Spatial Variation of Fluoride in Groundwater
GIS is a spatial variation method used in mapping of water quality determination, health risk assessment and groundwater utilization rates (Jang et al. 2016; Liang et al. 2019). As shown in Fig. 2, in this study, ArcGIS 10.5 software was used to map fluoride levels in groundwater. There were coherent spatial variations fluoride concentration levels, especially between the summer and spring seasons. In general, it was observed that the fluoride concentrations increased from south to north.
Figure 2 Spatial distribution map of fluoride concentration (a) Summer, (b) Spring
The seasonal fluoride concentration levels in groundwater were measured at 53 sampling points as shown in Fig. 2. According to this, fluoride amounts exceeding 1.20 mg/L were observed to be higher at Sarim (W-39) (1.65 mg/L), Karatas (W-31) (1.47 mg/L), and Kesmetas¸ W-10 (1.30 mg/L) and W-11 (1.33 mg/L) villages. Overall, no remarkable seasonal variation was determined in fluoride concentration levels. Thus, the study area groundwaters are within acceptable limits (between 650 and 2500 µS/cm) for EC, as seen in Table 3. Additionally, no remarkable seasonal variation was observed in EC values. Annual average groundwater temperature and pH are 20.92 oC and 7.76, respectively.
Table 3
Physicochemical parameter values of groundwater in the study area
Sampling Points | pH | EC (µS/cm) | Temperature (oC) | Ca2+ (mg/L) | Mg2+ (mg/L) | K+ (mg/L) | Na+ (mg/L) | HCO3− (mg/L) | SO42− (mg/L) | Cl− (mg/L) | NO3− (mg/L) |
W-1 | 7.27 | 508 | 18.8 | 99.92 | 10.82 | 3.531 | 6.234 | 350 | 12.762 | 10.107 | 4.753 |
W-2 | 7.80 | 273 | 18.6 | 50.28 | 4.93 | 0.790 | 3.263 | 132.5 | 44.911 | 7.560 | 2.125 |
W-3 | 7.69 | 365 | 18.9 | 67.51 | 6.14 | 2.401 | 3.711 | 183.3 | 40.658 | 7.763 | 9.965 |
W-4 | 7.54 | 415 | 19 | 69.78 | 14.19 | 1.317 | 4.735 | 225 | 58.872 | 6.437 | 5.912 |
W-5 | 7.66 | 412 | 21 | 53.58 | 19.07 | 1.053 | 5.572 | 245 | 25.758 | 4.452 | 9.204 |
W-6 | 7.65 | 455 | 20.1 | 50.18 | 26.49 | 1.589 | 5.533 | 235 | 56.178 | 6.396 | 3.875 |
W-7 | 7.60 | 951 | 19.8 | 80.73 | 24.78 | 53.188 | 14.655 | 375 | 26.450 | 10.887 | 15.744 |
W-8 | 7.68 | 549 | 19.6 | 67.41 | 9.82 | 12.806 | 6.855 | 265 | 20,333 | 5.367 | 9.067 |
W-9 | 7.85 | 303 | 22 | 44.88 | 21.43 | 2.551 | 5.584 | 215 | 40.318 | 9.267 | 5.180 |
W-10 | 7.83 | 410 | 21.4 | 76.05 | 8.22 | 9.650 | 4.268 | 265 | 15.807 | 10.966 | 8.090 |
W-11 | 7.82 | 334 | 20.2 | 50.63 | 5.13 | 3.246 | 4.755 | 180 | 9.936 | 4.515 | 8.981 |
W-12 | 7.80 | 344 | 19.4 | 51.06 | 8.33 | 1.689 | 4.470 | 185 | 29.279 | 7.854 | 2.499 |
