Prevalence Of Enamel Fluorosis Research Articles

Effect of Fluoride on Oral Health Status Among General Population Residing in High- and Low-Level Fluoride Blocks in Erode District, Tamil Nadu, India: A Cross-Sectional Study.

The aim of this study was to evaluate the fluoride levels in groundwater and their effect on oral health status among the general population of Erode district, Tamil Nadu, India. A descriptive cross-sectional study was conducted among the general population of index age groups 5, 12, 15, 35-44, and 65-74 years. A total of 540 subjects participated in the study. High fluoride blocks of Erode district were selected based on the Central Ground Water Board (CGWB), Ministry of Jal Shakti, Department of Water Resources, River Development and Ganga Rejuvenation, Government of India, 2010, and the low fluoride were taken from the Groundwater Year Book (GWYB) of Tamil Nadu and UT of Puducherry, 2018. The Oral Health Assessment Form 2013 (adult and children) of the World Health Organization (WHO) was used to assess dental caries and enamel fluorosis. Clinical examination was performed using a mouth mirror and explorer under natural illumination by a single examiner. Data obtained were processed and analyzed using IBM SPSS Statistics version 26. A Chi-squared test was employed to analyze the difference between the high and low fluoride blocks. A P value of 0.05 was set to be statistically significant. The current study had a contrary finding with the CGWB on water quality analysis of fluoride levels in drinking water for high fluoride block, Ammapet (1.12 ppm) and Anthiyur (1.08 ppm). The prevalence of enamel fluorosis in high fluoride block Ammapet was 44.4% and Anthiyur was 54.8%. The prevalence of dental caries in high fluoride block Ammapet was 45.9% and in Anthiyur was 43%. The prevalence of enamel fluorosis in low fluoride block Bhavanisagar was 27.4% and in Gobichettipalayam was 28.2%. The prevalence of dental caries in low fluoride block Bhavanisagar was 61.5%, and in Gobichettipalayam was 54.8%. This study's contradictory finding emphasizes the importance of drinking water; sanitation staff should monitor and report water fluoridation data on a monthly basis in accordance with the Water Fluoridation Reporting System, and CGWB should plan and organize a team for the upgradation of water quality in India. The National Program for Prevention and Control of Dental Diseases should look on to the endemic areas for the prevention of dental fluorosis, which should be assessed, implemented, and monitored by the public health dentist who should be recruited as oral health program officers in both central and state governments.

A cost-effectiveness analysis of community water fluoridation for schoolchildren

BackgroundCommunity water fluoridation (CWF), the controlled addition of fluoride to the water supply for the prevention of dental caries (tooth decay), is considered a safe and effective public health intervention. The Republic of Ireland (Ireland) is the only country in Europe with a legislative mandate for the fluoridation of the public water supply, a key component of its oral health policy. However, more recently, there has been an increase in public concern around the relevance of the intervention given the current environment of multiple fluoride sources and a reported increase in the prevalence of enamel fluorosis. The aim of this economic analysis is to provide evidence to inform policy decisions on whether the continued public investment in community water fluoridation remains justified under these altered circumstances.MethodsFollowing traditional methods of economic evaluation and using epidemiological data from a representative sample of 5-, 8-, and 12-year-old schoolchildren, this cost-effectiveness analysis, conducted from the health-payer perspective, compared the incremental costs and consequences associated with the CWF intervention to no intervention for schoolchildren living in Ireland in 2017. A probabilistic model was developed to simulate the potential lifetime treatment savings associated with the schoolchildren’s exposure to the intervention for one year.ResultsIn 2017, approximately 71% of people living in Ireland had access to a publicly provided fluoridated water supply at an average per capita cost to the state of €2.15. The total cost of CWF provision to 5-, 8-, and 12-year-old schoolchildren (n = 148,910) was estimated at €320,664, and the incremental cost per decayed, missing, or filled tooth (d3vcmft/D3vcMFT) prevented was calculated at €14.09. The potential annual lifetime treatment savings associated with caries prevented for this cohort was estimated at €2.95 million. When the potential treatment savings were included in the analysis, the incremental cost per d3vcmft/D3vcMFT prevented was -€115.67, representing a cost-saving to the health-payer and a positive return on investment. The results of the analysis were robust to both deterministic and probability sensitivity analyses.ConclusionDespite current access to numerous fluoride sources and a reported increase in the prevalence of enamel fluorosis, CWF remains a cost-effective public health intervention for Irish schoolchildren.

