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__ ~ _
111
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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