Fluorosis In Children Research Articles

Topical fluoride as a cause of dental fluorosis in children.

Topical fluoride as a cause of dental fluorosis in children.

Korelacija između rizika od dentalne fluoroze i specifične alkalne fosfataze za kosti, osteokalcina, matriks metaloproteinaze i parathiroidnog hormona kod dece

Background: The aim of this study was to investigate the association between dental fluorosis occurrence in children and bone metabolism-related indicators, including bone-specific alkaline phosphatase (BALP), osteocalcin (OC), matrix metalloproteinase (MMP-2, MMP-9, MMP-20), and parathyroid hormone (PTH). Methods: A total of 189 cases of school-age children who underwent health examinations in our hospital were enrolled, according to the presence or absence of dental fluorosis. They were divided into the fluorosis group (n=97) and fluoride-free group (n=92), and the serum BALP, OC, MMP-2, MMP-9, MMP-20, and PTH levels of the two groups were compared and relevant clinical data were collected. This study employed multivariate logistic regression to examine the factors associated with the development of dental fluorosis in children. Results: The urine fluoride levels, BALP, MMP-2, and MMP9 of the children in the fluorosis group were higher than fluoride-free group, and the mother's educational level, per capita annual household income, OC, and PTH were lower than fluoride-free group (P<0.05). Based on Spearman correlation analysis, a positive correlation was identified between the urinary fluoride level, the extent of dental fluorosis, and indicators such as BALP, MMP-2, and MMP-9. (r=0.618, 0.558, 0.567, 0.597, 0.602, 0.571, P<0.001), and negatively correlated with OC and PTH (r=-0.580, -0.603, -0.549, -0.515, P<0.001). As the urinary fluoride level and the extent of dental fluorosis increased, there was a gradual elevation in serum BALP, MMP-2, and MMP-9 levels in children, while OC and PTH levels gradually decreased (P<0.05). After adjusting for confounding factors, including urinary fluoride, maternal education level, and per capita annual household income, multivariate Logistic regression analysis showed that BALP, OC, MMP-2, MMP-9, and PTH were independently associated with the risk of dental fluorosis (P<0.05). Conclusions: High BALP, MMP-2, MMP-9, low OC, and PTH are independent factors affecting the occurrence of dental fluorosis and are related to the extent of dental fluorosis.

Epidemiological analysis of drinking water-type fluorosis areas and the impact of fluorosis on children’s health in the past 40 years in China

This study analyzed the effect of China’s fluorosis prevention and control program, which has been in effect for more than 40 years, and the impact of fluorosis on children’s health. Relevant research studies were retrieved from the following online databases from the time of their inception to May 2022: PubMed, ScienceDirect, Embase, Cochrane, China National Knowledge Infrastructure, and Wanfang. The Review Manager 5.3 software was used in statistical analyses. This article included seventy studies: Thirty-eight studies reported the effect of improving water quality and reducing fluoride content, the incidence rate of dental fluorosis in children, and the level of urinary fluoride, and thirty-two studies reported the intelligence quotient (IQ) and health status of children. Following water improvement strategies, the fluoride levels in drinking water decreased significantly; urinary fluoride levels and dental fluorosis decreased significantly in children. With regard to the effect of fluorosis on the IQ of children, the results showed that the IQ of children in areas with a high fluoride of fluorosis was lesser than that in areas with a low fluoride, and this difference was significant. Based on the prevalence of dental fluorosis and its effect on the intelligence of children, it appears that reducing fluoride levels in drinking water and monitoring water quality are important strategies for the prevention and treatment of fluorosis.Graphical abstract

Relationships between dental fluorosis and fluoride concentrations in bottled water and groundwater in low-income children in Mexico.

