Dental fluorosis: prevalence, severity, treatment need and impact on quality of life among secondary school students in Arusha, Tanzania

Abstract

ABSTRACT Background: Dental fluorosis is very common in Tanzania especially in fluoride endemic areas. Dental fluorosis presents clinically as a chalk-like discoloration of teeth with white spots or lines on tooth enamel. People who are affected by high levels of fluoride present with brown teeth discoloration and mottled teeth, hence their esthetic are compromised. The most commonly employed method of assessing dental fluorosis treatment need is clinically defined by dental professionals. Using the established fluorosis indexes alone as the basis for treatment need estimation may lead to overestimation of the need if general health and social impacts related to dental fluorosis are not taken into consideration. Objective: This study aimed to determine prevalence, severity and treatment need of dental fluorosis and its impacts on oral health quality of life among secondary school students in Arusha, Tanzania. Methodology: This study was a cross-sectional analytical study which was conducted between January and February, 2017 among secondary school students in Arusha City. It involved 426 students who were selected among secondary school students in Arusha City. A cluster sampling method was used for selection of secondary schools, which was followed by random sampling of students from the selected schools. The subject’s socio-demographic particulars, subjective treatment need and their perceived impacts were gathered through self-administered structured questionnaires. Clinical examination form was used to assess dental fluorosis according to Thylstrup and Fejerskov Index (TFI), clinical examinations were carried out by one calibrated dentists (Kappa = 0.86) under natural light, further TFI scores were categorized to determine treatment need groups. All the information collected were coded, entered in a computer and analyzed using SPSS version 20.0 software and statistical level of significance was put to p< 0.05. Chi-square test was used to compare proportions for any association and Pearson correlation coefficient was used to find correlation between Oral Impacts on Daily Performance (OIDP) scores and TFI scores. Linear logistic regression was used for multivariate analysis between severity of dental fluorosis and perceived impacts. Results A total of 426 students aged 13-18 years were involved in this study with 50.2% being males. The prevalence of dental fluorosis was high (85.4%). Majority of the participants (37.1%) had moderate dental fluorosis (TFI 4-5), 34.9% severe dental fluorosis (TFI 6-9) and 28% mild dental fluorosis (TFI 1-3). Overall prevalence of oral impacts on daily performance among students with dental fluorosis was 76.2% while for those without dental fluorosis was 8.8%. The most perceived dental treatment was removal of brown teeth discoloration 70.7%, followed by pain relief 25.4%, filling of cavities 14.8%, correction of arrangement of teeth 14.1% and 3.5% needed extractions. The study showed also that there was a very big difference in perceived impacts on oral health quality of life between students with dental fluorosis and those without dental fluorosis (p<0.001). Conclusion The prevalence of dental fluorosis was high. Moderate and severe forms of dental fluorosis were the commonest. Majority of the students perceived at least one oral impact and dental fluorosis was the main cause of the perceived impacts. The prevalence of oral impacts increases with an increase in the severity of dental fluorosis. Majority of the participants perceived removal of brown tooth discoloration as their most perceived dental treatment need.