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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 4  |  Issue : 2  |  Page : 69-72

Prevalence of dental fluorosis in school going children of Dammam, Saudi Arabia


1 Department of Clinical Affairs, College of Dentistry, University of Dammam, Dammam 31441, Saudi Arabia
2 Department of Substitutive Dental Sciences, College of Dentistry, University of Dammam, Dammam 31441, Saudi Arabia
3 Department of Biomedical Dental Sciences, College of Dentistry, University of Dammam, Dammam 31441, Saudi Arabia
4 Dental Intern, College of Dentistry, University of Dammam, Dammam 31441, Saudi Arabia
5 Department of Restorative Dental Sciences, College of Dentistry, University of Dammam, Dammam 31441, Saudi Arabia

Date of Web Publication11-Dec-2015

Correspondence Address:
Soban Qadir Khan
Department of Clinical Affairs, College of Dentistry, University of Dammam, Dammam 31441
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-4696.171516

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  Abstract 

Objective: Purpose of the study was to determine the prevalence of dental fluorosis and its pattern in primary and permanent teeth among 6-12-year-old Pakistani school going children living in Dammam, Saudi Arabia. Materials and Methods: This cross-sectional study was performed between June and September 2014. A total number of screened children were 496 among them 259 were males and 237 were females. World Health Organization's scale was used to examine children for dental fluorosis. Results: Prevalence of dental fluorosis was found to be 33% among a total number of examined children. Among the children who had dental fluorosis (n = 164), it was observed that mild and moderate level of fluorosis were prevailing in 113 (69%) children. Furthermore, a number of males who were suffering from fluorosis was more than the females. There were 97 males and 67 females found affected from dental fluorosis and this difference was found statistically significant (P = 0.038). Conclusion: Prevalence of dental fluorosis among Pakistani school going children was not high. However, the severity of fluorosis was alarming, mild, and a moderate level of fluorosis was observed in most of the children who were affected from fluorosis.

Keywords: Children, dental fluorosis, permanent teeth, prevalence, primary teeth


How to cite this article:
Khan SQ, Moheet IA, Farooq I, Farooqi FA, ArRejaie AS, Al Abbad MA, Khabeer A. Prevalence of dental fluorosis in school going children of Dammam, Saudi Arabia. J Dent Allied Sci 2015;4:69-72

How to cite this URL:
Khan SQ, Moheet IA, Farooq I, Farooqi FA, ArRejaie AS, Al Abbad MA, Khabeer A. Prevalence of dental fluorosis in school going children of Dammam, Saudi Arabia. J Dent Allied Sci [serial online] 2015 [cited 2019 Aug 24];4:69-72. Available from: http://www.jdas.in/text.asp?2015/4/2/69/171516


  Introduction Top


Dental caries is one of the most prevalent diseases affecting children. [1] Fluoride plays an important role in preventive dentistry due to its superior cariostatic potential. However, superfluous intake of fluoride can lead to dental and skeletal fluorosis. [2] Dental fluorosis has been described in the literature as a "developmental disturbance initiated by continuous exposure to high levels of fluoride during the development of teeth, leading to the formation of enamel with decreased mineral content and increased porosity." [3] The main sources which could be responsible for increased fluoride consumption are fluoride containing drinking water and supplements such as tablets, gums, gel, and toothpastes. [4] The suggested safety dosage of fluoride in drinking water is 1 ppm [5] whereas, the daily safety level of fluoride intake is 0.05-0.07 ppm mg F/kg. [6]

It has been suggested earlier that the most critical time for the initiation of fluorosis is the "postsecretory or early maturation phase of tooth development." [7] The intake of excessive fluoride during different stages of tooth development can have diverse effect on teeth which includes the appearance of white lines or stains on enamel, yellow or brown stains on enamel, and overall involvement of enamel with chalky white or dark colored stains. [8]

Prevalent fluorosis has been reported from various countries in the past. [9],[10] From Saudi Arabia, an earlier study has reported a low prevalence of fluorosis (7.7%) among 6-7-year-old children [11] but another study conducted in the Hail region of Kingdom of Saudi Arabia however, has demonstrated a very high prevalence of dental fluorosis among children between the age of 12 and 15 years (90% of 2355 examined children). [12]

There is very limited information in the literature regarding the prevalence of dental fluorosis from Dammam (PubMed database was accessed). Therefore, this study was carried out to evaluate the prevalence of dental fluorosis among Pakistani school going children living in Dammam, Saudi Arabia.


