|Year : 2014 | Volume
| Issue : 1 | Page : 37-40
Prevalence of dental fluorosis in the district of Salem, Tamil Nadu, South India: A pilot study
Maya Ramesh1, R Shankar2, Ramesh Krishnan3, Narasimhan Malathi4, Rita Mary Aruna5
1 Department of Oral Pathology, VMSDC, Ariyanoor, Tamil Nadu, India
2 Department of Community Medicine, VMKV, Tamil Nadu, India
3 Department of Pedodontics, VMSDC, Ariyanoor, Tamil Nadu, India
4 Department of Oral Pathology, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
5 Department of Nuclear Medicine, PIDC, Salem, Tamil Nadu, India
|Date of Web Publication||15-May-2014|
Reader, Department of Oral Pathology, VMSDC, NH 47, Sankari Main Road, Ariyanoor, Salem - 636 308, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Tamil Nadu is one of the 18 states affected by fluorosis in India. The maximum tolerance limit of fluoride in drinking water specified by the World Health Organization (WHO, 1984) is 1.5 mg/l while it is proved to be above in many areas of Salem. Aims and Objectives: The aim of the following study is to identify the prevalence of dental fluorosis among children in the district of Salem. To compare the prevalence of dental fluorosis between different sexes and age groups. Materials and Methods: A pilot study was conducted in a private school where oral examination was done using mouth mirror and probe under sunlight in 965 students, for the presence or absence of dental fluorosis. As it was a pilot study, the fluorosis indexes were not taken into consideration. Results: In our study, 965 students were examined for dental fluorosis out of which, 624 were boys and 341 were girls. Dental fluorosis was present in 31.1% of boys, and 30.3% of girls 297 students out of 965 (30.8%) showed the presence of dental fluorosis. Conclusion: The present study showed that Salem is one of the districts affected by dental fluorosis in Tamil Nadu. An extensive study including the grades of fluorosis and estimation of water fluoride levels in different areas is required for better evaluation of the situation. Government should take actions to prevent fluorosis. Awareness should be given to the population to drink only the water supplied by the government.
Keywords: Dental fluorosis, fluorine, ppm of fluoride, prevalence, skeletal fluorosis
|How to cite this article:|
Ramesh M, Shankar R, Krishnan R, Malathi N, Aruna RM. Prevalence of dental fluorosis in the district of Salem, Tamil Nadu, South India: A pilot study. J Orofac Sci 2014;6:37-40
|How to cite this URL:|
Ramesh M, Shankar R, Krishnan R, Malathi N, Aruna RM. Prevalence of dental fluorosis in the district of Salem, Tamil Nadu, South India: A pilot study. J Orofac Sci [serial online] 2014 [cited 2021 Jul 28];6:37-40. Available from: https://www.jofs.in/text.asp?2014/6/1/37/132584
| Introduction|| |
India is one of the countries where hydrofluorosis is a major public health problem, affecting 18 of the 33 constituent states of the country. Tamil Nadu is one of the Southern states having 10 out of the 29 districts affected with fluorosis. Fluorosis is caused by ingestion of excess fluoride mainly through drinking water contamination.
Fluoride is 13 th in the order of abundance on the earth's crust among the various elements. Fluorine is the most reactive electronegative element of all known elements with electronegativity 4.0.  Its abundance in the continental crust is about 626 μg/g. , It rarely occurs free in nature, therefore is generally found as the fluoride ion (F− ). Occurrence of fluorine in groundwater has drawn world-wide attention due to its considerable impact on human physiology.  Small doses of fluoride have beneficial effects on the teeth by hardening of enamel and reducing the incidence of caries, but excessive intake of fluoride results in dental and skeletal fluorosis. ,
The maximum tolerance limit of fluoride in drinking water specified by the World Health Organization (WHO, 1984) is 1.5 mg/l.  More than 23 countries in the world, including India, have problems with F− in the drinking water.  The problems are most pronounced in the states of Andhra Pradesh, Bihar, Gujarat, Madhya Pradesh, Punjab. Small doses of fluoride have beneficial effects on the teeth by hardening the enamel and reducing the increase of caries, but excessive intake of fluoride, results in dental and skeletal fluorosis. 
The problem of fluorosis has been known in India for a long time. The disease earlier called "mottled enamel" was first reported by Viswanathan  to be prevalent in human beings in Madras Presidency in 1933. Mahajan  reported a similar disease in cattle in certain parts of old Hyderabad state. However, Shortt  was the first to identify the disease as "fluorosis" in human beings in Nellore district of Andhra Pradesh.
The main objective of the study was to conduct a pilot study to identify the prevalence of dental fluorosis in population of Salem.
