Knowledge and awareness about uses of luoride among adults-a survey

Sutharshan G. S.1, Gheena S.*2, Ganesh Lakshmanan3 1Saveetha Dental College and Hospitals, Saveetha Institute of medical and technical sciences, Saveetha University, Chennai, Tamil Nadu, India 2Department of Oral Pathology, Saveetha Dental College, Saveetha Institute of Medical and Technical science, Saveetha University, Chennai, Tamil Nadu, India 3Department of Anatomy, Saveetha Dental College and Hospital, Saveetha Institute of medical and technical sciences, Chennai, Tamil Nadu, India


INTRODUCTION
Fluoride supplements have been used for years to prevent dental caries. Fluoride has a preemptive effect in caries prevention and also certain levels of luoride is present in saliva (Chong and Tseng, 2011;Shree, 2019). The most effective way to prevent dental caries through topical luoride is through luoridated toothpaste (Levy et al., 1995;Gunasekaran and R, 2016;Palati et al., 2020). Tooth brushing reduces bacteria, hence reduces dental caries and it is the reason for using toothpaste. The abrasive effects of toothpaste were extended. Oral hygiene was found to have a caries prevention effect and long-term compliance in oral self-care (Selwitz et al., 1998;Prasanna and Gheena, 2016;Manohar and Abilasha, 2019).
Fluoridation of water is a basic procedure that ensures the presence of precise amounts of luoride content in the drinking water so as to provide systemic and local bene its. Community water luoridation is recommended by nearly all public health, medical, and dental organizations, because of its contribution to the large decline in cavities.
School water luoridation and school-based luoride tablet programs both have been shown in many studies to be effective in preventing dental caries. Fluoride content in toothpaste helps to prevent dental caries (Bellini et al., 1981). Dental caries are controlled in children who drink luoridated water (Bentley et al., 1999;Harrita and Santhanam, 2019).
According to Rozier RG, Fluoride supplements should be prescribed only for children who are at high risk of developing caries and whose primary source of drinking water is de icient in luoride (Rozier, 2010;Sheriff and Santhanam, 2018). According to Narendran S, de iciencies and ambiguity in respondent luoride knowledge, as well as prescription practices, indicated a need for educational intervention (Narendran, 2006;Ahad and Gheena, 2016). According to Horowitz, dental diseases can be controlled and prevented using luoride (Horowitz, 2003). The main aim of the study is to assess the knowledge and awareness about the uses of luoride among adults.

MATERIALS AND METHODS
An online survey was conducted with a selfstructured questionnaire with a sample size of 100 comprising dental students. The questionnaire consisted of questions related to awareness about the uses of luoride and inally, questions related to established facts. The participants were given a short introduction about the awareness of the uses of luoride. The questionnaire was validated in a standard manner. Measures such as a selection of participants randomly, steps to prevent asking irrelevant questions to the participants, placing restrictions over participant population and age groups are taken to minimise the bias occurring in sampling. The questionnaire was designed using the online survey platform "google forms". For statistical analysis, data was initially entered in Microsoft excel sheet and analysed using IBM SPSS Software version 20.0. Descriptive statistics were expressed by means of frequency. Percentage and chi-square analysis for gender responses were also carried out using the same statistical software. The results of the survey were represented in the form of pie charts and bar charts.

