The stained teeth crisis: How fluoride is stealing smiles and futures

In 2019, Asif Twaib, then 17, aced every test in Kenya Defence Forces recruitment—except one. After leading his group in a grueling race under Makindu’s scorching sun, an officer delivered the crushing verdict: “Your teeth are too brown.” Six years later, the Technical University of Mombasa student still carries the shame. “I haven’t tried again,” he admits.

The 23-year-old third year student is among thousands of Makindu residents affected by dental fluorosis, a condition of the bone which is characterised with discolouration and mottling of teeth. It is associated with ingestion of high levels of fluoride.

Also read: Kemri study: Only 14 pc of parents clean their children’s teeth despite widespread health campaigns

Although fluoride is an essential component of healthy teeth, high levels of the chemical are a health hazard. According to the World Health Organization (WHO), fluoride causes dental and skeletal fluorosis if the concentration is higher than 1.5 milligrammes per litre in drinking water. A spot check by Healthy Nation shows that dental fluorosis is a major health crisis in Makindu township and its environs. “All my households are affected by teeth discolouration. It is more pronounced among indigenous Makindu residents. We link the stained teeth crisis to the hard water we take from boreholes and shallow wells,” said Bibiana Mutuku, a village elder.

Medical records at Makindu Sub-County Hospital corroborate Ms Mutuku’s concerns. “Every day, you cannot miss a patient from Makindu complaining of a tooth problem. They mostly present with dental caries. In most cases, the discoloured teeth are also mottled. They are brittle. This accelerates the progression of cavities. We link the teeth problems to high levels of fluoride in local water sources,” Muindi Nzioki, a dentist at the public hospital, told Healthy Nation. 
 
Kibwezi Makindu Water and Sanitation Company, which distributes water in Makindu and its environs, has absolved itself from blame. “We draw the bulk of the water we distribute from Kwa Venge springs, which is also the source of River Kiumbi. Our tests conducted regularly confirm that the water is fit for human consumption. The latest test shows that water from Kwa Venge springs has 0.06 milligrammes of fluoride per litre. This is way below WHO standards, which are 1.5 milligrammes of fluoride per litre. We also get water from a borehole near Kwa Venge springs. A recent test shows that its water has 0.82 milligrammes of fluoride per litre,” Kibwezi Makindu Water and Sanitation Company Managing Director Joseph Mwololo told Healthy Nation in a recent interview, citing a chemical study on the two sources of water that was conducted by Makueni County Water Quality Officer Nzyoki Mululi in March.  
 
A 2017 study published in the Journal of Earth Science & Climate Change is consistent with Mr Mwololo’s remarks on the quality of water from Kwa Venge springs. The study, however, flags out many of the Makindu water sources as a key source of high levels of fluoride. A report of the study seen by Healthy Nation shows that the concentration of fluoride in sampled boreholes in the area was higher than the WHO admissible level.

“Kiboko borehole had the highest concentration of fluoride at 4.2 milligrammes per litre followed by Makindu Boys borehole with a concentration of 2.85 milligrammes per litre. Kalii borehole had the lowest fluoride concentration (1.62 milligrammes per litre) among the sampled boreholes. Raw water from Makindu Spring, the main source of drinking water for Makindu town, had fluoride concentration of 1.1 milligramnes per litre, which is well below the WHO maximum allowable value,” says the study by Francisca Mbithi, Patrick Kariuki and Peter Njuru. 
 
A new trend in which fluorosis has spawned a national crisis worries development experts. “Fluorosis is no longer a problem restricted to the countryside. There is a spike in dental fluorosis in Nairobi and other major cities. This is linked to the mainstreaming of borehole water in urban water systems,” said Gladys Maina, a dental surgeon.

Medics concur with scientists that soft water is key in fighting dental fluorosis. Aware of the link between their water sources and discoloured teeth, and the promise of soft water in addressing dental fluorosis, some of the Makindu residents have embarked on buying soft water from the neighbouring Kajiado County in a bid to reverse fluorosis in their children. Throughout the year, vendors make a killing by selling the commodity, which they access from Sultan Hamud township – 60 kilometers away from Makindu. A 20-litre jerrican goes for Sh70. “My household requires at least three jerricans of soft water in a week. The demand spikes during school holidays. Water from Sultan Hamud is strictly for drinking purposes,” said Rajab Musya. 
 
However, not everyone can afford the soft water. “My children take water from wells. That is what I can afford,” said Floridah Katumbi, whose six children are affected by fluorosis.  “We are disappointed because our children end up developing brown teeth regardless of exposing them to clean water. As soon as they drop the primary teeth around the 8th birthday, they develop signs of brown teeth. We are helpless,” said Fatuma Musa, a community health promoter whose children are affected by severe dental fluorosis. 
 
Apart from locking out youth such as Mr Twaib from jobs and other opportunities, Ms Musa has seen dental fluorosis steal self-esteem from children and young adults in the region. “Affected girls rarely show their teeth when laughing. They cover their mouths with their palms to hide the stain on their teeth caused by dental fluorosis. They use pumice stone, charcoal and a combination of toothpastes in a desperate bid to clean their discoloured teeth and end up frustrated when their efforts fail,” she said. 
 
“A healthy mouth is a healthy mind. People affected by dental fluorosis have been shown to shy away from speaking, participating in class and taking up jobs because they feel they do not look as good as they wound have wanted to. They have been bullied, laughed at, and isolated. With low self-esteem, their mental health is affected and they lose confidence. In very severe cases when the teeth break down, people are not able to feed. This means their general nutrition is affected. This leads to more hospital visits, increased financial pain and reduced quality of life. Some people with severe fluorosis will experience pain and discomfort, which causes distress. This reduces their productivity and affects quality of life,” Dr Maina told Healthy Nation. 
 
As other regions ask for grading of feeder roads and nursery school classrooms during budget making public forums convened by Makueni County government, Makindu residents have over the years pushed for a water filtration solution. The clearest move which the county government has made in addressing the dental fluorosis scourge is drawing water from River Athi in a flagship project, which is set to serve Makindu, Nguumo, and Kikumbulyu North wards.

“Taking clean water while cooking with water that has high levels of fluoride does not address the fluorosis problem. We also need to check on the sources of our fruits and vegetables. Growing crops in areas with high fluoride levels in the soil means ingesting fluoride. Pregnant women need to visit a dentist as soon as they start attending antenatal clinics since the fluorosis problem in children starts in pregnancy. Parents should take their children to regular dental clinics because what may present as a normal discolouration on the teeth may be a pointer to something big,” Dr Maina said. 
 
Dental fluorosis can be managed through various medical and cosmetic interventions such as cleaning and whitening of the affected teeth applying fillings to cover the areas of the teeth that look unsightly. “In severe cases, we apply white coating made of porcelain, which covers the teeth partially or entirely. The intervention depends on how much of the teeth has been lost to fluorosis,” Dr Maina said.

Original article online at: https://nation.africa/kenya/health/the-stained-teeth-crisis-how-fluoride-is-stealing-smiles-and-futures–5110704