Dental Disease Burden, Treatment Needs And Cost Of Treatment Among 13-17-Year-Olds With Fluorosis Compared To Those Without Fluorosis In Kajiado, Kenya

Abstract

Background: The dental disease burden (caries, periodontitis, gingivitis and fluorosis) and treatment needs assessment if objectively done in combination with patients' perception facilitates in planning for rational health resource allocation ,utilization and personnel distribution so as to tackle the health problems in a holistic way.

Objective: To assess the dental disease burden, treatment needs and cost of treatment among 13-17- year- olds affected by dental fluorosis and those not affected by dental fluorosis in Kajiado North District of Kenya.

Materials and methods:

Study design: A comparative cross sectional study of the dental disease burden and treatment needs among two age matched population groups using school based children.

Study population: The study involved 248 children, 98(40%) males and 150(60%) females aged between 13 - 17 years (mean age = 14.75 ±1 .45) selected by simple random sampling.

Study area: A total of 9 schools were randomly selected in Kajiado North District that was purposively selected. The children were all clinically examined under natural light for plaque and gingival scores, dental caries, periodontal disease and fluorosis using indices:- Silness and Loe 1963, Loe and Silness 1964, DMFT,CPITN and TFI. Information on biodata, consumption of sugary snacks, brushing and health

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seeking behaviour were collected using an interviewer administered questionnaire. The cost of dental treatment was established by obtaining copies of the fees guidelines from the Kenya Medical Practitioners and Dentists Board (KMPDB), the sub district, district, provincial and the national referral hospital.

Water sampling: Public boreholes for collection of water samples were randomly selected and water drawn from them which was sent for fluoride level testing at the government chemist laboratories.

Data analysis: To calculate disease burden (DMFT, prevalence of gingivitis and periodontitis, treatment needs and the cost of treatment) were done. The confounding factors were snacking and oral hygiene practices. For categorical variables association between dependent variables and fluorosis was tested using a pearson chi-square test while a student t-test was used for continuous variables and the conventional p value of cut-off of < 0.05 was used to establish a significant association. To determine the agreement rates between assessors, a Cohen kappa score was calculated for each assessment (tooth and surface). A median agreement rate was then computed from all individual scores calculated. Data collected was analyzed using statistical package for social sciences (SPSS version 17.0).

Results: Gishagi borehole had low fluoride levels of 0.1 ppm, Kerarapon springs

0.44ppm and Lemelepo borehole 0.5ppm. Ngong main borehole had the recommended levels by WHO of 1ppm. Embulbul roadside and Embulbul community water supplies had very high levels of fluoride at 8.3 and 15 ppm.

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The overall mean DMFT was 0.45 and there was no statistically significant difference in the DMFT for the children with dental fluorosis when compared to those without fluorosis [p=0.226 (p:S;0.05)]. There was also no statistically significant difference in caries experience in each group by gender [p=0.272 for males and p=0.891 for females (p:S;0.05)] in fluorosis group as well as those without dental fluorosis. However, there was a statistically significant difference in the mean plaque scores (PS) of the children who had severe degrees of dental fluorosis and those who did not have fluorosis [p=0.002(p:S;0.05)] and when compared by gender [p=0.001 (p :S;0.05)].There was also no statistically significant difference in the mean gingival scores p=0.844 for the two groups of children. Gingivitis in males showed a statistically significant difference, [p=0.001 (p:S;0.05)] compared to females. Periodontitis was found in 3(1.2%) of the study participants in the group with dental fluorosis only. On varying degrees of dental fluorosis, in the maxillary/mandibular teeth, the TFI scores 4-5 were frequently recorded. In the maxillary teeth TFI 4-5 was on 2301 (52.3%) teeth surfaces, TFI 6-9 scores 1208(28%). In the mandibular teeth, the TFI scores 4-5 affected 2240(51.8%) teeth surfaces and TFI 6-9 at 1030(23.8%).

The treatment needs for gingivitis were similar, majority (88%) children with fluorosis and 86% without fluorosis required oral hygiene instructions and prophylaxis. There were 3(1.2%) children who had periodontitis in the group with dental fluorosis and required scaling and root planing. There were 50% children with caries in the fluorosis group who required one surface and 24.2% for two surface

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amalgam/composite restorations and for those without fluorosis, 76% required one surface and 15.2% two surface amalgam/composite restorations. There were 321 (60.8%) teeth surfaces which required bleaching and micro-abrasion or composite masking and another 207(39.2%) for direct composite / porcelain veneers or crowns. According to KMPDB to treat the dental disease burden for children with fluorosis was higher and would cost Kshs 24, 785,500.00 (97.2%) compared to Kshs 701,500.00(2.8%) for those without dental fluorosis which was statistically significant

[p<0.001 (p :50.05)].

Conclusion: Children with dental fluorosis were burdened more by dental disease p=< 0.001 and had more treatment needs (dental caries, fluorosis, periodontitis and gingivitis) when compared to those without dental fluorosis. The cost of treating the children with dental fluorosis constituted 97.2% of the total treatment needs for all the children.

Recommendation: Kajiado may require more oral health budgetary allocation and posting of more dental personnel especially Ngong and Kajiado hospitals to deal with the dental diseases especially fluorosis. There is need for the government to harmonize and aim at increasing the budgetary allocation for oral health in high fluoride areas in line with the stipulated fees guidelines by KMPDB for dental procedures in public hospitals and make them affordable to the community. The government is urged to defluoridate all the boreholes to ensure the recommended levels by WHO. Otherwise there should be provision of alternative sources of drinking water.