W-13 | 7.68 | 329 | 20.5 | 60.18 | 3.39 | 2.630 | 1.909 | 140 | 44.178 | 6.536 | 7.657 |
W-14 | 7.77 | 435 | 20.9 | 61.48 | 10.09 | 1.387 | 6.987 | 210 | 19.412 | 10.429 | 5.520 |
W-15 | 7.81 | 297 | 21 | 47.55 | 7.23 | 1.982 | 11.594 | 140 | 59.421 | 10.765 | 7.366 |
W-16 | 7.68 | 474 | 21.5 | 58.98 | 10.30 | 8.963 | 6.356 | 165 | 62.980 | 16.792 | 9.246 |
W-17 | 8.12 | 300 | 21.3 | 44.26 | 5.99 | 11.140 | 4.326 | 155 | 23.483 | 13.402 | 3.830 |
W-18 | 7.85 | 357 | 21.3 | 49.59 | 7.17 | 2.269 | 3.867 | 195 | 5.632 | 8.411 | 6.114 |
W-19 | 7.68 | 419 | 20.1 | 63.32 | 11.91 | 2.911 | 7.780 | 240 | 25.106 | 6.464 | 4.844 |
W-20 | 7.84 | 321 | 20 | 49.08 | 7.78 | 6.445 | 11.463 | 160 | 35.287 | 11.178 | 22.192 |
W-21 | 7.64 | 647 | 20.2 | 70.04 | 17.34 | 31.240 | 10.855 | 330 | 11.838 | 13.381 | 12.133 |
W-22 | 7.68 | 410 | 21.4 | 40.60 | 22.32 | 2.763 | 5.161 | 265 | 7.305 | 5.786 | 16.317 |
W-23 | 7.39 | 619 | 19.7 | 91.03 | 5.50 | 14.922 | 5.601 | 295 | 8.187 | 8.382 | 25.742 |
W-24 | 7.80 | 502 | 23.6 | 42.47 | 30.12 | 1.600 | 12.314 | 345 | 12.576 | 9.569 | 5.772 |
W-25 | 7.69 | 538 | 19.3 | 61.97 | 17.22 | 6.901 | 12.348 | 280 | 13.345 | 7.690 | 50.092 |
W-26 | 7.91 | 387 | 23.3 | 42.77 | 17.95 | 2.092 | 6.137 | 200 | 7.885 | 10.462 | 41.207 |
W-27 | 8.07 | 348 | 19.9 | 37.76 | 15.11 | 0.928 | 3.769 | 190 | 12.083 | 7.213 | 8.974 |
W-28 | 7.91 | 325 | 21.6 | 35.65 | 20.31 | 1.537 | 5.084 | 188.8 | 39.006 | 6.128 | 4.093 |
W-29 | 7.81 | 407 | 23.2 | 39.57 | 23.26 | 2.477 | 10.110 | 220 | 58.975 | 6.190 | 4.338 |
W-30 | 7.58 | 606 | 21.1 | 73.64 | 21.29 | 8.184 | 10.902 | 290 | 35.542 | 15.300 | 10.319 |
W-31 | 7.79 | 443 | 23.7 | 37.60 | 23.08 | 2.164 | 12.557 | 233.8 | 55.502 | 13.767 | 4.949 |
W-32 | 7.49 | 1050 | 23.1 | 100 | 19.07 | 24.272 | 17.939 | 370 | 40.606 | 21.534 | 38.514 |
W-33 | 7.62 | 835 | 22 | 71.25 | 27.49 | 27.506 | 23.351 | 347.5 | 49.337 | 15.869 | 20.373 |
W-34 | 7.72 | 428 | 23.2 | 43.27 | 21.04 | 7.837 | 16.940 | 270 | 25.851 | 8.532 | 4.716 |
W-35 | 7.71 | 322 | 20.7 | 56.08 | 6.53 | 4.937 | 4.641 | 178.8 | 43.842 | 10.088 | 6.406 |
W-36 | 7.73 | 395 | 20.6 | 62.69 | 7.99 | 3.616 | 7.595 | 160 | 63.704 | 20.082 | 8.507 |
W-37 | 7.64 | 342 | 20.6 | 55.60 | 14.43 | 6.608 | 10.921 | 210 | 45.619 | 9.467 | 8.556 |
W-38 | 7.82 | 291 | 20.3 | 41.09 | 21.01 | 6.722 | 15.272 | 245 | 28.503 | 6.483 | 7.108 |
W-39 | 8.23 | 419 | 21.8 | 32.50 | 20.77 | 3.335 | 26.453 | 220 | 25.437 | 16.559 | 4.849 |
W-40 | 7.84 | 307 | 20.4 | 79.34 | 4.37 | 1.135 | 8.816 | 230 | 45.343 | 6.333 | 6.585 |
W-41 | 8.38 | 344 | 20.2 | 56.33 | 18.35 | 2.314 | 21.838 | 210 | 42.795 | 17.921 | 5.955 |
