Pilot testing of international instruments for dental fluorosis risk awareness and OHRQoL

Abstract

Introduction Dental fluorosis is a public health concern in Moldova, especially in endemic areas where drinking-water fluoride may exceed the limit recommended by the World Health Organization. Rural communities rely mainly on groundwater, including artesian sources; therefore, risk of fluorosis onset and progression remains high. OHRQoL assessment can capture functional and psychosocial impact and support prevention in children and adolescents. Aim of the study To test, align and adapt standardized instruments for selfassessment of OHRQoL and awareness of dental fluorosis risk, using a combined OHRQoL and CS-OIDP questionnaire. Material and methods A cross-sectional descriptive pilot study included 31 families with children from endemic areas characterized by elevated fluoride concentrations in artesian water sources. The study aimed to evaluate the feasibility and applicability of internationally standardized instruments adapted for assessment of oral health-related quality of life (OHRQoL) and awareness of dental fluorosis risk in children living in endemic regions of Moldova. The 49-item assessment tool combined two standardized questionnaires (OHRQoL and CS-OIDP) adapted to the fluorosis context and structured to evaluate sociodemographic characteristics, oral health perceptions, daily functional limitations, aesthetic selfassessment, awareness of fluorosis severity, and the impact of fluorosis on quality of life. Internal consistency and reliability of the adapted instrument were planned to be evaluated using Cronbach’s alpha coefficient. Descriptive statistical methods were used to summarize participant characteristics and response distribution. Ethical principles were maintained throughout the study, including voluntary participation, confidentiality, anonymity, and informed consent obtained from parents or legal guardians prior to inclusion in the study. Results The tool was structured into six sections: general information, OHRQoL, fluorosis impact on daily activities, dental aesthetic self-assessment, self-rated fluorosis severity, and post-intervention assessment; administration was feasible. Among children, 54.9% were boys and 45.1% girls; 87.1% had lived in endemic areas up to age 7 years and 81.7% currently resided there. Dental visits were reported for preventive consultation (22.1%), tooth pain (25.8%), treatment continuation (22.6%), and family physician referral (6.5%); 22.6% attended a dental consultation only for the second time in their lives. Socioeconomic status was reported as unsatisfactory in 16.3%, satisfactory in 32.3%, and good/very good in the remaining families. Conclusion Pilot adaptation of a standardized assessment instrument for endemic dental fluorosis may support OHRQoL indicator development and awareness assessment; further validation is warranted.