Dental fluorosis. Impact on quality of life and treatment need among adolescents with dental fluorosis in an endemic area, Kilimanjaro Region, Tanzania

Abstract

Background Dental fluorosis is the hypomineralization of dental enamel caused by chronic ingestion of fluoride during the formative stages of the dental hard tissues. Fluoride in excess of 1.5 mg/L in water is the principle cause of endemic dental fluorosis. Other causes of dental fluorosis are fluoride supplements (e.g. toothpaste) and food additives like traditional salt "trona". Dental fluorosis has social and psychological effects, whereby individuals affected even with the mild form demonstrate significant dissatisfaction over their appearance thus affecting their ability to interact and form relationships leading to exclusion, loneness, long term depression and other undesirable social behaviors.

Aim

The aim of this study was to determine the impact of dental fluorosis on quality of life using OrDP index, to determine the normative and subjective oral treatment need among individuals with dental fluorosis, the relationship between clinically defined dental fluorosis at different diagnostic cut-off points and self-rated appearance among adolescents. Methodology

This cross-sectional study was conducted at Kibosho, a known area for endemic dental fluorosis in Kilimanjaro between August and September 2009. A sample of 269 secondary school students aged 15-18 years with dental fluorosis was involved. Data were collected using self administered questionnaire and clinical examination forms, orDP questions were used to assess the impact of dental fluorosis on quality of life. Clinical examinations were carried out by one calibrated dentists (Kappa = 0.90) under natural light. Prior to examination the front teeth and first premolars of both maxilla and mandible were cleaned and dried with gauze. Dental fluorosis was diagnosed according to TF index. Data analysis was done using SPSS version 15 and statistical level of significance was p< 0.05. Results

Total of269 students with dental fluorosis aged15-18 years (mean age 17.3) were involved in this study where 62.5% were female. Majority of the participants (65.4%) had severe dental fluorosis (TFI6-9), while (29.4%) had TFY 4-5 and (5.2%) had dental fluorosis ofTFI 1-3. Most of the students (92.6%) perceived at least one oral impact on daily performance. The performances most affected were smiling 88.l%, emotional stability (81.4%), and having contact with others (75.5%). Brown discoloration of teeth was the most frequent perceived actual cause of oral impact on all eight performances. The treatment most frequently perceived was removal of brown discoloration 95.2% and 72.0% required esthetic veneer for treatment. Conclusions Dental fluorosis has impact on quality of life especially on smiling, emotional stability and having contact. Treatment of dental fluorosis at Kibosho is highly desired as expressed by subjective and objective treatment need. Low awareness of the role of "magadi" as a principal cause dental fluorosis at Kibosho was observed. Recommendations Oral health education programme on causes, prevention and treatment of dental fluorosis should be initiated in Kibosho. Efforts should be made to identify alternative salt for tenderization. Esthetic veneer should be promoted among dentists especially in endemic dental fluorosis area.