Dental Fluorosis diet and stigma-Related Stigma on Gihaya Island, Western Province, Rwanda

Introduction:
Dental fluorosis, caused by prolonged and excessive fluoride exposure during childhood enamel formation, often leads to aesthetic changes in tooth shape, pitting and color. It is highly prevalent on Gihaya Island, Rwanda. To better understand potential fluoride sources and community impact, our research aimed to identify food and water sources consumed by island residents and to characterize social experiences of young adults impacted by dental fluorosis.

Methods:
All families (N=137) with children up to nine years of age were invited to complete surveys on food/water consumption. Mothers with small children and young adults were invited to participate in focus group discussions on food preparation and stigma, respectively.

Results:
In total, 136 families participated in the survey. High fluoride content items frequently consumed by children were drinking water from Lake Kivu, infant formula, green marog (amaranth), ugali (made of cassava flour), fish,cooked beans, and porridge (made of sorghum, millet, wheat, etc.). Focus group data identified safe water access as a major community concern and confirmed the presence of social stigma for those with dental fluorosis. This was described as negative impacts on marriage prospects, self-esteem, and social identity. The aesthetic consequences of dental fluorosis, likely caused by combined exposure to fluoride-containing foods and water, negatively impact Gihaya Island residents.

Conclusion:
Interventions to reduce dental fluorosis must be multi dimensional, addressing reduced access to safe water, poverty, the nutritional trade-offs of locally sourced foods, and the social consequences of this stigmatizingcondition.