Browsing by Author "Webb E"

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    Ecological study of fractures in paedatric Melanesian communities with varying endemic environmental fluoride exposure
    (MDPI (Basel, Switzerland), 2021-09) Webb E; Elmansouri A; Ross R; Clynes M; Tangis J; Stewart C; Dennison EM; Bahamonde RG
    Introduction: Osteoporotic fracture is a major public health burden worldwide, causing significant mortality and morbidity. Studies that have reported bone health in areas of high endemic fluorosis have commonly reported adverse skeletal, as well as dental effects. Vanuatu, sited in the Pacific, and never previously studied with regard to bone health, has six continuous degassing volcanoes on separate islands, resulting in a natural experiment for an ecological study of relationships between naturally occurring fluoride exposure and fracture incidence in paediatric populations. Methods: This ecological study recruited 1026 lifetime residents of the rural Vanuatu islands. A short questionnaire was administered detailing gender, age, and residential history. Participants were asked if they had broken a bone and, if so, were asked to mark its location on a questionnaire manikin. Dental fluorosis was assessed using Dean’s index. Community drinking-water samples were sampled for fluoride concentration. Results: The measured water fluoride concentration and recorded dental fluorosis displayed expected gradients from Aneityum (low) to Ambrym (high) (p < 0.001). The age of participants studied varied from 7.8 (SD 1.2) in Aneityum to 10.6 (3.7) in Lamap/Uliveo. The highest self-reported fracture rates were recorded in the area with medium fluoride levels (Lamap/Uliveo), where 14.9% of boys and 15.6% of girls sampled reported a fracture. In Ambrym, where the mean age of participants was similar, corresponding fracture rates were 4.5% and 2.6%. (p value for differences all < 0.05). Conclusions: Reports of fractures were common in children living in Vanuatu, but demonstrably higher in Lamap, the region with medium fluoride concentrations, rather than Ambrym which had very high rates of naturally occurring fluoride levels. Longer term studies that report validated fracture after peak bone mass acquisition are required.
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    Timings of permanent tooth emergence in children of rural Vanuatu, Melanesia
    (Pasifika Medical Association, 2021-12-30) Webb E; Stewart C; Woods L; Dunlop PF; Tangis J; Stephens J; Dennison E
    Introduction: Global patterning and timing of permanent tooth emergence is influenced by ethnicity, with no known timings reported for ethnic Melanesian children living in the tropical archipelago of Vanuatu. Aim: To determine timings of permanent tooth emergence and sequencing for children who reside in rural Vanuatu Methods: Children aged 4-17 years (n=1026), part of a larger oral health cross-sectional study, were examined recording all permanent teeth present, across four spatially separated islands. Binary logistic modelling established children’s median age of emergence of each permanent tooth for each study area. Findings: The median emergence of first permanent molars for girls is 4.9-years and 5.3 -years for boys. In all locations, children had all permanent teeth emerge by age 11 years (excluding 3rd molars). Clinically important differences exist for permanent tooth emergence by study area. Discussion: Permanent teeth emerge earlier for Ni-Vanuatu children compared to both Melanesian children of Papua New Guinea as well as other ethnicities across Oceanic countries. These results can be used as a set standard for Vanuatu. Early tooth emergence suggests oral health education programmes should target pregnant women with clinical preventive strategies commencing for their children before 5-years of age.
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    Variability of naturally occurring fluoride in diverse community drinking-water sources, Tanna Island, Vanuatu
    (IWA Publishing, 2021-07) Webb E; Stewart C; Sami E; Kelsey S; Fairbairn Dunlop P; Dennison E
    Large variations in fluoride concentrations exist in natural waters, many of which are the source of community drinking-water supplies. Determining fluoride concentrations in community drinking waters can be challenging in developing Pacific countries such as Vanuatu that have limited laboratory capacity. Knowledge of naturally elevated fluoride concentrations that cause irreversible, adverse health outcomes may allow communities the opportunity to treat and manage their drinking-water supplies. Community drinking-water samples (n = 69), sourced from groundwaters, roof catchment rainwaters, surface waters and springs, were sampled on Tanna Island, Vanuatu between 2017 and 2020. In an 18 km2 area of Western Tanna, a set of 30 groundwater-based drinking-water samples had a median fluoride concentration of 3.3 mg/L, with 20 samples >1.5 mg/L and seven samples >4.0 mg/L. These concentrations increase the risk of dental and skeletal fluorosis, respectively. Repeat resampling at five sites showed little variation over the sampling period. Rainwater-fed drinking-water supplies were lower overall and highly variable in fluoride concentrations (<0.05–4.0 mg/L, median of 0.53 mg/L), with variable inputs from volcanic emissions from Yasur volcano. We recommend a comprehensive oral health and bone health study for the whole island to determine adverse health effects of excess fluoride in this vulnerable population.