Aims and objectives
The aim is to identify the prevalence of dental fluorosis among school children in the Salem district. To compare the prevalence of dental fluorosis between different sexes and age groups.
| Materials and Methods|| |
Salem, which is also called as Mango city, is located about 160 km Northwest of Coimbatore and about 340 km Southwest of the state capital, Chennai in the North Central part of the state. We conducted a pilot study for the prevalence of dental fluorosis in a private school in the district of Salem. The population consisted of 965 students in that school from 11 to 17 years. Presence or absence of dental fluorosis was noted using mouth mirror and explorer with adequate daylight. Age and sex were noted down.
- Students in a school between the age of 11 and 17 years
- Students who were native and born and brought up in the district of Salem.
- Students below 11 years
- Students who are not born and brought up in Salem.
| Results|| |
In our study, the population consisted of 965 students, out of which 624 were boys and 341 were girls, are shown in [Table 1] and Graph 1. Number of students examined in each age group is given in [Table 2] and Graph 2. Prevalence of dental fluorosis based on sex is given in [Table 3] and Graph 3. 31.1% of boys and 30.3% of girls showed the presence of dental fluorosis. Prevalence of dental fluorosis based on age is given in [Table 4] and Graph 4. Totally 297 students out of 965 (30.8%) showed dental fluorosis.
| Discussion|| |
In India, approximately 62 million people, including 6 million children suffer from fluorosis because of consumption of water with high fluoride concentrations.  Due to its strong electronegativity, fluoride is attracted by positively charged calcium in teeth and bones causing dental fluorosis, teeth mottling, skeletal fluorosis and deformation of bones in children as well as in adults. 
More than 90% of the rural Indian population uses groundwater for domestic purposes. In Tamil Nadu, the high concentration of fluoride in groundwater is found to be in Dharmapuri and Salem district closely followed by Coimbatore, Madurai, Trichy, Dindugal and Chidambaram district. The districts having low fluoride level are Thirunelveli, Pudukottai, North Arcot, and Ramnad districts. 
WHO (1984) has suggested a cut-off level of 1.5 ppm of fluoride, but some experts say that a lower level of 1.0 ppm as safe limit in tropical climates like in India, where higher amounts of drinking water is consumed. Previous studies showed that the proportion of water sources having 1.0 ppm of fluoride was the highest in the villages of Dharmapuri and Krishnagiri (100%), followed by Vellore and Salem (70-80%) and Erode (17%). Data collected by the Tamil Nadu Water Supply and Drainage Board showed that >50% of the water sources had 1.0 ppm of fluoride in the districts of Krishnagiri (62%) followed by Vellore (60%), Salem (56%), Dharmapuri (53%), and Erode (26%). 
The results of the study done by Warren et al. among the children residing at Iowa show that primary tooth fluorosis is relatively uncommon, but is the most frequently seen on the posterior teeth, particularly the primary second molars, which form at later stages of development. 
A study conducted on osteo-dental fluorosis in 21 villages of Banswara, Dungarpur, and Udaipur districts of southern Rajasthan, where fluoride (F) concentrations in drinking waters ranged from 1.5 to 4.0 ppm showed a variable prevalence of fluorosis in villages having almost the same F concentrations. At 1.5 ppm, 21.3, 25.6, and 38.9% of children and 33.3, 36.9, and 44.8% of adults in different villages of these districts were found to be affected with dental fluorosis. The maximum prevalence of dental fluorosis (77.1%) was found in the 17-22. No significant correlation was found between prevalence figures and gender. 
In a study conducted by Karthikeyan and Shanmugasundarraj in the nearby district of Krishnagiri, he reported that 39 villages of only three panchayats, namely, Mallinayanapalli, Periyamuthur, and Kallukuruki, contained water sources having fluoride within the tolerance limits. The remaining 216 villages, constituting 84.7%, had their drinking water sources contaminated with excessive fluoride. The door-to-door survey indicated the prevalence rate of dental fluorosis among the school going children of these villages to be between 65% and 70%, respectively. The water sources of these five panchayats contained exceedingly high fluoride levels, ranging up to 4.3 and 5.6 mg/l. 
| Conclusion|| |
The present study shows that Salem is one of the districts affected by dental fluorosis in Tamil Nadu. An extensive study including the grades of fluorosis and estimation of water fluoride levels in different areas is required for better results. Government should take action to identify the fluorotic villages. If only dental fluorosis is present, that can be considered as low endemic areas and if crippling bone deformities are present, that places should be considered as high endemic areas. Defluoridation plants should be established in high endemic areas and it should be ensured that all individuals receive water with optimum fluoride levels. Rain water harvesting can be done and water from nearby rivers and dams should be provided as a source of water supply. Awareness should be given to the population to drink only the water supplied by the Government. Nutritious food should be provided for all children mainly through schools with therapeutic doses of calcium, vitamin D and vitamin C to decrease the consequences of fluorosis.
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[Table 1], [Table 2], [Table 3], [Table 4]