title: Association of dental and skeletal fluorosis with calcium intake and serum vitamin D concentration in adolescents from a region endemic for fluorosis.
abstract: BACKGROUND
  Fluorosis is controlled by the duration of fluoride exposure and calcium and Vitamin D nutrition status.
  
  
  OBJECTIVE
  To examine (a) prevalence of dental and skeletal fluorosis in adolescents from upper, middle, and lower socioeconomic strata (SES) and (b) association of fluorosis with calcium intake and Vitamin D status.
  
  
  METHODS
  A cross-sectional study conducted in 10-13.9 years apparently healthy adolescents (n= 90), from different SES of Patan (Gujarat, India).
  
  
  METHODS
  Dental fluorosis was graded as mild, moderate, and severe. Radiographs of the right hand and wrist were examined and graded. Serum 25 hydroxyvitamin D3(25OHD) and parathyroid hormone concentrations were measured. Diet was recorded (24 h recall) and calcium intake was computed (C-diet V-2.1, 2013, Xenios Technologies Pvt. Ltd).
  
  
  METHODS
  Generalized linear model was used to analyze relationships between fluorosis, SES, serum 25OHD concentration, and calcium intake.
  
  
  RESULTS
  Fluorosis was predominant in lower SES (17% had both dental and radiological features whereas 73% had dental fluorosis); no skeletal deformities were observed. Mean 25OHD concentrations and dietary calcium were 26.3 ± 4.9, 23.4 ± 4.7, and 18.6 ± 4 ng/ml and 441.2 ± 227.6, 484.3 ± 160.9, and 749.2 ± 245.4 mg/day, respectively, for lower, middle, and upper SES (P< 0.05). Fluorosis and SES showed a significant association (exponential β = 2.5,P= 0.01) as compared to upper SES, middle SES adolescents were at 1.3 times while lower SES adolescents were at 2.5 times higher risk. Serum 25OHD concentrations (P= 0.937) and dietary calcium intake (P= 0.825) did not show a significant association with fluorosis.
  
  
  CONCLUSIONS
  Fluorosis was more common in lower SES adolescents, probably due to the lack of access to bottled water. Relatively adequate calcium intake and serum 25OHD concentrations may have increased the efficiency of dietary calcium absorption, thus preventing severe fluorosis.
authors.affiliation: Department of Biotechnology, Hemchandracharya North Gujarat University, Patan, Gujarat, India.
authors.forename: Prerna P
authors.initials: PP
authors.lastname: Patel
authors.affiliation: Department of Biotechnology, Hemchandracharya North Gujarat University, Patan, Gujarat, India.
authors.forename: Pinal A
authors.initials: PA
authors.lastname: Patel
authors.affiliation: Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom.
authors.forename: M Mughal
authors.initials: MM
authors.lastname: Zulf
authors.affiliation: Department of Biochemistry, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India.
authors.forename: Bhrugu
authors.initials: B
authors.lastname: Yagnik
authors.affiliation: Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.
authors.forename: Neha
authors.initials: N
authors.lastname: Kajale
authors.affiliation: Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.
authors.forename: Rubina
authors.initials: R
authors.lastname: Mandlik
authors.affiliation: Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.
authors.forename: Vaman
authors.initials: V
authors.lastname: Khadilkar
authors.affiliation: Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.
authors.forename: Shashi A
authors.initials: SA
authors.lastname: Chiplonkar
authors.affiliation: Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Phanse
authors.affiliation: Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Patwardhan
authors.affiliation: Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Joshi
authors.affiliation: Department of Biotechnology, Hemchandracharya North Gujarat University, Patan, Gujarat, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.
authors.forename: Anuradha V
authors.initials: AV
authors.lastname: Khadilkar
keywords: 25 hydroxyvitamin D3; adolescents; calcium; dental fluorosis; skeletal fluorosis