RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
4TH ‘T’ BLOCK, JAYANAGAR,
BANGALORE – 560041
(KARNATAKA)
PROPOSAL FOR REGISTRATION OF SUBJECT FOR DISSERTATION
SUBMITTED BY :
Thippeswamy H .
1 YEAR M.Sc. NURSING
VIVEKANANDA COLLEGE OF NURSING,
B.L. GOWDA LAYOUT, TURUVANUR ROAD
CHITRADURGA
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE-41
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
01 / CCNDIDATE NAME / Mr.THIPPESWAMY02 / NAME OF THE INSTITUTAION / VIVEKANANDA COLLEGE OF NURSING,CHITRADURGA-577501
KARNATAKA
03 / COURSE OF STUDY AND SUBJECT / M.Sc NURSING 1ST YEAR (PAEDIATRIC NURSING)
04 / DATE OF ADMISSION TO THE COURSE / 03-05-2010
05 / TITLE OF TOPIC / “impact of self introduction module on prevention of fluorosis among primary school children in chitradurga”
Brief resume of intended work
6.1 Introduction
“Even pearls are dark before the whiteness of his teeth.” ~William R. Alger
The prevalence of dental and skeletal fluorosis is not entirely clear. It is believed that fluorosis affects millions of people around the world, but as regards dental fluorosis the very mild or mild forms are the most frequent.
Removal of excessive fluoride from drinking-water is difficult and expensive. The preferred option is to find a supply of safe drinking-water with safe fluoride levels. Where access to safe water is already limited, de-fluoridation may be the only solution. The different methods which includes are use of bone charcoal, contact precipitation, use at Nalgonda .Since all methods produce sludge with very high concentration of fluoride that has to be disposed of and only water for drinking and cooking purposes should be treated, particularly in the developing countries17.
Chronic fluoride intoxication (fluorosis) is a worldwide health problem and is endemic in areas where Fluoride content is high in drinking waters. The primary Manifestations of fluorosis are mottling of teeth and osteosclerosis of the skeleton; secondary effects include damage to the nervous system in state of Rajasthan, almost all districts have high Floride (up to 18.0 part/million) in their drinking/ground water sources. In southern Rajasthan, where tribal populations are predominant, 0.3 to 10.8 Fluoride part/million concentration is reported18.
The community water fluoridation is the adjustment of the fluoride concentration in the community water supply to a level beneficial to reduce tooth decay and promote good oral l health. The mineral fluoride is essential for strong healthy teeth that resist decay. The almost all waters contain some quality of naturally occurring fluoride, but usually at level s insufficient to prevent decay. The optimum concentration of fluoride in water has been determined to be between 0.7 to 1.2 milligrams per liter depending on the air temperature in a given region . Given the dramatic decline in tooth decay during the past 60 years, the centers for disease control and prevention named water fluoridation one of ten great public health interventions of the 20th century. Community water fluoridation has been recommended by the past dive united state surgeon generals.
The tooth decay is caused by bacteria in the mouth. When a person eats sugar of other refined carbohydrate, these bacteria produce acid that removes minerals from the surface of the tooth, a process known as demineralization goes on long enough, a cavity is formed. Fluoride can promote the remineralization of enamel, thereby preventing the cavity from continuing to form. In addition fluoride reduces the ability of the oral bacteria to produce acid19.
Dental fluorosis is a health condition caused by a child receiving too much fluoride during development. The critical period of exposure is between 1 and 4 years old children over age 8 are not at risk.
Dental fluorosis occurs because of the excessive intake of fluoride, either through fluoride in the water supply, naturally occurring or added to it; or through other sources. The damage occurs between the ages of 3 months to 8 years from the overexposure to fluoride. Teeth are generally composed of hydroxyapatite and carbonated hydroxyapatite; when fluoride is present, some fluorapatite is generated. Excessive fluoride can cause white spots, and in severe cases, brown stains or pitting or mottling of enamel. Fluorosis cannot occur once the tooth has erupted into the oral cavity. At this point, fluorapatite is beneficial because it is more resistant to dissolution by acids (demineralization). Although it is usually the permanent teeth which are affected, occasionally the primary teeth may be involved.
The fluorosis is more prevalent in rural areas where drinking water is derived from shallow wells or hand pumps. It is also more likely to occur in areas where the drinking water has a fluoride content greater than 1 ppm (part per million), and in children who have a poor intake of calcium.
