exudates and Fluorosis--Dental

The aim of this study was to assess (by direct determination) the fluoride (F) exposure from ingested toothpaste among 4-5-year-old Malaysian children.. This was part of a larger study to determine fluorosis status and F exposures. A total of 1343 10-11-year-old subjects were sampled by two-stage systematic random sampling for assessment of fluorosis. Two hundred 4-5-year-old siblings of these index subjects were sub-sampled for determination of F exposures from ingested toothpastes and other sources. Estimations of F ingested from toothpaste (FI) was made by the method of difference between 'F in toothpaste taken for use' and the 'F in toothpaste used but not swallowed', by the duplicate technique under normal home conditions. F ions were determined with the combination selective ion electrode.. The subjects ingested 32.9% of the toothpaste placed on the brush. Fluoride exposure from ingested toothpaste was highly variable and the mean was 426.9 +/- 505.5 microg (SEM 38.9)/48 h, or 213.5 microg/day and 131.9 microg per brushing.. The amount of ingested fluoride (FI) per brushing in this study was the lowest of all studies reporting this parameter and was within the pea-size range of 125-250 microg. Because of the highly statistically significant correlations between the FI from toothpaste and the amount of toothpaste dispensed (Pearson's correlation coefficient 0.647, P = 0.000), parents should assume responsibility for placement of toothpaste and limit the amount of toothpaste used.

Topics: Analysis of Variance; Cariostatic Agents; Child; Child, Preschool; Deglutition; Female; Fluorides; Fluorosis, Dental; Humans; Malaysia; Male; Toothbrushing; Toothpastes; Water

To assess the prevalence and severity of dental fluorosis and caries among Malaysian children following the reduction in fluoride concentration from 0.7 to 0.5 parts per million (ppm) in the public water supply.. This study involved lifelong residents aged 9- and 12-year-olds in fluoridated and nonfluoridated areas in Malaysia (n = 1155). In the fluoridated area, children aged 12 years and 9 years were exposed to 0.7 and 0.5 ppm, respectively, at the times when maxillary central incisors developed. Standardized photographs of maxillary central incisors were blind scored for fluorosis using Dean's criteria. Dental caries was examined using ICDAS-II criteria.. The prevalence of fluorosis (Dean's score ≥ 2) among children in the fluoridated area (35.7%, 95% CI: 31.9%-39.6%) was significantly higher (P < 0.001) than children in the nonfluoridated area (5.5%, 95% CI: 3.6%-7.4%). Of those in the fluoridated area, the prevalence of fluorosis decreased from 38.4% (95% CI: 33.1%-44.3%) for 12-year-olds to 31.9% (95% CI: 27.6%-38.2%) for 9-year-olds, although this difference was not statistically significant (P = 0.139). The mean caries experience in the permanent dentition was significantly lower in the fluoridated area than in the nonfluoridated area for both age groups (P < 0.05). In the multivariate models, the difference in the differences of caries experience between fluoridated and nonfluoridated areas remained statistically significant. This suggests that caries-preventive effect is still maintained at 0.5 ppm.. Findings indicate that the change in fluoride level from 0.7 to 0.5 ppm has reduced fluorosis and maintains a caries-preventive effect. Although there is a reduction in fluorosis prevalence, the difference was not statistically significant.

Topics: Child; Dental Caries; Fluoridation; Fluorides; Fluorosis, Dental; Humans; Malaysia; Prevalence; Water Supply

