Prevalence of Dental Fluorosis amongst Young Adults and Adolescents in Chennai
Anisha A Mahtani1, Arthi Balasubramaniam2*, Ravindrakumar Jain3
1 Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Senior Lecturer, Department of Public Health Dentistry, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
3 Reader, Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
*Corresponding Author
Arthi Balasubramaniam,
Senior Lecturer, Department of Public Health Dentistry, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai
600077, Tamil Nadu, India.
Tel: 9894977838
E-mail: arthib.sdc@saveetha.com
Received: July 30, 2021; Accepted: August 11, 2021; Published: August 18, 2021
Citation:Anisha A Mahtani, Arthi Balasubramaniam, Ravindrakumar Jain. Prevalence of Dental Fluorosis amongst Young Adults and Adolescents in Chennai. Int J Dentistry Oral Sci. 2021;8(8):3990-3994. doi: dx.doi.org/10.19070/2377-8075-21000815
Copyright: Arthi Balasubramaniam©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Many studies have been conducted to evaluate the prevalence of dental fluorosis in different states and countries. The purpose of this study is to evaluate the prevalence of dental fluorosis amongst young adults and adolescents in Chennai. In this retrospective study, case records of 564 patients of all ages who were diagnosed with dental fluorosis upon reporting to the University hospital in Chennai were reviewed. About 90 patient records of age group 15-20 years (adolescents) and 21-25 years (adults) were retrieved and analysed. Descriptive statistics and tests of association were done at a p value < 0.05. The results revealed the prevalence of dental fluorosis in adolescents was 4.07% and 11.8% amongst young adults. The study found no significant association between the age and prevalence of dental fluorosis (p=0.998) or between gender and prevalence of dental fluorosis (p=0.386). Age and gender has no influence on prevalence of dental fluorosis.
2.Introduction
3.Conclusion
4.References
Keywords
Adolescents; Dean’s Fluorosis Index; Dental Fluorosis; Young Adults.
Introduction
Dental fluorosis is defined as the hypomineralization of enamel
that occurs due to the ingestion of excessive levels of fluoride
during enamel formation. Drinking water is a major source of
fluoride in India. It affects the population of 20 states in India
[1] and about 62 million Indians suffer from dental, skeletal and
non-skeletal fluorosis. Fluorosis is endemic in most of the states
in India due to its tropical climate. Dental fluorosis requires aesthetic
treatment since it affects the quality of life. In mild cases of
fluorosis, tooth bleaching can be done, in moderate cases, enamel
microabrasion is required and in severe cases, composite fillings,
micro abrasion, crowns and veneers can be used [2-7].
Previous researchers found that the source of water till eight years
of age was significantly associated with the prevalence of dental
fluorosis and adolescents who drank water from a hand pump
were more prone [8]. Prevalence of dental fluorosis in Kerala [9],
Gujarat [10], Udaipur [11] and Haryana [12] were found to be 16.8
%, 17.7%, 36.3% and 92.7% respectively. In Greater Noida [13]
prevalence of fluorosis was 21% but the very mild form of dental
fluorosis was more prevalent in adolescents with 27.6%.
In a study to assess the groundwater fluoride concentration in
Kanchipuram,Tamil Nadu, it was found that the fluoride concentration
ranged between 0.05-1.04 mg/l. In Madurai, Tamil Nadu,
fluoride contents in all samples ranged between 0.12-1.2 mg/l,
which is less than the optimum range of 1.5 mg/L, as recommended
by WHO. Hence, fluoride contents in all the samples exhibit
their suitability for drinking [14-16]. But districts in Tamil
Nadu such as Salem, Dharmapuri and Krishnagiri have >3ppm
of fluoride in drinking water. Previously our team has a rich experience
in working on various research projects across multiple
disciplines [17-31]. Now the growing trend in this area motivated
us to pursue this project.
Since existing studies show a high prevalence of fluorosis in other
states in India, we evaluate the prevalence of fluorosis among
adolescents and young adults in Chennai.
Materials and Methods
Study design and Study setting:
The present study was conducted in the author’s University hospital
in Chennai to evaluate the prevalence of dental fluorosis
amongst young adults and adolescents from June 2019 to March
2020. The retrospective study was done by reviewing 86,000 patient
records with signed informed consent from University hospital.
Permission:
Prior permission was obtained from the University to utilize the
data of case records for data analysis.
Sampling:
Of 86,000 case records, 564 consecutive case records of patients
with dental fluorosis were retrieved. No gender restriction was
placed. On subjecting to selection criteria about 90 case records
of patients of age group 15-20 years and 21-25 years were sorted.
An effort was taken to verify dental fluorosis using clinical photographs.
The study contained regional data generalised to the
South Indian population.
Data Collection:
The retrospective study involved 90 patients of 15-25 years who
were diagnosed with dental fluorosis. The data on severity of dental
fluorosis was measured using Dean’s Fluorosis Index upon reporting
to the dental hospital by Trendley H Dean in 1942. They
were categorised into Questionable (0.5), Very mild (1), Mild (2),
Moderate (3), Severe (4). A calibrated single examiner reviewed
the score and tabulated them. Data on age and gender were retrieved
from the case records.
Statistical Analysis:
The collected data was validated, tabulated and analysed with
Statistical Package for Social Sciences for Windows, version 20.0
(SPSS Inc., Chicago, IL, USA). Frequency distribution of severity
of dental fluorosis among adults and adolescents was calculated.
Pearson’s chi-square association was used to test associations between
age, gender and dental fluorosis. P value < 0.05 was considered
statistically significant.
