Prevalence of dental fluorosis and dental caries in relation to fluoride in drinking water among 13-15 year old school going chidren of Melur Block, Madurai District

TO FLUORIDE IN DRINKING WATER AMONG 13-15 YEAR OLD SCHOOL GOING CHIDREN OF MELUR BLOCK, MADURAI DISTRICT”

A dissertation submitted

In partial fulfillment of the requirements For the degree of

MASTER OF DENTAL SURGERY

BRANCH VII

PUBLIC HEALTH DENTISTRY

THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI – 600032

2015 - 2018

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Urkund Analysis Result

Analysed Document: combinepdf.pdf (D34850517) Submitted: 1/19/2018 1:55:00 PM

Submitted By: prathapdr@yahoo.com

Significance: 7 %

Sources included in the report:

U_TEST_111.pdf (D21361530)

Mohamed Ramlath Sabura Result and Discussion.docx (D31353833) 10 text of ALL RESULTS 19-29.docx (D34127318)

thesis santhi.docx (D34390400)

FINAL DISSERTATION.docx (D34118505)

ORAL HEALTH STATUS AND RELATED QUALITY OF LIFE AMONG FACTORY WORKERS (TOBACCO FACTORY AND COTTON GINNING MILLS) IN GUNTUR~1.pdf (D34364904)

https://www.readbyqxmd.com/read/25083044/relationship-between-drinking-water-fluoride- levels-dental-fluorosis-dental-caries-and-associated-risk-factors-in-9-12-years-old-school- children-of-nelakondapally-mandal-of-khammam-district-andhra-pradesh-india-a-cross- sectional-survey

http://onlinelibrary.wiley.com/doi/10.1111/j.1752-7325.1997.tb02964.x/abstract https://vdocuments.site/dental-caries-and-dental-fluorosis-at-varying-water-fluoride- concentrations.html

https://documents.mx/documents/associations-among-dental-caries-experience-fluorosis-and- fluoride-exposure.html

Instances where selected sources appear:

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TABLE.

NO

TITLE PAGE

NO.

1 RESPONSES TO QUESTIONNAIRE 39

2 DISTRIBUTION OF STUDY POPULATION-AGE WISE 42

3 DISTRIBUTION OF STUDY POPULATION - GENDER WISE 42

4 PREVALENCE OF DENTAL FLUOROSIS – AGE WISE 43

5 PREVALENCE OF DENTAL FLUOROSIS - GENDER WISE 43 6 PREVALENCE OF DENTAL CARIES EXPERIENCE -AGE

WISE

44 7 PREVALENCE OF DENTAL CARIES EXPERIENCE -SEX

WISE

44

8 PREVALENCE AND SEVERITYOF DENTAL FLUOROSIS

ACCORDING TO FLUORIDE LEVELS IN DRINKING WATER

45

8a POST HOC ANALYSIS 46

9 CFI SCORE IN DRINKING WATER 46

10 CORRELATION BETWEEN FLUORIDE LEVELS IN DRINKING WATER AND DENTAL FLUOROSIS

47 11 PREVALENCE OF DENTAL CARIES EXPERIENCE

ACCORDING TO FLUORIDE LEVELS IN DRINKING WATER

47

11a POST HOC ANALYSIS 48

12 MEAN CARIES EXPERIENCE ACCORDING TO FLUORIDE LEVELS IN DRINKING WATER

48

12a POST HOC ANALYSIS 49

.

13 CORRELATION BETWEEN FLUORIDE LEVELS IN DRINKING WATER AND DENTAL CARIES

49

14 CORRELATION BETWEEN CFI

AND DENTAL CARIES

50

.

FIGURE.

NO

TITLE PAGE

NO

1 PREVALENCE AND SEVERITY OF DENTAL

FLUOROSIS ACCORDING TO FLUORIDE LEVELS IN DRINKING WATER

51

2 PREVALENCE OF DENTAL CARIES ACCORDING TO

FLUORIDE LEVELS IN DRINKING WATER

51

.

FIGURE.

