Contents

1. Background 2. Rationale 3. Aim and Objectives 4. Literature Review 5. Research Design Statement of the problem Research Methodology 6. Method Quantitative Stage Qualitative Stage Participants of the research Sampling Data and Data Analysis 7. Ethical Issues Population Permissions

BACKGROUND

In 1969 the World Health Organisation suggested that the areas where the community water supply with the fluoridated water is below the normal optimum fluoride level, to prevent dental caries should be provided with fluoridated water which has got the required amount of fluoride in it (K. Park). Fluoride in water has got two different impacts according to the amount of its content. It is a toxic element in normal water and on the other hand it is an essential element in ground water. Fluoride in drinking water has got various advantages on the human body when it is an essential level but when it exceeds the normal value of 1ppm it becomes toxic. The normal value of fluoride which is essential for the human body is 1ppm or less than that which is non hazardous to the human body and health. Thereby the study here shows the ill effects of fluoride on human body and the correlation between the fluoride optimum level and its remuneration on human body and life (M Rajan 2008). Fluorosis is a condition which occurs due to the excessive intake of fluoride through drinking water. The studies have shown that fluorosis once accrued cannot be treated and also never be cured. Preventing the occurrence of this condition is the only way for solving this problem. The amount of the fluoride been consumed determines the severity of this condition. Hence it varies between each person. People who are exposed to higher levels of fluoride are more prone to have intense level of fluorosis. Also long term exposure to higher levels of fluoride can also bring about this condition. But on the other hand there are some factors which can bring about differences in the effect of fluoride on the body such as the dietary intake of the person, the health condition and also the fluoride excreting capacity of the body when it exceeds the normal limit (India waterportal, 2007).

Food and drinking water are the two main sources by which human body receives fluoride. There are several other sources by which human body

consumes fluoride other than through drinking water and through diet. Fluoride is a natural element which is present in the environment and can also be present in the environment due to human and artificial activities. The main artificial source by which the human body receives fluoride is through tooth pastes. This is done purposefully and not accidentally. Fluoride is added to tooth pastes in order to supplement additional fluoride to the body in order to prevent dental caries. Certain amount of fluoride is required for the human body which has the ability to prevent dental caries. But once it exceeds the optimum level it results in some pathological conditions (India water portal, 2008). Studies have shown that nearly about 63 million people in India are affected by hydrofluorosis out of which 6 million are children. This is due to the excessive consumption of fluoridated water (R. Harikumar, 2007). In 1948, WHO stated that an optimum level (i.e. <1mg/ltr) of intake of fluoride is required for the human body and also it can prevent dental caries to great extant. Human body receives fluorides from the main natural recourses like air and food stuffs. This amount of fluoride which we consume from the nature is normal and will not cause any harm. But according to the studies conducted by UNICEF it had been shown clearly that several supplement additional fluorides through water, tooth pastes etc, in order to prevent the occurrence of dental caries without even knowing the ill effect of excessive fluoride on human body (UNICEF,1995). It has been proved earlier that arsenic is a poisonous substance but later it had been concluded that fluoride is even more poisonous than arsenic. The shocking fact is that the sodium fluoride is the component which is used in the fluoridated pastes and gels which is a aluminium industry remnant. Even in the main source of fluoride which is the water the component which is added to make it fluoridated is hydrofluorosilic acid which is a remnant of fertilizer industry (Natural Health Articles, March2009). The UNICEF has explained the action of the fluoride as, that it has the ability to inhibit the action of oral bacteria which has got a highly acidic media that can dissolve the tooth

enamel matrix. But later what happens is that when the amount of fluoride in boby increases in level it binds with the calcium in the tooth and finally results in the calcium less matrix which is the pathological condition called dental fluorosis (UNICEF, 1995). In 1997, WHO coined that Deans Fluorosis Index is the scale by which the intensity of the condition can be measured (WHO, 1997). Peter in 2009 explained that the dental fluorosis can be measured in different levels according to its intensity. The scores can be given such as normal, questionable, very mild, mild, moderate and severe. When the enamel is normal it will be creamy white in colour and will be having a slight translucency. But when it comes to the next score the enamel loses its translucency and will have small white flux which later on in its advanced stages will increase in its size and number and covers almost the whole surface of the teeth. Later on when it becomes severe the tooth surface will be covered with brownish black flex (Peter2009,pp.350-352).