The aim of the current study was to investigate associations between dental fluorosis in children living in low socioeconomic areas in Mexico, and fluoride concentrations in tap water, fluoride concentrations and in bottled water, and body mass index (BMI). A cross-sectional study involving 585 schoolchildren aged 8-12 years was conducted in communities in a southern state of Mexico with >0.7 parts per million (ppm) fluoride in the groundwater. The Thylstrup and Fejerskov index (TFI) was used to evaluate dental fluorosis, and the World Health Organization growth standards were used to calculate age-adjusted and sex-adjusted BMI Z-scores. A BMI Z-score ≤ -1 SD was used as the cut-off point for thinness, and multiple logistic regression models for dental fluorosis (TFI ≥ 4) were constructed. The mean fluoride concentration in tap water was 1.39 ppm (SD 0.66), and the mean fluoride concentration in bottled water was 0.32 ppm (SD 0.23). Eighty-four children (14.39%) had a BMI Z-score ≤ -1 SD. More than half (56.1%) of the children presented with dental fluorosis in TFI categories ≥ 4. Children living in areas with higher fluoride concentrations in the tap water [odds ratio (OR) 1.57, p = 0.002] and bottled water (OR 3.03, p < .001) were more likely to have dental fluorosis in the severe categories (TFI ≥ 4). BMI Z-score was associated with the probability of dental fluorosis (TFI ≥ 4; OR 2.11, p < 0.001), and the effect size was 29.3%. A low BMI Z-score was associated with a higher prevalence of dental fluorosis in the severe category. Awareness of the fluoride concentrations in bottled water may help prevent dental fluorosis, particularly in children exposed to several high fluoride content sources. Children with a low BMI may be more vulnerable to dental fluorosis.

Toothbrushing practices as risk factors for dental fluorosis in an area with varying fluoride levels in drinking water.

Despite contributing to a reduction in dental caries, improper use of fluoridated toothpaste could add to the burden of dental fluorosis in children. To assess the association between tooth-brushing practices such as the type and amount of toothpaste used, frequency of tooth brushing, parental assistance in tooth brushing, timing of tooth brushing and dental fluorosis in school children in Kurunegala district, an endemic area for dental fluorosis in Sri Lanka. For this case-control study, a sex-matched sample of 15-year-old school children attending government schools in Kurunegala district and who were lifetime residents of the district was selected. Dental fluorosis was measured using the Thylstrup and Ferjeskov (TF) Index. Those children with a TF⟩1 were considered as cases and those with a TF score of 0 or 1 served as controls. An interview of parents/caregivers of the participants was used to assess risk factors for dental fluorosis. The fluoride concentration in drinking water was measured using spectrophotometry. Data analysis used chi-square tests and conditional logistic regression. Tooth brushing ≥ twice/day, brushing after breakfast and parent/care giver brushing the child's teeth reduced the likelihood of developing fluorosis. Use of fluoridated toothpaste adhering to the recommended guidelines could prevent dental fluorosis in children in this endemic area.

The Protective Effect of Breastfeeding on Dental Fluorosis Among Children in Rural Fluoride-Endemic Areas.

Background: Living in fluoride-endemic areas and the inevitable use of groundwater for consumption have imposed children at high risk of dental fluorosis. To mitigate exposure to excessive fluoride at age of developing dentition, breastfeeding might serve as a natural public health intervention against dental fluorosis in that socially disadvantaged context. Objective: This study aimed to evaluate the preventive effect of breastfeeding against dental fluorosis in children living in fluoride-endemic areas in Nakhon Pathom Province, Thailand. Evaluation of the association through several epidemiological models depicted by a directed acyclic graph (DAG) was undertaken. Methods: A case-control study of 127 cases of dental fluorosis and 85 controls was conducted. Independent factor of breastfeeding, along with other past exposure variables, were traced backwardly since infancy by caregiver history taking. Fluoride concentrations in groundwater utilized for household supply matching to residence and number of years by age of each child were collected from 2008 to 2015. Multivariable Poisson regression with robust standard errors was sequentially executed to estimate prevalence ratio (PR) according to models in DAG. Results: Breastfeeding was significantly higher (95.3%) among controls compared to cases (84.2%), p = 0.014. Contrastingly, prevalence of using toothpaste larger than pea-sized and having fluoride ≥1.5 ppm in household water supply was higher among cases. Univariable and subsequent five multivariable regression models according to DAG consistently unveiled significant protective effect of breastfeeding on dental fluorosis with PR ranging from 0.66 to 0.75. Conclusions: Breastfeeding for at least 6 months had preventive effect against dental fluorosis among children living in fluoride-endemic areas.