W-42 | 7.36 | 726 | 19.8 | 92.29 | 31.28 | 2.947 | 22.358 | 385 | 41.971 | 12.317 | 21.246 |
W-43 | 7.92 | 327 | 20.6 | 52.18 | 5.96 | 4.418 | 4.073 | 120 | 53.437 | 12.896 | 21.660 |
W-44 | 7.87 | 284 | 20.4 | 60.88 | 23.46 | 2.532 | 3.708 | 80 | 98.989 | 59.968 | 33.440 |
W-45 | 7.75 | 293 | 21.3 | 52.79 | 6.21 | 8.878 | 5.191 | 170 | 32.023 | 8.297 | 6.441 |
W-46 | 7.78 | 428 | 20 | 59.98 | 7.78 | 18.790 | 7.118 | 180 | 47.394 | 17.496 | 15.802 |
W-47 | 7.84 | 302 | 19.5 | 56.52 | 15.62 | 2.724 | 8.746 | 240 | 14.696 | 15.645 | 5.092 |
W-48 | 7.81 | 283 | 20 | 55.85 | 15.29 | 1.569 | 8.898 | 185 | 49.595 | 13.168 | 16.964 |
W-49 | 7.82 | 290 | 21.6 | 55.32 | 7.28 | 1.025 | 4.043 | 131.3 | 64.634 | 7.830 | 3.375 |
W-50 | 7.83 | 362 | 21.4 | 59.21 | 5.91 | 3.736 | 4.523 | 205 | 17.268 | 12.651 | 5.211 |
W-61 | 7.71 | 364 | 18 | 57.50 | 9.32 | 0.767 | 5.359 | 180 | 40.964 | 23.240 | 6.688 |
W-52 | 7.68 | 364 | 23.9 | 56.85 | 14.38 | 1.777 | 5.984 | 215 | 23.275 | 12.000 | 20.848 |
W-53 | 7.54 | 530 | 21.1 | 65.07 | 20.77 | 6.429 | 6.777 | 230 | 38.048 | 37.103 | 15.835 |
Table 3 Physicochemical parameter values of groundwater in the study area
Hydrochemical Facies Of Groundwater
The Piper diagram defined four hydrochemical facies: (1) SO4⋅Cl-Ca⋅Mg; (2) HCO3-Na; (3) HCO3-Ca⋅Mg; (4) SO4⋅Cl-Na. As shown in Fig. 3, groundwater sampling points in the study area were primarily located in the main hydrochemical facies being HCO3-Ca⋅Mg.
The Schoeller diagram a classic procedure used for determining drinking water quality. This method distinguishes diverse parameter concentrations in a single graph and ensures the ability to contrast parameters (Babanezhad et al. 2018). In the Semi-Logarithmic Schoeller Diagram (Schoeller 1955), almost all of the groundwaters in the study area are Ca + HCO3 (Fig. 4). These results are consistent with the results in the Piper diagram. Mir et al. (2017) used the Schoeller diagram method to classify the facies of water resources in a study conducted on the quality of water resources in the Sistan-Baluchistan region of Iran to manage a possible water shortage during dry periods. In a similar study, Aksever et al. (2016) used the Schoeller diagram to specify the water quality for drinking and irrigation in a Turkish region. Additionally, Al-Barakah et al. (2017) also benefited from this method.
Furthermore, changes in F− content occurred simultaneously with changes in water chemistry facies. The water chemistry facies of water samples with F− concentrations exceeding 1.5 mg/L were HCO3-Ca⋅Mg. This showed that the HCO3-Ca⋅Mg water chemistry facies enriched more easily the fluoride in groundwater in the study area (Fig. 5).