The latest information shows that fluorosis is endemic in at least 25 countries across the globe. The total number of people affected is not known, but a conservative estimate would number in the tens of millions. In 1993, 15 of India's 32 states were identified as endemic for fluorosis. In Mexico, 5 million people (about 6% of the population) are affected by fluoride in groundwater. Fluorosis is prevalent in some parts of central and western China and caused not only by drinking fluoride in groundwater but also by breathing airborne fluoride released from the burning of fluoride-laden coal. Worldwide, such instances of industrial fluorosis are on the rise20.
6.2 Need for study
Dental fluorosis is defined by an alteration of dental hard tissues and occurs when fluoride intakes are excessive. Medical authorities recommend a total daily consumption of 0.05 mg/kg of fluoride, without exceeding 1 mg. The two reported clinical observations confirm that fluorosis is a consequence of excessive fluoride intakes. Etiological diagnosis allows a better understandingof this pathology. In the majority of the cases, dental fluorosis can be avoided. Dental fluorosis is the sole risk of fluoride use, but it is not a fate. It does not constitute a problem of public health in France and the benefits/risks ratio is widely in favour of the use of fluoride 30.
Dental fluorosis refers to changes in the appearance of tooth enamel that are caused by long-term ingestion of fluoride during the time teeth are forming .the severity of tooth decay was lower and dental fluorosis was higher in areas with more fluoride in the drinking water . In response to these findings, community water fluoridation programs were developed to add fluoride to drinking water to reach an optimal level for preventing tooth decay, while limiting the chance of developing dental fluorosis . paralleling the expansion of water fluoridation and the increased availability of other sources of ingested fluoride, such as fluoride toothpaste (if swallowed) and fluoride supplements . This report describes the prevalence of dental fluorosis. in the United States and changes in the prevalence and severity of dental fluorosis among adolescents31.
Fluoride ion in drinking water is known for both beneficial and detrimental effects on health. The prevalence of fluorosis is mainly due to the intake of large quantities of fluoride. The objective is to predict optimal fluoride level in drinking water for fluoride endemic regions by comprising the levels of fluoride and other water quality parameters in drinking water, the increase of fluoride level above 1.33 mg/l in drinking water increases the community fluorosis , the optimum value more than 0.6, an optimum value above which fluorosis is considered to be a public health problem. Every increase of 0.5mg/l unit of water fluoride level increases the bone fluoride level of 52 mg/kg unit within 2 to 3 years. Further more, the consumption of drinking water containing, the more than 0.65 mg/l of fluoride can raise the total fluoride intake per day more than 4 mg, which is the optimum fluoride dose level recommended, the people in fluoride endemic areas in South India are advised to consume drinking water with fluoride level within the limit of 0.5 to 0.65 mg/l to avoid further fluorosis risk29.
In India, dental fluorosis has previously been described in humans ingesting 0.5 to 1.0 part/million Floride in drinking water, while at concentrations of 3.4 to 3.8 part/million, 100% dental fluorosis has been reported. In the present study, The highest overall prevalence of dental fluorosis (63.4% in Banswara, 77.2% in Dungarpur, and 72.5% in Udaipur district) was observed in villages with 3.7 part/million, 3.2 part/million, and 4.0 part/million Fluoride concentration, respectively.
Astudy was conducted to asses the prevalence of fluorosis in those villages having almost the same fluoride levels in their drinking/ground water sources of three districts of southern Rajasthan: Banswara, Dungarpur, and Udaipur. Radiological examinations for other skeletal deformities in flouristic subjects as well as inspections for thyroidism (goiter) were also carried out25.
In groundwater, the natural concentration of fluoride depends on the geological, chemical and physical characteristics of the aquifer, the porosity and acidity of the soil and rocks, the temperature, the action of other chemical elements, and the depth of wells. Because of the large number of variables, the fluoride concentrations in groundwater can range from well under 1 part/million to more than 35 part/million In Kenya and South Africa, the levels can exceed 25 part/million. In India, concentrations up to 38.5 part/million have been reported.
Fluoride was first used to fight dental cavities its effectiveness defended on two grounds
Fluoride inhibits enzymes that breed acid-producing oral bacteria whose acid eats away tooth enamel. This observation is valid, but some scientists now believe that the harmful impact of fluoride on other useful enzymes far outweighs the beneficial effect on caries prevention.
