Oral diseases and socio-demographic factors in adolescents living in Maasai population areas of Tanzania: a cross-sectional study.

BACKGROUND: Oral diseases may cause serious health problems, especially in socially disadvantaged populations and in low-income countries. In populations living in the rural areas of Tanzania there is paucity of reports on oral health. The study aim was to estimate the prevalence, severity and socio-demographic distribution of oral diseases/conditions in adolescents living in Maasai population areas of Tanzania and to compare oral diseases/conditions between Maasai and non-Maasai ethnic groups. METHODS: A total of 23 schools were randomly selected from 66 rural public primary schools in Monduli and Longido districts, Tanzania. All pupils in the selected classes, 6th grade, were invited to participate in the study. A total of 989 were invited and 906 (91.6%) accepted the invitation and completed an interview and a clinical oral examination. RESULTS: Out of 906 study participants (age range 12-17 years), 721(79.6%) were from Maasai and 185 (20.4%) from non-Maasai ethnic groups. Prevalence of poor oral hygiene, gingival bleeding, dental caries experience (DMFT> 0), dental fluorosis TF grade 5-9, dental erosion (into dentin), tooth wear (into dentin) and TMD was 65.6, 40.9, 8.8, 48.6, 1.9, 16.5 and 11.8%, respectively. Multiple variable logistic regression analysis revealed that, girls (OR = 2.0) and participants from Longido (OR = 2.6) were more likely to present with good oral hygiene (p < 0.05). Adolescents from Monduli (OR = 1.7), males (OR = 2.1), being born within Arusha region (OR = 1.9) and Maasai (OR = 1.7) were more likely to present with gingival bleeding (p < 0.05). DMFT> 0 increased by age (OR = 2.0) and was associated with non-Maasai ethnic group (OR = 2.2), (p < 0.05). Adolescents from Monduli district (OR = 10.0) and those born in Arusha region (OR = 3.2) were more likely to present with dental fluorosis (p < 0.05). Dental erosion was more common among non-Maasais (OR = 2.0) as well as having mother with high education (OR = 2.3), (p < 0.05). CONCLUSIONS: Oral diseases like dental caries and dental erosion were less common, but gingival bleeding, dental fluorosis, tooth wear and TMD were common findings in adolescents attending primary schools in the Maasai population areas of Tanzania. Notable differences between Maasai and non-Maasai ethnic groups and certain correlations to sociodemographic factors were detected. Our findings can be utilized by policy makers in the planning of oral health programs in public primary schools of Maasai population areas of Tanzania.

Dental fluorosis and a polymorphism in the COL1A2 gene in Mexican children.

OBJECTIVE: To determine the allelic and genotypic frequencies of rs 412777 polymorphism in the Collagen type I alpha 2 chain (COL1A2) gene and the association with the severity of dental fluorosis in children between 6 and 12 years old in the State of San Luis Potosi, Mexico. DESIGN: A cross-sectional study was designed; participants were 230 children from two rural communities of San Luis Potosí. Fluoride in drinking water and urine samples was quantified using a potentiometric method with a selective ion electrode. Dental fluorosis was diagnosed using the Thylstrup-Fejerskov index while the identification of the polymorphism was made by allelic discrimination, using allele-specific probes by real-time Polymerase chain reaction (PCR). Statistical analysis was carried out with Student's t-test and Chi-square and Odds Ratio (OR). A confidence interval of 95% and a value of p < 0.05 were considered. RESULTS: The concentration of fluoride in drinking water was 2.36 ± 0.02 mg/L in Ojo Caliente and 4.56 ± 0.07 mg/L in La Reforma, the concentration of fluoride in urine was 2.05 ± 0.62 mg/L and 2.99 ± 0.99 mg/L respectively. The prevalence of dental fluorosis was 100% and the frequency of alleles was 67% wild-type and 33% mutant allelic, alleles were found in Hardy-Weinberg equilibrium (X2 = 0.33, p = 0.89). The association between the degree of dental fluorosis and the evaluated polymorphism was statistically significant (OR = 7.10, 95% CI = 3.96-12.70, p < 0.05). CONCLUSIONS: An association of rs 412777 polymorphism in the COL1A2 gene with dental fluorosis was found. Therefore, genetic variants represent a relevant risk factor to develop dental fluorosis, as it was proven in this study conducted in Mexican children.

