FLUORIDES IN HEALTH

1. FLUORIDE IN HEALTH
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2. CONTENTS
• Introduction
• Indian scenario
• Places in India having high fluoride concentration
• Recommended fluoride ranges
• Health and fluorides
• - Urban mortality –
• Cancer mortality –
• Congenital Anomalies –
• Developmental defects –
• Al-F Interaction –
• Effect on RBCS
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3. • Effect on skeletal muscles
• Effect on ligament and blood vessels
• Neurological manifestations
• Kidney
• GI system
• Endocrine
• Bone (arthritis and osteoporosis)
• Reproductive system
• Cardiovascular system
• Immunological and lymphoreticular system
• At molecular level
• Immune system
• Dental enamel
• Conclusion
• References
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4. INTRODUCTION
• Fluorine is the ninth element of the periodic table.
• Nevertheless, its applications and biological significances
were known only in the decades of 1920’s.
• It is the lightest member of the halogen family and the most
electronegative among all chemical elements(Hodge and
Smith, 1965).
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5. • Fluorine has both notable chemical qualities and physiological
properties, which are of great interest and significance to
human health.
• Fluorine is rarely or never found free in the nature in
elemental form. It has strong affinity to combine chemically
with other elements to form compounds called ‘fluoride’.
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6. • The chemical activity of the fluoride ion (E0 = -2.8 Volts)
makes it physiologically more active than other elemental ion.
• Therefore, fluoride ions play an important role in human
physiology. Its presence in low concentration may either
inhibit or stimulates enzymatic process and its interaction with
other organic and inorganic body components may cause
disruption in normal physiological functions of human body.
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7. Fluoride in animal products
• Beef, pork and mutton-0.3ppm
• Fish products- up to 20ppm Dried sea foods also fluoride rich
84.5ppm (South East Asia)
• Fluoride in beverages ranges from 0.05 to 1.05 ppm
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8. Fluoride from food
• 0.3 to 0.6 mg/day - Fluoride intake in first 6months of life-
bottle/breast fed Breast fed infant receives 0.003 to
0.004mg/day
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9. Indian Scenario
• India is among the 23 nations around the globe where health
problems occur due to excess ingestion of fluoride (>1.5 mg/l)
by drinking water.
• 1.1-2.1 ppm : New Delhi to Sirsa and Hissar, Sangrur
Bhatinda, Faridkot, Firozpur of Punjab, Suratgarh, Sirohi
South of Jaipur in Rajasthan, Kutch, and Western Jamnagar
District in Gujrat.
Hussain J and Sharma KC. Environmental Monitoring and Assessment March 2010, Volume 162, Issue 1, pp 1-14
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10. • 4.0 – 8.0 ppm : Chandi and Betul areas of Madhya Pradesh,
Anantpur, Karimnagar, Krishna District (> 5.0 ppm)
Nalgonda, Karnool, Hyderabad.
• Between 1.5 – 5.0 ppm : Coimbatore, Dharmapuri, North
Arcot, Salem, Tiruchy, Madurai in Tamilnadu.
• 9.5 ppm Gulabpur, 8.5 ppm Phag, Chirava, 19.0 ppm Sagalia
in Western India.
Textbook of community Dentistry, TR Gururaja Rao, 2004, Pg 3101/23/2019 10

11. Recommended Fluoride Ranges
• WHO in 1963 has recommended a range of 0.7-1.2 ppm F in
drinking water.
• This acts as an optimum limit of dental caries.
• Dental fluorosis occurs in human beings consuming water
containing 2.0mg/litre or more of fluoride particularly during
first 8 years of life and skeletal fluorosis results if the water
contains above 4.0ppm and is consumed regularly over a long
period of time.
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12. • The acute lethal dose for an adult is 32-64 mg/kg body
weight.
• That is, for an adult of 70kg weight, it could be around 2.2
gm of fluoride and safety tolerated dose is 8-16 mg/kg body
weight.
• Even if a child swallows the contents of family sized tooth
paste (270mg)., the child will ingest 270mg of fluoride which
is below certainly the lethal dose of 320 mg fluoride in a 2 yr
old child.
• Moreover it is difficult for a child to swallow 270 gm
toothpaste.
