Impact of dental fluorosis on the oral health related quality of life of adolescents in an endemic area.

Introduction: Oral diseases and conditions affect the physical, social, and psychological well-being of an individual. The aim of this study was to determine the association between the severity of dental fluorosis and oral health related quality of life (OHRQoL) among 15-year-old school children residing in an endemic area for dental fluorosis in Sri Lanka. Design: A cross-sectional study was conducted among 989, 15-year-old school children who were lifetime residents of Kurunegala district. A validated Sinhala version of the Child Perception Questionnaire (CPQ 11-14) was used to assess OHRQoL. Dental fluorosis was assessed using the Thylstrup and Ferjeskov index (TF index) while dental caries and malocclusion were assessed using the WHO Basic Methods and Dental Aesthetics Index (DAI) respectively. In addition, information pertaining to parental level of education, type of toothpaste used, frequency of toothbrushing and use of dental services was also gathered. Results: The prevalence of dental fluorosis was 52%. The overall prevalence of impacts based on the CPQ was 38.2%. The severity of dental fluorosis was not significantly associated with the overall prevalence of impacts. However, the severity of dental fluorosis was significantly associated with three oral impacts namely "having pain in teeth, lips, jaws, or mouth", "felt irritable or frustrated" and "other children teased or called names". According to the multiple logistic regression analysis, use of dental services and moderate to severe malocclusion were significantly associated with poor OHRQoL but not dental fluorosis. Conclusion: The severity of dental fluorosis was not associated with OHRQoL of the participants.

Toothbrushing practices as risk factors for dental fluorosis in an area with varying fluoride levels in drinking water.

BACKGROUND: Despite contributing to a reduction in dental caries, improper use of fluoridated toothpaste could add to the burden of dental fluorosis in children. AIM: To assess the association between tooth-brushing practices such as the type and amount of toothpaste used, frequency of tooth brushing, parental assistance in tooth brushing, timing of tooth brushing and dental fluorosis in school children in Kurunegala district, an endemic area for dental fluorosis in Sri Lanka. METHODS: For this case-control study, a sex-matched sample of 15-year-old school children attending government schools in Kurunegala district and who were lifetime residents of the district was selected. Dental fluorosis was measured using the Thylstrup and Ferjeskov (TF) Index. Those children with a TF⟩1 were considered as cases and those with a TF score of 0 or 1 served as controls. An interview of parents/caregivers of the participants was used to assess risk factors for dental fluorosis. The fluoride concentration in drinking water was measured using spectrophotometry. Data analysis used chi-square tests and conditional logistic regression. RESULTS: Tooth brushing ≥ twice/day, brushing after breakfast and parent/care giver brushing the child's teeth reduced the likelihood of developing fluorosis. CONCLUSION: Use of fluoridated toothpaste adhering to the recommended guidelines could prevent dental fluorosis in children in this endemic area.

Dental fluorosis among 15- year- old school children in an endemic district in Sri Lanka.

AIM: To determine the prevalence, severity, and intraoral distribution of dental fluorosis among 15-year-old school children in Kurunegala district of the North-Western Province, Sri Lanka. METHOD: A cross-sectional study was conducted among 15-year-old school children residing in Kurunegala district since birth. One thousand and forty participants from 42 schools were selected using two stage cluster sampling method. A single calibrated dentist examined all participants for dental fluorosis using Thylstrup and Ferjeskov index. Water samples from the drinking water source of participants were analyzed for their fluoride content. RESULTS: The prevalence of dental fluorosis was 52% and 42% when TF score ⟩ 0 and TF score ⟩1 were considered as cut-offs for dental fluorosis respectively. Of those with dental fluorosis, a majority (20.9%) had a TF score of 2. Only 0.5% had a TF score of 6 which was the highest score observed for any participant. With regards to the intra-oral distribution of dental fluorosis, the premolars were the most affected teeth and the least affected were the central incisors. The fluoride levels in the drinking water source ranged between 0.0-1.9 mg/L and the prevalence of dental fluorosis increased with the increase in the fluoride level in drinking water source. CONCLUSIONS: The prevalence of dental fluorosis was high and it increased with the increase in the fluoride content in the drinking water source.