Enamel Hypoplasia and Dental Fluorosis in Children With Special Healthcare Needs: An Epidemiological Study.

Background Children with cerebral palsy, intellectual difficulties, or hearing deficiencies may have enamel hypoplasia. Moreover, as the child begins to walk, the fluorosis progresses to bone malformations in the lower limbs, and it fully manifests as the child grows up. Methodology An epidemiological study was conducted to assess the prevalence of dental caries, oral hygiene status,enamel opacities, and oral hygiene habits among children 4-15 years of age from various schools for special healthcare needs including government schools and non-government organizations. Results The study sample comprised 1,047 children with special healthcare needs in the age group of 4-15 years, with 608 males and 439 females. It was seen that 29.79% of vegetarian children were affected with caries, while only 16.14% of children with a mixed diet were affected with caries. Conclusions There is no significant association between enamel hypoplasia and the physical and mental disabilities of children with special healthcare needs.

Fuzzy K-Nearest Neighbor Based Dental Fluorosis Classification Using Multi-Prototype Unsupervised Possibilistic Fuzzy Clustering via Cuckoo Search Algorithm.

Dental fluorosis in children is a prevalent disease in many regions of the world. One of its root causes is excessive exposure to high concentrations of fluoride in contaminated drinking water during tooth formation. Typically, the disease causes undesirable chalky white or even dark brown stains on the tooth enamel. To help dentists screen the severity of fluorosis, this paper proposes an automatic image-based dental fluorosis segmentation and classification system. Six features from red, green, and blue (RGB) and hue, saturation, and intensity (HIS) color spaces are clustered using unsupervised possibilistic fuzzy clustering (UPFC) into five categories: white, yellow, opaque, brown, and background. The fuzzy k-nearest neighbor method is used for feature classification, and the number of clusters is optimized using the cuckoo search algorithm. The resulting multi-prototypes are further utilized to create a binary mask of teeth and used to segment the tooth region into three groups: white-yellow, opaque, and brown pixels. Finally, a fluorosis classification rule is created based on the proportions of opaque and brown pixels to classify fluorosis into four classes: Normal, Stage 1, Stage 2, and Stage 3. The experimental results on 128 blind test images showed that the average pixel accuracy of the segmented binary tooth mask was 92.24% over the four fluorosis classes, and the average pixel accuracy of segmented teeth into white-yellow, opaque, and brown pixels was 79.46%. The proposed method correctly classified four classes of fluorosis in 86 images from a total of 128 blind test images. When compared with a previous work, this result also indicates 10 out of 15 correct classifications on the blind test images, which is equivalent to a 13.33% improvement over the previous work.

Fluorine in shallow groundwater in China: A review of distribution, occurrence and environmental effects

With rapid economic development and the increasing demand for drinking water, a large amount of groundwater is exploited, resulting in a high F− content in groundwater, which is harmful to the environment and human body. In this study, 5,464 data points of fluoride in shallow groundwater were collected, and the F− content distribution, occurrence form and environmental impact of shallow groundwater were discussed. The results showed that 1) the F− content in shallow groundwater in China ranged from 0 to 60 mg/L, with a mean content of 0.90 mg/L; the lowest average F− content in shallow groundwater in Southwest China was 0.36 mg/L; South China (1.20 mg/L), Northeast China (1.25 mg/L) and Northwest China (1.25 mg/L) were considered high-fluoride areas, and North China (0.93 mg/L), East China (0.67 mg/L) and Central China (0.80 mg/L) were considered low-fluoride areas. The mean F− content in groundwater differed between provinces and cities. 2) The F− in shallow groundwater mainly occurred in ionic, complex ionic and organic fluoride molecular states. 3) The influence of a high F− content in shallow groundwater on the environment was mainly manifested in the increase in water F− concentration and soil F− and vegetable F− content. The influence of a high F− content on the human body was mainly manifested in an increase in urinary F− content in children, a high prevalence of dental fluorosis in children, an increase in skeletal fluorosis rate in adults with age, and an influence on cognitive function of older adults. These results provide a basis for F− pollution control and high-fluoride water treatment.