RATIONALE

It was in the year of 1937, it was found in the state of Andhra Pradesh in India that the state is fluoride endemic with more amount of fluoride in the natural resources of water. Even though India is a developing there are several states in the country which is found to be fluoride endemic and large amount of people are suffering due to this pathological condition. In this developing country nearly about 17 states are found to be endemic in fluorosis. Out of these 17 states the most number of fluorosis effected people are found to be in the state of Tamil Nadu. The studies conducted in the state of Tamil Nadu revealed the fact that out of 28 districts in this state 23 districts were found to be fluoride endemic. The most number of fluorosis effected people are found in the district or Salem. This is just because of the Mettur dam which is located in the Mettur Taluk. This is the dam from which the whole district of Salem is being supplied

with the drinking water required for the local people who live in this district. Since the amount of fluoride being diluted in this dam is more than the normal range than the amount it is suppose to be, the people who had been using this water for a long time are affected by fluorosis. Unknowingly the water in this dam is still been fluoridated continuously. In the pre-monsoon and in the postmonsoon studies had been conducted in these areas the ground water sample results showed that in the post-monsoon the fluoride level in the ground water ranged from 0.4 to 4.0mg/L and pre-monsoon fluoride level ranged from 0.1 to 2.8mg/L which is considered to be high.

AIMS AND OBJECTIVES

The aim of the research is to analysis the various factors that leads to dental fluorosis in Mettur district, Tamil Nadu India. The study also explores the knowledge level of the respondents about water fluoridation and about its harmful effects on health. The main objectives are, To find out the awareness of the respondent regarding fluoridation of water. To assess the respondents knowledge about various sources that brings about dental fluorosis. (Water, Tooth paste etc.). To explore the problems that comes out of the aesthetic dissatisfaction. To explore the respondents awareness about the long term consumption effects of fluoridated water.

Literature Review

The most countries of the world had already developed in all the aspects except certain matters such as preventing the people from the hazards or ill effects of

fluoride. Hence various countries or parts of the world are still fluoride endemic. In several parts of the world like Middle East, Asia, Africa, etc, researches are still being carried on in order to prevent the excess presence of fluoride in water and to make the people aware of the after effects of excess or long term conception of fluoridated water. The researches done by Awadia in 2000 showed that several attempts had been made to find out the amount of fluoride content in the drinking water in the areas of Tanzania since the amount of fluoride content in the drinking water of these areas had been found to be excess earlier. Hence these results were taken to correlate it with the result which was found earlier and also to find the incidence of dental fluorosis in the children of these areas. Ncube in 2005 stated that several studies had been done in South Africa the usage of the normal ground water by the people of those areas with the incidence of dental fluorosis. In that study it was made clear about the correlation between the presences of fluoride i the drinking water and the occurrence of dental fluorosis among the people in those areas. Even in the studies done by Rubina in the year 2003 showed the clear correlation between the presence of fluoride in water and the incidence of the condition in the city of Faisalabad in Pakistan. In their studies they revealed the fact that the most of the cities around those areas were found to be fluoride endemic but at the same time some areas were not affected by the harmful effects of fluorosis and they found out the reason for it as the people in those areas are not consuming the same drinking water as the other people. The sources of water for these people were different from the fluoride endemic areas. But studies have revealed the facts that, the incidence of dental caries in these areas are mark ably higher than the other areas which have higher levels of fluoride than the optimum level. The author says that the condition is not different in India where 8700 villages which comprises of about 24 million people consume the water containing high fluoride level.