Generally, natural waters contain low concentrations of fluoride (Varol et al. 2008; Yeşilnacar et al. 2016). According to the Turkish Water Pollution Control Regulation (2004), the highest fluoride value is categorized as Class I and Class II water (TWPCR 2004). The highest value of fluoride gauged by national and international classifications is generally below the limit values according to Turkish Standard Instutation (2005) (maximum value 1.0 and 1.5 mg/L according to water class and facies) (TSE 2005). According to the WHO (2011) and the EPA (2012), the limit values are 1.5 and 2.0 mg/L for Class I and Class II category, respectively. However, the optimum fluoride value has been revised to 0.7 to 1.2 mg F−/L by the EPA (2012) and the Department of Health and Human Service (Yetiş et al. 2019).
Risk Assessment
Hazard index was calculated as oral and dermal exposure (Sheng et al. 2021). The findings obtained show that the HQ values in the oral exposure were much higher than those in the dermal exposure. For this reason, distribution maps were created for HQing data only. Table 4 indicates that the HQing value taken from the wells for adult age groups is below the hazard index in all seasons. However, for children, the HQing value was higher than the indicated hazard index, especially in the summer and autumn. Furthermore, total hazard index of the sampling points calculated seasonally are included in Table S4.
Table 4
Seasonal hazard index values for different age groups based on oral exposure in study are
WELLS
|
HQing Summer
|
HQing Autumn
|
HQing Winter
|
HQing Spring
|
Children
|
Teenage
|
Adult
|
Children
|
Teenage
|
Adult
|
Children
|
Teenage
|
Adult
|
Children
|
Teenage
|
Adult
|
W-1
|
1.40
|
0.64
|
0.15
|
0.31
|
0.14
|
0.03
|
0.81
|
0.37
|
0.09
|
1.25
|
0.57
|
0.14
|
W-2
|
1.40
|
0.64
|
0.15
|
0.36
|
0.17
|
0.04
|
0.78
|
0.36
|
0.09
|
1.22
|
0.55
|
0.13
|
W-3
|
1.50
|
0.68
|
0.16
|
0.32
|
0.14
|
0.03
|
0.96
|
0.44
|
0.10
|
2.34
|
1.07
|
0.26
|
W-4
|
1.53
|
0.70
|
0.17
|
0.38
|
0.17
|
0.04
|
0.96
|
0.44
|
0.10
|
1.31
|
0.60
|
0.14
|
W-5
|
1.57
|
0.72
|
0.17
|
0.56
|
0.25
|
0.06
|
0.31
|
0.14
|
0.03
|
1.17
|
0.53
|
0.13
|
W-6
|
1.30
|
0.59
|
0.14
|
0.49
|
0.22
|
0.05
|
0.74
|
0.34
|
0.08
|
1.52
|
0.69
|
0.17
|
W-7
|
1.68
|
0.76
|
0.18
|
0.47
|
0.22
|
0.05
|
0.45
|
0.20
|
0.05
|
1.05
|
0.48
|
0.11
|
W-8
|
1.44
|
0.66
|
0.16
|
0.36
|
0.17
|
0.04
|
0.78
|
0.36
|
0.09
|
0.70
|
0.32
|
0.08
|
W-9
|
1.87
|
0.85
|
0.20
|
0.42
|
0.19
|
0.05
|
0.91
|
0.41
|
0.10
|
1.30
|
0.59
|
0.14
|
W-10
|
3.88
|
1.77
|
0.43
|
0.32
|
0.15
|
0.04
|
1.33
|
0.61
|
0.15
|
1.95
|
0.89
|
0.21
|
W-11
|
4.27
|
1.95
|
0.47
|
0.35
|
0.16
|
0.04
|
1.09
|
0.50
|
0.12
|
2.00
|
0.91
|
0.22
|
W-12
|
2.22
|
1.01
|
0.24
|
0.38
|
0.17
|
0.04
|
0.78
|
0.36
|
0.09
|
1.33
|
0.61
|
0.15
|
W-13
|
2.46
|
1.12
|
0.27
|
0.36
|
0.16
|
0.04
|
0.51
|
0.23
|
0.06
|
1.61
|
0.73
|
0.18
|
W-14
|
2.37
|
1.08
|
0.26
|
0.53
|
0.24
|
0.06
|
0.44
|
0.20
|
0.05
|
0.69
|
0.31
|
0.08
|
W-15
|
2.23
|
1.02
|
0.24
|
1.13
|
0.51
|
0.12
|
0.48
|
0.22
|
0.05
|
1.95
|
0.89
|
0.21
|
W-16
|
2.99
|
1.36
|
0.33
|
0.44
|
0.20
|
0.05
|
0.13
|
0.06
|
0.01
|
1.85
|
0.84
|
0.20
|
W-17
|
2.47