To assess examiner reliability when scoring dental fluorosis in Malaysian children using clinical (Dean's Index) and photographic methods.. The upper central incisors of 111 children were examined both clinically and photographically for fluorosis status using Dean's index. Twenty children were re-examined after a two-week interval for intra-examiner reliability by a single examiner. In addition, two independent examiners and the clinical examiner scored 111 photographic images of the same children in a standardized manner. Fluorosis scores were compared individually between examiners for both clinical and photographic scoring. Examiner reliability was assessed using both simple and weighted kappa statistics at tooth level. Sensitivity, specificity, positive-negative predictive values and a Receiver Operating Characteristic (ROC) curve were also calculated to determine the accuracy of the test.. Across the three examiners, the prevalence of fluorosis (Dean's score ≥ 2) using photographs was lower (ranged from 23% to 26%) than the prevalence recorded by clinical examination (30%). The kappa score for intra-examiner reliability for the duplicate clinical examination was excellent (0.89). Inter-examiner reliability between the photographic method and the clinical examination (gold standard) for each examiner was substantial with weighted kappa values ranging from 0.74 to 0.77. The photographic method indicated higher specificity (99%) than sensitivity (79%) and the area under the ROC curve was also high (0.89) which suggests good accuracy of the diagnostic test.. These results suggest that photographic examination of fluorosis on central incisors can be recorded with good examiner reliability. The recorded fluorosis prevalence was lower using the photographic scores.

Topics: Area Under Curve; Child; Fluorosis, Dental; Humans; Image Processing, Computer-Assisted; Incisor; Malaysia; Observer Variation; Photography; Predictive Value of Tests; Reproducibility of Results; ROC Curve; Sensitivity and Specificity

Very mild fluorosis is quite prevalent in children and one of the sources may be attributed to poor fluoride toothpaste utilization habits.. To investigate the frequency of toothbrushing, parental supervision, the person who usually applied the toothpaste, toothpaste swallowing and spitting habits, size of toothbrush, type of toothpaste used and amount of toothpaste used by shape and weight.. Observational cross-sectional study of a representative random sample of 373 children aged 5-6 year-old. The children were interviewed using a structured close ended questionnaire. Direct observations were made on their toothpaste dispensing habit during a toothbrushing exercise.. All children reported practising toothbrushing with 90% on a daily basis. Almost all used fluoridated toothpaste (91.4%). About one-half (50.7%) reported that their parents never supervised them. More than one-third of children used adult toothpaste and 60.1% of the toothpaste was flavoured. Most (92%) used toothbrush meant for children. About 40% applied a pea-sized amount of toothpaste. The mean weight of toothpaste applied was 0.43 g (SID + 0.35 g).. The majority used the recommended child-sized toothbrush and toothpaste that contained fluoride but less than one-half of the parents supervised their children. Most children used flavoured children's toothpaste but a sizable proportion used toothpastes meant for adults. The amount applied by shape and weight exceeded the amount recommended by experts.

Topics: Child; Child, Preschool; Cross-Sectional Studies; Female; Fluorosis, Dental; Humans; Malaysia; Male; Surveys and Questionnaires; Toothbrushing; Toothpastes

This study aims to assess the magnitude of the problem of fluorosis among 10-11 year old schoolchildren in a fluoridated area in Malaysia.. An analytical cross-sectional design was adopted. Sampling of subjects was by a 2-stage systematic random sampling technique in Selangor, a fully fluoridated area. 1,343 10-11 year olds were assessed for fluorosis using the Dean's index.. The prevalence of fluorosis was 58.7% (788 subjects); 478 (35.6%) subjects exhibited very mild fluorosis, 196 (14.6%) mild, 102 (7.6%) moderate, 12 (0.9%) severe and 555 (41.3%) no fluorosis. Tooth prevalence was 30.1%. Overall, the Community Fluorosis Index (CFI) was 0.96 and ranged from 0.23 to 1.72. Fifteen out of 30 schools had CFI > 1.0 (medium public health significance).. The prevalence of dental fluorosis in Malaysia (mostly very mild to mild) at 58.7% is indicative of slightly above optimal levels of exposure. There were pockets of areas where fluorosis were of medium public health significance (CFI > 1.0). It must be cautioned that, fluorosis if not monitored closely, can become an increasing public health concern.

