Perceptions of fluorosis in northern Cape communities

The objective of the study was to determine the perception of fluorosis in communities living in the Northern Cape Province of South Africa where there is a considerable range in fluoride levels of drinking water. The fluoride levels of the drinking water were categorised as suboptimal (0.40-0.60 ppmF), optimal (0.99-1.10 ppmF) or supra-optimal (1.70-2.70 ppmF). The teeth of 694 children aged 6, 12 and 15 years were examined. Dental fluorosis occurred among children of all ages in all areas studied. As anticipated there appears to be a direct relationship between fluoride levels in the drinking water and levels of dental fluorosis, and the severity of the condition increased with an increase in levels of fluoride in the water supplies. Children in low fluoride areas showed some form of mild fluorosis (37% very mild and 17% mild). However, 19% of this group experienced moderate or severe forms of fluorosis. In areas with optimal levels of fluoride 30% of children showed a questionable form of fluorosis and 21% mild fluorosis. Moderate or severe forms of fluorosis were recorded in 31% of children in the optimal fluoride area. The Community Fluorosis Index (CFI) scores for the sub-optimal and optimal areas were of medium public health significance and for the supra-optimal area of very high public health significance. Of concern is the high percentage of children (45%) in the supra-optimal area with severe forms of fluorosis. The awareness and concern for stains on teeth were mostly expressed by children with moderate or severe fluorosis. This study suggests that the proposed fluoride concentration (not more than 0.7 ppmF) prescribed in the Regulations on Fluoridating the Water Supplies for South Africa would minimise the risk of dental fluorosis.