Demographic factors associated with dental fluorosis in children and adolescents in the department of La Paz

La ingesta de flúor por períodos prolongados durante la formación del esmalte produce fluorósis dental. Objetivo. El objetivo del presente trabajo es determinar factores demográficos asociados a fluorósis dental en niños y adolescentes en el departamento de La Paz. Material y Método. El estudio es transversal analítico, los participantes fueron 1393 estudiantes que fueron seleccionados aleatoriamente para ello se tomaron en cuenta 36 unidades educativas de 7 regiones del departamento de La Paz. Se realizó un levantamiento epidemiológico aplicando el índice de Dean. Resultados. La prevalencia de fluorósis dental fue del 13,6% (188), los más afectados fueron los adolescentes con un 10,7% (149), el sexo femenino tenía una prevalencia de 7,4% (103). Un 8% (112) de fluorósis dental se observó en el área rural. Según severidad, con 8 % (113) fue fluorósis discutible, muy leve 4% (51), leve 1,3% (18), moderada 0,4% (5) y severa se observó en un estudiante. Se observa una asociación estadísticamente significativa (p=0,000) entre edad y fluorósis dental. Conclusión. La fluorósis dental se considera como un problema estético y el controlarlo es una medida preventiva muy buena.

Extended caries prevention programme with biannual application of fluoride varnish for toddlers: prevalence of dental fluorosis at ages 7–9 years and associated factors

Objective To investigate the prevalence of and factors associated with dental fluorosis in children living in areas of high caries risk in Stockholm and who had participated in a prospective, parallel, cluster-randomized, controlled caries prevention trial between ages 1 and 3 years. Materials and Methods The study group comprised a random sample of the children who had completed the 2-year prevention trial (n = 2536) in 2011–2014. All children were instructed to use fluoride toothpaste; the test group received fluoride varnish applications twice a year. Dental fluorosis prevalences in the reference (n = 220) and the test (n = 234) groups were compared. Presence of fluorosis was determined using the Thylsturp & Fejerskov (TF) index on photos of the permanent maxillary incisors. Results No significant difference in dental fluorosis was observed between the two groups. Nearly one-third (29.7%) of the children in the study cohort exhibited dental fluorosis (TF index ≥ 1). Associations with use of fluoride toothpaste at age 1 year and with socioeconomic status factors were found. Conclusions Biannual applications of fluoride varnish in toddlers was not associated with dental fluorosis, which when found was rarely of aesthetic concern. Parental education in tooth-brushing routines is recommended.

Association Between Dietary Fluoride and Calcium Intake of School-Age Children With Symptoms of Dental and Skeletal Fluorosis in Halaba, Southern Ethiopia.

BackgroundIn the Ethiopian Rift Valley, ways to reduce the fluoride (F) burden from drinking water have been unsuccessful. Calcium (Ca) intake may mitigate fluorosis by binding with F ions and preventing absorption. The purpose of this study was to examine the association between Ca intake and proportion of fluorosis symptoms in school-age children in an area where F levels are known to be higher than WHO limit of 1.5 mg F/L water.MethodsA cross-sectional survey in the Halaba zone involved 135 eligible children aged 6–13 year who were recruited to have dental fluorosis assessed by a dentist and skeletal fluorosis assessed by a physiotherapist. Dietary Ca intake was determined by 24-h recall. Food items and samples from ground wells, taps and spring water were collected for F concentration. Associations were measured using bivariate logistic regression, adjusted for known confounders.ResultsWater F averaged 5.09 mg/L. Total F intake was high, 10.57 mg/day, and Ca intake was low, 520 mg/day. Prevalence of dental fluorosis (from very mild to severe symptoms) was 73.1% for younger children (6–8 years) and 68.3 % for older children (9–13 years). The prevalence of children having symptoms of skeletal fluorosis ranged between 55.1 and 72.4%, with no apparent age difference. Dietary F intake of children was significantly positively associated with presence of dental fluorosis. Dietary Ca intake of children was significantly negatively associated with dental fluorosis. Higher than average dietary F intake significantly increased the odds of developing skeletal fluorosis symptoms when measured as inability to stretch and fold arms to touch back of head. Higher than average Ca intake was significantly associated with decreased odds of developing skeletal fluorosis measured as inability to bend body to touch the toes or floor.ConclusionsHigh dietary F, as expected, was associated with fluorosis in children. In the presence of higher Ca intake (>520 mg/day) some fluorosis symptoms were mitigated. There is a need to improve Ca intakes as all were below recommended levels, and this nutritional strategy may also reduce burden of excess F.

