| Abstract|| |
Aim: To determine the periodontal status and treatment needs among dental fluorosis subjects residing in Ennore, Chennai, using Community Periodontal Index of Treatment Needs (CPITN).
Materials and Methods: All the subjects with dental fluorosis above 15 years of age, permanent residents of Ennore, were included in the study. Subjects with known systemic diseases and subjects with other intrinsic dental stains were excluded from the study. Periodontal status was estimated using CPITN and Dental fluorosis was recorded using Dean's Dental Fluorosis Index.
Results: The total number of study subjects was 1075, of which 489 were males and 586 were females. Males were predominantly affected with periodontal disease than females. This was found to be statistically significant (P=0.000). The association between Degree of Fluorosis and Periodontal Status is statistically significant (P=0.000). There was statistically significant difference in mean number of sextants between the degree of fluorosis in each of the periodontal status (P=0.000).
Conclusion: The finding that the lower prevalence of shallow pockets in the study area, where the fluoride level in the drinking water ranges from 1.83 to 2.01 ppm, indicates that the use of fluoride in water is beneficial to the periodontal tissues.
Keywords: Community periodontal index of treatment needs, dental fluorosis, Ennore, periodontal status
|How to cite this article:|
Kumar PR, John J. Assessment of periodontal status among dental fluorosis subjects using community periodontal index of treatment needs. Indian J Dent Res 2011;22:248-51
Oral diseases form an important health problem in the community. During the last decade, there has been an increasing prevalence of dental health problems in India. Oral diseases have attracted the researchers as early as 1941.  The prevalence of periodontal disease in India ranges from 90% to 95% in different population groups,  only differing in severity between the various age groups.Although the critical role of dental plaque in the etiology of periodontal disease is well established, it does not explain the difference in susceptibility of given population or individuals to periodontitis. Relative role of various etiologic factors in periodontal disease have been investigated by means of epidemiologic surveys and clinical studies.  The various determinants of periodontal disease are age, sex, race, socioeconomic status, and lifestyle habits such as tobacco usage, pan chewing, and oral hygiene practices. The interplay of these factors might lead to either advanced disease or edentulousness. Although the effect of fluoride in reduction of dental caries is well established, its effect on periodontal tissues is obscure.  There is inconsistent epidemiological data on the periodontal status of subjects living in high-fluoride areas.
|How to cite this URL:|
Kumar PR, John J. Assessment of periodontal status among dental fluorosis subjects using community periodontal index of treatment needs. Indian J Dent Res [serial online] 2011 [cited 2013 Dec 12];22:248-51. Available from: http://www.ijdr.in/text.asp?2011/22/2/248/84297
Studies to assess the periodontal status among the subjects in high-fluoride areas have been done in various parts of our country. ,, But the data regarding the periodontal status among the subjects in the high-fluoride area in Tamil Nadu  are unavailable. The information regarding the suspected fluoride belts in Chennai was obtained from Tamil Nadu Water Supply and Drainage Board (TWAD), Chennai. It was informed that the ground water in Thirunidravur, Veppor Padapai and Ennore, was with high fluoride content. To confirm, the fluoride concentration in drinking water in these areas was estimated, and it was found that in Ennore the fluoride level ranged from 1.8 to 2.0 ppm in the drinking water. Hence this study was planned with the purpose of assessing the periodontal status among the dental fluorosis subjects in Ennore, Chennai.
| Materials and Methods|| |
Ennore is located 14 km from the center of the city. Approximately 25,000 subjects are permanent residents of Ennore, of which 16,000 were males and 9000 females. The major source of drinking water was from open wells present at each house. There is virtually no dental care facility available and the socioeconomic status was low. All the subjects with dental fluorosis above 15 years of age, permanent residents of Ennore, were included in the study. Subjects with known systemic diseases and subjects with other intrinsic dental stains were excluded from the study. Periodontal status was estimated using Community Periodontal Index of Treatment Needs (CPITN) , and Dental fluorosis was recorded using Dean's Dental Fluorosis Index. ,
A specially designed proforma was used to assess the periodontal status among 30 dental fluorosis subjects who were above 15 years of age residing in Ennore to check the reliability, validity, and the feasibility of the study. A single examiner examined all the subjects. Difficulties encountered during the pilot study were overcome by redesigning the proforma and finalizing the diagnostic criteria. This data were used for estimating the final sample size by using statistical methods. These 30 patients were not included in the main study.
Sample size and sampling methodology
The prevalence of dental fluorosis in Ennore  was found to be 15%, the sample size was calculated using the formula, N=Zα2. PQ/L 2 where Zα2 = 3.84, P=15%, Q=1-P=85%, L=15% of P=2.25. Around 1075 patients were decided to be the sample size. A simple random sampling was done to select the houses in Ennore. A survey was done in the selected houses to select the subjects.
Before conducting the study, approval was taken from the Institutional Ethical Committee and the Head of the institution, College of Dental Surgery, Saveetha University, Chennai. The time limit set for data collection and examination of the subjects was scheduled for a period of 3 months. Prior to the study, the details of examination procedures were explained to the study subjects and written informed consent was obtained from each participant. The Examination was carried out in subjects' own settlement under natural day light, with the aid of a mouth mirror, No.5 explorer and a CPI Probe (WHO TRS - 621 probes). Periodontal status was estimated using Community Periodontal Index of Treatment Needs (CPITN) and dental fluorosis was recorded using Dean's Dental Fluorosis Index.