  Materials and Methods Top


This study was performed between June and September 2014 among Pakistani students attending schools in Dammam and Khobar, Saudi Arabia. Stratified random sampling was used to determine sample size. A total number of 496 school children of, aged between 6 and 12 years were examined after taking authorization from the schools. Out of which 259 were male students and 237were females. Inclusion criteria's for this study were volunteer participation, the age bracket of 6-12 years, and only those primary and permanent teeth were considered which fully erupted.

The examination was done by three dentists; they were assisted by three dental assistant for data recording. All six person were trained prior and tested for inter- and intra-examiner reliability by examining patients attending the Outpatient Department of College of Dentistry, University of Dammam. Kappa test was done to assess inter-examiner (0.76) and intra-examiner (0.69) reproducibility. The examination was done in school yard under natural light. Dean index was used to grade the severity of fluorosis (0 - normal, 1 - questionable, 2 - very mild, 3 - mild, 4 - moderate, and 5 - sever). [13] All the students were asked to brush teeth under the supervision of 7 th team member (dentist). The teeth were dried with cotton and examination was done visually using an explorer, a plane mirror, and tongue depressor as suggested by the World Health Organization.

Statistical Package for Social Sciences (IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp) was used for data entry and analysis. Data analysis was done in two parts; in first part descriptive statistics was computed and in second part tools of inferential statistics was employed. In descriptive statistics, cross tabulations, multiple bar diagrams, means and standard deviations were computed and in inferential statistics, the significance of relation between different variables was checked. Chi-square test, Student's t-test, and analysis of variance were used at 0.05 level of significance to check statistical significance.


  Results Top


Age variation in the sample was 6-12 years (mean age: 9.6 ± 2.1 years). A number of males examined for the study was more than the females. There were 259 males (52.2%) and 237 females (47.8%) examined for the study. When the students were asked about tooth brushing habits, almost 95% (n = 469) reported that they brushed their teeth daily. Students' examination for fluorosis revealed that the prevalence of dental fluorosis among Pakistani school going children living in Dammam was 33%, and the intensity of fluorosis varied from questionable to severe. It was observed that the males were affected more by fluorosis than the girls, and this difference was statistically significant as well with P = 0.038 [Table 1]. However, the effect of age and brushing habits were also tested with fluorosis. However, the analysis presented no statistical significance between the age of children (P = 0.17) and prevalence of fluorosis. The association between brushing habits and fluorosis was also checked, but the differences were insignificant again (P = 0.9). It was observed in each age group that the prevalence of mild fluorosis was higher as compared to other forms of fluorosis [Figure 1]. Statistics presented that mostly 9-10-year-old children (including male and female) were suffering from dental fluorosis, and about 45% and 44% of 9 and 10-year-old, respectively were having dental fluorosis [Figure 1].
Figure 1: Participants suffering from different forms of fluorosis in contrast with their age

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Table 1: Variation in levels of fluorosis according to gender of participants


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Detailed examination of the children for the prevalence of dental fluorosis revealed that the teeth in upper jaw were more affected by fluorosis as compared to the lower jaw. A total number of permanent teeth affected by fluorosis in the upper jaw were 230 whereas, in the lower jaw, only 25 teeth were affected and it was found statistically significant (P = 0.00). It was also observed that the anterior teeth which included central incisors, lateral incisors, and canines were mostly affected. In the maxilla, central incisors were the most common teeth which were suffering from fluorosis. Fluorosis was found in 127 central incisors among which 78% had mild or moderate form of fluorosis. After central incisors, lateral incisors and canines were the most common victim of fluorosis. There were 64 lateral incisors and 24 canines in the upper jaw which were affected from fluorosis and mild or moderate levels of fluorosis were seen again among majority of the teeth. Among remaining teeth in the upper jaw, eight first premolars and two molars were having fluorosis. In the mandible, there was no specific pattern of prevalence of fluorosis. Among 25 teeth which had fluorosis; 14 were central incisors, two were lateral incisors, four were canines, three were first premolars and two were first molars. Form of fluorosis varied between very mild to moderate among all the screened teeth in the lower jaw.