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13. • However in 1971- US national academy of sciences- 1mg for
an adult and the fixed concentration must not be more than
1mgF/lt of water.
• Fluoridated tooth paste
• Not to be given for children < 3 years
• >3 yrs – 1/3 toothpaste, pea sized
• 75gm tube - 75mg F
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14. • Use of fluoridated toothpaste - Blood fluoride levels in
children
• Rajan et al 1987,1988- 5-10yr, 10-14yr old
• Tested fluoride level in blood, before & after brushing with
fluoridated toothpaste.
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18. Health and Fluoridation
• It has been suggested over the years that many different
disorders can be caused or aggravated by fluoridation. [ Table
in next page ]
• • Urban Mortality : Rogot et al (1978) sampled 473 urban
areas of USA. Overall the findings clearly showed no
consistent relation between fluoridation and observed changes
in mortality over the 20 years of study period.
Murray et al, Fluorides in caries prevention, 3rd edit, chapter 17 page 3371/23/2019 18

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20. CANCER MORTALITY
• Cancer Mortality : Yiamouyiannis and Burk (1977) studied age dependence
on cancer mortality related to artificial fluoridation in USA
Murray et al, Fluorides in caries prevention, 3rd edit, chapter 17 page 3371/23/2019 20

21. • New Burn and also Royal Statistic society explained the
reason behind this result in 1977.
• US Census and San Francisco 20 year period study, 1970,
showed no trend in cancer mortality after age adjustment.
• Great Britain, Royal College of Physician 1976 conducted a
study and showed no tendency of ratio of greater cancer in
high fluoridated areas.
Murray et al, Fluorides in caries prevention, 3rd edit, chapter 17 page 337
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22. Murray et al, Fluorides in caries prevention, 3rd edit, chapter 17 page 3371/23/2019 22

23. Congenital anomalies
• Suggestion that fluoride is a cause of mongolism ( Down’s
syndrome) derives from two studies of Rapaport ( 1059, 1963) in
USA.
• Berry 1958 did the similar study in 9 English towns, making the sort
of intensive enquiries that are needed for complete ascertainment.
• Erickson et al (1976) very large study of 13,87,027 birthday using
two sources : the Metropolitan Atlanta Congenital Malformation
Surveillance Program and the National Cleft Lip and Palate
Intelligence Service, showing no association.
Murray et al, Fluorides in caries prevention, 3rd edit, chapter 17 page 3371/23/2019 23

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25. Developmental defects
• Fluoride crosses the placenta in limited amounts and is found
in fetal and placental tissue (Gedalia et al., 1961; Theuer et al.,
1971).
• The available human data suggest that fluoride has the
potential to be developmentally toxic at doses associated with
moderate to severe fluorosis.
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26. • The human and animal data suggest that the developing fetus
is not a sensitive target of fluoride toxicity.
• Exposure to high levels of fluoride has been described
together with an increased incidence of spina bifida (Gupta et
al., 1995).
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27. • The occurrence of spina bifida was examined in a group of 50
children aged 5–12 years living in an area of India with high
levels of fluoride in the drinking water (4.5–8.5 ppm) and
manifesting either clinical (bone and joint pain, stiffness, and
rigidity), dental, or skeletal fluorosis.
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28. • An age- and weight-matched group of children living in areas
with lower fluoride levels (#1.5 ppm) served as a control
group. Spina bifida was found in 22 (44%) of the children in
the high fluoride area and in six (12%) children in the control
group.
• This study did not examine the possible role of potentially
important nutrients such as folic acid, however, and had other
study design flaws.
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29. Aluminium – Fluoride interaction
• Brudevold, Moreno and Bakhos in 1973 showed that addition
of 0.2 ppm Al to a solution of 1 ppm F reduces the ionic
fluoride by 25-30%.
• Weddle and Muhler 1957, in their animal trials showed the
complex formed probably AlF6-3 was not readily absorbed.
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30. • The evidence as a whole ( Tennakone et al 1987, Nicholson et al
1987, Moody et al 1990) suggested one more finding that only a
most unusual combination of circumstances ( fluoridated water
boiled to small bulk in an aluminium vessel in the presence of citric
acid) would lead to undesirable high levels of Al (causing
Alzheimer’s dementia).