Topics: Child; Female; Fluoridation; Fluorosis, Dental; Humans; Malaysia; Male; Prevalence

The aim of this study was to investigate the prevalence and psychosocial impact of enamel defects among 16-year-old school children on the island of Penang. The data were collected through a self-administered questionnaire survey and an oral examination, using the Modified Developmental Defects of Enamel Index (FDI, 1992). In all, 1024 subjects were selected using a multistage random sampling technique. About two-thirds of the sample (67.1%) had at least one tooth affected by enamel defects. Enamel opacities accounted for 85.6% of the total condition. Diffuse-type opacity predominated (63.5%). Among subjects who expressed dissatisfaction, 18.8% reported covering their mouths when smiling, 8.7% avoided going out with friends and 39.1% had consulted their dentists. About 17% of the subjects reported that their parents had complained about the color of their front teeth but only 5.7% had experienced being teased by their friends about the problem. Two-thirds of the subjects were affected by enamel defects involving at least one tooth; however, the esthetic perception and psychosocial impact of those affected were minor.

Topics: Adolescent; Body Image; Chi-Square Distribution; Cross-Sectional Studies; Dental Enamel Hypoplasia; Esthetics, Dental; Female; Fluorosis, Dental; Humans; Interpersonal Relations; Logistic Models; Malaysia; Male; Personal Satisfaction; Prevalence; Psychology, Adolescent; Sampling Studies; Surveys and Questionnaires

Prevalence and severity of dental fluorosis was assessed in 1739 Singaporean children aged 9, 12 and 16 yr in three different ethnic groups. All subjects had resided since birth in Singapore, which has a tropical climate. The water supply was fluoridated in 1957 at a level of 0.7 ppm. In this sample, mouth prevalence was 82.6%, tooth prevalence was 66.9%, the community fluorosis index was at 1.96; 9.2% of children had severe fluorosis and 26.2% had moderate fluorosis. There were no significant gender or racial differences. Prevalences were higher than those reported in most other studies. Due to differences in indices used and methodology, comparisons could not be made directly with other studies.

Topics: Adolescent; Asian People; Child; China; Ethnicity; Female; Fluoridation; Fluorides; Fluorosis, Dental; Humans; India; Malaysia; Male; Prevalence; Sex Factors; Singapore; Tropical Climate; Water Supply; White People

Two hundred and twenty-nine children aged 12-15 years who were continuous residents of Penang island, in the north of Peninsular Malaysia were examined for caries and enamel defects. Caries prevalence was 82.2% with a DMFT score of 3.4 and DMFS score of 4.9; there were very few missing teeth and very little untreated caries in the population examined. Majority of DF (decayed/filled) lesions were pits and fissures with approximal and smooth surfaces relatively caries free. The prevalence of enamel defects was 76.4% with 19.1% of all teeth examined being affected. More posterior than anterior teeth were affected by enamel defects just as there were more maxillary than mandibular teeth affected by enamel defects. Diffuse patchy opacities were the most common defect diagnosed and this was found in 60.2% of the population examined. A bilateral distribution of diffuse patchy opacities was seen in 41.5% of the population examined. Tooth surfaces with enamel defects were no more susceptible to caries than defect-free surfaces.

Topics: Adolescent; Analysis of Variance; Child; Dental Caries; Dental Enamel; Dental Fissures; DMF Index; Female; Fluoridation; Fluorosis, Dental; Humans; Malaysia; Male; Observer Variation; Pilot Projects; Prevalence; Statistics, Nonparametric

Enamel defects were studied in a group of 11-12 year-old children in a fluoridated area using the DDE index. The mouth prevalence of this condition was 72.5 per cent with a tooth prevalence of 40.4 per cent. Enamel opacities accounted for 96.5 per cent of the total condition of which the diffuse patchy type predominates. The defects on the affected posterior teeth occurred most commonly on both the buccal and lingual/palatal surfaces, with most defects being located in the incisal one-half, gingival one-half and occlusal simultaneously. In the affected incisors, the highest proportion of defects affected the buccal surface only, with the most frequent location being the incisal one-half and gingival one-half simultaneously. In 20.9 per cent of the affected subjects, there was a 100 per cent tooth involvement.

Topics: Child; Female; Fluoridation; Fluorosis, Dental; Humans; Malaysia; Male