Assessment of Caries Index and Fluoride Intake in a Pediatric Middle Eastern Population
Zoukaa El Mir, Nada El Osta, Michel Salameh, Radwan Massoud, Lionel El Haddad, Nada Farhat Mchayleh
Children, Decay missed filled tooth, Fluoride, Ion chromatography, Source of water
Citation Information :
El Mir Z, El Osta N, Salameh M, Massoud R, El Haddad L, Mchayleh NF. Assessment of Caries Index and Fluoride Intake in a Pediatric Middle Eastern Population. J Contemp Dent Pract 2020; 21 (10):1098-1104.
Aims: To assess the fluoride concentration in water sources and its association with caries index in children living in Tripoli, Lebanon. Materials and methods: The concentration of fluoride was measured in tap and bottled water using ion chromatography. For tap water, eight water sources were evaluated before and after domestic distribution during June and November 2016. For bottled water, seven brands available on the market were tested. Caries were recorded in 402 children using DMFT/dmft indices. A questionnaire was distributed to parents to gather information about sociodemographic characteristics, the source of water consumed, the consumption of fluoride supplements, fluoridate salt, tea and sweets, and the frequency of toothbrushing. Results: The fluoride concentration in tap water was not significantly different from the optimal concentration (p value > 0.05). However, the amount of fluoride in bottled water (0.14 ± 0.698 mg/L) was significantly lower than the optimal amount of fluoride recommended by the World Health Organization for decay prevention (0.5–1 mg/L) (p value < 0.001). The prevalence of caries was elevated in children aged 5 years (90.5%) and 12 years (89.6%). The carious indices were lower in children who consume tap water, tea, and fluoridated salt and those who consume less sweet. Conclusion: Additional studies covering all Lebanese regions should be performed to develop a national policy concerning fluoride-based scientific evidences. Clinical significance: Pedodontists should take in consideration the source of water consumed by the patient before prescribing a fluoride supplementation to avoid an overconsumption. They should promote effective oral hygiene methods and nutritional education and encourage regular tea consumption as an affordable source of fluoride to prevent caries.
Kassis A, El Osta N, Tubert-Jeannin S, et al. Cross-cultural adaptation and validation of the child perceptions questionnaire (CPQ11-14) among children in Lebanon. BMC Oral Health 2018;18(1):18. DOI: 10.1186/s12903-018-0482-x.
Pahel BT, Rozier RG, Slade GD. Parental perceptions of children's oral health: the early childhood oral health impact scale (ECOHIS). Health Qual Life Outcomes 2007;5(1):6. DOI: 10.1186/1477-7525-5-6.
Mount GJ, Hume WR. Preservation and restoration of tooth structure. 2nd ed., Brighton (Australia): Knowledge Books and Software; 2005.
Armfield JM. Community effectiveness of public water fluoridation in reducing children's dental disease. Public Health Rep 2010;125(5): 655–664. DOI: 10.1177/003335491012500507.
Murthy VH. Surgeon general's perspectives. Public Health Rep 2015;130(3):1–3. DOI: 10.1177/003335491513000303.
Petersen PE, Ogawa H. Prevention of dental caries through the use of fluoride–the WHO approach. Commun Dent Health 2016;33:66–68.
Petersen PE. The world oral health report 2003: continuous improvement of oral health in the 21st century--the approach of the WHO global oral health programme. Commun Dent Oral Epidemiol 2003;31(Suppl 1):3–23. DOI: 10.1046/j.2003.com122.x.
Doumit M. Dental caries and fluorosis among children in Lebanon. J Oral Health Craniofac Sci 2017. 001–008.
Doumit M, Baez R, Oral Health Programme In Lebanon: Technical assistance provided for development of baseline studies for salt fluoridation. 2004.
Jurdi M, Kambris M. Decision to fluoridate 1. Fluoride levels in herbal teas used in Lebanese communities. Food Nutr Bull 2001;22(1):62–65. DOI: 10.1177/156482650102200110.
Fawell JBK, Chilton J, Dahi E, et al. Fluoride in drinking-water. WHO; 2006.
L'eau en société KM, Pratiques et perceptions des usagers à l’égard du service public en charge de la distribution de l'eau potable et de l'assainissement à Tripoli 2007. République Libanaise Etablissement des Eaux du Liban Nord. http://www.corail-developpement.org/docs/les_references/Etude_Usagers_Tripoli_2007.pdf. Last Access 2019.
Shivakumar K, Prasad S, Chandu G. International caries detection and assessment system: a new paradigm in detection of dental caries. J Conserv Dent 2009;12(1):10–16. DOI: 10.4103/0972-0707. 53335.
Word Health Organization. Guidelines for drinking-water quality. Incorporating the First Addendum. 4th ed., Geneva 2017.
Walia T, Abu Fanas S, Akbar M, et al. Estimation of fluoride concentration in drinking water and common beverages in United Arab Emirates (UAE). Saudi Dent J 2017;29(3):117–122. DOI: 10.1016/j.sdentj.2017.04.002.
Cochrane N, Hopcraft M, Tong A, et al. Fluoride content of tank water in Australia. Aust Dent J 2014;59(2):180–186. DOI: 10.1111/adj. 12163.