Dental fluorosis among people and livestock living on Gihaya Island in Lake Kivu, Rwanda

BackgroundDental fluorosis is caused by prolonged exposure to excessive fluoride during the period of permanent tooth formation and is characterized by tooth discoloration, pitting, and loss of shape. Communities living near Lake Kivu in Western Rwanda exhibit a high prevalence of dental fluorosis; however, data on prevalence and risk factors are scarce.MethodsThis cross sectional, quantitative study used a One Health approach to investigate dental fluorosis prevalence among people and livestock and to measure fluoride content in the environment. In 2018, oral health examinations were conducted to assess the prevalence of fluorosis in children (aged 9 to 15 years), cattle and goats residing on Gihaya Island (Rwanda, East Africa). All children and cattle/goats meeting basic eligibility criteria (e.g., island residence) were invited to participate. Presence and severity of dental fluorosis was categorized according to the Dean’s Fluorosis Index. Samples of local foods, water, soil and grass were collected from communal sources and individual households and analyzed for fluoride content using standard laboratory techniques. Descriptive and binomial analyses (Fisher Exact Test) were used to assess this dataset.ResultsOverall, 186 children and 85 livestock owners (providing data of 125 livestock -23 cattle and 102 goats) participated. Dental fluorosis was recorded in 90.7% of children and 76% of livestock. Moderate to severe fluorosis was observed in 77% children while goats and cattle most often exhibited mild or absent/questionable severity, respectively. Water from Lake Kivu (used primarily for human cooking water and livestock drinking water) contained fluoride levels that were consistently higher than the maximum threshold (1.5 mg/L) recommended by the World Health Organization. Other sources (borehole and rainwater) were within safe limits. All food, soil and grass samples contained fluoride. The highest levels were observed in porridge (0.5 mg/g) and small fishes (1.05 mg/g).ConclusionsAltogether, dental fluorosis was highly prevalent among children and goats on Gihaya Island with various food and water sources contributing a cumulative exposure to fluoride. An immediate and coordinated response across human, animal and water professionals is needed to reduce fluoride exposure within safe limits for island residents.

Hydrogeogenic fluoride in groundwater and dental fluorosis in Thai agrarian communities: a prevalence survey and case\u2013control study

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.

Effect of fluoridated water on dental caries and fluorosis in schoolchildren who use fluoridated dentifrice.

This cross-sectional study evaluated the prevalence and severity of dental caries and fluorosis in children and adolescents using fluoridated toothpaste, from areas with and without fluoridated water. Parents of 5-year-old children and 12-year-old adolescents from neighbourhoods that are supplied with and without fluoridated water answered questionnaires for determining socio-economic and demographic characteristics and habits related to oral health. The individuals were examined, and dental caries and fluorosis were measured by dmft/DMFT and TF indexes, respectively. Descriptive, bivariate and logistic regression analyses were performed (p < 0.05). Of 692 participants, 47.7% were 5-year-olds and 52.3% were 12-year-olds. The mean dmft/DMFT in the 5-year-olds/ 12-year-olds from Exposed and Not Exposed fluoridated water groups was 1.53 (± 2.47) and 3.54 (± 4.10) / 1.53 (± 1.81) and 3.54 (± 3.82), respectively. Children (OR = 2.86, 95% CI = 1.71-4.75) and adolescents (OR = 1.95, 95% CI = 1.24-3.05), who did not consume fluoridated water, had greater caries experience. Among adolescents, there was an association between fluoridated water and the prevalence of very mild/mild fluorosis (OR = 5.45, 95% CI: 3.23-9.19) and moderate fluorosis (OR = 11.11, 95% CI = 4.43-27.87). Children and adolescents, who consumed fluoridated water, presented lower prevalence and severity of dental caries compared to those who used only fluoridated toothpaste as the source of fluoride. There is an association between water fluoridation and very mild/mild and moderate fluorosis in adolescents.