• Hence only a small proportion of Al salts are normally absorbed
from the gut, so even if an Al-F complex did form, it would be most
unlikely to be absorbed.
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31. Effect on Red Blood Cells
• It is known that when fluoride is ingested, it accumulates on the
erythrocyte membrane, besides other cells, tissues and organs.
• The erythrocyte membrane in turn looses calcium content.
• The membrane which is deficient in Ca content, is pliable and is
thrown into folds.
• The RBCs attain the shape of an amoeba with pseudopodia like
folds projecting in different directions.
• Such RBCs are termed as Echinocytes.
Text book of community Dentistry. Vimal Sikri 2003, Chp 5, Pg 2431/23/2019 31

32. • The life span of RBCs is 120-130 days, the echinocytes
undergo phagocytosis and are eliminated from circulation
quite clearly.
• This means that RBCs in individuals exposed to fluoride
poisoning do not live the entire life span, but are likely to be
eliminated as echinocytes.
• This leads to low hemoglobin levels.
Text book of community Dentistry. Vimal Sikri 2003, Chp 5, Pg 2431/23/2019 32

33. Effect on Skeletal Muscles
• In a fluorosed muscles there are wide spread changes within a
fibre revealing destruction of the actin and myosin filaments.
• The mitochondria loses its structural integrity, thereby
providing evidence that muscle energy is likely to be depleted.
• Certain phosphokinase levels are high in serum of patients
suffering from skeletal fluorosis which is an indication that the
muscle mitochondria is destroyed and muscle membrane has
become highly permeable.
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34. Effect on ligaments and blood vessels
• A unique feature of excess fluoridation is that the soft tissues
like ligaments and blood vessels tend to harden and calcify.
• • The blood vessels can be blocked by such calcifications.
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35. Neurological manifestations
• Nervousness, depression, tingling sensation in finger and toes,
excessive thirst (polydyspia) and tendency to urinate frequency
(polyuria) are controlled by certain regions of the brain and it
appears to be adversely affected.
• The neurological manifestations have been exclusively
reported from India.
• Credit for the earliest description of neurological
complications in fluorosis must be given to Shortt et al.
(1937), who reported ten such cases from Nellore district of
Madras.
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36. • A few sporadic cases have also been described from other
parts of India (Chuttani et al., 1962; Janardhanan and
Venkaswamy, 1957; Murthi et al., 1953).
• Fluoride has been shown to interfere with glycolysis. Because
the central nervous system relies heavily on this energy source,
hypotheses have been advanced as to a mechanism for fluoride
effects on the central nervous system.
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37. • Although effects on glycolytic enzymes could explain the
neuromuscular symptoms seen frequently in cases of fluoride
poisoning (e.g., tetany, paresthesia, paresis, convulsions),
studies tend to indicate that hypocalcemia caused by fluoride
binding of calcium causes these symptoms (Eichler et al.,
1982).
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38. • The decreases in intelligence were reported in children living
in areas of China with high levels of fluoride in the drinking
water, as compared to matched groups of children living in
areas with lowl levels of fluoride in the drinking water (Li et
al., 1995; Lu et al., 2000), but these studies are weak in as
much as they do not address important confounding factors.
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39. Effect on kidneys
• It is in literature that fluoridation is safe for persons with
normal kidney functions.
• There are remote possibilities that renal failure may cause
fluoride retention leading to higher tsuue fluoride
concentration and smaller margin of safety than for normal
individuals.
• Roholm et al 2002, concluded in his study that cryolite
produces considerable changes in bone and ligament over
long period of exposure but not oral changes.
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40. • No renal pathology in animal experimental studies is been found
with 50 ppm of fluoride or less.
• Certain species exhibited changes for about 100ppm.
• Urine may be yellowish red in color and itching may occur.
• Sometimes in acute conditions : - Congestion and cloudy swelling of
renal tubular cells - Hyperemia and fatty degeneration of tubular
epithelium - Not limited to kidney but widely distributed acyte
visceral hyperemia. - If the individual survives, regeneration may
occur during recovery.
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41. Effect on gastrointestinal system
• The primary gastrointestinal effects following both acute and
chronic oral exposure to fluoride consist of nausea, vomiting,
and gastric pain. The irritation of the gastric mucosa is
attributed to fluoride (as sodium fluoride) forming
hydrofluoric acid in the acidic environment of the stomach
(Hoffman et al., 1980;Waldbott, 1981).
