Perceptions of dental fluorosis in the Central Karoo District of the Western Cape Province
Dental fluorosis is an endemic condition in a number of regions of South Africa, varying in degree of affliction according to the drinking water fluoride concentration in the area. Objective: While a number of South African studies have reported on the relationship between fluorosis and fluoride concentration in the drinking water, the purpose of this study was to determine perceptions of dental fluorosis in the Central Karoo District of the Western Cape. Methods: Learners aged 12-15 years and who had been lifelong residents in their respective areas were selected from schools in Leeu Gamka, Merweville, Nelspoort and Murraysburg. All the children meeting the inclusion criteria were included realising a total sample of 189. Drinking water fluoride concentration of each town was determined and concomitant fluorosis affliction was assessed. An interviewer administered questionnaire was used to determine respondents’ self-rated perceptions of fluorosis as well as their responses to a set of statements on clinically defined fluorosis. To this end four photographs, each depicting a different degree of fluorosis: (No fluorosis; Mild fluorosis; Moderate fluorosis; Severe fluorosis) were shown to the respondents. Results: In Leeu Gamka, with the highest fluoride concentration ([F] = 1.62ppm), 82% of respondents were aware of fluorosis stains as opposed to 6%-20% awareness in Merweville ([F] = 0.68), Nelspoort ([F] = 0.70) and Murraysburg ([F] = 0.56). Two thirds of respondents in Leeu Gamka found the appearance of their teeth embarrassing compared to only 2%-10% in the other 3 areas. The majority of respondents in Leeu Gamka (82%) indicated that they would want to remove the fluorosis spots with only 4%-20% in the lower fluoride areas. Two thirds (67%) of the Leeu Gamka respondents were teased compared to 2%-6% in the other areas. Most of the respondents have not tried to do anything to the appearance of the teeth, even in the higher fluoride area of Leeu Gamka. The average response varied little for all the photographs across the geographic areas (the minimum and maximum scores varied between 4.00 and 5.00) and reflected a greater tendency towards strongly disagreeing with the statement on aesthetics-even for the photographs depicting no fluorosis and mild fluorosis. The average response varied between 1 and 2 among all four geographic regions showing a tendency to “agree” and “strongly agree” to the statement on embarrassment. The average response to the statement on neglect varied little for all the photographs across the geographic areas as the minimum and maximum average response scores varied between 1.36 and 2.39 (agree and strongly agree). The response to the statement on disadvantage varied little for all the four photographs across the geographic areas (minimum=1.00, maximum=2.07) and reflected a greater tendency toward strongly agreeing and agreeing with the statement. Conclusion: The respondents from the higher fluoride area were more aware of dental fluorosis, had a greater perception of embarrassment and the strongest desire to remove the fluorosis staining. There was little variation in the average response to the statements on clinically defined fluorosis across the geographic areas. The learners erroneously believed that dental fluorosis was due to neglect, which is an indication that many learners are not aware of the cause of dental fluorosis in their community. The general consensus of the communities was that fluorosis was judged with feelings of negativity (embarrassment and a disadvantage for the child into adulthood).