Prevalence of Enamel Fluorosis in Libyan Children-A Cross Sectional Study

Fluorosis is caused by hypo mineralization in the enamel due to increased fluoride ingestion during early childhood [1-3]. A considerable amount of evidence has been reported over the years, which has shown that presence of fluoride ions at up to one part per million in public water supply has reduced the prevalence of teeth decay with minimal chance of dental fluorosis. The WHO recognized these facts by its resolution in 1969 [4] and 1975 [5], which stated that water fluoridation, where applicable, should be the cornerstone of any national policy of caries prevention. Optimally fluoridated water has proven to be the most effective preventive measure against dental caries

Fluoride And Caring for Children’s Teeth (FACCT): Clinical Fieldwork Protocol

Background: The reduction in dental caries seen between Irish national surveys of children’s oral health in 1984 and 2002 was accompanied by an increase in the prevalence of enamel fluorosis. To minimise the risk of enamel fluorosis in Irish children, in 2007, the level of fluoride in drinking water was reduced from 0.8-1.0 ppm to 0.6-0.8 ppm fluoride. Recommendations on the use of fluoride toothpastes in young children were issued in 2002. Fluoride and Caring for Children’s Teeth (FACCT) is a collaborative project between the Oral Health Services Research Centre, University College Cork and the Health Service Executive dental service, with funding from the Health Research Board. Aim: FACCT aims to evaluate the impact and the outcome of the change in community water fluoridation (CWF) policy (2007) on dental caries and enamel fluorosis in Irish schoolchildren, while also considering the change in policy on the use of fluoride toothpastes (2002). Methods/Design: A cross-sectional study with nested longitudinal study will be conducted in school year (SY) 2013-2014 by trained and calibrated dental examiners in primary schools in counties Dublin, Cork and Kerry for a representative sample of children born either prior to or post policy changes; age 12 (born 2001) and age 5, (born 2008). Five-year-olds will be followed-up when they are 8-year-olds (SY 2016-2017). The main explanatory variable will be fluoridation status of the children (lifetime exposure to CWF yes/no). Information about other explanatory variables will be collected via parent (of 5-, 8- and 12-year-olds) and child completed (8- and 12-year-olds only) questionnaires. The main outcomes will be dental caries (dmf/DMF Index), enamel fluorosis (Dean’s Index) and oral health-related quality of life (OHRQoL). Multivariate regression analyses will be used to determine the impact and outcome of the change in CWF policy on oral health outcomes controlling for other explanatory variables.

Fluoride And Caring for Children's Teeth (FACCT): Clinical Fieldwork Protocol.

Background: The reduction in dental caries seen between Irish national surveys of children's oral health in 1984 and 2002 was accompanied by an increase in the prevalence of enamel fluorosis. To minimise the risk of enamel fluorosis in Irish children, in 2007, the level of fluoride in drinking water was reduced from 0.8-1.0 ppm to 0.6-0.8 ppm fluoride. Recommendations on the use of fluoride toothpastes in young children were issued in 2002. Fluoride and Caring for Children's Teeth (FACCT) is a collaborative project between the Oral Health Services Research Centre, University College Cork and the Health Service Executive dental service, with funding from the Health Research Board. Aim: FACCT aims to evaluate the impact and the outcome of the change in community water fluoridation (CWF) policy (2007) on dental caries and enamel fluorosis in Irish schoolchildren, while also considering the change in policy on the use of fluoride toothpastes (2002). Methods/Design: A cross-sectional study with nested longitudinal study will be conducted in school year (SY) 2013-2014 by trained and calibrated dental examiners in primary schools in counties Dublin, Cork and Kerry for a representative sample of children born either prior to or post policy changes; age 12 (born 2001) and age 5, (born 2008). Five-year-olds will be followed-up when they are 8-year-olds (SY 2016-2017). The main explanatory variable will be fluoridation status of the children (lifetime exposure to CWF yes/no). Information about other explanatory variables will be collected via parent (of 5-, 8- and 12-year-olds) and child completed (8- and 12-year-olds only) questionnaires. The main outcomes will be dental caries (dmf/DMF Index), enamel fluorosis (Dean's Index) and oral health-related quality of life (OHRQoL). Multivariate regression analyses will be used to determine the impact and outcome of the change in CWF policy on oral health outcomes controlling for other explanatory variables.

