PREVALENCE AND SEVERITY OF DENTALFLUOROSIS AMONG PATIENTS VISITING THEPROVINCIAL GENERAL HOSPITAL IN NAKURU

ByCHAUHAN AMANDEEP KAURBACHELOR OF DENTAL SURGERY,LEVEL III

A COMMUNITY DENTISTRY RESEARCHPROJECT REPORT SUBMITTED IN PARTIALFULFILLMENT FOR THE AWARD OF THEBACHELOR OF DENTAL SURGERY (BDS)DEGREE OF THE UNIVERSITY OF NAIROBI,2008

DECLARATIONI, Amandeep Kaur Chauhan declare that this is my original work and that it

has not been submitted by any other person for research purpose, degree or

otherwise in any other university college.

Signature __ *"""""--+- _

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APPROVAL

This research has been submitted in partial fulfillment of the Bachelor of

Dental Surgery with our approval as university supervisors.

Dr MACIGO F.G., BoS, MPH, PGo-STI (Nbi)

Signatur~ ,dJR;- Date 1 0 III L 0"0

Or olMBA, BoS (Nbi), PHo (BER9EN)

Signature Date__ ~ _

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DEDICATION

I dedicate this project to my family for all their love and support, prayers and

contribution towards making me who I am today.

IV

ACKNOWLEDGEMENTSI am grateful to God almighty for enabling me to do this project.

I would also like to express my deepest gratitude to all the Provincial General

Hospital dental clinic staff in Nakuru for their co-operation and my supervisors

who offered constant support and encouragement towards completion of this

project.

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TABLE OF CONTENTSPage title ~

Title (i)

Declaration (ii)

Approval (iii)

Dedication (iv)

Acknowledgements (v)

Table of contents (vi)

List of figures & tables (viii)

List of abbreviations (ix)

ABSTRACT 1

Chapter 1 3

INTRODUCTION 3

Chapter 2 5

LITERATURE REVIEW 5

Problem statement 8-

Justification of the study 8

Objectives 9

Hypothesis 9

Variables 9

Chapter 3 10

MATERIALS AND METHODS 10

Study area 10

Study population 10

Study design 10

Sampling size determination 10

VI

Sampling method 11Inclusion criteria 11Exclusion criteria 12Data collection instruments and techniques 12Data analysis and presentation 12Logistics 13Ethical consideration 13Perceived benefits 13RESULTS 14

DISCUSSION 22Conclusion 24

Recommendations 24

REFERENCES 25

APPENDICES 26

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LIST OF FIGURES

Figure Page

Figure 1: Age distribution of respondents 14

Figure 2: Dental fluorosis severity for tooth 11 17

Figure 3: Dental fluorosis severity for tooth 24 18

Figure 4: Dental fluorosis severity for tooth 36 18

Figure 5: Dental fluorosis severity for tooth 42 19

Figure 6: Distribution of participants by residences 20

LIST OF TABLES

Table Page

Table 1: Prevalence of dental fluorosis 15

Table 2: Severity of dental fluorosis by gender 15

Table 3: Distribution of source of drinking water 16

Table 4: Distribution of participants by severity of 16

dental fluorosis & source of drinking water

Table 5: Distribution of participants by duration of 21

residence and severity of dental fluorosis

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ABBREVIATIONS

UON - University of Nairobi

Kshs - Kenyan Shillings

Ppm - Parts per million

TFI- Thylstrup Fejerskov Index

KNH - Kenyatta National Hospital

Km - Kilometers

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ABSTRACT

BACKGROUND: Dental fluorosis is considered today as one of the major

dental problems in Kenya. Nakuru District has been reported to have high

concentrations of fluoride in water, atmosphere and dust. The negative effects

of dental fluorosis include brown discoloration, loss of enamel, skeletal

fluorosis and negative psychological effects such as lowering one's esteem.

Currently there is no published information on studies done to determine the

prevalence and severity of dental fluorosis in Nakuru. Inadequate knowledge

on dental fluorosis leads to continued consumption of high fluoride. This study

will motivate the stakeholders to formulate policies on prevention and

management of dental fluorosis in areas containing high concentrations of

fluoride in drinking water.

AIM OF STUDY: To determine the prevalence and severity of dental fluorosis

among patients visiting the provincial general hospital in Nakuru.

STUDY DESIGN: A descriptive, cross- sectional study.

SETTING: Provincial General Hospital (PGH) dental clinic.

STUDY PARTICIPANTS: Patients visiting the dental clinic in Provincial

General Hospital.

MATERIALS AND METHODS: A total of 170 patients were selected using

the convenience sampling method and examined for dental fluorosis. Intra-

oral clinical examination was conducted under natural light, in which the facial

surfaces of 11, 24, 36, and 42 were examined. Severity of dental fluorosis

was recorded in the clinical examination form with reference to the TF Index.

Other variables recorded included age, gender, source of drinking water,

residence and duration of residence. Data analysis was done manually and

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computer aided and presented in the form of tables, pie charts, bar charts and

line graphs.

RESULTS: The respondents were aged between 10 to 65 years with 60%

females and 40% males. The modal age group was 21-30 years (38.2%).AII

the participants with severe fluorosis were females. Central incisor (11) was

the most severely affected (TF 2-8) tooth. All the respondents had a TF score

of ~ 1. Therefore the prevalence was 100%.

The most common sources of drinking water were tap water (48.8%) followed

by bore-hole water (32.3%) and lastly riverllake/spring water (18.8%).None of

the respondents used mineralized bottle water or water from vendors. Majority

of the respondents drinking tap water had mild fluorosis (62.7%) while those

drinking bore-hole (52.7%) and riverllake/spring (62.5%) water had moderate

fluorosis. Severe fluorosis was the highest in those drinking riverllake/spring

water (6.25%).

CONCLUSION: Prevalence of dental fluorosis was 100% with all respondents

having a TF Index of > 1. Majority of the patients (51.2%) had mild form of

fluorosis (TF Index 1-4)

RECOMMENDATIONS: concerted efforts should be made to correct poor

aesthetics as a result of dental fluorosis and also recommend government

and professional support for the water defluoridation program by Catholic

Church of Nakuru for a wider coverage.

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