The result from the studies of Pushpa (2005) says that 2 districts, namely Bagalkot and Gadag which is in the state of Karnataka was found to be highly endemic in fluorosis. The level of fluoride level here is so high that it was up to is just 1.0 ppm. In order to find the reason of this they conducted a study. For this they selected 6 villages which were found to be fluoride endemic. They selected people from each village randomly in such a way that at least one person should be there to represent each family in these villages. The total calculation was to select at least 10% of people from the total population. Finally when they concluded the study they came to a conclusion that the fluoridated water was effecting them in such a way that at least one person in a family will be affected by this condition. They did not take this matter lightly and to get better opinion they hired dental specialists and made to examine these people by noticing their clinical symptoms. Another research was conducted by Suseella (1972) again in the fluoride endemic areas in India. The one and the only aim of their study were to determine the after effects of fluoridation of water. For this with the help of Dr. George, she formulated a group of doctors and then trained them to identify the non skeletal fluorosis. They finally concluded that the amount of fluoride in take can show great differences in the intensity. There was another research conducted by Steven (1998) who says that in intensity of fluoride content in the body can affect the growth and development of bones. Otherwise even if it grows it will not be healthy and will have the risk of having fractures or osteoporosis.

Research Design

Statement of the problem:

This is focused on to the psychological problems faced by the people of young age group specially the teenagers because this is the age which they will be

more concerned about their beauty and aesthetics. When these people are kids they will not be much conscious about the food and the quality of the water they intake. But due to the constant use of fluoridated water when they grow up these people will start developing the ill effects of fluorosis. Then they find it difficult to go to the colleges and also to interact with the other people because of the ugly brownish black appearance of the teeth due to pathological condition dental fluorosis. This can even finally ends up in a psychological and emotional problem in the children of this age group. The second major focus of this study is on to the hazards of the long term usage of water which is fluoridated and its harm to the human body in the long run.

Research Methodology: Given the varied objectives of this study, the methodology was designed with a combination of qualitative and quantitative research tools. According to Polit and hungler (1999) the quantitative research designs focus on understanding the various natures of relationships between phenomena. It is a method through which the happenings of the world are explained through numerical data (Smith and Hunt 1997).

Method

Quantitative Stage: The study will be carried on with the structured questionnaire which is because of its comfort of gathering the information. With the help of this method more number of respondents can be approached and the data can be collected. There are some disadvantages for this method too. The main problem regarding this is the chance of misunderstanding the question which is being asked. Another problem is that the emotional stability and the presence of mind of the respondent can reflect on the quality of the data been collected for the study. It

also prevent the respondent from expressing his or her feeling regarding the study topic (Bowling 2009).

Qualitative Stage: This is a method by which the respondent can express his or her view or feeling towards the topic of study. This can render more credibility to the study. Focused group are unstructured interviews with a small number of respondents and with their interactions within themselves and with the group leader. (Bowling 2009).

Participants of the research: The research conducted among both male and female population in Mettur District of Tamil Nadu, India. The age group included under the study is between 10- 30. The reason for the selection of this age group is that dental fluorosis is noticed initially when it becomes an aesthetic concern. So it will be easy to get willing samples for the data collection. The focused group discussions will be among 8-10 samples. Age proportion will be taken cared in the selection process.

Sampling: The samples used for the study should be representative this will ensure accuracy in the collected information. Quantitative data will be collected with the help of 100 questionnaires. The sampling method for the study is visualised to be purposeful from the population as it involves accessibility and consent issues considering the phenomenon under study.

Data and Data Analysis: Nominal and ordinal are the two types by which the quantitative data will be gathered. The collected information are coded and entered into either statistical

package for social science. (SPSS) or excel spread sheet for its analysis. The qualitative data arising out of the focused group discussion is coded and arranged into themes for easy understanding and analysis.

Ethical Issues

Population: Amongst the young individuals which include the teenagers aesthetics is a most concerned issue. Hence when the data is being collected great care should be taken. The main factor which should be kept in mind is that the data collected by the respondent should be kept confidentially in order to ensure the privacy of the person. Even the name of the respondent will not be entered correctly which will be mentioned as anonymous. The people involved in the study will be made to understand the purpose and need of the study.

Permissions: The permissions will be taken prior to the study from the local government sectors in the area of the study in order to prevent the problems while collecting the data from the local people. The purpose and the need for the study should me explained and made to be understood to the local leaders which can later on prevent chaos and confusions.

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