Every time Dorothy Achieng’s nine-year-old sees a dentist she pays Sh7,500. The dentist visits started when the child was two years old and her teeth started discolouring.
A resident of Nyayo Estate, Nairobi, she says managing fluorosis in her child — a dental condition caused by water containing high levels of fluoride that causes teeth staining and decay — has cost her more than Sh150,000.
“At first, the doctor assumed poor dental hygiene and consumption of sweets. When the discolouration worsened, her teeth got a permanent, brownish colour and were brittle; I was told that my daughter has irreversible fluorosis. It was caused by drinking water with high levels of fluoride,” she says.
“Although the stained and breaking teeth haven’t affected her self-esteem, I’d have to look for about Sh500,000 for cosmetic dentistry when she is of age,” adds Ms Ochieng’.
Dental fluorosis was a condition synonymous with residents of areas around Baringo, Nakuru and Naivasha due to the high fluoride levels in water sources. But this is now changing.
In Nairobi, children in middle-class estates, especially areas grappling with water scarcity, are struggling with tooth discolouring and decay.
The perennial water shortage has increasingly forced homeowners and residents to turn to use of borehole water under limited supply from Nairobi City Water and Sewerage Company.
The water demand in Nairobi is at 850,000 cubic metres per day while the supply is 525,000 cubic metres, leaving a deficit of 325,000 cubic metres per day.
Just as other underground water sources, borehole water is known to have high levels of fluoride and in some places, it carries excessive and dangerous amounts of the element.
Scientists say most of Kenya’s underground water contains fluoride levels that are higher than the 1.5 milligrammes per litre recommended by the World Health Organisation (WHO).
Thomas Munyao, a paediatric and orthodontic dentist with Ivory Dental Care, says that dental fluorosis is caused by drinking water with high fluoride levels and in Nairobi, it is from boreholes.
Dr Munyao explains that areas mostly affected by the problem are metropolitan towns, including Ngong, Rongai, Embakasi, parts of Westlands, Kilimani, Syokimau and Kileleshwa due to the sudden rise of the number of apartments.
He avers that there are increasing cases of dental fluorosis in Nairobi due to water scarcity resulting from population increase, making sinking boreholes a priority.
“Major sources in Nairobi include borehole water, unknown water sources, especially the water bowser,” he points out.
On average, he says, dental consultation, done frequently, can range between Sh1,000 and Sh3,000 for proper assessment and treatment planning. The cost goes up when a child’s teeth are cleaned and X-rays done.
The doctor explains that treatment varies depending with the degree of fluorosis, age of the patient, desires of the patient and materials to be used.
Dr Roy Gucha, a dental specialist, adds that masking – which is using a white filling to cover the brown stains on the teeth – costs Sh5,000 per tooth and is available for children under 15 years because their jaws are yet to fully mature.
For those above 15 years, more permanent restoration procedures exist including crowning or porcelain veneer.
“One crown goes for Sh38,000 for the front teeth and if not severe, we can do whitening or bleaching Sh30,000 for both upper and lower jaws,” he says.
He adds that with the schools having closed, the number of children seeking dental care have increased.
During the weekends, he says, his dental clinic used to handle between four and five visits on average and two during weekdays with fluorosis being the most common case. However, the numbers have increased with the children now on holiday.
“We expect more of the cases with schools having closed although the numbers will decrease as schools reopen,” he says.
Although fluoride is not known to affect the development of the foetus during pregnancy when consumed in moderate levels, overexposure to the mineral can have effect on the foetus from the first six weeks of pregnancy when the teeth and bones are being formed in the womb.
The risk, explains Dr Munyao, is made worse by the fact that there are no obvious signs and symptoms of the condition and one is only able to detect the problem once the teeth grow.
Low awareness has contributed to severe cases of flourisis in children in these Nairobi estates. Even as a child develops teeth, few families go for dental check-up and postnatal clinics rarely check the teeth.
“A child can get fluorosis right from birth. If the mother is exposed to water that is highly concentrated in fluoride, studies have shown fluoride has the ability to cross the placenta barrier,” says Dr Munyao.
Ms Ochieng’ says if she knew water in Nyayo Estate has high levels of fluorosis, she would have installed a reverse osmosis machine, from the time she was pregnant, to protect her child.
Dr Gucha says overexposure to fluoride right from birth to the moment they get their first permanent teeth — around six years of age — is detrimental to a child.
He explains that low levels of fluoride can strengthen teeth, but higher levels can make the teeth begin fracturing, denying you a beautiful smile.
This is damaging to the self-esteem of children, especially teenagers (adolescents) because of discrimination due to the brownness of the teeth.
For adults, the effect is less unless the levels are too high that is toxic to the body but such levels are not found in borehole waters.
The effects of dental fluorosis is beyond just the browning of the teeth, as it also affects one’s bone structure and density, leading to defects and skeletal weakness.
“If you grew in areas with water with high levels of fluoride then there are high chances that you will get fluorosis. It will affect babies and children below the age of six. However, those exposed to it after developing permanent teeth are less affected,” he points out.