Results & Discussion
The current study was conducted to evaluate the prevalence of
dental fluorosis among adolescents and young adults in Chennai
from June 2019 to March 2020. Among the 90 case records of
patients 74.4% were adults of age group 21-25 years and 25.5%
were adolescents of age group 15-20 years [Figure 1]. Males
(71.1%) were more predominant in the study population than females
(28.9%) [Figure 2].
The prevalence of dental fluorosis in adults was found to be
11.8% and 4.07% in adolescents. It was found to be higher among
the young adults compared to adolescents. This statement was
contradicted by Shruti MN [32] who found the prevalence to be
higher in children and adolescents rather than adults.
The prevalence of the severity of fluorosis, based on the Deans
Fluorosis Index in the 15-20 year age group was 8.6% with Questionable
(Grade 0.5); 17.3% with very mild fluorosis (Grade 1);
47.8% with mild fluorosis (Grade 2); 21.7% with moderate fluorosis
(Grade 3) and 4.3% of patients with severe fluorosis (Grade
4). In the 21-25 year age group the prevalence was 7.4% with
Questionable (Grade 0.5); 14.9% with very mild fluorosis (Grade
1); 50.7% with mild fluorosis (Grade 2); 22.3% with moderate
fluorosis (Grade 3) and 4.4% of patients with severe fluorosis
(Grade 4). The present study did not find a statistically significant
association between the prevalence of dental fluorosis and age of the patients (p=0.998) [Figure 3] This statement is supported by
Arif et al., [33]who found that the prevalence varied significantly
with age. However, a study conducted by Sukhabogi et al [(34)]
disagreed with this statement.
In accordance with gender, overall, 71.1% of males and 28.9%
of females were diagnosed with dental fluorosis. The prevalence
of the severity of fluorosis, based on the Deans Fluorosis Index
amongst the males was 9.3% with Questionable (Grade 0.5);
12.5% with very mild fluorosis (Grade 1); 51.5% with mild fluorosis
(Grade 2); 20.3% with moderate fluorosis (Grade 3) and
6.2% of patients with severe fluorosis (Grade 4). Among the females,
the prevalence was 3.8% with Questionable (Grade 0.5);
23% with very mild fluorosis (Grade 1); 46.1% with mild fluorosis
(Grade 2) and 26.9% with moderate fluorosis (Grade 3). Severe
fluorosis (Grade 4) was not seen in females. This study found no
statistically significant association between gender and prevalence
of dental fluorosis (p=0.555). [Figure 4] This statement was supported
by Sarvaiya et al [(35)] who found no significant difference
amongst both genders and the prevalence of fluorosis. It was also
supported by many other studies that found a non-significant association
[32-37]. In fact, in the Universally available literature,
no tendency towards developing dental fluorosis was reported by
either of the genders[13, 38-40].
In the present study, mild form of dental fluorosis (Grade 2)
was seen in 47.8% of the adolescents as the most predominant
type. Very mild type of dental fluorosis (Grade 1) was seen in
27.6% of the adolescents as the predominant type in the study
by Chaudhury.M et al., [13]. Milder forms of fluorosis were more
common than its severe forms. This finding was supported by
studies done by Srivatsava et al., [41] and Naidu et al., [8]. Dental
fluorosis is endemic in 150,000 villages in India [42-46].
A report described the interexaminer reliability achieved using
Dean's Index in a study of dental fluorosis. Using Dean's definition
of fluorosis, agreement on the presence or absence of fluorosis
ranged from 92 to 97 percent and therefore the respective
kappa values ranged from 0.75 to 0.94. Examiners showed good
to excellent agreement beyond chance in the use of this index.
Hence the index is very reliable to review dental fluorosis [47].
Our institution is passionate about high quality evidence based
research and has excelled in various fields [48-58]. We hope this
study adds to this rich legacy.
Limitations of the study include a restricted population group due
to it being a single centered study. Another limitation includes the
data only being collected for a period of 10 months. Also, since
it is a retrospective study based on case records, the cases could
not be reviewed clinically and we relied on the uploaded scoring
of the Dean’s fluorosis index by dentists in the hospital. However
these scores were all reviewed by a single calibrated examiner
with the help of clinical photographs as well. Future scope of
the study could be improved by conducting a prospective cohort
study considering the geographic location.
Figure 1. Bar chart depicting the distribution of age of patients in percentage. X axis represents the age of patients and Y axis represents the number of patients with dental fluorosis. Most of the patients were young adults (74.4%).
Figure 2. Bar chart depicting the distribution of gender of patients in percentage. X axis represents the gender of patients and Y axis represents the number of patients with dental fluorosis. Males (71.1%) predominated the study population.
Figure 3. Bar chart depicting the association between dental fluorosis and age groups. X axis represents the age of patients and Y axis represents the number of patients reviewed for Dean’s Fluorosis Index score. Association between dental fluorosis and age groups was done using Chi square test and it was not significant. Chi square association test (Fisher’s exact test value = 0.131; p value = 0.988; not significant). Age has no role in the severity of dental fluorosis.
Figure 4: Bar chart depicting the association between dental fluorosis based on gender. X axis represents the Gender of patients and Y axis represents the number of patients reviewed for Dean’s Fluorosis Index score. Association between dental fluorosis and gender was done using Chi square test and it was not significant. Chi square association test (Fisher’s exact test value = 0.349; p value = 0.555; not significant). Gender has no role in the severity of fluorosis.
Conclusion
The prevalence of dental fluorosis is not dependent on the age
and gender of the patients. The Mild form of dental fluorosis
was found to be the most prevalent type in both adults and adolescents.
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