Fluorosis was examined in the primary teeth as well. Upper jaw was found mostly affected from fluorosis compare to lower jaw. In the upper jaw central incisors, lateral incisors, canines, first and second premolars were having fluorosis and numbers of affected teeth were 5, 7, 14, 5, and 2, respectively. In the lower jaw central incisors, canines, and first molars were having fluorosis with the number of teeth being 5, 3, and 3, respectively.


  Discussion Top


Prevalence of dental fluorosis was found in 164 children among total screened boys and girls (n = 496). Hence, the prevalence of dental fluorosis was 33%; around 37% of boys and 28% of girls were having dental fluorosis among the total number of screened children. Twenty-five percentage in 164 children were affected by moderate level of fluorosis. Mild fluorosis got highest proportion which was 44%. Percentage of boys, affected from fluorosis, was higher than girls.

AlDosari et al. in 2010 reported 18% prevalence of dental fluorosis among 6-7-year-old children and 28% among aged 12-13 years living in 11 different regions of Saudi Arabia. [14] In Mexico, 8-12-year-old school children were examined for dental fluorosis and the prevalence was found between 40% and 60% depending on water fluoridation levels. [15] Another study reported 42% prevalence of dental fluorosis in rural areas around Bengaluru, India. Kadir and Al-Maqtari from Yemen reported 30.8% fluorosis among 14-year-old Yemeni adolescent with males being affected more than the females which was 32.3% and 29.3%, respectively. [16]

It has been stated through the results of present study that the prevalence of mild fluorosis was highest among rest of the fluorosis levels. It was found that out of total number of screened children around 14% were suffering from mild fluorosis, while the prevalence of moderate fluorosis got second place and was around 9%. Same pattern of fluorosis had been observed previously in the studies conducted in different regions of Saudi Arabia. In those studies, mild level of fluorosis was observed in most of the children who were affected from fluorosis. Proportion of mild fluorosis was 21.8% followed by moderate level which was 5.3%. [14] In Riyadh, Saudi Arabia, 5-12-year-old children were examined for oral health survey. Fluorosis was found in only 14% of total cases and all had mild level of fluorosis. [17] Moderate and severe level of fluorosis was reported from Western Sahara. A study was conducted among refugee children and observed that only 4% of 11-13-year-old children were free from fluorosis and almost 30% of them were affected from moderate fluorosis and prevalence of severe fluorosis was among 27% of total screened children. [18]

Prevalence of dental fluorosis in maxillary teeth was about 88% while in mandibular teeth it was only 12%. It was also observed that mostly incisors and canines were affected from fluorosis. Same pattern had been reported by other researchers. Mehta and Shah from India screened adolescent for dental fluorosis, they reported prevalence of fluorosis was more common in maxillary teeth compare to mandibular teeth. They also found that maxillary central incisor was affected from fluorosis in 94% of their patients. [19] Literature related to dental fluorosis also supported the present findings that prevalence of fluorosis in permanent teeth is more common than deciduous teeth and maxillary teeth is more commonly affected than mandibular teeth. [20],[21]

There was few limitation of the study as well. This study targeted Pakistani school going children only. Inclusion of students from different nationalities might have affected the results. Water fluoridation plays an important role in developing dental fluorosis. Variation of level of fluorosis in drinking water could be important to elaborate results.


  Conclusion Top


Prevalence of dental fluorosis among Pakistani school going children was not high. However, the severity of fluorosis was alarming, mild, and moderate level of fluorosis was observed in most of the children who were affected from fluorosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Smythe SJ, Shulman ER, Patrissi G, Drum D, Foreman FJ, Paquette DE, et al. Prevalence of dental caries in USAF family members age 3-15. Pediatr Dent 1990;12:172-9.  Back to cited text no. 1
    
2.
Saravanan S, Kalyani C, Vijayarani M, Jayakodi P, Felix A, Nagarajan S, et al. Prevalence of dental fluorosis among primary school children in rural areas of Chidambaram Taluk, Cuddalore district, Tamil Nadu, India. Indian J Community Med 2008;33:146-50.  Back to cited text no. 2
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Alvarez AJ , Rezende KMPC, Marocho SMS, Alves FBT, Celiberti P, Ciamponi AL, et al. Dental fluorosis: Exposure, prevention and management. J Clin Exp Dent 2009;1:14-8.  Back to cited text no. 3
    