The role of partial recording protocols in reporting prevalence and severity of dental fluorosis.

OBJECTIVES: To evaluate the role of partial recording protocols (PRPs) in reporting prevalence and severity of dental fluorosis and assess whether prevalence/severity estimates derived from PRPs differ by race/ethnicity. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) for the years 1999-2004 were analyzed with Stata(®) v.11. Prevalence of dental fluorosis obtained from a full-mouth examination (28 teeth gold standard) was compared with estimates derived from four subsets of teeth (maxillary canine-to-canine; maxillary first-premolar-to-first-premolar; all-premolars; all-molars). Sensitivity, negative predictive value (NPV), absolute bias, and correction factors were calculated against gold standard estimate. Analysis was stratified according to race/ethnicity to assess differences in estimates derived from PRPs. RESULTS: All subsets underestimated prevalence albeit to varying degrees. Two subsets (all-premolars and all-molars) had prevalence and severity estimates closest to gold standard estimates. The all-molars subset (eight teeth) recorded the highest sensitivity (84.5%) and the lowest absolute bias (3.5%) of all subsets relative to gold standard. Subsets derived from esthetically relevant teeth produced the lowest fluorosis prevalence. For instance, the maxillary canine-to-canine subset underestimated prevalence by 9.5%; incorporating the maxillary first premolars in the span improved prevalence estimate by 31%. Among non-Hispanic Whites, the all-premolars subset produced estimates closest to gold standard while the all-molars subset produced estimates closest to the gold standard among non-Hispanic Blacks and Hispanics. CONCLUSION: While the majority of dental fluorosis in the United States is very mild, concerns regarding its growing prevalence underscore the need for careful monitoring. The use of PRPs offers an alternative method of assessment, with validity of reported prevalence and severity dependent on choice of subset.

The relationship of PTH Bst BI polymorphism, calciotropic hormone levels, and dental fluorosis of children in China.

The aim of this study was to explore the association of parathyroid hormone (PTH) gene Bst BI polymorphism, calciotropic hormone levels, and dental fluorosis of children. A case-control study was conducted in two counties (Kaifeng and Tongxu) in Henan Province, China in 2005-2006. Two hundred and twenty-five children were recruited and divided into three groups including dental fluorosis group (DFG), non-dental fluorosis group (NDFG) from high fluoride areas, and control group (CG). Urine fluoride content was determined using fluoride ion selective electrode; PTH Bst BI were genotyped using PCR-RFLP; osteocalcin (OC) and calcitonin (CT) levels in serum were detected using radioimmunoassay. Genotype distributions were BB 85.3% (58/68), Bb 14.7% (10/68) for DFG; BB 77.6% (52/67), Bb 22.4% (15/67) for NDFG; and BB 73.3% (66/90), Bb 27.7% (24/90) for CG. No significant difference of Bst BI genotypes was observed among three groups (P > 0.05). Serum OC and urine fluoride of children were both significantly higher in DFG and NDFG than in CG (P < 0.05, respectively), while a similar situation was not observed between DFG and NDFG in high fluoride areas (P > 0.05). Serum OC level of children with BB genotype was significantly higher compared to those with Bb genotype in high fluoride areas (P < 0.05). However, no significant difference of serum CT or calcium (Ca) was observed. In conclusion, there is no correlation between dental fluorosis and PTH Bst BI polymorphism. Serum OC might be a more sensitive biomarker for detecting early stages of dental fluorosis, and further studies are needed.