Dietary Fluoride Intake by Children: When to Use a Fluoride Toothpaste?

Fluoride is recommended for its cariostatic effect, but excessive fluoride intake may have health risks. Increased prevalence of dental fluorosis in areas with low fluoride content in drinking water has been attributed to the inappropriate excessive intake of fluoride supplements (tablets and drops) and toothpaste ingestion. The aim of the present study was to estimate the fluoride intake and the risk of fluorosis in children (6 months–6 years) in the Castelli Romani area (province of Rome, Italy), which is volcanic, therefore with a higher concentration of fluorine. Measurements of the fluoride content in drinking water, mineral waters, vegetables and commercial toothpaste for children were performed. The fluoride concentrations of all samples were determined using a Fluoride Ion Selective Electrode (GLP 22, Crison, Esp). Data were analyzed by descriptive statistics. Differences between samples were determined by Student’s t-test. The fluoride content in tap water samples collected from public sources averaged from 0.35 to 1.11 ppm. The Pavona area showed the highest content of fluoride with respect to the others (p ≤ 0.05). The fluoride content in mineral water samples averaged from 0.07 to 1.50 ppm. The fluoride content of some vegetables showed increased mean values when compared to control vegetables (p ≤ 0.05). Within the limitations of the present study, considerations should be made when prescribing fluoride toothpaste for infants (6 months–4 years) in the areas with high fluoride content, because involuntary ingestion is consistent.

Prevalence of Brick Tea-type Fluorosis in Children Aged 8–12 Years in Qinghai Province, China

Prevalence of Brick Tea-type Fluorosis in Children Aged 8–12 Years in Qinghai Province, China

Dental Fluorosis in Children from Aguascalientes, Mexico: A Persistent Public Health Problem

This paper estimates the prevalence and severity of dental fluorosis among participants in the first wave of The Aguascalientes Longitudinal Study of Child Development (EDNA). The analytical sample includes 1052 children in 100 public elementary schools. Dental fluorosis is determined using the Modified Dean’s Index. There is a 43% general dental fluorosis prevalence, and the estimated Community Fluorosis Index is 0.99. Five municipalities report average groundwater fluoride concentrations above the official Mexican guideline value of 1.5 mg/L. In those municipalities, there is a 50% average dental fluorosis prevalence. An ordered logistic regression analysis indicates that obesity in participants increases the likelihood of suffering more severe dental fluorosis symptoms compared with normal-weight participants (OR = 1.62, p &lt; 0.05). Households consuming tap water are more likely to have children suffering more severe dental fluorosis symptoms (OR = 1.63, p &lt; 0.05). Children aged 8 years are more likely to present more severe dental fluorosis symptoms than their peers aged 7 years (OR = 1.37, p &lt; 0.05). Dental fluorosis will persist as a public health problem in Aguascalientes State unless appropriate technologies for fluoride removal from water are installed and operated.

Malocclusion index assessment in schoolchildren in the endemic fluorosis area (pilot study). Part I

Relevance . There are a lot of publications on the assessment of dental caries and fluorosis in children in the fluoride endemic areas. The studies on the analysis of the prevalence and severity of malocclusion in these children are few and contradictory. The aim of the study was to assess the prevalence and severity of malocclusion in schoolchildren in the endemic fluorosis areas. Materials and methods . A cross-sectional dental examination was performed according to the WHO method with a calibration expert in 361 schoolchildren aged 12 and 15 years old living in the areas with highly fluoridated drinking water (1.5-4.5 ppm). The clinical forms of dental fluorosis were assessed by the WHO classification and the prevalence and severity of malocclusion were evaluated by the DAI index. The obtained information was processed using the SPSS® Statistics 23.0 software. Results . A high prevalence of dental fluorosis was revealed in the examined schoolchildren with the predominance of mild forms of pathology. Most of the children had malocclusion; mild malocclusion was most often diagnosed. Conclusions. The study did not reveal any differences between the occurrence and severity of fluoride induced dental lesions, malocclusion in the studied age and sex groups. The prevalence and severity of malocclusion were comparable in the samples of students without dental fluorosis and with various clinical forms of this pathology.

