Environmental risk factors associated with tooth decay in children: a review of four studies in Indonesia

Abstract

There is growing concern over studying the environmental impacts on human health. Among the world's population, children are particularly vulnerable to environmental threats. Currently, in certain areas of Indonesia, there are significant problems with water quality, especially as many consume surface water for drinking. There is evidence that this contributes to tooth decay - the process of dental caries. Furthermore, teeth provide an excellent chronological record of nutritional status and trace metal exposure during human development. This paper provides an overview of risk factors for dental caries and reviews four epidemiological and laboratory studies that have addressed these issues in Indonesia. First, Winanto in 1993 showed that acidity and high tin (Sn) concentrations in drinking water are associated with the erosion of permanent teeth in children living close to a tin mining area. Second, Wulandari in 2009, using Graphite Furnace Atomic Absorption Spectrometry (GFAAS), showed that deciduous teeth containing high concentration of lead (Pb) have 3 times higher risks of contracting caries. Third, Satrio in 2010 compared the dental status of children who consumed rain water with those using other sources of drinking water: this revealed that low concentration of Fluoride in drinking water contributes 19 times higher risk of dental caries and low pH 22 times the risk compared to water of neutral pH. Fourth, Musadad in 2009 undertook an ecological study on the effect of drinking water quality in relation to dental caries and revealed significant associations with acidity, total water consumption, household expenditure and the distance from a subject's residence to the nearest dental health provider. Thus, in Indonesia, tooth decay is not only associated with poor diet and poor oral hygiene; it also reflects poor environment.