|
1.12
|
0.27
|
0.57
|
0.26
|
0.06
|
0.39
|
0.18
|
0.04
|
1.94
|
0.88
|
0.21
|
W-18
|
0.90
|
0.41
|
0.10
|
0.44
|
0.20
|
0.05
|
0.93
|
0.43
|
0.10
|
2.29
|
1.04
|
0.25
|
W-19
|
1.14
|
0.52
|
0.13
|
0.41
|
0.19
|
0.04
|
0.64
|
0.29
|
0.07
|
2.25
|
1.03
|
0.25
|
W-20
|
1.31
|
0.60
|
0.14
|
0.41
|
0.19
|
0.05
|
0.72
|
0.33
|
0.08
|
1.91
|
0.87
|
0.21
|
W-21
|
0.99
|
0.45
|
0.11
|
0.34
|
0.15
|
0.04
|
0.76
|
0.34
|
0.08
|
1.66
|
0.76
|
0.18
|
W-22
|
1.62
|
0.74
|
0.18
|
0.77
|
0.35
|
0.08
|
0.78
|
0.36
|
0.09
|
1.08
|
0.49
|
0.12
|
W-23
|
1.09
|
0.50
|
0.12
|
0.22
|
0.10
|
0.02
|
0.78
|
0.36
|
0.09
|
1.92
|
0.88
|
0.21
|
W-24
|
1.55
|
0.71
|
0.17
|
0.43
|
0.20
|
0.05
|
1.33
|
0.61
|
0.15
|
2.41
|
1.10
|
0.26
|
W-25
|
0.66
|
0.30
|
0.07
|
0.43
|
0.20
|
0.05
|
0.83
|
0.38
|
0.09
|
0.86
|
0.39
|
0.09
|
W-26
|
0.59
|
0.27
|
0.06
|
0.70
|
0.32
|
0.08
|
0.83
|
0.38
|
0.09
|
0.98
|
0.45
|
0.11
|
The HQing values for each individual sampling point are shown in Table 4. According to this table, in Sarim and Karatas, the summer HQing ranged from 0.05 to 0.47, 0.21 to 1.95, and 0.46 to 4.28 for children, teenagers, and adults, respectively. Risk density of dental fluorosis is split into five ranks, including no risk (0.5 < HQing < 1), mild risk (1 < HQing < 1.5), moderate risk (1.5 < HQing < 2.5), high risk (2.5 < HQing < 3.5), and very high risk (HQing > 3.5), according to a hazard index.
The maximum HQing value for children was calculated as 4.28 in the summer and 0.03 for adults in the autumn (Fig. 6). The HQing value in children was found to be higher than one. According to the results of the study, children are at the highest risk, followed by teenagers and then adults. The reason behind the high risk for children is low BW (body weight), resulting in higher exposure doses for lower age groups (Zhang et al. 2017). Kumar et al. (2019) showed that the risk of danger is higher in children than in young people and adults. Martínez-Acuña et al. (2016) determined that children in the city of Zacatecas, Mexico, face higher hazard risks in consuming high-fluoride water. Aslani et al. (2019) reported that the highest non-carcinogenic risk of fluoride was in the children group. Guissouma et al. (2017) showed that the young population (infants and children) in Tunisia were more exposed to fluoride health risks.
In the study area, it should be noted, HQing for children is highest in summer, followed by spring, winter, and autumn. In other words, as the seasonal temperature increased throughout the region, the hazard risk increased. The study area is defined as an arid and semi-arid region, and the high concentration of fluoride in summer can be attached to the wane in precipitation. In addition, high water request in both the personal and agricultural sectors can result in drops in groundwater levels. In seasons of higher precipitation (spring, autumn, and winter), lower fluoride levels can also be seen as a result of dilution of fluoride levels in groundwater. The adult age group has significantly decreased areas of very high risk in these seasons, and the risk-free areas are expanded significantly compared to the child-age group (Fig. 7).