Correction to: Geochemical characterization of fluoride in water, table salt, active sediment, rock and soil samples, and its possible relationship with the prevalence of enamel fluorosis in children in four municipalities of the department of Huila (Colombia)

Correction to: Geochemical characterization of fluoride in water, table salt, active sediment, rock and soil samples, and its possible relationship with the prevalence of enamel fluorosis in children in four municipalities of the department of Huila (Colombia)

Geochemical characterization of fluoride in water, table salt, active sediment, rock and soil samples, and its possible relationship with the prevalence of enamel fluorosis in children in four municipalities of the department of Huila (Colombia).

Fluoride is an element that affects teeth and bone formation in animals and humans. Though the use of systemic fluoride is an evidence-based caries preventive measure, excessive ingestion can impair tooth development, mainly the mineralization of tooth enamel, leading to a condition known as enamel fluorosis. In this study, we investigated the geochemical characterization of fluoride in water, table salt, active sediment, rock and soil samples in four endemic enamel fluorosis sentinel municipalities of the department of Huila, Colombia (Pitalito, Altamira, El Agrado and Rivera), and its possible relationship with the prevalence of enamel fluorosis in children. The concentration of fluoride in drinking water, table salt, active sediment, rock, and soil was evaluated by means of an ion selective electrode and the geochemical analyses were performed using X-ray fluorescence. Geochemical analysis revealed fluoride concentrations under 15mg/kg in active sediment, rock and soil samples, not indicative of a significant delivery to the watersheds studied. The concentration of fluoride in table salt was found to be under the inferior limit (less than 180μg/g) established by the Colombian regulations. Likewise, exposure doses for fluoride water intake did not exceed the recommended total dose for all ages from 6months. Although the evidence does not point out at rocks, soils, fluoride-bearing minerals, fluoridated salt and water, the hypothesis of these elements as responsible of the current prevalence of enamel fluorosis cannot be discarded since, aqueducts might have undergone significant changes overtime.

Enamel Fluorosis Prevalence after a 7‐year Interruption in Water Fluoridation in Jaú, São Paulo, Brazil

This paper analyzes the impact of a 7-year interruption in water fluoridation on the prevalence of enamel fluorosis in Jaú, state of São Paulo, Brazil. Fluorosis prevalence (TF index) was evaluated in permanent maxillary central incisors of children (9-14 years old) that were 36 (n=81; cohort -36), 27 (n=81; cohort -27), and 18 months old (+/-1 month; n=89; cohort -18) in October 1991, when the breakstarted, and 18months old(+/-1 month;n=70; cohort 18) after that date. Children brushed their teeth prior to examination, which was conducted under natural light by three calibrated examiners (agreement 87.8-93.8%, kappa 0.72-0.85). The fluorosis prevalence (TF> or =1) was 7.41 percent, 3.70 percent, 7.87 percent, and 18.57 percent, respectively, for cohorts -36, -27, -18, and 18. The difference between cohort 18 and the other groups was statistically significant (Kruskall-Wallis test, P=.05). These results suggest that the fluoridated water is not an important risk factor for enamel fluorosis, since the prevalence of enamel fluorosis was low in the cohorts -36, -27, and -18 when fluoridated water was used.

Prevalence and trends in enamel fluorosis in the United States from the 1930s to the 1980s

The National Survey of Dental Caries in U.S. School Children: 1986-1987 conducted by the National Institute of Dental Research, or NIDR, remains the only source of national data about the prevalence of enamel fluorosis. The authors analyze these data and describe changes in the prevalence of enamel fluorosis since the 1930s, as reported by H. Trendley Dean. A sample of children comparable to those described in the 1930s was selected from the NIDR data set among children living in households served by public water systems during the child's first eight years of life. The type of water system (that is, natural, optimal and suboptimal) for each household had been recorded in the NIDR data set using data from the 1985 U.S. Fluoridation Census. The NIDR data set included information about the children's history of fluoride exposure obtained from parents. In the 1986-1987 period, the prevalence of enamel fluorosis (ranging from very mild to severe) was 37.8 percent among children living in residences with natural fluoride (0.7 to 4.0 parts per million fluoride ions, or F-), 25.8 percent in the optimal fluoride group (0.7 to 1.2 ppm F- and 15.5 percent in the suboptimal fluoride group (< 0.7 ppm F-). The largest increase in fluorosis prevalence from the 1930s to the 1980s was in the suboptimal fluoride group (6.5 to 15.5 percent). Exposure to multiple sources of fluoride may explain the increase in enamel fluorosis from the 1930s to the 1980s. The exposure to fluoride from sources such as dietary supplements has decreased since the 1980s because of reductions in the recommended dosage, but these changes occurred too late to have an effect on the study cohort. Evidence of simultaneous use of systemic fluorides indicates the need to reinforce guidelines for the appropriate use of fluorides and promote research on measuring total fluoride exposure.

