Public Health Webinar: Household Use of Groundwater and Dental Fluorosis in Children

OK hi everyone, doctors in a poet and I worry an assistant professor at Hofstra University MPH program today. My I will give a talk on a topic related to the dental public health, which is the dental forces in children. An hydrogenic full ride in groundwater used for household consumption entire carrying communities are prevalent survey and a case control study combined.

So this is one of the work that I do as a professor here on the M PS program. So just to showcase it and hope you get some of the idea of.

What kind of the disease or the outcome that we can look for in terms of the study of dental public health and especially in the context of Thailand, which is a foreign country from the US so.

For this presentation, I declare that I don't have any.

Financial relationship to any funding organization, so the motivation for this research is done.

Dental forces is one of the problem that we can see it's quite prevalent. In some of the in some part of the world. So dental forces hyper mineralisation of the dental enamel by excessive for ingestion during the inner malformations. An dental forces can affect not just solidity normal part which is the outer part of the tooth. But it can damage the inner part which is a primary dent in as well. The manifestation of the way that.

Enamel will show once they continental forces. The manifestation can be opaque. White area in the my Phone. It can take the form of the streaks on the blotches of discoloration. This car or pits or yellow to dark Brown stain on the tooth so these kind of manifestation will.

Compromise the aesthetic after of the teeth and it can also have some more severe consequences, so for the moderate on level form of dental forces.

This disease can cause the permanent physical damage to in our Mail and this needs to be restored by dentists and most of the time it's required quite an expensive treatment. For example, like the Crown. Or maybe davinia in order to cover that discoloration or physical damage of that would surface.

So, in this slide. I want to show the level of different severity of dental forces so in the first picture here. You can see that it's the Milky white teeth like this is the normal condition of the T surface. However, when you develop the more severe form of dental forces. You can see the discoloration and breakage or the streak of discoloration on that would surface so in the serial form like the last picture here.

Not just only the discoloration that is obvious. It's also constant physical damage on the breakage under 2 itself is as well.

So for this study, we focus on the etiology or the cause of the disease. So dental forces can be caused by several factors. Most of the study focused on behavioral or Interventional factor that usually related to the use of the sodium fluoride. So most of the time, like for example, the study in dus. We focus on the etiology of dental forces by swallowing before I in.

Or in the 2 pairs or the mountains that young kids use also the ingestion of the food that contain a lot of varieties such as the Florida milk or some of the fortified food also there are some inappropriate indication on the use of the 4 I supplement by politicians as well and another issue that.

Is an important issue in the USA that has been debated for such a long time is a public water for a nation.

These factors can contribute to the problem of dental forces.

However, in this study, we focus on something different becaus. We focus more on the environmental factors or the full Rye that come from the nature so in this study. We focus on the natural Florida order and the source of the water actually come from the foreign containing rocks and these rock can be the full ride on the four Oh appetite. This rock provided natural source of fluoride at release before I into the soil and water.

Through the weathering process an dissolution in the water.

So why the natural sauces important becaus we can see that in some certain contexts are in some community based dental public health problem of dental forces in children so in one community, like in Thailand. A large number of children with mental forces has been observed and bungling district noncommittal pro wins in Thailand.

And in many community in this area where this case will also the groundwater have been used for community water supply due to know establish a regression system so you have to know that the context of this study is the rural agrarian communities. So it's quite different from the context in the USA where all the irrigation system is.

Well, established, but in this poor agrarian community growing. The crafts is kind of things in this area that that there is no established a regression. So when we go to measure the level of the four right in the water. We can also also high foreign level, which is exceeding .7 parts per million of American favorite has also been detecting the water sample obtained from the community water sources for several years as well.

So from this dental public health that you can see that a lot of children being affect my dental forces and there are some evidence related to some excessive fluoride in the water so the cap on the knowledge that lead to these studies that the prevalence and the severity of dental forces and his Association with the full right in the community water supply has not been investigate in order to provide information on dental forces surveillance system.

To establish in this community and to provide the information for policy formulation for save water supply.

So the research article IV for this study focused on 2 major object if the first one. We want to identify the prevalence and severity of the dental forces among the children living in this rural Garon communities. We want to evaluate its possible Association with hydro genic unnatural for in the ground water use for household consumption in the in the room.

Caring community in Thailand in 2015.

So the studies, saying here we actually visit the site for the 5 Sub District of bungling district. Anna competent province in Thailand. This rural Garon Sub District will select as groundwater has been used for community water supply.

So, in the first phase after study when we want to focus on the prevalence so we actually did a survey in 2000. In 289 children, ages 6 to 10 years old who obtained 8 primary school in the 5 Sub District of bungling.

And the outcome measurement here is the dental forces at its severity level.

And this outcome can be determined by one calibrate dentist using the measurement tools. Cardens index so showing this slide is the 6 level of the index of the two forces so the score 0 means no dental forces, a normal and the theoretic goes up when the level of the numbers go up so it does Conkle from one to 5, so far is the most severe?

Form of dental forces.

