“…The children in our study were the most affected by severe EF, with pitting and loss of permanent teeth, and increased tooth sensitivity were widely observed among the young children enrolled in the study. Such effects and increased risk of tooth decay have previously been documented in studies from other locations (Levy 2003; Burt and Eklund, 1999; Wondwossen et al, 2004; Mine et al, 2011; Zhang et al, 2014), and EF has also been linked to psychological and social impacts due to stigma arising from the brownish discoloration of individuals' teeth (Wondwossen et al, 2006). Consistent with these impacts, many individuals that participated in the study reported an inability to chew hard foods (loss of dental function) from a young age, which harms the overall quality of life.…”