Fluorosis: Environmental Risk Factor for Periodontal Disease?

Background: Periodontitis is multifactorial in nature. The effects of fluorosis as an environmental factor are not evaluated and researched to designate it as a risk factor similar to smoking. The primary objectives of this study were to investigate whether there is any association between fluorosis and periodontal disease and to assess salivary oxidative stress in fluorosed and nonfluorosed patients with periodontitis contributing to periodontal disease. Aim: This is a case–control study with an aim to investigate whether fluorosis acts as a risk factor for periodontal disease and to assess salivary oxidative stress in fluorosed and nonfluorosed patients with periodontitis contributing to periodontal disease. Materials and methods: About 295 systemically healthy patients were divided into test group (n = 154 fluorosed subjects) and control group (n = 141 nonfluorosed subjects) and assessed for their periodontal status. Clinical parameters recorded were plaque index, gingival bleeding index (GBI), and Jackson’s fluorosis index to assess the degree of fluorosis, and community periodontal index was to assess the periodontal status. Biochemical analysis of saliva was done for assessment of malondialdehyde (MDA) levels, superoxide dismutase (SOD) levels, and total antioxidant (TAOC) levels. Results: The plaque and GBI scores were found similar in fluorosed and nonfluorosed groups. Gingivitis was significantly higher in nonfluorosed than in fluorosed group; in contrast, periodontitis was significantly higher in fluorosed group than in nonfluorosed group. Gingivitis appeared to decline as the fluoride status worsened, while periodontitis showed an increasing gradient from lower fluoride score to higher fluoride score. As the degree of fluorosis increased, periodontitis also increased. The salivary antioxidant levels were found similar in both the groups.