High Prevalence Of Dental Fluorosis Research Articles

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.

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.

Fluoride in water, health implications and plant-based remediation strategies

Abstract The high prevalence of dental fluorosis and bone mineralization deficiency as a result of exposure to fluorides has increased in Kenya over the years due to consumption of water with elevated levels of fluoride. The World Health Organization (WHO) provides a guideline of 1.5 mg/L level of fluoride in drinking water. However, majority of studies carried out in Kenya over the last 40 plus years have indicated very high levels of fluoride in drinking water in various regions, with a prevalence in dental fluorosis observed in children and adults living in Rift valley and central regions due to basaltic and volcanic rocks. Unfortunately, this trend of fluoride-induced enamel changes has been observed in other regions such as Nairobi and Machakos which were originally presumed to contain low fluoride levels. This study sought to analyse the applicability of Maerua subcordata root powder (MSRP) in the removal of fluorides in borehole drinking water. Fresh Maerua subcordata roots were peeled to obtain the white flesh, chopped into small pieces, dried and ground into powder. The process parameters varied were; fluoride ion concentration [F−] (0–12 mg/L), adsorbent dosage (0–200 g/L) and equilibration time (30–240 min) [F−] were hence analysed before and after treatment using ion selective electrode (ISE) fluoride meter. Results indicated that MSRP is a viable plant in fluoride treatment with approximately 68% fluoride ion removal efficiency. An MSRP dosage of 200 g/L was found optimal in [F−] reduction while a 2 mg/L [F−] concentration recorded the highest reduction of [F−]. The optimal equilibration time was found to be 30 min. The results can be used to develop a low-cost column for treatment of high fluoride waters in rural areas using MSRP. Borehole samples were treated with MSRP using the optimized conditions; however their reduction levels were lower than the [F−] standards used. It is envisaged that with further modification and/or doping with zero-valent iron nanoparticles, it’s efficiency will be improved.

Geogenic enrichment of fluoride in groundwater of hard rock aquifer in fluorosis prevalent area of Balangir district, Odisha, India

Hydrogeochemical characterization of groundwater has been carried out in a hard rock aquifer from Balangir district, a fluorosis-affected area of Odisha, India with the aim of understanding the sources and processes controlling fluoride (F−) enrichment. A total of 37 groundwater (tube wells) and 7 surface water (pond) samples were collected during the pre-monsoon period. Groundwaters are mostly categorized as moderate to very hard water types with alkaline nature. The enhanced Na+ and HCO3− concentration in groundwater is mostly a result of silicate weathering. The F− concentration in groundwater ranged from 0.4 to 4.29 mg/l, with 38% of samples exceeded the drinking water limit (1.5 mg/l; as prescribed by the World Health Organization, 2011), in contrast to very low F− (<0.9 mg/l) in surface water. High F− concentrations in underlying granitic bedrocks (up to 700 mg/kg), which spatially corresponds to F− rich groundwater, suggest that lithological composition is the main control of F−. Fluoride-rich waters are mostly Na–HCO3 type, followed by mixed Na–Ca–HCO3 (Cl) type with Na+/Ca2+ ratio >1. The significant positive correlations of F− with Na+, HCO3−, and pH indicate that the weathering of sodium-rich silicate minerals and increase of pH mobilizes F− ion. Geochemical modeling indicates that the activity of F− in groundwater increased by precipitation of calcite, dolomite, and aragonite. Fluoride risk assessment indicates that 38% of groundwater samples can cause a high prevalence of dental fluorosis with children being at greater risk than adults. Henceforth, it is advisable to treat this contaminated groundwater before consumption or provide alternative drinking water to avoid further fluorosis risks in the concerned area.

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.

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.

THE PREVALENCE OF NON-CARIOUS TOOTH DEFECTS ASSOCIATED WITH INDUSTRIAL EXPOSURE IN RESIDENTS OF PENZA REGION (RUSSIA)