Now, after we determine the outcome in the second phase of the study, which is a case control study. So we define the case and the non cares for the cares.

We define that the children with very mild to severe dental forces were regarded as case and these children are compared to the other group of assured in with normal or questionable level.

And these normal and questionable level of the two forces were regarded as non case so in this case control study. We further determine other major exposures that may be related as the possible cause of the disease so for I concentration, which is the major exposures that we want to study we actually have the full like concentration measure in community water sources, corresponding to the resident of.

Picture.

And these concentration with stress since the year of birth of each other an average for an 0 measurement during 2008 to 2015.

And exposure measurement here is based on the ecological correlation principle, which means that the direct exposure to before right in each year and couldn't be determined. But we just use the proxy measure based on the committee water source that there house use the water.

So.

The ascertainment of other exposure or factors. These include other potential confounders so other possible confounders, confounding factors include sharp edge. The sex of the child family monthly income. Charles brushing frequency 2 pairs to pairs size and a water treatment methods before they use it for consumption measure of these exposure were undertaken using the self administered questionnaire and the children.

Brought the question asked to their parents or caregivers in order to provide the answers. The reason why do we need to collect this data becaus. These other alternative explanation of? Why the two forces occur? To them and they can be a possible cause of the problem as well. But the major focus of the study is on there for a concentration in groundwater. So we have to control the effect of this potential confounders.

So the statistical analysis of the result here we apply the multivariable majestic regression.

To determine the effect of 4. I can't in the water on viruses. Adjusting for the other covariates or the Conf under the major exposure here on the mean for a level were categorized into 3 groups. The first group, which is a reference group range. The concentration from zero up 2.69 PM. RPM Papa million.

The first comparison group are the first index group.

Therefore, I concentration range from .7 after 1.49, so these days cut point of .7 after 1.49 is the criteria used in Thailand and also in the curious as well.

And also the index group to which has the concentration of the 4I which range from one point 5 and above PPM. This is a WH. Oh, Oh hell organization. Guideline value for the full ride in the water that the full right in the world should not 1.5.

In order to avoid mental forces.

So after we apply that method of study, we can again define that there will 157 children or 54.3% having the dental forces with severe with similarly ranging from the very mild to moderate level.

And no severe case was identified.

Right so you can see that the prevalence of up to 50. Four percent 54.3%. It means that more than half of those children in this study operation have the disease. So this is quite common very common here now when we look at the Table 1 here you can see that for the control group on the shooting without forces. The number is 132? Why the Rays and the case an?

When we look at the Association, which is the second part of the study. We can see that the risk estimates for each level of the four I so.

Chicken zero up 2.69 as their comparison group on the reference group. You can see that when the concentration of before I goes up from .7 to 1.49, the risks of the dental forces.

Go up to 4.8 times the arts, so it means that she really living in the area where the for eye is in this level, the chance are the probability of getting the disease by estimate by the art is 4.85. Time compared to children living in the normal area of the four right when we looked at the Top category here when you look at the categories here, which is the highest level of the full ride app.

Exceed 1.49 so it's going out to 1.5, the risk estimate by the odds ratio here caught up to nearly 20 times, which means that she really living in the area where the foreign concentration in the water is very high.

The chance on the odds of getting the disease is up to 20 times compared to Chevron living in the normal area.

So the conclusion from this study, there are 2 key things that we have to take away if this study, the first key messages that the high full right concentration in groundwater used for household consumption was strongly associated with the high prevalence of dental forces in children so in this study, we illustrate how environmental factors can really influence. The occurrence of the oral disease and the second thing is that to be taken away from this study is that?

This study this evidence should be informed to the local residence as a public health implication that their local resident or the public health officers. They have to consider this information in order to provide the surveillance of the water source to say which source is safe to be used as a water for consumption and which sources are not safe.

Regarding the occurrence of the dental forces so the one is awesome, with the excessive foreign concentration should be award, and filling the alternative water sources are recommend in this study.

So this is the.

Brief.

Presentation of this study, and if you have any questions right now. You can ask me by typing in the questions from an also, if you have some of the questions are interested in more details of this study, you can also contact the information that provide in this last slide as well.

So OK, we don't really have any questions, but maybe one of the questions that have been asked on on this slide on this slide is that So what level of the four I should we use, especially like if we apply. This knowledge back to the US to the context of the USA. So, in the US. Most of the time the recommendation of the former concentration in the water is .7 or lower so this can be.

Quite safe for the water Florida nation in the USA, but anyway in Thailand from the results. We go back to see. It shows somehow like the .7 can also create the some of the cases where even though the result is not significant. The reason for this difference is that in Thailand, which is a tropical area. The water in one parent and the foreign concentration in the water become more concentrated.

But I still honestly think that the .7 that the that for I got the discomfort concentration that the USS is still pretty safe.

In terms of their for water for addition in the USB cause. We have quite a very well established irrigation system and we control the concentration very well.

So if you have anymore questions you can.

Contact me with this information by sending me the email. Thank you so much for attending this webinar.