Prevalencia de caries dental y fluorosis en áreas de fluorosis endémica en el Estado Portuguesa, Venezuela / Prevalence of dental caries and flurosis endemic fluorosis areas of Portuguesa State, Venezuela

Determinar la prevalencia y severidad de caries y fluorosis dental en una zona de fluorosis endémica en Portuguesa. 187 individuos entre 2-62 años de edad de cuatro comunidades del Municipio Santa Rosalía fueron evaluados para caries dental según el índice CPOD/ceo (OMS) y para fluorosis dental de acuerdo al Índice de Dean. Todos los participantes en la presente investigación firmaron un consentimiento informado. Cada paciente respondió un cuestionario estructurado a tal fin y los datos fueron registrados. El examen clínico fue realizado por un examinador calibrado y se utilizó sonda WHO, espejo plano #5 y luz natural. Según el género, de los 187 pacientes, 96 fueron masculino (51%) y 91 femeninos (49%) y 90,9% de la población estudiada pertenecía a los estratos 4 y 5 de Graffar. El 69% de pacientes estaban libres de caries dental y los índices promedio CPOD y ceo fueron 1,7±3,62 y 0,41±1,15, respectivamente siendo el índice CPOD en Cogote significativamente menor (p<0,05) al compararlos con los observados en San Pablo y Playón (p>0,05), pero sin diferencias significativas al compararlo con el de Punto Fijo. El 76,9% de los individuos evaluados presentaban fluorosis dental siendo el grado de severidad promedio la categoría de moderado (Grado 4). Se le debe dar una alta prioridad a la defluoruración del agua, y en caso de que no sea posible, se debe proveer a la población de agua con concentraciones de fluoruro óptimas. No se observó asociación entre el grado de severidad de fluorosis dental y los niveles de fluoruro en el agua. Estudio parcialmente financiado por la Facultad de Odontología, UCV.

The purpose of this study was to determine the prevalence and severity of dental caries and fluorosis in an endemic area of Portuguesa State. One hundred eighty seven individuals, age ranging between 2-62 years, from four communities of Santa Rosalía Municipality were evaluated for dental caries index DMFT/dmf according to the WHO criteria and dental fluorosis using the Dean index. All participants signed the written consent to be enrolled for the study. The clinical examination was done by a calibrated examiner using the WHO probe, mirror #5 and natural light. The results from the study showed that 96/187 (51%) were male and 91/187 (49%) were female. According to socioeconomic status 90.9% of the studied population was level 4 and 5 according to Graffar criteria. Sixty nine percent of the patient was dental caries free and the mean indexes DMFT/dmf were 1.7±3.62 and 0.41±1.15, respectively. The lower DMFT scores were observed in Cogote (p<0.05) with statistical significant differences when compared to San Pablo and Playón but without differences when compares to Punto Fijo community (p>0.05). When analyzing the presence of dental fluorosis, 76.9% of the subjects had the condition being moderate (Grade 4). We may conclude that water defluoridation is of high priority in these communities, as well as to provide the population with optimal fluoride concentration in water. Our results indicate the absence of association between the fluoride concentration for water consumption and the dental fluorosis severity in endemic areas. Study partially supported by the Faculty of Dentistry, UCV.

Oral health status and practices of 5 and 12 year old Indian tribal children.

OBJECTIVES: To assess oral health status and practices of 5- and 12-year-old Tribal school children. METHODS: A total of 418, 5-year-old children and 327, 12-year-old children were enrolled Information on demographic characteristics of participants along with oral health behavior was collected. Clinical data were collected on dental fluorosis, periodontal status, dental caries and treatment needs. Dean's index criterion was used to assess dental fluorosis. Community Periodontal Index (CPI) for periodontal conditions and Dentition status and treatment needs for dental caries were recorded. RESULTS: Between meal sugar consumption was high (100%). None of the children in both the age groups had visited trained health personnel for dental treatment. Dental fluorosis prevalence in 5- and 12-year olds was 11.9% and 22.9% respectively. Bleeding on probing and calculus was common between both the age groups. A low mean number of healthy sextants were found and this decreased with age. Mean dmft/DMFT values for 5- and 12-year olds were 4.13 +/- 3.90 and 1.15 +/- 1.62. Significant caries index (SIC) scores for 5- and 12-year olds were 7.17 +/- 4.30 and 3.78 +/- 3.21 respectively. CONCLUSION: The present study reveals high sugar consumption, dental fluorosis, poor oral hygiene, and untreated dental disease of tribal children. Under these circumstances, the implementation of preventive programs including restriction of sweets in school premises for the tribal children is the key to good oral health.