Fluoride intake and prevalence of dental fluorosis: trends in fluoride intake with special attention to infants.

Although the predominant beneficial effect of fluoride occurs locally in the mouth, the adverse effect, dental fluorosis, occurs by the systemic route. The caries attack rate in industrialized countries, including the United States and Canada, has decreased dramatically over the past 40 years. However, the prevalence of dental fluorosis in the United States has increased during the last 30 years both in communities with fluoridated water and in communities with nonfluoridated water. Dental fluorosis is closely associated with fluoride intake during the period of tooth development. We reviewed the major changes in infant feeding practices that have occurred since 1930 and the changes in fluoride intakes by infants and young children associated with changes in feeding practices. Based on this review, we conclude that fluoride intakes of infants and children have shown a rather steady increase since 1930, are likely to continue to increase, and will be associated with further increase in the prevalence of enamel fluorosis unless intervention measures are instituted. We believe the most important measures that should be undertaken are (1) use, when feasible, of water low in fluoride for dilution of infant formulas; (2) adult supervision of toothbrushing by children younger than 5 years of age; and (3) changes in recommendations for administration of fluoride supplements so that such supplements are not given to infants and more stringent criteria are applied for administration to children.

RISK OF ENAMEL FLUOROSIS IN NONFLUORIDATED AND OPTIMALLY FLUORIDATED POPULATIONS: CONSIDERATIONS FOR THE DENTAL PROFESSIONAL

Few studies have evaluated the impact of specific fluoride sources on the prevalence of enamel fluorosis in the population. The author conducted research to determine attributable risk percent estimates for mild-to-moderate enamel fluorosis in two populations of middle-school-aged children. The author recruited two groups of children 10 to 14 years of age. One group of 429 had grown up in nonfluoridated communities; the other group of 234 had grown up in optimally fluoridated communities. Trained examiners measured enamel fluorosis using the Fluorosis Risk Index and measured early childhood fluoride exposure using a questionnaire completed by the parent. The author then calculated attributable risk percent estimates, or the proportion of cases of mild-to-moderate enamel fluorosis associated with exposure to specific early fluoride sources, based on logistic regression models. In the nonfluoridated study sample, sixty-five percent of the enamel fluorosis cases were attributed to fluoride supplementation under the pre-1994 protocol. An additional 34 percent were explained by the children having brushed more than once per day during the first two years of life. In the optimally fluoridated study sample, 68 percent of the enamel fluorosis cases were explained by the children using more than a pea-sized amount of toothpaste during the first year of life, 13 percent by having been inappropriately given a fluoride supplement, and 9 percent by the use of infant formula in the form of a powdered concentrate. Enamel fluorosis in the nonfluoridated study sample was attributed to fluoride supplementation under the pre-1994 protocol and early toothbrushing behaviors. Enamel fluorosis in the optimally fluoridated study sample was attributed to early toothbrushing behaviors, inappropriate fluoride supplementation and the use of infant formula in the form of a powdered concentrate. By advising parents about the best early use of fluoride agents, health professionals play an important role in reducing the prevalence of clinically noticeable enamel fluorosis.

Caries experience and fluorosis prevalence in Chilean children from different socio-economic status.

Caries experience and enamel fluorosis prevalence in 8-year-old children belonging to different socio-economic classes were determined in two Chilean twin cities that are served by optimally fluoridated community water from the same waterworks facility. Low socio-economic status (LSES) children had a higher mean dmft and DMFT indices (P < 0.001) than high socioeconomic status (HSES) children. Prevalence of enamel fluorosis in the permanent teeth of LSES children was 0.79, significantly higher (chi 2 = 9.0; P < 0.003) than the value 0.59 found in HSES children. The proportion of Dean's scores 2, 3, 4 and 5 in first molars, mandibular and maxillary incisors in LSES children was higher than in HSES children (P < 0.001). Differences in prevalence and severity of enamel fluorosis between both groups are tentatively attributed to a different pattern of tap water and tea consumption at pre-school ages. Suggestions are advanced to minimize the undesirable prevalence and severity of enamel fluorosis.