— Aim of the study: to assess the level of dental pathology in Penza Region (Russia) and estimate the impact of the industrial environment. Materials and methods: A clinical examination and analysis of the frequency of enamel erosion, fluorosis and hypoplasia, wedge-shaped defect and multiple enamel cracks were carried out among the main professional groups of the region's population — workers of the machine-building and timber processing industries in the Penza region. Results and Discussion. Among the residents of Penza region, the frequency of enamel erosion was 4.0%, pathological tooth wear — 7.1%, wedge-shaped defect — 6.1%, multiple enamel fractures — 11.1%. There is a high frequency of noncarious tooth defects that occur before teething. In patients working in the machine-building industry, a high frequency of pathological tooth wear was noted (24,5%); in workers of the timber processing industry, it was 2 times lower (12,6%), as well as a high frequency of wedge- shaped defects, enamel erosion and multiple enamel cracks — all this was 2–2.5 times higher compared to similar indicators in patients from agricultural populations. However, the prevalence of dental fluorosis and hypoplasia was almost the same as in the agricultural population. Conclusion: Penza region has a high prevalence of dental fluorosis and hypoplasia. At the same time, the influence of industrial environment on the incidence of various types of non-carious dental pathology in workers of machine-building and timber processing industries in Penza region was established.

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.

Fluorosis and infancy feeding relationship: an epidemiological study

Background: Dental fluorosis is considered mostly as an aesthetic issue that has an adverse impact on the children’s psychological health and self-esteem. The current study aimed to assess the prevalence of dental fluorosis and the association between using bottled water in infants’ formula and dental fluorosis risk factor in infancy among school children aged between 7 and 13 years in Riyadh city. Methodology: An epidemiological questionnaire-based study was carried out among students at primary public schools in Riyadh, Saudi Arabia, using a survey that was distributed to 389 primary public schools. Almost 201 students were examined using an oral diagnosis kit and an ordinary light provided by our college. The surveys were collected, and the data were analyzed using the Statistical Package for the Social Science program. Results: Out of the 201 school children who were aged 7-13 years, 124 (61.7%) had dental fluorosis, 77 (38.3%) were without fluorosis, and the fluorosis’ prevalence increased in the central incisors for 36 children (17.9%). The number of children (72) with fluorosis who used boiled bottled water with milk formula was higher than the number of children (42) with no fluorosis and who used boiled bottled water with milk formula.Conclusion: In the present study, children aged 7-13 years showed a higher prevalence of dental fluorosis (61.7%). The prevalence of dental fluorosis increased in the central incisors (36, 17.9 %), followed by the first permanent molars (31, 15.4 %), and in both (37, 18.4%). Mothers should use distilled/deionized water for reconstitution of infant formula to reduce fluoride intake.

Occurrence of Dental Anomalies in Colombian Patients with Special Needs

Objective: To determine the occurrence of dental anomalies in patients with special needs from Barranquilla, Colombia. Material and Methods: An observational, cross-sectional descriptive study with a sample of 59 patients chosen at convenience for 6 months during the course of 2017. With prior approval by experts, an instrument that identified dental anomalies was applied, followed by an institutional clinical history, intraoral clinical examination and final evaluation of the study variables, with descriptive statistics. Results: With regards to age ranges, 25% of subjects were between 14 to 17 years, and 19% between 22 to 25 years. The average age was 14 (± 7.9). No cases were found in the age range of 26 to 29 years. In terms of gender, males predominated with 78%. The anomaly that predominated was fluorosis (50.8%), followed by agenesis (23.7%). The syndrome and / or disorder with the highest frequency of dental anomalies was mental retardation with 39%, followed by behavioral disorders (22%) Conclusion: The frequency of dental anomalies in patients with special needs was evidenced, showing higher prevalence of dental fluorosis in patients with mental retardation, and a higher incidence in males; in the patients with syndromes and / or disorders who were observed, there were a few oral findings unrelated to dental anomalies.

Oral health-related quality of life among 12–15-year children suffering from dental fluorosis residing at endemic fluoride belt of Uttar Pradesh, India

Introduction: Dental fluorosis, a specific disturbance in tooth formation and an esthetic condition, is defined as a chronic fluoride-induced condition in which enamel development is disrupted, and the enamel is hypomineralized. There is potential for excessive exposure to fluorides to cause dental fluorosis, which may change the appearance of teeth and cause negative impacts on oral health-related quality of life (OHRQoL). Aim: The aim of the study was to assess the impact of dental fluorosis on the OHRQoL of 12–15-year-old children residing at an endemic belt of Uttar Pradesh. Materials and Methods: A cross-sectional survey was done with the sample of 220 children aged 12–15 years residing at endemic belt (5.35 ppm f/L) of Uttar Pradesh. Dental fluorosis was measured using Dean's fluorosis index-modified (1942) and quality of life of children was assessed with the help of child's perception questionnaire. Descriptive statistics, ANOVA, and Pearson's correlation coefficient test were used for analysis. Results: The mean overall OHRQoL score for children with questionable fluorosis was 73.9 ± 7.51 and with very mild fluorosis was 81.9 ± 6.88. Statistically significant difference was found across self-assessment (P = 0.012), oral symptoms (P = 0.018), functional limitation (P < 0.001), and spare time activity (P = 0.007) based on dental fluorosis status. Conclusion: This study concluded that there was a high prevalence of dental fluorosis in this area and also dental fluorosis has a greater effect as well as the impact on the OHRQoL.