Fluorosis in subjects belonging to different ethnic groups of Rajasthan, India.

A total of 11205 and 7416 subjects (both sexes) belonging to different ethnic groups viz., Scheduled tribes (S.T.), Scheduled castes (S.C.) and General Castes (G.C.) of Dungarpur and Udaipur districts of Southern Rajasthan (India), respectively were examined for evidence of dental and skeletal fluorosis and observed the relative prevalence and severness of fluoride (F) toxicity in these ethnic groups. An overall and the highest prevalence of dental and skeletal fluorosis (69.0% and 27.7% respectively) were observed in the subjects of S.T. followed by 57.2% and 20.8% in S.C. and 38.6% and 9.3% in G.C. ethnic group. The severity of fluorosis in these groups have also been observed. The severity of dental fluorosis was found 28.1% in S.T., 24.6% in S.C. and 22.0% in G.C. whereas, the severity of skeletal fluorosis varied from 54.2% in S.T., 46.2% in S.C. to 32.6%, in G.C. These data were also analysed statistically and found to be highly positive correlation (r = + 1.00; p<0.001). The variation in the prevalence of fluorosis in these ethnic groups is related with the variation in the fluoride exposure through nutritional components of diet and feeding habits. X-rays of different regions of the tribal subjects (S.T.) also showed the maximum calcification in the ligaments and interosseous membranes as well as increased mass and density of bones. These radiological changes were less sever in the individuals of G.C. Besides, the F concentration, the water quality (alkalinity, total hardness, pH, NO3 etc.) is also influence and accelerate the prevalence and severness of fluorosis which has also been focussed in the present communication.

[Oral health and dental care in refugee children]. / Gebitstoestand en tandheelkundige zorg bij kinderen van asielzoekers.

An epidemiological study was performed on caries, fluorosis and plaque in children of refugees 8, 9 and 10 years of age. Tooth brushing habits and dental attendance were evaluated with a questionnaire. Of the 87 children participating (response rate 89%), 85% showed caries experience, 17% fluorosis and 46% clearly visible plaque. Only 14% of the children had filled teeth. The number of children brushing their teeth two times a day was 42%; 58% ever visited a dentist, mostly because of toothache. Statistically significant differences exist between ethnic categories for caries prevalence, tooth brushing frequency and dental attendance. As oral health in refugee children turned out to be less favourable than in Dutch children, organised activities are recommended to fulfill the observed need of professional curative and preventive oral care.

Fluoride exposure and dental fluorosis in Newburgh and Kingston, New York: policy implications.

OBJECTIVES: This analysis was conducted to determine the changes in the effect of exposure to fluoridation and other sources of fluoride on dental fluorosis in children attending Newburgh and Kingston school districts in New York State. METHODS: Data for this analysis were obtained from two surveys conducted in the 1986 and 1995 school years. Analyses were limited to 3500, 7-14-year-old lifelong residents of a fluoridated or a nonfluoridated community. Dean's classification and DMFS index were used for recording dental fluorosis and caries, respectively. A questionnaire was used to collect fluoride exposure data. Regression procedures were used to estimate the effect of fluoridation, fluoride supplements, and brushing before the age of 2 years on dental fluorosis. RESULTS: Children examined in 1996 were at higher risk for both questionable and very mild to severe dental fluorosis if they received fluoride from water or daily tablet use, or started brushing before the age of 2 years. The increase in risk from 1986 to 1995 was greater for African-American children. CONCLUSION: This analysis showed that the risk of developing dental fluorosis did not decline over time in these communities. Continuous exposure to water fluoridation had an observable effect on dental fluorosis. However, implementation of fluoridation in Newburgh Town did not result in an increase in dental fluorosis prevalence.