RESULTS AND DISCUSSION
In this study, the results are collected, analyzed and discussed. A majority of 85% of respondents were aware and understood the advantages and disadvantages of luoride. The outright results prove it.              Figure 1 depicts that luoride exists in all water supplies naturally. 78%(blue) have knowledge of luoride existence, 4%(green) have partial knowledge about it and 18%(red) do not have knowledge of luoride existence. Figure 2 Bar chart represents the association between the gender of the participants and awareness about the sources of luoride. The association between the variables was analyzed using Chi-square test (Pearson's Chi-square value -6.711; P-value -0.035 (>0.05)) and was found to be statistically not signi icant. The X-axis represents the gender of the participants and Y-axis represents the number of responses. Out of 42% of the participants who are aware, 33% constitutes male and 9% constitutes female. Figure 3 shows knowledge and awareness on the consumption of luoridated city water for most of our water needs from birth until the age of 18. 57%(blue) had drunk the luoridated city water, 39%(red) didn't drink luoridated city water and 4%(green) didn't know that they had drunk luoridated city water or not. Figure 4 depicts an awareness of luoridated water. 44%(blue) were aware of luoridated water, 40%(red) were not aware of luoridated and 16%(green) were partially aware of luoridated water prevents tooth decay. Figure 5 depicts that drinking public water causes dental luorosis. 37% (blue) of participants know that it causes dental luorosis; 43% (red) of participants don't know that public water causes dental luorosis and 20%(green) of participants partially know that public water causes skeletal luorosis. Figure 6 depicts that drinking public water causes skeletal luorosis. 53% (blue) of participants know that it causes skeletal luorosis, 21% (red) of participants don't know about it and 26% (green) of participants partially know that public water causes skeletal luorosis. Figure 7 depicts that dental luorosis can lead to dental caries. 58% (blue) of participants agree, 22% (red) of participants disagree and 20% (green) partially agree to it. Figure 8 shows that luoride application could prevent tooth decay. 37% (blue) of participants know that it prevents tooth decay, 37% (red) of participants unaware and 26% (green) partially aware of it. Figure 9 depicts awareness of the fact that if a pregnant woman ingested a high dose of luoridated water, it affects the development of teeth in the foetus. 44% (blue) of participants aware, 22% (red) of participants unaware about it, 34% (green) partially aware of it. Figure 10 depicts that prescription of luoride supplements. 48% (blue) of participants consumed pills, 36% (red) of participants had not consumed pills. Figure 11 shows a Bar chart representing the association between the gender of the participants and awareness about the fact that luoride affects the thyroid gland. The association between the variables was analyzed using Chi-square test (Pearson's Chi-square value -5.176; P-value -0.075 (>0.05)) and was found to be statistically signi icant. The Xaxis represents the gender of the participants and Y-axis represents the number of responses. Out of 54% of the participants who are aware, 34% constitutes male and 20% constitutes female. Figure 12: Bar chart represents the association between the gender of the participants and the use of luoridated toothpaste during 0-10 years. The association between the variables was analyzed using Chisquare test (Pearson's Chi-square value -10.184; Pvalue -0.006 (<0.05)) and was found to be statistically signi icant which clearly indicates the majority of males are more aware of the use of luoridated toothpaste during the age period of 0-10 years than females. The X-axis represents the gender of the participants and Y-axis represents the number of responses. Out of 44% of the participants who are aware, 37% constitutes male and 7% constitutes female. Figure 13 depicts the fact that the consumption of luoridated well water could prevent caries. 61% (blue) are aware that consuming luoridated well water could prevent caries, 23% (red) unaware and 16% (green) partially aware that consumption of well water could prevent caries. Figure 14: Bar chart represents the association between the gender of the participants and awareness about the luoride water bene its lower socio-economic backgrounds. The X-axis represents the gender of the participants and Y-axis represents the number of responses. Out of 37% of the participants who are aware, 30% constitutes male and 7% constitutes female. The association between the variables was analyzed using Chi-square test (Pearson's Chi-square value -7.237; P-value -0.027(>0.05)) and was found to be statistically signi icant. Hence the majority of males are more aware that luoride water bene its people of lower socio economic backgrounds than females. Figure 15 depicts that bottled water is luoridated. 59% (blue) were aware that bottled water is luoridated, 17% (red) were aware that bottled water is luoridated and 24% (green) were ambiguous on the awareness that bottled water is luoridated.
According to O Jensen, the most effective way to administer luoride is through the regular use of luoride toothpaste (Jensen et al., 2011;Sarbeen and Gheena, 2016) (Figure 12). Hence using luoridated toothpaste helps in the prevention of caries. This survey helps us to know the awareness that the use of luoride at a minimum level in toothpaste prevents dental caries (Jagtap, 2012;Palati et al., 2019;Sukumaran and Padavala, 2018) (Figure 2). Parnell C explained in their study about the advantages of using luoride and the use of luoride (Parnell and O'mullane, 2013;Abitha and Santhanam, 2019;Uma, 2020). Fluoride toothpaste helps in the prevention of dental caries (Heller et al., 1997;Murray et al., 1986) (Figure 4). Suppose excess intake of luoride content causes dental luorosis ( Figure 5) and skeletal luorosis (Figure 6). Dental luorosis is caused by taking in too much luoride over a long period when the teeth are forming. Only children aged 8 years and younger are at risk because this is when permanent teeth are developing and children older than 8 years, adolescents, and adults cannot develop dental luorosis. The study done by Lubon AJ relates about training rural women and children to improve access to oral health awareness programs in remote villages (Lubon et al., 2018;Krishnan et al., 2018) (Figure 9, Figure 10).
The previous study conducted was successful in creating awareness for rural people, mainly for pregnant women. Because if pregnant women drink luoridated water, it can make kids less intelligent (Knevel and Gide, 2016;Namkaew and Wiwatanadate, 2012). (Hannah et al., 2018;Arshad and Imran, 2017) If pregnant women ingest a high dose of luoridated water, it affects the tooth development of the fetus. (Djordjevic, 2018;Chandrashekar and Anuradha, 2004) (Figure 9) The limitations associated with the study is the limited sample size and therefore is not representative of the population by large. Water sources tested in the rural areas had lower luoride concentration than the recommended level of 0.5 mg/L luoride in water. Hence, a signi icant amount of luoride should be supplemented to meet the biological needs.
Survey of a wider population to increase awareness on the uses of luoride-containing dentifrices and community water luoridation. The main aim is to prevent or decrease dental caries in all areas and reduce the incidence of dental caries (Brindha et al., 2011). In future strategies should be made to utilize media more effectively for oral health education. (Madhankumar and Singarampillay, 2012). Dental treatments are expensive; in the future, the cost of dentistry will be reduced. Thus, the extension of preventive dentistry is still indispensable.

CONCLUSION
Within the limits of the present study, awareness and knowledge among the participants about the usage of luoride are analysed and the study concludes that the majority of the population are aware of the uses of luoride and the level needed to pre-vent themselves from Dental Caries. So it is evident from this study that people are aware of the positive and negative impacts due to the level of luoride in their daily routine and in preventing diseases.