NO

TITLE

1 WATER SAMPLE COLLECTION AT VILLAGES 2 COLLECTED WATER SAMPLES

3 THERMO SCIENTIFIC ORION VERSA STAR – ADVANCED ELECTROCHEMISTRY METER WITH FLUORIDE ION SELECTIVE ELECTRODE BN 9609

4 ARMAMENTARIUM FOR CLINICAL EXAMINATION 5 DATA COLLECTION FROM SCHOOL CHILDREN 6 VERY MILD DENTAL FLUOROSIS

7 MILD DENTAL FLUOROSIS

8 MODERATE DENTAL FLUOROSIS 9 MODERATE DENTAL FLUOROSIS

CONTENTS

SL.NO TITLE PAGE N0

1 INTRODUCTION 1

2 AIM AND OBJECTIVES 6

3 REVIEW OF LITERATURE 7

4 MATERIALS AND METHODS 21

5 RESULTS 29

6 DISCUSSION 52

7 SUMMARY AND CONCLUSION 66

8 RECOMMENDATIONS 69

9 REFERENCES -

10 ANNEXURES -

1

Natural wellbeing involves those parts of human wellbeing including personal satisfaction that are dictated by physical, organic, social and mental factors in the earth. The connection between nature and its effect on human wellbeing is very intricate. The family unit, work environment, open air and indoor conditions may posture dangers to wellbeing in various diverse ways. The low quality of air which we may inhale, the sullied water we may drink and the surroundings in which we live, decide our personal satisfaction. While the hereditary elements may likewise be in charge of causing maladies however the ecological variables assume significantly more dynamic part in contracting different infections.¹

Water is a basic common asset for maintaining life and a critical piece of our condition. New water that we utilize originates from two sources via surface water and ground water.² Though surface water sources have satisfied the water requirements for quite a while, by and by with continuous elimination of surface water sources because of the relentlessly expanding use, ground water sources are looked upon as the promising alternatives.³

Groundwater, constituting 97% of worldwide freshwater and utilized for drinking by over half of the total populace, fills in as the main financially suitable choice for some groups of population.⁴

Groundwater shapes a noteworthy wellspring of savoring water urban and additionally in country territories. This is consistent with a more prominent degree on account of creating nations like India where an expected 80% of local utilization in rustic and half in urban territories are met by groundwater sources alone.4 More than 90% of the country populace utilizes groundwater for household purposes.⁵ Because of different anthropogenic and normal components combined with aimless "mining",

2

the quality and amount of groundwater have dwindled to alarmingly low levels. In this way, notwithstanding shortage, the passage of geogenic toxins like fluoride and arsenic into groundwater has turned into the most critical and testing natural issue the world over, particularly in creating countries.⁴

In India almost 74% of populace lives in towns and don't have an entrance for brought together funneled water supply. Henceforth they acquire water by penetrating wells.⁶ The issue of high fluoride in groundwater has now turned out to be a standout amongst the most vital toxicological and geo ecological issues in India.⁷

Dissolution or weathering of rocks and soils, dissolving of lime, gypsum and other salt sources, mining activities, industrial activities, agricultural activities and geological formations of area etc., carries available minerals to and percolates with rainwater and joins the ground water. Some of the commonly occurring constituents are calcium, magnesium, sodium, potassium, iron, manganese, arsenic, nitrate, chlorides, fluoride, bicarbonate etc. Presence of these ions in excess of permissible limits, as prescribed by IS 10500 & WHO in 1983, results in undesirable health effect.³

Some elements are essential in trace amount for human being while higher concentration of the same can cause toxic effects. Fluoride is one of them. Due to rapid urbanization and growth of modern industries (anthropogenic source of fluoride) as well as geo chemical dissolution of fluoride bearing minerals (natural source of fluoride), fluoride concentration is increasing in the environment including water resources.⁷ Among various ions present fluoride is one such that is present in ground water. Fluoride is a salt of an element called fluorine. Fluorine is the most highly reactive element of halogen family.³

