EFFECTS OF FLUORIDE LEVEL IN DRINKING-WATER, NUTRITIONAL-STATUS, AND SOCIOECONOMIC-STATUS ON THE PREVALENCE OF DEVELOPMENTAL DEFECTS OF DENTAL ENAMEL IN PERMANENT TEETH IN SAUDI 14-YEAR-OLD BOYS

Fourteen-year-old boys from three regions of Saudi Arabia were surveye d in 1992/3. These regions were Jeddah (which receives desalinated wat er containing 0.22 mgF/l), Riyadh (receiving water containing 0.78 mgF /l) and Qassim (2.66 mgF/l). For each of these urban communities an ad jacent rural community was selected; these received water with 0.25, 0 .80, and 2.71 mg/l, respectively. Subjects from the urban communities were classified into high, medium and low socio-economic status based on area of residence, income and education level of parents. Nutrition al status was calculated from height and age using WHO methods and exp ressed as height for age percentage of the median of the reference pop ulation (HAM); children with HAM scores of less than 95% were classed as malnourished. The developmental defects of enamel index was recorde d on the buccal surface of all permanent teeth, by one examiner. Colou r photographs of anterior teeth were read 'blind' to investigate exami ner bias between regions there was no bias. A total of 1,539 children were examined who had been continuously resident in that community. Ov erall, 83% of subjects had one or more enamel defects with a mean numb er of teeth affected per person of 9.6. Diffuse defects were the most common. Multivariate analyses revealed that all three variables - regi on, nutritional status, socio-economic status - were statistically sig nificantly related to the prevalence of defects and the number of teet h affected: prevalence was highest in the region with the highest wate r fluoride concentration, in rural areas and in malnourished subjects. Maxillary incisor teeth were the most affected teeth in all regions. The findings have implications for those in public health who determin e optimum fluoride levels in drinking water in Saudi Arabia and beyond .