• • The uncharged hydrogen fluoride molecule can then
penetrate cell membranes and enter the neutral environment of
the cytoplasm.1/23/2019 41

42. • Non- ulcer dyspepsia due to excess intake of fluoride
• nausea ‘
• loss of appetite
• pain in stomach
• gas formation & bloated feeling
• constipation followed by intermittent diarrhea,
• Headache Treatment –drink safe water
(Susheela et al 1992, Das et al 1994, Dasarathy et al 1996) • A study by Susheela et al. (1993) assessed the prevalence and
severity of gastrointestinal disturbance in an area of endemic skeletal and dental fluorosis in India.
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43. • The highest prevalence (52.4%) of non-ulcer dyspeptic
symptoms was found among 288 individuals (69 families)
living in a village where the mean fluoride concentration in the
36 separate water sources was 3.2 ppm(range 0.25 to 8.0 ppm).
• Eleven of these water sources were defined by the authors as
safe (i.e., with fluoride levels of 1.0 ppm or less).
• The authors noted that in patients who reverted to safe water,
dyspeptic symptoms and complaints disappeared within 2-3
weeks.
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44. Endocrine effects
• In the endocrine system where the intermediary metabolism
and synthesis of highly sensitive hormones involves enzymatic
action, it is expected that interferences with the mechanism by
chemical agents would produce early and pronounced clinical
effects.
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45. • Considerable attention has consequently been given of recent
years to the behavior of fluoride in hormone chemistry and to
the possible and to the possible clinical disturbances of
endocrine function, particularly the thyroid gland Robinson et
al., 2002).
• Significant increases in serum thyroxin levels were observed
in residents of North Gujarat, India with high levels of fluoride
in the drinking water (range of 1.0–6.53 mg/L; mean of 2.70
mg/L) (Michael et al., 1996).`
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46. •No significant changes in serum triiodothyronine or thyroid
stimulating hormone levels were found. Increases in serum
epinephrine and norepinephrine levels were also observed. It is
unclear if nutritional deficiencies played a contributing role to the
observed endocrine effects.`
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47. Effect on Thyroid
• It has been found that sometimes excessive fluoridation effect
does not exist for thyroid.
• The main facts behind this statement are: - Fluorine does not
accumulate in thyroid. - Fluorine does not affect the uptake of
iodine by the thyroid tissues. - Pathological changes in the
thyroid shows no increased frequency
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48. • The administration of fluorine does not interfere with
prophylactic action of iodine on endemic goiter. - The
beneficial effect of iodine in threshold dosage to experimental
animals is not inhibited by administration of fluorine even in
an excessive dose.
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49. Fluoride and bone
• Animal studies- F effect on bone strength
• Human population - bone in children, hip in
elderly
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50. Fluoride and arthritis (Eichmiller – JADA
2005)
• 50yr old man- cancer –topical fluoride gel for a long period
Gastric symptoms , leg muscle soreness and knee joint
soreness...
• Research from India – severe arthritic changes & crippling
neurologic complications
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51. Osteoporosis
• Fluoride above 4 mg/l in drinking water may cause a condition of dense
and brittle bones known as osteoporosis. It affects tens of million of people
worldwide and is responsible for as many as 75% of all fractures in people
over the age of 45.
• Costly and disabling fractures of spine, hip, wrist and other bones can be
preceded by years of undetected bone loss. It is found that as many as 20%
of those who suffer from osteoporosis related hip fractures die within 6
months.
• Women are at four times greater risk of developing osteoporosis than
males (Bezerra et al., 2003).
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52. Reproductive system
• There are limited data on the potential of fluoride to induce
reproductive effects in humans following oral exposure.
• A meta analysis found a statistically significant association
between decreasing total fertility rate and increasing fluoride
levels in municipal drinking water (Freni, 1994).
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53. • Annual county birth data (obtained from the NationalCenter
for Health Statistics) for over 525,000 women aged 10–49
years living in areas with high fluoride levels in community
drinking water were compared to a control population
approximately 985,000 women) living in adjacent counties
with low fluoride drinking water levels.