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Murray JJ, Rugg-Gunn AJ. Modes of action in reducing caries. In: Fluoride in Caries Prevention. Dental Practitioner's Handbook No. 20. 2 nd ed. Boston: Wright PSG; 1982. p. 222-3.  Back to cited text no. 4
    
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Anuradha B, Laxmi GS, Sudhakar P, Malik V, Reddy KA, Reddy SN, et al. Prevalence of dental caries among 13 and 15-year-old school children in an endemic fluorosis area: A cross-sectional study. J Contemp Dent Pract 2011;12:447-50.  Back to cited text no. 5
    
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Burt BA. The changing patterns of systemic fluoride intake. J Dent Res 1992;71:1228-37.  Back to cited text no. 6
    
7.
Fejerskov O, Yanagisawa T, Tohda H, Larsen MJ, Josephsen K, Mosha HJ. Posteruptive changes in human dental fluorosis - A histological and ultrastructural study. Proc Finn Dent Soc 1991;87:607-19.  Back to cited text no. 7
    
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Messer LB, Mekertichian K. Fluorid modalities. In: Cameron AC, Widmer R, editors. Handbook of Pediatric Dentistry. Mosby, Elsevier; 2008. p. 53-70.  Back to cited text no. 8
    
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Beltrán-Aguilar ED, Barker L, Dye BA. Prevalence and severity of dental fluorosis in the United States, 1999-2004. NCHS Data Brief 2010;53:1-8.  Back to cited text no. 9
    
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Akosu TJ, Zoakah AI, Chirdan OA. The prevalence and severity of dental fluorosis in the high and low altitude parts of Central Plateau, Nigeria. Community Dent Health 2009;26:138-42.  Back to cited text no. 10
    
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Al-Shammery RA, Guile EE, El-Backly M. The prevalence of dental fluorosis in Saudi Arabia. Saudi Dent J 1997;9:58-61.  Back to cited text no. 11
    
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Akpata ES, Fakiha Z, Khan N. Dental fluorosis in 12-15-year-old rural children exposed to fluorides from well drinking water in the Hail region of Saudi Arabia. Community Dent Oral Epidemiol 1997;25:324-7.  Back to cited text no. 12
    
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Dean HT. Classification of mottled enamel diagnosis. J Am Dent Assoc 1934;21:1421-6.  Back to cited text no. 13
    
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AlDosari AM, Akpata ES, Khan N. Associations among dental caries experience, fluorosis, and fluoride exposure from drinking water sources in Saudi Arabia. J Public Health Dent 2010;70:220-6.  Back to cited text no. 14
    
15.
Mariño R. The prevalence of fluorosis in children is associated with naturally occurring water fluoride concentration in Mexico. J Evid Based Dent Pract 2013;13:100-1.  Back to cited text no. 15
    
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Kadir RA, Al-Maqtari RA. Endemic fluorosis among 14-year-old Yemeni adolescents: An exploratory survey. Int Dent J 2010;60:407-10.  Back to cited text no. 16
    
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al-Banyan RA, Echeverri EA, Narendran S, Keene HJ. Oral health survey of 5-12-year-old children of National Guard employees in Riyadh, Saudi Arabia. Int J Paediatr Dent 2000;10:39-45.  Back to cited text no. 17
    
18.
Almerich-Silla JM, Montiel-Company JM, Ruiz-Miravet A. Caries and dental fluorosis in a Western Saharan population of refugee children. Eur J Oral Sci 2008;116:512-7.  Back to cited text no. 18
    
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Mehta DN, Shah J. Reversal of dental fluorosis: A clinical study. J Nat Sci Biol Med 2013;4:138-44.  Back to cited text no. 19
    
20.
Levy SM, Hillis SL, Warren JJ, Broffitt BA, Mahbubul Islam AK, Wefel JS, et al. Primary tooth fluorosis and fluoride intake during the first year of life. Community Dent Oral Epidemiol 2002;30: 286-95.  Back to cited text no. 20
    
21.
Abanto Alvarez J, Rezende KM, Marocho SM, Alves FB, Celiberti P, Ciamponi AL. Dental fluorosis: Exposure, prevention and management. Med Oral Patol Oral Cir Bucal 2009;14:E103-7.  Back to cited text no. 21
    


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