A comparison of the oral health status of children and adults living in low, optimal, and high fluoride areas
Date
2014-06-10
Authors
Molefe, Meshack Itumeleng
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Abstract
Dental caries prevalence in many developing countries is low but an increased
prevalence has recently been reported from some of these countries. This is in contrast
to the data from the industrialised countries which show a consistent decrease in caries
prevalence, particularly in urban populations. The phenomenon of a low caries
experience in areas having an optimal fluoride concentration in water is well
documented. On the other hand, many reports show that higher than optimal levels of
fluoride in drinking water are associated with varying degrees of fluorosis (Murry et. al,
1991). In developing countries, a high prevalence of periodontal disease has been
reported in both teenagers and adults. The present study compared the caries profile,
periodontal disease and fluorosis among children and adults residing in low, "optimal"
and high fluoride areas in four villages in the Mankwe region, North-West Province of
South Africa.
The population of the Mankwe region was approximately 63 000 in 1993 and fifty
percent of whom were children (Development Bank of South Africa, 1994). The
climateis hot and dry, and until recently, people depended on underground and rain
water. Access to tap water was costly. Oral health facilities were limited and there
were inadequate oral health personnel.
The method of sampling, examination techniques, instruments used and the statistical
analysis were carried out under supervision of experienced epidemiologist and in
consultation with expert statisticians. The indices used included the Decayed, Missing
and Filled Teeth (DMFT, drnft), Community Periodontal Index of Treatment Needs
(CPITN) (WHO 1987; Ainamo et al, 1982), Dean's Index (Dean et al. 1942) and the
Tooth Surface Index of Fluorosis (TSIF) (Horowitz et at,1984).
A total of 360 subjects aged 6-7,12-13 and 30-55 years were examined. More than 90
percent of the 6-7 year old children were caries-free in the permanent dentition at all
four study villages. Both ttmft and DMFT scores were very low. DMFT values for the
12-13 year old group was also well within the WHO goals in all the villages but
increased in the adult group. The D-component was dominant in all groups with the
occlusal surfaces most affected. There was a high percentage of periodontal disease
but with low severity. Less than 30 percent of the adults aged 30-55 years
demonstrated bleeding on probing at all the four villages. In the 30-55 year age groups,
calculus was predominantly found at Lerome and less than 32 percent and 20 percent
had shallow and deep pockets respectively at all the four villages. All those in the 12-13
and 30-55 year age groups were assessed as needing oral hygiene instructions and
less than 20 percent of the adults needed advanced periodontal care.
When using Dean's index in the 12-13 year age group, the highest percentage with
fluorosis was found at Ruighoek which had an excessive amount of fluoride in drinking
water, but fluorosis was also pronounced at Lerome. The central incisors were more
affected than the lateral incisors when using the TSIF. Also, mandibular first molars
were more affected than maxillary first molars. In the 30-55 year olds, there was a
decrease in the severity of fluorosis with age at the high fluoride villages, but all of the
adults examined had brown discolouration at Ruighoek.
Based on the finding of this study it is suggested that greater efforts be made to
introduce proven preventive treatment programmes in these communities. More human
resources particularly in the form of auxiliaries should also be employed in order to
promote oral health education and provide basic periodontal intervention. The fluorosis
problem could be addressed by introducing potable water and the unsightly brown
discolouration in adolescents could be eliminated by either bleaching, composite
veneers or crowns, However, the latter solution is expensive and Is dependent on
sophisticated equipment and highly trained dental personnel.