Abouleish MY. Evaluation of fluoride levels in bottled water and their contribution to health and teeth problems in the United Arab Emirates. Saudi Dent J 2016;28(4):194–202. DOI: 10.1016/j.sdentj.2016.08.002.
Grobler SR, Dreyer AG, Blignaut RJ. Drinking water in South Africa: implications for fluoride supplementation. SADJ 2001;56: 557–559.
Taghipour N, Amini H, Mosaferi M, et al. National and subnational drinking water fluoride concentrations and prevalence of fluorosis and of decayed, missed, and filled teeth in Iran from 1990 to 2015: a systematic review. Environ Sci Pollut Res Int 2016;23(6):5077–5098. DOI: 10.1007/s11356-016-6160-0.
Guissouma W, Hakami O, Al-Rajab AJ, et al. Risk assessment of fluoride exposure in drinking water of Tunisia. Chemosphere 2017;177: 102–108. DOI: 10.1016/j.chemosphere.2017.03.011.
Zhang L, Huang D, Yang J, et al. Probabilistic risk assessment of Chinese residents’ exposure to fluoride in improved drinking water in endemic fluorosis areas. Environ Pollut 2017;222:118–125. DOI: 10.1016/j.envpol.2016.12.074.
Arif M, Husain I, Hussain J, et al. Assessment of fluoride level in groundwater and prevalence of dental fluorosis in Didwana block of Nagaur district, Central Rajasthan, India. Int J Occup Environ Med 2013;4:178–184.
Semerjian LA. Quality assessment of various bottled waters marketed in Lebanon. Environ Monit Assess 2011;172(1-4):275–285. DOI: 10.1007/s10661-010-1333-7.
Thippeswamy HM, Kumar N, Anand SR, et al. Fluoride content in bottled drinking waters, carbonated soft drinks and fruit juices in Davangere city, India. Indian J Dent Res 2010;21(4):528–530. DOI: 10.4103/0970-9290.74206.
Aldrees AM, Al-Manea SM. Fluoride content of bottled drinking waters available in Riyadh, Saudi Arabia. Saudi Dent J 2010;22(4):189–193. DOI: 10.1016/j.sdentj.2010.07.003.
Canadian Dental Association. CDA position on use of fluorides in caries prevention. 2015. 2–5. http://www.cda-adc.ca/_files/position_statements/fluoride.pdf.
Ahiropoulos V. Fluoride content of bottled waters available in Northern Greece. Int J Paediatr Dent 2006;16(2):111–116. DOI: 10.1111/j.1365-263X.2006.00702.x.
Policy on early childhood caries (ECC): unique challenges and treatment options. Pediatr Dent 2017;39:62–63.
El-Nadeef MA, Hassab H, Al-Hosani E. National survey of the oral health of 5-year-old children in the United Arab Emirates. East Mediterr Health J 2010;16(01):51–55. DOI: 10.26719/2010.16.1.51.
Al-Malik MI, Holt RD, Bedi R. Prevalence and patterns of caries, rampant caries, and oral health in two- to five-year-old children in Saudi Arabia. J Dent Child (Chic) 2003;70:235–242.
Azizi Z. The prevalence of dental caries in primary dentition in 4- to 5-year-old preschool children in northern Palestine. Int J Dent 2014;2014:839419. DOI: 10.1155/2014/839419.
Al-Mutawa SA, Shyama M, Al-Duwairi Y, et al. Dental caries experience of Kuwaiti kindergarten schoolchildren. Commun Dent Health 2010;27:213–217.
Duangthip D, Gao SS, Lo EC, et al. Early childhood caries among 5- to 6-year-old children in Southeast Asia. Int Dent J 2017;67(2):98–106. DOI: 10.1111/idj.12261.
American Academy of Pediatric Dentistry Council on Clinical Affairs. Policy on dietary recommendations for infants, children, and adolescents. Pediatr Dent 2017;39:64–66.
Kastorini CM, Critselis E, Zota D, et al. Greek national dietary guidelines scientific team. national dietary guidelines of Greece for children and adolescents: a tool for promoting healthy eating habits. Public Health Nutr 2019;22(14):2688–2699. DOI: 10.1017/S1368980019001034.
Bast LS, Nordahl H, Christensen LB, et al. Tooth brushing among 11- to 15-year-olds in Denmark: combined effect of social class and migration status. Community Dent Health 2015;32:51–55.
Sheiham A, James WP. A reappraisal of the quantitative relationship between sugar intake and dental caries: the need for new criteria for developing goals for sugar intake. BMC Public Health 2014;14(1):863. DOI: 10.1186/1471-2458-14-863.
Goenka P, Sarawgi A, Karun V, et al. Camellia sinensis (tea): Implications and role in preventing dental decay. Pharmacogn Rev 2013;7(14): 152–156. DOI: 10.4103/0973-7847.120515.
Tomasin L, Pusinanti L, Zerman N. The role of fluoride tablets in the prophylaxis of dental caries. A literature review. Ann Stomatol (Roma) 2015;6:1–5. DOI: 10.11138/ads/2015.6.1.001.