# Prevalence and Distribution of Developmental Defects of Enamel in Children Aged 12–15 Years in Fazilka District, Punjab, India, and Their Correlation With Drinking Water Fluoride Level

## TL;DR

This study examines how high fluoride levels in drinking water correlate with enamel defects in children aged 12-15 in Fazilka, Punjab, India.

## Contribution

The study provides new evidence of a strong correlation between elevated fluoride in drinking water and developmental enamel defects in children.

## Key findings

- 73.4% of children showed enamel defects, with diffuse opacity being the most common.
- Fluoride levels in drinking water ranged from 0.5 to 2.0 ppm.
- A significant positive correlation (r=0.95) was found between fluoride levels and defect type severity.

## Abstract

Background and objectives: Dental fluorosis is a developmental disturbance of dental enamels, caused by successive exposures to high concentrations of fluoride during odontogenesis, leading to enamels with lower mineral content and increased porosity. The objective of the present study was to assess the prevalence and severity of developmental defects and their relationship to fluoride levels in drinking water.

Methods: Ten villages were selected from Fazilka district, Punjab, India. A total of 1000 (519 males, 481 females) school children aged 12-15 years formed the study population. Eutech ION 2700 (Thermo Fisher Scientific, Waltham, Massachusetts, United States) was used for the estimation of fluoride levels in water. Developmental defects were screened and assessed using the modified Developmental Defects of Enamel (DDE) Index. Statistical evaluation was done using Karl Pearson's coefficient of correlation and the Chi-square test with IBM SPSS Statistics for Windows, Version 23, (Released 2015; IBM Corp., Armonk, New York, United States).

Results: The fluoride concentration in drinking water ranged from 0.5 to 2.0 ppm. The prevalence of developmental defects among the study population was 73.4% (range 59% to 100%). The most commonly observed type of defect was diffuse opacity (score 4) in 22.8% of the children. The premolars were the most commonly affected teeth. There was a significant positive correlation between the type (r=0.95; p<0.001) and extent (r=0.82; p<0.001) of developmental defects to the fluoride levels in drinking water.

Conclusion: The drinking water from about 50% of the villages had fluoride levels of 1 ppm or >1 ppm. A significant positive correlation between the severity of enamel defects and increased fluoride levels in water was deciphered. Thus, a simple, effective, and inexpensive method of de-fluoridation of drinking water should be prioritized if alternative sources of drinking water are not made available.