Fluoride ions bind with calcium ions will be strengthening tooth enamel as it forms in children. Many researchers now consider this more of an assumption than fact because of conflicting evidence from studies in India and several other countries over the past 10 to 15 years. Nevertheless, agreement is universal that excessive fluoride intake leads to loss of calcium from the tooth matrix, aggravating cavity formation throughout life rather than remedying it, and so causing dental fluorosis. Severe, chronic and cumulative overexposure can cause the incurable crippling of skeletal fluorosis27.
The Groundwater is the major source of drinking water. it contains high fluoride up to 16 mg FLoride, which has caused dental and skeletal fluorosis. Standard rate is 0.7 mg Floride per liter. To find the major sources of fluoride intake, fluoride contents in various water sources, such as village water supply, shallow and deep ground waters, rain water and bottled water, and the local people's behavior on water uses was recorded by interview and questionnaire study. It was found that the highest risk of fluoride ingestion comes from cooking rice with fluoride-containing water because of a lack of knowledge on fluoride sources . To reduce the health risks arising from fluoride intake, educational program on the sources and risks of fluoride in water was developed and implemented in the local schools. The participatory educational program promoted active involvement of schoolchildren in USA28.
Dental fluorosis in children residing in communities with different water fluoride levels the purpose of examination was to monitor the changes in preventive dental fluorosis, children who are residents of one of three communities with varying levels fluoride in their communal water supply, the fluorosis increased by approximately 14%, 20%, 6%, in negligibly, optimally and 4X optimally fluoridate communities respectively and the prevalence of dental fluorosis in young children restrict intake during the year of that enamel formation is occurring development period21.
Dental fluorosis and dental caries prevalence in Senegalese children living in a high fluoride area and consuming a poor fluoridated drinking water ingestion of excessive fluoride during tooth development can cause structural changes in tooth enamel named fluorosis, water samples collected from 2 wells and analyzed using a spectrometer and specific fluoride electrode the fluoride levels in the water well more comprised between 0.03ppm and 0.09ppm the prevalence of dental fluorosis 39.33ppm and tooth decay prevalence was 48.66 a low to moderate dental fluorosis associated with a significant decrease of caries prevalence was found in children living in a high fluoride area and consuming poorly fluoridated water22.
The results of two surveys in Salvador, Bahia State, Brazil, on prevalence and severity of dental fluorosis in 12 and 15-year-olds.The article discusses the survey methodologies in relation to their sampling process, calibration of examiners, and data collection procedures, comparing the resulting differences using chi-square and 95% confidence intervals obtained with the Dean index. A total of 3,313 adolescents 12 and 15 years of age were analyzed in 2001 and 1,032 in 2004. Both surveys used examiner calibration, and the samples were population-based. In the second survey there were a higher proportion of students from public schools for both ages, as compared to 2001 (p< 0.001). There was no significant difference in the fluorosis rate at 12 years, with a prevalence of 32.64% in 2004 and 31.4% in 2001. For 15-year-olds, the prevalence in
2004 (16.83%) was lower than in 2001 (27.6%). No increase was observed in the prevalence or severity of fluorosis in Salvador from 2001 to 2004 23.
USA the study in quantitative look at fluorosis, fluoride exposure and intake in children using a health risk assessment approach. The prevalence has increased in us during 30 years, the cumulative daily fluoride intake in fluoridated area was estimated as 0.20 and 0.11mg/kg/day for RME (reasonable maximum exposure) and CTE (central tendency exposure) scenarios respectively for infants. The CTE and RME estimate for cumulative daily average intake were 0.11 to 0.08mg/kg for infants and 0.21 to 0.06 mg/kg for children, this suggests that some children may be at risk of fluorosis24.
To determine the prevalence and severity of dental fluorosis among 12-15-year-old students by artificial fluoridation of drinking water the use of fluoridated dentifrice was also surveyed. A sample of 1,402 students was randomly selected. Clinical exams were carried out by two calibrated dentists under natural indirect light. Upper and lower front teeth were cleaned with gauze and dried, and then examined. A questionnaire on dentifrice ingestion and oral hygiene habits was applied to the students. The results revealed that fluorosis prevalence in this age group was higher than expected. Thus suggesting that fluorosis is not a public health problem in the locality26.