Dental Fluorosis Risk
In the 1930s, Dean et al. investigated fluoride levels in water and dental fluorosis (Dean and Elvove, 1936; 1937). The “dose-response” relationship between naturally occurring fluoride concentrations in water sources and dental fluorosis was established with data from 22 cities in 10 states in the USA. These data were very important for the first policy on fluoride in water resources and became a reference for setting drinking water standards. McClure (1943) defined 1.0 mg F−/L as the “allowable” level for naturally occurring fluoride in water supplies according to US drinking water standards. Dean and colleagues focused primarily on fluoride dosage in water and dental caries in their dental fluorosis studies (Dean et al. 1942). They conducted their studies on dental fluorosis and caries simultaneously (Whelton et al. 2019). The Dean index is an evaluation based on the aesthetic appearance of dental fluorosis (Fig. 8).
A total of 10,777 teeth of 451 students in 53 villages were examined, including 5396 permanent teeth and 5381 primary teeth. As a result of the dental examination, severe dental fluorosis was detected in the children in the study area. Examples of dental fluorosis degrees of the children’s teeth examined at all points in the study area are seen in Fig. 9. Accordingly, the highest degree of fluorosis was found in Sarim and Karatas villages.
A geomedical map of the study area was produced, taking into account the measured fluoride concentration and the geological structure of the region, as well as the degrees of dental fluorosis obtained as a result of dental examinations (Fig. 10). In this map, the three most important data are overlapped. It can be clearly seen that the level of fluorosis strongly coincides with regions where groundwater fluoride amounts are high. It is also possible to establish a relationship between the fluorosis events of the geological unit and the groundwater with high fluoride content. Yetis et al. (2021) noted the efficiency of XRF (CaO, SiO2, MgO, Fe2O3, P2O5, and K2O) and XRD (Quartz and Zr) analysis results from rock data in regions with high levels of dental fluorosis and fluoride. Finally, the fluoride contained in the rock structure affects the fluoride content in the groundwater. In children who consume this water, the degrees of dental fluorosis vary depending on the fluoride level in the water. A small point should be clarified: even though the fluoride level in the groundwater of Kizilburc village was 0.65 mg/L, fluorosis was specified to be at degree 4, potentially because the number of subjects was low, and the students are transported from small villages to the schools in larger villages by way of intervillage migration and transportation systems. Consequently, the prepared thematic map may be one of the most significant results of this study (Fig. 10).
According to the results of this study and the study conducted by Atasoy and Yesilnacar (2017), the amount of fluoride in groundwater varies between 1 and 4 mg/L. In Sarim and Karatas in particular, samples obtained were higher than the values deemed acceptable by the WHO (0.5–1.5 mg/L). High fluoride concentrations in groundwater caused dental fluorosis in region. Derin et al. (2018), groundwater samples were taken from the same points in 2018 to investigate whether the current problem persists. According to the groundwater analysis results, the average F concentration was obtained as 2.35 mg/L. It has been found that these measured values are still above the allowable limit. In addition, a female student who had a dental examination 10 years earlier was examined again. Dental fluorosis is still a problem for her and for others (Fig. 11).
Statistical Evaluation
All descriptive statistical analysis for the presented parameters were forecasted using Excel 2016 software. Statistical analysis such as one-way ANOVA test analysis was done by SPSS. P values less than 0.05 were regarded statistically remarkable. The responses to the data collection forms were entered into the computer, and after a consistency check, the statistical analysis was carried out in the computer environment. In this study, descriptive statistical methods in the evaluation of data, one-way ANOVA tests for comparisons between groups, LSD multiple comparison tests for subgroup comparisons, T-tests for comparison of paired groups, and Pearson correlation tests were used.
Indexes that measure the severity of dental caries, which are among the epidemiological indexes, were included. These indexes show how often society is affected by tooth decay and its consequences. DMF(T) and df (t) are indices in this group (D: decay; M: missing; F: filled). DMF(T) shows the ratio of the total number of caries, filled, and missing teeth in the individuals examined to the total number of individuals examined; it is not expressed as a percentage. And df (t) is the calculated form of the DMF(T) index for deciduous teeth.