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54. • The fluoride-exposed population lived in counties reporting a
fluoride level of 3 ppm or higher in at least one system. • The
weighted mean fluoride concentration (county mean fluoride
level weighted by the 1980 size of the population served by the
water system) was 1.51 ppm (approximately 0.04mg
fluoride/kg/day), and 10.40% of the population was served by
water systems with at least 3 ppm fluoride.X
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55. • The mean weighted mean fluoride concentration in the control
population was 1.08 ppm (approximately 0.03 mg
fluoride/kg/day).
• However, this meta-analysis relied on a comparison of two
quite disparate data sets, inasmuch as the fluoridation
population often did not correlate well with the population for
whom health statistics was available.
• Furthermore, other studies have not found a similar
correlation. Another study found significantly decreased serum
testosterone levels in 30 men diagnosed with skeletal fluorosis
and in 16 men related to men with fluorosis and living in the
same house as the patient (Susheela and Jethanandani, 1996).1/23/2019 55

56. • The mean drinking water fluoride levels were 3.9 ppm
(approximately 0.11 mg fluoride/kg/day), 4.5 ppm (0.13
mg fluoride/kg/day), and 0.5 ppm (0.014 mg
fluoride/kg/day) in the patients with skeletal fluorosis,
related men, and a control group of 26 men living in areas
with low endemic fluoride levels.
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57. • No correlations between serum testosterone and urinary
fluoride levels or serum testosterone and serum fluoride levels
were found. One limitation of this study is that the control men
were younger (28.7 years) than the men with skeletal fluorosis
(39.6 years) and the related men (38.7 years). In addition, the
groups are small and potentially confounding factors are not
well addressed (Mychreest et al., 2002).
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58. Cardiovascular effects
• The cardiovascular effects of fluoride have been attributed to
hypocalcemia and hypercalemia caused by high fluoride
levels.
• Fluoride can bind with serum calcium if the dose is sufficient
and cause hypocalcemia. Calcium is necessary for the
functional integrity of the voluntary and autonomic nervous
systems.
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59. • Hypocalcemia can cause tetany, decreased myocardial
contractility, and possibly cardiovascular collapse (Bayless and
Tinanoff, 1985).
• Hyperkalemia has been suggested as the cause of the repeated
episodes of ventricular fibrillation and eventual death that are
often encountered in cases of fluoride poisoning (Baltazar et
al., 1980)
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60. Immunological and lymphoreticular effects
• A request to the American Academy of Allergy was made by
the U.S. Public Health Service for an evaluation of suspected
allergic reactions to fluoride as used in the fluoridation of
community water supplies (Austen et al., 1971).
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61. • The response to this request included a review of clinical
reports and an opinion as to whether these reports constituted
valid evidence of a hypersensitivity reaction to fluoride
exposure of types I, II, III, or IV (Austen et al., 1971), which
are, respectively, anaphylactic or reaginic, cytotoxic, toxic
complex, and delayed-type reactivity.
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62. • The Academy reviewed the wide variety of symptoms presented
(vomiting, abdominal pain, headaches, scotomata [blind, or partially
blind areas in the visual field], personality change, muscular
weakness, painful numbness in extremities, joint pain, migraine
headaches, dryness in the mouth, oral ulcers, convulsions, mental
deterioration, colitis, pelvic hemorrhages, urticarial, nasal
congestion, skin rashes, epigastric distress, and hematemesis) and
concluded that none of these symptoms were likely to be
immunologically mediated reactions of types I–IV.
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63. • No studies were located that investigated alterations in
immune response following fluoride exposure in humans. No
studies were located that investigated alterations in immune
response following fluoride exposure in human. In a study
with rabbits administered 4.5 mg fluoride/kg/ day as sodium
fluoride for 18 months, decreased antibody titers were
observed (Jain and Susheela, 1987).
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64. • These results were observed after 6 months of treatment; the
authors hypothesized that a threshold level is reached at which
time the immune system is impaired.
• However, as only one dose level (4.5 mg fluoride/ kg/day) was
tested, no dose-effect.
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65. Effect at molecular level
• The acceleration of the aging process by fluoride occurs at the
bio-chemical level through enzyme inhabitation, collagen
break down, genetic damage or disruption of the immune
system. Fluoride damage enzymes, and results in a wide range
of chronic disease.