High prevalence of dental fluorosis among schoolchildren in three villages in Vavuniya District: an observational study

Studies of groundwater sources in Sri Lanka show that in the entire Northern, North Central, Uva and Eastern Provinces, and also in a large area of the North Western Province, groundwater fluoride content is within the range 1.0 mg/l and 3.0 mg/l. The WHO recommended safe upper limit of fluoride for drinking water is 1.5 mg/l. Our objective was to determine the prevalence and degree of dental fluorosis in a cohort of schoolchildren in Sinnasippikulam in Vavuniya District, the fluoride content in their serum and urine, and fluoride levels in drinking water in dug wells of the area. Invitations in Tamil and Sinhala were sent to all households by courier. Demographic information and oral hygiene practices of 307 responsive children were recorded by interviewing children and their mothers. Detailed clinical examinations were performed according to WHO basic methods, with some modifications. Assessment of dental fluorosis in the children was done according to Dean’s Index codes and criteria. We found drinking water sources (dug wells) in Sinnasippikulam (n= 82) to have a high mean concentration of fluoride ( x̄ 1.58+ 0.69 mg/l). Of 307 children examined, 224 (72.9%) had clinical evidence of dental fluorosis of varying degrees of severity. The mean fluoride level in serum of schoolchildren was 0.198 mg/l (SD + 0.074; S.E.M. 0.013), and in their urine, 1.44 mg/l (SD + 0.59; SEM 0.11). Our results show that harmful levels of fluoride are extremely common in groundwater sources in the study area, and consequently, dental fluorosis is highly endemic (72.9%) among resident schoolchildren.

Factors affecting dental fluorosis in low socioeconomic status children in Mexico.

To assess the association between dental fluorosis and maternal education in schoolchildren of medium and low socioeconomic status in a low income region of Mexico. Cross-sectional study. Public schools in the south-central region of Oaxaca, Mexico where the mean fluoride water concentration was 1.01 mg/L (SD 0.21; range 0.71-1.40). Fluoridated salt (200mgF/kg) was available in the region. 794 schoolchildren. To identify the socioeconomic status of the participants, the Bronfman index was used. Dental fluorosis was assessed applying the Thysltrup-Fejerskov Index, (TF). The children's mean age was 10.4 (SD1.2) years. The prevalence of dental fluorosis (TF⟩0) was high 95.7% and 45.2% of the children showed dental fluorosis of TF≥4. The percentage of children showing TF≥4 was 48.8% where their mothers' education was ⟨6 years of schooling compared to 36.7% among other children (p⟨0.001). The multinomial logistic regression model using as base outcome category TF≤2 showed that severe forms of fluorosis (TF≥4) were associated with the consumption of boiled water, (OR= 1.65, p=0.039) of fluoridated salt (OR= 2.61 p=0.001), high brushing frequency (OR=3.12, p=0.001) and lower maternal education (OR=1.71, p=0.007). A high prevalence of dental fluorosis was observed in the study region. An unequal burden of fluorosis in aesthetically objectionable categories was found in children exposed to several sources of fluoride and whose mother had lower educational level.

High prevalence of dental fluorosis among adolescents is a growing concern: a school based cross-sectional study from Southern India

