Prevalence and Distribution of Developmental Defects of Enamel in Children Aged 12-15 Years in Fazilka District, Punjab, India, and Their Correlation With Drinking Water Fluoride Level

Abstract

Background and objectives: Dental fluorosis is a developmental disturbance of dental enamels, caused by successive exposures to high concentrations of fluoride during odontogenesis, leading to enamels with lower mineral content and increased porosity. The objective of the present study was to assess the prevalence and severity of developmental defects and their relationship to fluoride levels in drinking water. Methods: Ten villages were selected from Fazilka district, Punjab, India. A total of 1000 (519 males, 481 females) school children aged 12-15 years formed the study population. Eutech ION 2700 (Thermo Fisher Scientific, Waltham, Massachusetts, United States) was used for the estimation of fluoride levels in water. Developmental defects were screened and assessed using the modified Developmental Defects of Enamel (DDE) Index. Statistical evaluation was done using Karl Pearson's coefficient of correlation and the Chi-square test with IBM SPSS Statistics for Windows, Version 23, (Released 2015; IBM Corp., Armonk, New York, United States).

Results: The fluoride concentration in drinking water ranged from 0.5 to 2.0 ppm. The prevalence of developmental defects among the study population was 73.4% (range 59% to 100%). The most commonly observed type of defect was diffuse opacity (score 4) in 22.8% of the children. The premolars were the most commonly affected teeth. There was a significant positive correlation between the type (r=0.95; p<0.001) and extent (r=0.82; p<0.001) of developmental defects to the fluoride levels in drinking water. Conclusion: The drinking water from about 50% of the villages had fluoride levels of 1 ppm or >1 ppm. A significant positive correlation between the severity of enamel defects and increased fluoride levels in water was deciphered. Thus, a simple, effective, and inexpensive method of de-fluoridation of drinking water should be prioritized if alternative sources of drinking water are not made available.

Keywords: dde index; dental fluorosis; enamel defects; enamel hypoplasia; esthetics; fluoride concentration.

Figure 1. Clinical picture of dental fluorosis

Intraoral picture showing diffuse mottling of enamel without any surface pitting.

Figure 2. Clinical picture of dental fluorosis

Intraoral picture showing dental fluorosis with mottling and pitting of enamel.

Figure 3. Clinical picture showing dental fluorosis

Intra-oral picture showing diffuse mottling of enamel, pitting of enamel, and intrinsic stains.

Figure 4. Graphical representation

Graph showing the mean value of total scores based on the type of enamel defects between various fluoride concentrations in parts per million

Figure 5. Graphical representation

Graphical representation of the mean value of total scores based on the extent of defects and fluoride concentrations in parts per million. It shows the association between the overall severity of the extent of enamel defect (mean value of total scores considered) with varying concentrations of fluoride in drinking water.