Altitude as a risk indicator of dental fluorosis in children residing in areas with 0.5 and 2.5 mg fluoride per litre in drinking water.

The purpose of this study was to assess the association between altitude and dental fluorosis among Ugandan children in two fluoride (F) districts while controlling for other factors related to fluorosis. A random sample of 481 children aged 10-14 years was examined for fluorosis using the Thylstrup and Fejerskov (TF) index. The prevalence and severity of dental fluorosis increased significantly with increase in altitude (900 vs. 2,200 m in the low- and 1,750 vs. 2,800 m in the high-F district) and in F concentration in the drinking water. In bivariate correlation analyses, F exposure from liquid (FEL), altitude, infant formula, vegetarianism and storing of drinking water in earthenware pots were significantly associated with the tooth prevalence of fluorosis (TPF), i.e. at a severity of TF score >/=1 (p<0.05); age and gender were not. The stepwise multiple linear regression explained 35 and 55% of the variance in TPF within the low- and high-F districts, respectively. The change in R2 due to FEL was 28 and 51% points compared with 5 and 4% points due to altitude. The significant effect of FEL and altitude was confirmed by multiple logistic regression analyses. Thus, although most of the variation in the prevalence and severity of dental fluorosis was explained by the F intake from liquid, altitude was a significant risk indicator after controlling for potential confounders.

Prevalence of dental fluorosis in children in Singapore.

Prevalence and severity of dental fluorosis was assessed in 1739 Singaporean children aged 9, 12 and 16 yr in three different ethnic groups. All subjects had resided since birth in Singapore, which has a tropical climate. The water supply was fluoridated in 1957 at a level of 0.7 ppm. In this sample, mouth prevalence was 82.6%, tooth prevalence was 66.9%, the community fluorosis index was at 1.96; 9.2% of children had severe fluorosis and 26.2% had moderate fluorosis. There were no significant gender or racial differences. Prevalences were higher than those reported in most other studies. Due to differences in indices used and methodology, comparisons could not be made directly with other studies.

Dental status of rural school children in a sub-optimal fluoride area.

Past investigations by us have shown high levels of caries experience in rural coloured school children of the Western Cape. These studies were all undertaken in fluoride poor areas. In contrast studies of children in areas with optimal and higher concentrations of fluoride in their drinking water have shown lower DMFT scores. On a previous visit to the town of Fraserburg in the North Western Cape we observed fluorosis in children, although the fluoride content of the municipal drinking water was sub-optimal (0.68-0.78 ppm F-). The purpose of this study was therefore to measure the dental status of 6, 12 and 15 year old school children using the dmft, DMFT and Dean's Fluorosis Index according to the 1987 WHO guidelines. The examinations were done by two calibrated examiners using portable equipment. Results showed low mean dmft values of 3.31 +/- 3.90 and 0.22 +/- 0.86 for the 6 and 12 year olds respectively. The corresponding DMFT scores including that for 15 year olds were 0.08 +/- 0.35; 1.45 +/- 1.81 and 1.00 +/- 1.60 respectively and no significant statistical gender differences were observed (p>0.05). The mean fluorosis scores for 6, 12 and 15 year olds were 1.68 +/- 1.05; 2.78 +/- 1.34 and 2.90 +/- 1.58 respectively. For both the 12 and 15 year olds the severity of fluorosis ranged from no fluorosis to severe mottling and corrosion. It can be concluded that the results even at a sub-optimal fluoride level show a high similarity to the dental status of children in rural fluoride rich areas. Defluoridation of the Fraserburg municipal drinking water therefore becomes imperative and a concentration of 0.4 ppm F- is suggested. Furthermore the children have no access to dental services and this has led to accumulated needs which demand urgent addressing.