title: Impact of caries and dental fluorosis on oral health-related quality of life: a cross-sectional study in schoolchildren receiving water naturally fluoridated at above-optimal levels.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the impact of caries and fluorosis on oral health-related quality of life (OHRQoL) among schoolchildren living in areas with high concentrations of fluoride in water.
  
  
  METHODS
  Five hundred and twenty-four schoolchildren (8-12 year olds) residing in rural communities in central Mexico were examined for oral hygiene, caries (International Caries Detection and Assessment System, ICDAS II), and fluorosis (Thylstrup and Fejerskov Index, TFI). OHRQoL was evaluated with the Child Perceptions Questionnaire for two age groups (CPQ8-10and CPQ11-14). Generalized structural equation models were constructed for data analysis.
  
  
  RESULTS
  Overall prevalence of caries was 88.5% and fluorosis 46.9%. In the group of 8-10 year olds, 48% of the children had advanced carious lesions in primary or permanent teeth (ICDAS ≥4), 22.6% had moderate/severe fluorosis, and 59.9% of children had an impact on OHRQoL. Schoolchildren with ICDAS ≥4 were more likely [OR = 1.75, (95% CI 1.34-2.28)] to suffer a negative impact on OHRQoL. In the group of 11-12 year olds, 19.9% of children had advanced carious lesions and 23.2% showed moderate/severe fluorosis; 67.3% of children reported had an impact on OHRQoL. Children 11-12 year olds with fluorosis (TFI ≥4) [OR = 2.39 (95% CI 2.12-2.69)], caries (ICDAS ≥4) [OR = 2.18 (95% CI 2.13-2.24)], and low brushing frequency [OR = 2.04 (95% CI 1.21-3.44)] were more likely to have deterioration on OHRQoL.
  
  
  CONCLUSIONS
  A negative impact on OHRQoL was observed in children with caries and fluorosis.
  
  
  CONCLUSIONS
  Deterioration on OHRQoL found in children as a sequel of caries and fluorosis should be considered when designing health policies leading to prevention and effective health promotion programs and incorporated to clinical guidelines for timely dental treatment.
authors.affiliation: Department of Ocular Epidemiology and Visual Health, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: García-Pérez
authors.affiliation: Health Care Department, Metropolitan Autonomous University-Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, Del. Coyoacán, Mexico City, Mexico. meirigo@correo.xoc.uam.mx.
authors.forename: María Esther
authors.initials: ME
authors.lastname: Irigoyen-Camacho
authors.affiliation: Postgraduate Unit, Dental School, National Autonomous University of Mexico, Mexico City, Mexico.
authors.forename: S Aída
authors.initials: SA
authors.lastname: Borges-Yáñez
authors.affiliation: Health Care Department, Metropolitan Autonomous University-Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, Del. Coyoacán, Mexico City, Mexico.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Zepeda-Zepeda
authors.affiliation: Postgraduate Program in Biological and Health Science, Metropolitan Autonomous University-Xochimilco, Mexico City, Mexico.
authors.forename: Irvin
authors.initials: I
authors.lastname: Bolona-Gallardo
authors.affiliation: School of Dentistry, Fairbanks School of Public Health, and Indiana University Network Science Institute, Indiana University, Indianapolis, IN, USA.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Maupomé
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D005260:Female; D005457:Fluoridation / Q000379:methods*; D009050:Fluorosis, Dental / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009909:Oral Health; D015995:Prevalence; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Dental caries; Fluorosis; Quality of life; Schoolchildren