Dental Fluorosis – An Underestimated Public Health Challenge; Evidence from Rural Delhi

Abstract

Oral health problems being the most prevalent chronic morbidities, contribute to heavy burden on health care delivery system universally. Although, fluoride has been recognized for the observed decline of caries among children as well as adults, its excessive consumption has put global population at risk of fluorosis. India is among the 23 nations around the globe with reported oral health problems due to excessive fluoride in drinking water. Since there is paucity of epidemiological data in Delhi on Dental fluorosis, the present study was conducted to study the prevalence and severity of dental fluorosis among middle aged school children (7-15 years) in rural areas of North-West Delhi i.e. Barwala and Pooth Khurd. For this 194 middle school students studying in two government schools were selected. The students underwent oral examination in broad day light and were classified on the basis of the Dean’s index on severity of fluorosis. A pre-structured semi-quantitative questionnaire was used for collecting information on socio-demographic parameters, regularity of brushing, use of toothpaste and its type, potential sources of drinking water and consumption of manufactured beverages etc. After that, water samples were collected from the children’s homes and school and fluoride levels were measured using Fluoride Ion-Selective Electrode Method. Males and females constituted 60.3% (117) and 39.7% (77) of the sample. The prevalence of dental fluorosis was found to be 65.5% with majority having mild dental fluorosis (30.9%). On univariate analysis, only participation in dental health programmes and drinking water from the open well (OR=4, 95% CI=2.3-5.2) were found to have higher odds of having dental fluorosis as compared to other correlates. The Community fluoride index (CFI) was calculated to be 3.5 indicating Dental fluorosis of high public health importance in this region. The present results reflect the gravity of the present situation with a high prevalence of dental fluorosis and a right time for intervening by defluoridation of the supply water and implementation of school dental health programmes in this region.