Dental fluorosis of children aged 8-12 in diseased areas in Xi’an City from 2014 to 2018

Objective To evaluate the dynamic prevalence of dental fluorosis of children and levels of fluoride in drinking water after improvement of water in Xi’an City, to provide scientific basis for water fluoridation improvement. Methods A total of 35 fluorosis endemic villages were selected as fixed monitor sites in 2014-2018, the ways of water improvement were surveyed, water fluorine content were detected and the prevalence of dental fluorosis in children aged 8 to 12 years were examined. Results Rates of excess fluoride in drinking water from 2014 to 2018 were 22.86%, 14.29%, 11.43%, 11.43% and 8.57%, the difference were significant ( χ 2 = 16.44, P <0.01).The dental fluorosis detection rates of children aged 8 to 12 years were 20.89%, 18.22%, 17.46%, 18.13% and 16.76% in 2014-2018 which showed a obvious descending trend by year ( χ 2 = 10.02, P <0.01). The detection rate of dental fluorosis in children aged 8 and 9 years showed a decreasing trend by year ( χ 2 = 6.53, 4.54, P <0.05). The difference of total rate of dental fluorisis, rate of mild cases rate of moderate-to-severe cases were statistically between the villages without qualified water and the villages with normal fluorine water ( χ 2 = 179.22, 167.93, 10.35, P <0.01). The rate of detection in the villages with the water fluorine exceed standard in 2014-2018 showed a declining trend year by year ( χ 2 = 28.50, P <0.01). The detection rate were significant different across water improvement methods ( χ 2 = 197.76, P <0.01). Detection rate of dental fluorosis decreased from 2014 to 2018 in the areas with municipal water supply showed a decreasing after year ( χ 2 = 12.16, P <0.01). Conclusion The improvement of municipal water supply shows significant effects on water fluorosis control, the detection rate of water fluoride and children’s dental fluorosis in some villages with the other ways of water improvement are still higher than expected, the continuously monitor of fluoride content in water and dental fluorosis in children should be strengthened. 【摘要】 目的 动态监测西安市饮水型氟中毒病区改水后水氟和儿童氟斑牙病情变化趋势,为改水降氟提供科学依据。 方法 2014—2018年在西安市选择 10 个区县的 35 个病区村作为固定监测点,调査改水方式、水氟含量和 8~ 12岁儿童氟 斑牙病情。 结果 2014—2018 年病区村水氟含量超标率分别为 22.86%, 14.29%,11.43%, 11.43%和 8.57%,差异有统计学 意义( χ 2 = 16.44, P <0.01)。各年度间 8~12岁儿童氟斑牙总检出率依次为 20.89%, 18.22%, 17.46%, 18.13%, 16.76%,且呈 逐年下降趋势( χ 2 趋势 = 10.02, P <0.01)。 8,9岁组儿童氟斑牙检出率各年度间比较,呈逐年下降的趋势( χ 2 趋势 值分别为 6.53, 4.54, P 值均<0.05)。水氟含量超标村儿童氟斑牙总检出率、轻度及以下、中度及以上检出率与水氟含量合格村比较,差异 有统计学意义( χ 2 值分别为 179.22,167.93,10.35, P 值均<0.01)。水氟含量超标病区村各年度间的氟斑牙检出率呈逐年 下降趋势( χ 2 趋势 =28.50, P <0.01)。市政供水、低氟井与除氟处理 3 种改水方式儿童氟斑牙检出率差异有统计学意义( χ 2 = 197.76, P <0.01)。市政供水各年度间儿童氟斑牙检出率呈逐年下降趋势( χ 2 趋势 = 12.16, P <0.01)。 结论 市政供水改水降 氟效果显著,其他改水方式仍有部分病区村水氟及儿童氟斑牙检出率未达标,应继续加强改水后水氟含量和儿童氟斑牙病 情监测。