It is now well established that oral health cannot be assessed merely by clinical indicators but also complemented with subjective measures. This study aimed to validate the Sinhalese version of the Child Perception Questionnaire (CPQ11-14). The English version of the CPQ11-14 was translated to Sinhala and face and content validity were assessed. The Sinhala version of the CPQ11-14 was then administered to a sample of 150, fifteenyear-old school children from Kurunegala district. Discriminant validity was determined by comparing total CPQ scores with severity of dental caries, dental fluorosis and malocclusion status. Convergent validity was determined by assessing the correlations between global indicators of oral health and total and subscales of the CPQ. In order to check for test-retest reliability, the questionnaire was administered to the same group of students two weeks' a part and Intra-class Correlation Coefficient (ICC) was assessed. Internal consistency was assessed using Cronbach's alpha. There were significant correlations between the global indicators and total and subscales of CPQ11-14 thus ensuring convergent validity. The severity of dental caries, dental fluorosis or malocclusion was not significantly associated with the total CPQ scores and thus discriminant validity could not be proven. Cronbach's alpha for the total scale was 0.8 and ranged from 0.4-0.7 for subscales. ICC for the total scale was 0.9 and ranged from 0.7 to 0.8 for the different subscales. The Sinhala translation of the short-form CPQ11-14 questionnaire showed adequate internal consistency, convergent validity and test-retest reliability. Therefore, it is a valid instrument to determine OHQOL in 15-year-old Sinhala speaking children.
Fifty percent of the dry zone areas in Sri Lanka have fluoride levels above 1 ppm. This paper discusses the ground conditions and recommends an appropriate range of fluoride in drinking water which can support preventive practices for improving the oral health of children 8‐years old and younger. In efforts to address the Chronic Kidney Disease of Unknown etiology (CKDU), water treatment to reduce contaminant level in potable water has been implemented. Such treatment would also remove fluoride and has resulted in potable water with various fluoride levels, depending on concentrations in the raw water. While it is important to reduce fluoride levels, it is important to have appropriate residual levels for prevention of dental caries. It needs, however, to be noted fluoride in excess can cause dental fluorosis. In Sri Lanka's dry zone areas increasing prevalence of dental fluorosis with decreasing prevalence of dental caries has been noted. Consumption of tea and powdered milk could increase total intake of fluoride. Fluoridated toothpaste, when used properly, may, however, result in negligible intake of fluoride. Sri Lanka's hot tropical climate which results in substantial intake of fluids reinforces the need to consider reduction in water fluoride. Consideration of local studies and international standards indicate fluoride levels should be in the range of 0.225–0.500 ppm. In the range of 0.225–0.500 ppm, the prevalence of dental fluorosis and caries was only 14% and 8%, respectively, in an endemic district. When fluoride levels are above 0.500 ppm, the issue of dental fluorosis shall need to be addressed. When levels are below 0.225 ppm, oral health care services shall need to be directed at preventing dental caries.
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