In general, the df (t) and DMF(T) values of these patients were 1.5898 and 0.303769, respectively. The average age of the children examined was 9.09 ± 1.60, with a minimum age of seven and a maximum of 13. P values less than 0.05 were regarded statistically remarkable. According to the ANOVA test results shown in Table 5, the df (t) value varied according to age groups (p = 0.013). A statistically significant negative correlation was observed between df (t) values and age values (r = -0.117, p = 0.013). As the age values increased, the df (t) values decreased.
Table 5
df (t) value and its relationship with age group
W-27
|
0.54
|
0.24
|
0.06
|
0.58
|
0.27
|
0.06
|
1.09
|
0.50
|
0.12
|
0.87
|
0.40
|
0.10
|
W-28
|
0.46
|
0.21
|
0.05
|
0.68
|
0.31
|
0.07
|
0.64
|
0.29
|
0.07
|
1.03
|
0.47
|
0.11
|
W-29
|
0.52
|
0.24
|
0.06
|
0.76
|
0.35
|
0.08
|
1.23
|
0.56
|
0.13
|
1.02
|
0.46
|
0.11
|
W-30
|
0.53
|
0.24
|
0.06
|
0.47
|
0.22
|
0.05
|
1.11
|
0.51
|
0.12
|
0.78
|
0.36
|
0.09
|
W-31
|
2.21
|
1.01
|
0.24
|
0.77
|
0.35
|
0.08
|
0.39
|
0.18
|
0.04
|
1.23
|
0.56
|
0.13
|
W-32
|
0.76
|
0.35
|
0.08
|
0.29
|
0.13
|
0.03
|
0.65
|
0.30
|
0.07
|
0.70
|
0.32
|
0.08
|
W-33
|
0.97
|
0.44
|
0.11
|
0.74
|
0.34
|
0.08
|
1.61
|
0.73
|
0.18
|
1.06
|
0.48
|
0.12
|
W-34
|
2.09
|
0.95
|
0.23
|
2.00
|
0.91
|
0.22
|
0.61
|
0.28
|
0.07
|
2.56
|
1.17
|
0.28
|
W-35
|
1.26
|
0.58
|
0.14
|
0.43
|
0.20
|
0.05
|
0.43
|
0.19
|
0.05
|
0.89
|
0.40
|
0.10
|
W-36
|
1.18
|
0.54
|
0.13
|
0.44
|
0.20
|
0.05
|
0.64
|
0.29
|
0.07
|
0.88
|
0.40
|
0.10
|
W-37
|
1.18
|
0.54
|
0.13
|
0.33
|
0.15
|
0.04
|
0.28
|
0.13
|
0.03
|
0.87
|
0.40
|
0.10
|
W-38
|
0.75
|
0.34
|
0.08
|
1.03
|
0.47
|
0.11
|
0.91
|
0.41
|
0.10
|
0.97
|
0.44
|
0.11
|
W-39
|
1.35
|
0.61
|
0.15
|
3.10
|
1.42
|
0.34
|
0.74
|
0.34
|
0.08
|
3.10
|
1.42
|
0.34
|
W-40
|
1.40
|
0.64
|
0.15
|
0.44
|
0.20
|
0.05
|
0.78
|
0.36
|
0.09
|
2.04
|
0.93
|
0.22
|
W-41
|
0.74
|
0.34
|
0.08
|
0.51
|
0.23
|
0.06
|
0.86
|
0.39
|
0.09
|
0.73
|
0.33
|
0.08
|
W-42
|
1.53
|
0.70
|
0.17
|
0.80
|
0.37
|
0.09
|
0.72
|
0.33
|
0.08
|
1.02
|
0.46
|
0.11
|
W-43
|
2.85
|
1.30
|
0.31
|
0.31
|
0.14
|
0.03
|
2.24
|
1.02
|
0.25
|
0.72
|
0.33
|
0.08
|
W-44
|
3.34
|
1.52
|
0.37
|
0.31
|
0.14
|
0.03
|
1.29
|
0.59
|
0.14
|
0.70
|
0.32
|
0.08
|
W-45
|
3.16
|
1.44
|
0.35
|
0.30
|
0.14
|
0.03
|
0.76
|
0.34
|
0.08
|
0.82
|
0.37
|
0.09
|
W-46
|
3.32
|
1.51
|
0.36
|
0.34
|
0.15
|
0.04
|
1.15
|
0.52
|
0.13
|
0.89
|
0.41
|
0.10
|
W-47
|
3.16
|
1.44
|
0.35
|
0.32
|
0.14
|
0.03
|
0.53
|
0.24
|
0.06
|
0.64
|
0.29
|
0.07
|
W-48
|
3.55
|
1.62
|
0.39
|
0.34
|
0.16
|
0.04
|
0.33
|
