Prevalence of Dental Fluorosis in India: A Systematic Review and Meta‐Analysis

BACKGROUND: Dental fluorosis is considered to be a public health concern globally, including in India. This review aims to determine the prevalence of dental fluorosis in India and its distribution by geographical region, water fluoride level, and severity. METHODS: May 2024. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Studies Reporting Prevalence Data. RESULTS: Out of 6652 records identified, 55 studies including 108,678 individuals accounted for available data for meta-analysis. The pooled prevalence of overall dental fluorosis was estimated to be 34.5% (95% CI; 28.9-40.3) for all age groups, and in children (5 to 18 years) was 32.1% (95% CI; 26.6-37.9). The dental fluorosis commonly reported was in the very mild (10.6%) to mild (9.7%) category. There was a more than three-fold increase in prevalence in regions with water fluoride levels of more than 1 ppm compared to those with less than 1 ppm (50.3% versus 15.1%). Further, a higher prevalence was observed in males (40.7%), community settings (40.7%), rural populations (38.1%), and the western Indian region (43.9%). CONCLUSION: Dental fluorosis in India was found to be highly prevalent, with the milder forms being the most common. A high prevalence was found in regions with high water fluoride levels, with a wide variation across India. Drinking water is the main source of exposure studied, though the effect of other factors and fluoride intake pathways needs to be explored.