Presentation and Management of Dental Fluorosis in a Resource-Limited Facility in North-Central, Nigeria

Background: Dental fluorosis is a developmental disturbance characterized by excess fluoride in hard tissues of the teeth. The appearance of teeth affected by dental fluorosis may negatively affect individuals’ self-esteem and overall quality of life. Hence, the need for treatment, although there is still debate on the best treatment modalities. The objective of this study was to document the presentation and management of dental fluorosis in a resource limited facility in North-Central Nigeria. Materials and methods: A cross-sectional hospital-based study conducted among out-patients attending a secondary oral health care facility in Jos, North-Central Nigeria between June 2020 and June 2022. Sociodemographic characteristics were recorded. All patients were examined for presence of dental fluorosis. Dean’s Index was used to classify dental fluorosis. Patients with dental fluorosis who consented to the study were treated. Treatment modalities included oral prophylactic treatment, micro-abrasion, and resin infiltration. Data analysis was by the use of Statistical Package for Social Sciences (SPSS) version 23.0. A p-value of < 0.5 was taken as statistically significant. Results: During the study period, 1201 patients presented with different oral health challenges. Among these, 200 (16.7%) were diagnosed of dental fluorosis. The mean of the patients with dental fluorosis was 14.15 ± 1.91 years. Nearly half


Introduction
Dental fluorosis is a developmental disturbance While prevalence of dental fluorosis varies from country to country, there is still debate on the best treatment modalities. Dental fluorosis has been mostly reported among people in less developed than developed countries, 3 due to relative scarcity of treated water consumed by the public in the former. Surface water contains less fluoride concentration (<1.5mg/L) than underground water. 5,8 Underground water from boreholes and wells, without chemical analysis and treatments, is a major source of drinking water in many communities in Nigeria. Fluoride concentration in drinking water within 0.5-1mg/l benefits the body, but a concentration higher than 1.5 mg/L constitute a risk of dental and skeletal fluorosis. 5,9 Although the leading cause of fluorosis is a higher concentration of fluoride in drinking water, 9-12 fluorosis has also been reported in areas where fluoride concentration in drinking water is lower or even within the safety level. 5 Fluorosis in this situation was       Table   3.         showed that the condition is more common among children than adults. 15, 23 The quest for better appearance of teeth among the children and adolescents compared to adults may be the reason why there was a higher proportion of patients who were in the younger age group than those who were in the older age group.

Figure 3a
Females presented with more dental fluorosis than males as reported in other previous studies. [24][25][26][27] However, these results were at variance with findings from other studies that reported that dental fluorosis was higher among males than females 23,28 and no sex preponderance. 29 The higher proportion of female patients than male patients presenting with dental fluorosis was also observed in the classes of fluorosis presentation where more females presented all classes of dental Fluorosis, except in the moderate class where males were slightly more. Also, patients with severe dental fluorosis were more among females than males. This is in agreement with a previous report where there were more patients with severe dental fluorosis compared to any other class of dental fluorosis presented in the clinic. 2 The unpleasant appearance of teeth in severe dental fluorosis may be the major reason for these findings. More females presenting with severe dental fluorosis in this study may be due to females' consciousness of better aesthetic appearance than males.
The preponderance of female patients presenting with dental fluorosis in this study may be attributed to the fact that more females sought dental care than males as reported previously in other clinically based studies. 30,31 It may also be as a result of females having more concern and seeking for better appearance of their teeth and that of their children compared to male patients.

Conclusion
Dental fluorosis causes low self-esteem and negatively affects quality of life among dental patients. It was a reason for dental visit as a significant proportion of the dental out-patients sought for intervention at the study center.
Presentation was more among children and teenagers below 20 years. More females presented and requested for intervention than the males. Resin infiltration was found to be cost effective at this facility. More patients presented with moderate class of dental fluorosis, and dental caries infection was found not to be significantly related to any specific class of dental fluorosis in this study.