0.15
|
0.04
|
1.91
|
0.87
|
0.21
|
W-49
|
3.81
|
1.74
|
0.42
|
0.31
|
0.14
|
0.03
|
0.70
|
0.32
|
0.08
|
1.84
|
0.84
|
0.20
|
W-50
|
2.27
|
1.03
|
0.25
|
0.35
|
0.16
|
0.04
|
0.52
|
0.24
|
0.06
|
2.01
|
0.91
|
0.22
|
W-51
|
2.42
|
1.10
|
0.27
|
0.32
|
0.14
|
0.03
|
0.22
|
0.10
|
0.02
|
1.85
|
0.84
|
0.20
|
W-52
|
2.35
|
1.07
|
0.26
|
0.43
|
0.20
|
0.05
|
0.72
|
0.33
|
0.08
|
2.01
|
0.91
|
0.22
|
W-53
|
2.33
|
1.06
|
0.25
|
0.62
|
0.28
|
0.07
|
0.98
|
0.45
|
0.11
|
2.02
|
0.92
|
0.22
|
The results of the LSD test, a post-hoc analysis undertaken to determine the age group of the difference, show the df (t) index is lower in the 11–13 age groups than in the other age groups (Table 6).
Table 6
df (t) value and its relationship with age group
Age Group
|
N
|
Mean
|
Std. Deviation
|
Std. Error
|
Minimum
|
Maximum
|
F-test
|
P value
|
7–8
|
182
|
1.69
|
2.299
|
0.170
|
0
|
10
|
4.399
|
0.013 < 0.05
|
9–10
|
171
|
1.65
|
1.978
|
0.151
|
0
|
10
|
11–13
|
98
|
0.98
|
1.624
|
0.164
|
0
|
6
|
Total
|
451
|
1.52
|
2.063
|
0.097
|
0
|
10
|
There was no statistically significant relationship between DMF(T) values and age values (r = -0.003, p = 0.944). One-way analysis of variance determined that the DMF(T) values did not differ according to age groups (p = 0.964) (Table 7).
Table 7
DMF(T) value and its relationship with age group
(I) age code
|
(J) age code
|
P value
|
7–8
|
9–10
|
0.843 > 0.05
|
11–13
|
0.006 < 0.05
|
9–10
|
7–8
|
0.843 > 0.05
|
11–13
|
0.010 < 0.05
|
11–13
|
7–8
|
0.006 < 0.05
|
9–10
|
0.010 < 0.05
|
In dental fluorosis screenings performed in 53 villages, nine students with fifth-degree fluorosis, most of them in Sarim and Karatas locations, were identified, and the rate in all screenings was 2%. Another 14 students with fourth-degree fluorosis were identified, and 22 students with a rate of 3.1% and third-degree fluorosis were identified. Its rate in all scans corresponds to 4.9% (Table 8). The average number of teeth examined throughout the study is 23.90. The average number of decayed teeth detected was 1.82.
Table 8
Distribution of dental fluorosis degre
Age Group
|
N
|
Mean
|
Std. Deviation
|
Std. Error
|
Minimum
|
Maximum
|
F−test
|
P value
|
7–8
|
182
|
0.31
|
0.746
|
0.055
|
0
|
4
|
|
|
9–10
|
171
|
0.29
|
1.200
|
0.092
|
0
|
14
|
0.037
|
0.964 > 0.05
|
11–13
|
98
|
0.32
|
0.781
|
0.079
|
0
|
4
|
|
|
Total
|
451
|
0.30
|
0.949
|
0.045
|
0
|
14
|
|
|
The average number of decays in milk and permanent teeth is 1.52 and 0.30, respectively. While the average number of losses in milk teeth was 0.06, no loss of permanent teeth was observed.