BackgroundFluorosis, caused by ingestion of excessive amount of fluoride through food or water, is a major public health problem in India. This study was undertaken to quantify the dental fluorosis burden among school going adolescents and to find factors associated with dental fluorosis in Kolar taluka, Karnataka, India.MethodsA total of 1026 high school adolescents (12–17 years) were enrolled from different schools selected by stratified sampling method. Dental examination was done to record Dean’s fluorosis index, and socio-demographic, food consumption and oral hygiene data were recorded using a pre-tested structured questionnaire. Fluoride content was measured using Orion apparatus, and Community Fluorosis Index (CFI) was calculated from drinking water samples from various drinking sources. Multivariable analysis with generalized estimating equation (GEE) regression model was used to explore the factors associated with dental fluorosis.ResultAmong 1026 enrolled students, 64.3% of adolescents were detected with dental fluorosis; more than 50% had either severe or moderate fluorosis according to the Dean’s Fluorosis Index and Community Fluorosis Index (CFI). The majority of affected students were from government schools. The significantly associated factors with dental fluorosis were living in study area for more than 5 years and studying in government school. A strong positive correlation between the amount of fluoride content in drinking water sample collected and CFI was observed (rho = 0.570).ConclusionPrevalence of dental fluorosis was considerably high, affecting nearly two-thirds of the students, and mainly in government schools and long-term residents of the area. Health education and community awareness for preventing fluorosis, apart from setting-up defluoridation plants or training for home based defluoridation techniques in study villages, should be considered.

Is there an association between the presence of dental fluorosis and dental trauma amongst school children?

Our objective was to evaluate whether there is an association with the different levels of dental fluorosis and the presence of dental trauma amongst school children. A transversal study was conducted amongst school children from the age of 12. Dental examinations were conducted by 24 well trained and fully qualified dental surgeons. Data was collected from 36 randomly selected public schools amongst 89 schools in a municipality. The criteria used to diagnose dental fluorosis was based on the Dean's fluorosis Index and for diagnosing dental trauma we looked for clinical signs of crown fractures and dental avulsions. Multiple descriptive analysis, which was bivariate, was carried out. Amongst the 2,755 school children that took part in the study 1,089 (39.6%) were diagnosed with dental fluorosis and 106 (3.8%) had one tooth or more with dental trauma. We noted a high prevalence of dental fluorosis, independent of the level of severity, amongst individuals with one tooth or more who had dental trauma. This association was even more evident where there were severely high levels of fluorosis. We also noted that the presence of fluorosis was greater amongst those that actively paid more attention to discoloration on their teeth and who received treatment from a dental professional at their schools. Nevertheless dental fluorosis was associated with the presence of dental trauma, independent of its severity.

"Borderline" fluorotic region in Serbia: correlations among fluoride in drinking water, biomarkers of exposure and dental fluorosis in schoolchildren.

This study explores relation between dental fluorosis occurrence in schoolchildren, residents of Ritopek, a small local community near Belgrade, and fluoride exposure via drinking water. Additionally, fluoride levels were determined in children's urine and hair samples, and efforts were made to correlate them with dental fluorosis. Dental fluorosis and caries prevalence were examined in a total of 52 schoolchildren aged 7-15years (29 boys and 23 girls). Fluoride levels in three types of samples were analyzed using composite fluoride ion-selective electrode. Results showed high prevalence of dental fluorosis (34.6%) and low prevalence of dental caries (23.1%, mean DMFT 0.96) among children exposed to wide range of water fluoride levels (0.11-4.14mg/L, n=27). About 11% of water samples exceeded 1.5mg/L, a drinking-water quality guideline value for fluoride given by the World Health Organization (2006). Fluoride levels in urine and hair samples ranged between 0.07-2.59 (n=48) and 1.07-19.83mg/L (n=33), respectively. Severity of dental fluorosis was positively and linearly correlated with fluoride levels in drinking water (r=0.79). Fluoride levels in urine and hair were strongly and positively correlated with levels in drinking water (r=0.92 and 0.94, respectively). Fluoride levels in hair samples appeared to be a potentially promising biomarker of fluoride intake via drinking water on one hand, and severity of dental fluorosis on the other hand. Based on community fluorosis index value of 0.58, dental fluorosis revealed in Ritopek can be considered as "borderline" public health issue.

Total daily fluoride intake and the relative contributions of foods, drinks and toothpaste by 3- to 4-year-old children in the Gaza Strip - Palestine.