3

The government enlist of United States Food and Drug Administration portrays fluoride as a basic component. The WHO master board of trustees on follow components has included fluorine as one among the 14 physiologically basic components required for the typical development and improvement of the body.8 Fluorides have certain physiological properties of awesome enthusiasm for connection to human wellbeing and prosperity. Fluoride has double significance.⁸ Fluoride is regularly depicted as a 'twofold edged sword' as deficient ingestion is related with dental caries, where as exorbitant admission prompts dental, skeletal and delicate tissue fluorosis which has no cure.⁹

Fluoride being a profoundly electronegative component tends to get pulled in by decidedly charged particles like calcium. Consequently the impact of fluoride on mineralized tissues like bone and teeth prompting formative rotations is of clinical essentialness as they have most astounding measure of calcium and in this manner draw in the greatest measure of fluoride that gets saved as calcium– fluorapatite crystals.¹⁰

Fluoride discovers its way in to human body to a great extent through the drinking water and causes fluoride poisonous quality influencing bones and teeth.

Endemic dental fluorosis is an unsettling influence of tooth development caused by unnecessary admission of fluoride amid the developmental time of dental polish (amelogenesis).⁶ Tooth finish is made mainly out of crystalline hydroxylapatite.

Under ordinary conditions, when fluoride is available in water supply, the greater part of the ingested fluoride particles get fused into the apatite precious stone cross section of calciferous tissue finish amid its arrangement. The hydroxyl ions gets substituted by fluoride particle since fluorapatite is more steady than hydroxyapatite.

Consequently, a lot of fluoride gets bound in these tissues and just a little sum is

4

discharged through sweat, pee and stool. The force of fluorosis isn't only reliant on the fluoride content in water, yet additionally on the fluoride from different sources, physical action and dietary habits.¹⁰ Fluoride inebriation relies on the sum, frame and recurrence of fluoride ingestion, the length, bioavailability of fluoride compound and hereditary variations.⁶

Around 200 million individuals from 25 countries have wellbeing dangers in view of high fluoride in ground water.¹¹ The most recent data demonstrates that fluorosis is endemic in no less than 25 nations over the world. Known fluoride belts ashore include: one that extends from Syria through Jordan, Egypt, Libya, Algeria, Sudan, Kenya and Tanzania, and another that extends from Turkey through Iraq, Iran, Afghanistan, India, Northern Thailand and China. There are comparable belts in the America and Japan.⁹ Two most populated nations of the world, China and India, remain at the best in the rundown of most exceedingly awful hit countries in groundwater sullying with fluoride.⁴

India is among the numerous nations on the planet; where high fluoride sullied ground water is making wellbeing perils. Safe savoring water rustic ranges of India is dominatingly reliant on groundwater sources, which are profoundly debased with fluoride.¹² The issue of over the top fluoride in groundwater in India was first detailed in 1937 in the State of Andhra Pradesh. In India, around 62 million individuals including 6 million youngsters experience the ill effects of fluorosis in light of utilization of water with high fluoride concentrations.⁵ Fluorosis is an endemic condition pervasive in 337,690,000 populaces dwelling in 390,000 towns in 22 of the 32 conditions of India. The most truly influenced states are Andhra Pradesh, Punjab, Haryana, Rajasthan, Gujarat, Uttar Pradesh, Bihar, Tamil Nadu, Kerala, Karnataka and Maharashtra.¹³

5

In Tamil Nadu, the high convergence of fluoride in groundwater is observed to be in Dharmapuri and Salem area intently took after by Coimbatore, Madurai, Trichy, Dindigul and Chidambaram region. The areas having low fluoride are Thirunelveli , Pudukottai , North Arcot , and Ramnad.

Geogenic factors are in charge of large amounts of fluoride in groundwater in the Madurai. The higher centralization of fluoride is seen in the Charnockite rocks which lies in the northern part (Melur) of the area propose that there is the lithological control in the appropriation of fluorides. The pH assumes a crucial part in the disintegration and draining of fluoride into the groundwater.¹⁴ Based on this data an investigation was intended to discover the Prevalence of dental fluorosis and dental caries in connection to fluoride in drinking water among 13-15 year old fashioned going offspring of Melur taluk of Madurai.