatment was assessed using digital image analysis using Adobe Photoshop software and color change (ΔE) was calculated. Results: The inferential statistics included Kruskal–Wallis test and Friedman's ANOVA test. Vital bleaching showed the highest esthetic improvement followed by diode laser bleaching, vital bleaching, and control group at all the different time intervals. The results, however, were not statistically significant. Conclusion: All the three treatment measures brought about esthetic enhancement with the vital bleaching group showing slightly better results when compared with other study groups.

Cross-cultural adaptation and psychometric properties of the Hindi version of Child Perception Questionnaire (CPQ11-14 ) in school children.

There is a need to validate OHRQoL measures in Hindi to assess the OHRQoL of Indian children. To develop a Hindi version of the CPQ11-14 and to appraise its validity and reliability for use among North Indian children aged 11-14years. The cross-culturally adapted Hindi version of CPQ11-14 was achieved by forward translation, backward translation, committee review, and pretesting. A total of 1000 children were recruited from schools, chosen by two-stage cluster random sampling technique. After completing the self-administered questionnaire CPQ11-14 by the child, oral examination was conducted using decayed/missing/filled teeth (DMFT) index, malocclusion index, and Dean's fluorosis index. Test-retest reliability was checked on 100 participants after one week. The floor effect was present in 3.6% individuals, and there was no ceiling effect. Cronbach's alpha for the overall CPQ11-14 scale was 0.963. Intra-class correlation (ICC) coefficient was 0.952 for the entire scale. Cronbach's alpha value for test-retest was 0.918. There was a non-significant change in domain-level and overall median CPQ11-14 scores with an increase in DMFT scores. For malocclusion and fluorosis, there was a statistically significant increase in overall and domain-level scores with increased severity scores. CPQ11-14 and individual domains significantly correlated with both the global questions. Hindi version of CPQ11-14 is a reliable scale to assess OHRQoL in Hindi speaking 11- to 14-year-old children.