Data entry was carried out carefully and then transferred for statistical analysis. The software SPSS Version 15.0 was used in data analysis. Chi-square test was used. The significance level was fixed at <0.05.
| Results|| |
The total number of study subjects was 1075, of which 489 were males and 586 were females [Table 1]. [Table 2] and [Table 3] show the periodontal status among the study population. Periodontal disease was found to be more among males than females and this variation in gender was found to be statistically significant (P=0.000). The prevalence of periodontal disease varies with the advance of age and this relationship was found to be statistically significant (P=0.000). [Table 4] presents the association between degree of fluorosis and periodontal status to be statistically significant (P=0.000). There is statistically significant difference in mean number of sextants between the degree of fluorosis in each of the periodontal status (P=0.000) [Table 5]. [Figure 1] illustrates that 50% of the study population need professional cleaning of teeth and removal of plaque retentive factors and oral hygiene instructions.
|Table 2: Gender-wise distribution of periodontal condition among study subjects |
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|Table 3: Age-wise distribution of periodontal condition among study subjects |
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|Table 4: Distribution of study subjects based on periodontal status and degree of fluorosis |
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|Table 5: Mean number of sextants based on periodontal condition and degree of fluorosis |
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|Figure 1: Treatment needs among study subjects. (TN-0 = No need for treatment, TN-1 = Need for improvement in personal oral hygiene, TN-2a = Need for professional cleaning of teeth and removal of plaque retentive factors and oral hygiene instructions, TN-2b = Need for oral prophylaxis, root planning, and oral hygiene instructions)|
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| Discussion|| |
The relative role of the various suspected etiologic factors in periodontal disease have been investigated by means of epidemiologic surveys and clinical studies. It is evident that many local and systemic factors influence the etiology and pathogenesis of periodontal disease and one such factor could be fluoride. Fluoride has long been known to have a significant effect on dental caries.  Some recent work on the effect of fluorides on specific bacteria suggests that fluoride has a bactericidal effect on microorganisms and is important in the treatment of periodontal disease. ,
Totally acceptable and valid comparisons could not be done between the present study and already reported studies in the literature due to variations in the study designs, age group, indices, methodologies, and certain other conditions. Nevertheless, a sincere attempt was done to compare wherever possible and to the extent feasible.
A total of 1075 (males=489, females=586) permanent residents of fluorosis area were examined. In the present study, gingivitis was seen in all the age groups and its prevalence (57%) was high in high-fluoride areas between the age group of 15-24 and 45-54 years. Similar observations were made by Vandhana et al.  in high-fluoride areas of Davanagere districts, Karnataka. Also, Murray  reported similar results regarding gingivitis in high-fluoride areas between the ages 15 and 65 years. Similar observations were noted by Reddy et al.  in high-fluoride area of South Africa and by Haikel et al.  Although the overall prevalence of periodontitis was low (12.3%) in the present study, there was a steady increase in periodontitis as the age advances to 54 years. The findings of the present study confirm that there is a strong association between age and periodontal condition among dental fluorosis subjects.
The results of the present study reveal that the occurrences of gingivitis and periodonitis show some predilection with gender among the dental fluorosis subjects. Males were affected more than the females. Similar observations were reported by WHO.  However, Vandhana et al.  in their study reported that females predominantly suffered from periodontitis.
On correlating the periodontal condition with degrees of fluorosis, it was found that the mean sextant scores for periodontal condition decreased as the degree of dental fluorosis increased. This is in contrary to the study conducted by Vandhana et al.,  Davanagere, Karnataka.
In the present study, 30.7% of the study subjects do not require treatment; 7.1% of them need improvement in personal oral hygiene; 50% of the study subjects need professional cleaning of teeth and removal of plaque retentive factors and oral hygiene instructions; 12.2% of the study subjects need oral prophylaxis, root planning, and oral hygiene instructions.
| Conclusion|| |
The finding that the lower prevalence of shallow pockets in the study area, where the fluoride level in the drinking water ranges from 1.83 to 2.01 ppm, indicates that the use of fluoride in water is beneficial to the periodontal tissues. The present study is not adequate to support the above hypothesis because a comparative assessment of periodontal status from nonfluoride area was not attempted. However, studies conducted in naturally fluoridated and artificially fluoridated areas confirm our finding that fluoride in water is beneficial to periodontal health.
In the conduct of this future research, it will be necessary to consider the most important host and environmental factors which can affect periodontal disease. Ideally, in both groups' (with and without fluorosis) race, age, sex, education, socioeconomic status, habits, state of general health, oral hygiene, and other factors should be held constant. It appears there is a need for execution of longitudinal studies to ascertain the benefits of fluoride on periodontium. Microbiological analysis of dental plaque and periodontium in order to confirm the effects of fluoride on periodontal conditions are even required.
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Pradeep R Kumar
Department of Public Health Dentistry, Saveetha Dental College, Saveetha University, Chennai
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]