Children in Gaza Strip suffer from a high prevalence of dental fluorosis. To estimate and compare total daily fluoride (F) intake (TDFI) and investigate the relative contributions of different sources of F to TDFI, in 3- to 4-year-old children in Gaza Strip, exposed to low (<0.7 mg/litre), moderate (0.7-1.2 mg/litre) or high (>1.2 mg/litre) F concentrations in tap water. A 3-day food diary and samples of tap water, drinks, foods, toothpastes and toothbrushing expectorate were collected from 216 children receiving low (n = 81), moderate (n = 72) or high (n = 63) F concentrations in tap water. F concentration of samples was analysed using an F-ion-selective electrode. TDFI from all sources was estimated. Data were analysed by anova and Tukey's test. The mean (±SD) F concentration in low, moderate and high F tap waters was 0.21(±0.15), 0.91(±0.13) and 1.71(±0.35) mg/litre, respectively. Mean (±SD) TDFI was 0.02(±0.01), 0.04(±0.01) and 0.05(±0.03) mg/kg bw/day, respectively (P < 0.0001). Foods made the largest contribution (63.9%) to TDFI. Total daily fluoride (F) intake increased as F concentration in tap water increased. Foods were the primary source of F. Programmes for monitoring fluoride expose should consider the fluoride concentration of water used for food preparation and local dietary behaviours.

Knowledge and Public Perception of Dental Fluorosis in Children Living in Palestine

Rare knowledge of dental fluorosis increases the risk of having it. Knowledge and public perception towards dental fluorosis is important factor in public health interventions and were not studied before in Palestine or Arabic countries. Objective: To study the knowledge and the public perception of dental fluorosis among Palestinian children (aged 12-18 years old) and their mothers. Methods: A cross-sectional study recruited stratified cluster random sample of 350 children aged 12-18 years and their mothers. Data of knowledge and public perception of dental fluorosis was collected through interview questionnaires with children and their mothers. Ethical approvals followed the guidelines of the Helsinki Declaration. Results: Most children (99.4%) and all mothers did not know what dental fluorosis is and had not received information about it. The majority (99.7%) did not know dental fluorosis’s causes or prevention. Concerning the public perception of dental fluorosis, 87.7% of the children and 88.6% of mothers did not have a problem with fluorosed teeth colour. Although all respondents felt that others with fluorosed teeth did not have good appearance, 96.9% of children did not hide their smile. Most of the mothers (99.7%) thought that the government should find an immediate solution for this problem. Conclusions: Lack of knowledge about dental fluorosis increases the risk of having dental fluorosis in Palestine and Arabic countries. This suggests the importance of developing immediate preventive intervention for dental fluorosis. Suffering from unrest political circumstances and having high prevalence of dental fluorosis for decades could diminish the negative impact of having coloured teeth on children’s perception and personality.

Dietary behaviours and dental fluorosis among Gaza Strip children

A high prevalence of dental fluorosis has been identified among children in the Gaza Strip. This study aimed to determine the history of breastfeeding and dietary behaviours among children in the Gaza Strip and to examine potential associations with the prevalence and severity of dental fluorosis. A cross-sectional study recruited a stratified cluster random sample of 350 children aged 12-18 years and their mothers. Data about dietary behaviours in the first 7 years of life were collected by interview questionnaire. Dental fluorosis was determined using the Thyllstrup-Fejerskov index. A majority of children were breastfed exclusively in the first 6 months (82.9%) but 98.1% were given tea in the first year of life. The prevalence of dental fluorosis was 78.0%. Both intake of animal proteins and plant proteins were negatively associated with the prevalence and severity of dental fluorosis. Further studies to investigate fluoride intake is required to plan preventive interventions.

Prevalence and severity of dental fluorosis and genu valgum among school children in rural field practice area of a medical college

ObjectiveTo assess the prevalence of dental fluorosis and genu valgum among school children in the above mentioned area. MethodsA Cross sectional study was conducted on school children of 1st to 7th standard in the rural field practice area of a medical college. Children were examined for dental fluorosis and genu valgum. Drinking water samples were also tested for fluoride levels. Proportion of children with dental fluorosis and genu valgum were calculated by severity, age and sex. Statistical significance was analyzed by using Chisquare test or Mc Nemar test. ResultsOf the 1 544 children examined 42.1% and 8.4% had dental fluorosis and genu valgum respectively. Prevalence of very mild dental fluorosis and moderate grade genu valgum were high compared to other categories. Prevalence rates increased with the age (P<0.05) and was more among girls (45.2%) as compared to boys (39.1%) (P<0.05). Of the 26 water samples analysed, 18 samples (69.2%) revealed the fluoride content above the permissible limit. ConclusionsFindings of the present study reveal a high prevalence of dental fluorosis and genu valgum amongst school children and high fluoride level in the water. Further studies are needed to evaluate the other risk factors and reasons for gender differences.