• Fluoride as low as 1 mg/l causes breakdown of collagen, the
most abundant of the body protein at 30%.
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66. • It leads to irregular formation of collagen, which serves as a
major structural component of skin, ligaments, tendons,
muscles, cartilage, bone and teeth. A number of studies
revealed that fluoride causes genetic damage.
• The mechanism cannot be exactly pinpointed because fluoride
interferes with a number of physiological processes.
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67. • Most evidence indicates that it acts on the DNA Repair
Enzyme system.
• It may also interfere with DNA synthesis. If the unprepared
DNA damages occur in a cell, producing a sperm or egg it will
be replicated in every cell of the offspring body and leads to
birth defects.
• Irreparable damage of a segment of DNAis responsible for
control of cell growth and may cause tumors or cancer
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68. Effect on immune system
• Fluoride interacts with the bonds of protein molecular required
to maintain the normal shape of proteins. The fluoride effect
the immune system by
• i) Damage the immune system by inhibiting the migration rate
of white blood cells to infected means,
• ii) Interferes with phagocytosis
• iii) Induces the release of super oxide free radicals in resting
white blood cell.
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69. Effect on dental enamel
• Dental fluorosis is a condition that results from the intake of
excess levels of fluoride during the period of tooth
development, usually from birth to approximately 6–8 years of
age.
• It has been termed a hypoplasia or hypo mineralization of
dental enamel and dentine and is associated with the excessive
incorporation of fluoride into these structures.
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70. • The severity of this condition, generally characterized as
ranging from very mild to severe, is related to the extent of
fluoride exposure during the period of tooth development.
• Mild dental fluorosis is usually typified by the appearance of
small white areas in the enamel; individuals with severe
dental fluorosis have teeth that are stained and pitted
(“mottled”) in appearance.
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71. • In human fluorotic teeth, the most prominent feature is a
hypomineralization of the enamel. In contrast to many
animal species, fluoride induced enamel hypoplasia
(indicating a severe fluoride disturbance of enamel matrix
production) seems to be rare in affected human enamel.
• The staining and pitting of fluorosed dental enamel are both
post eruptive phenomena (i.e., acquired after tooth eruption
and occur as a consequence of the enamel
hypomineralization).
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72. • The incorporation of excessive amounts of fluoride into
enamel is believed to interfere with its normal maturation, as a
result of alterations in the rheologic structure of the enamel
matrix and/or effects on cellular metabolic processes
associated with normal enamel development (WHO, 1984;
Aoba, 1997; Whitford, 1997). Experimental animal studies
suggest that this hypomineralization results from fluoride
disturbance of the process of enamel maturation (Richards et
al., 1986).
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73. • In India, Viswanathan (1951) first reported a disease similar
to mottled enamel, which is prevalent in human beings in
Madras presidency. Mahajan (1934) reported a similar
disease in cattle in certain parts of old Hyderabad state.
However, Shortt et al. (1937) was the first to identify the
disease as fluorosis.
• Subsequent to these findings, cases of fluorosis were
reported from several other parts of the country.
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74. • Dental fluorosis is caused in human being consuming water
containing 1.5 mg/l or more of fluorides, particularly frombirth
to the age of eight.Mottled enamel usually takes the shape of
modification to produce yellow brown stains or an unnatural
opaque chalky white appearance with occasional striations
patting.
• The incidence and severity of mottling was found to increase
with increasing concentration of fluoride in drinking water. In
extensive studies, Dean and coworkers (Dean, 1942; Dean and
Elvove, 1937) have correlated the appearance and severity of
dental fluorosis to different fluoride levels in the drinking
water with the aid of a special classification and weighing of
severity of the lesion.
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75. • Distribution of dental fluorosis at different levels of fluoride in
drinking water may be assessed by a mottled enamel index of
the community, which is defined in terms of the degree of
severity of mottled enamel observed clinically. Since no such
data available in India to evaluate community index of
fluorosis and in the absence of this permissive or excessive
limits of fluoride in drinking water are only arbitrary.
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76. CONCLUSION
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77. • Certainly Lethal dose (CLD) – 32 – 64mg/kg body weight
• Safety tolerated dose (STD) – 8 – 16mg/kg body weight
(1/4TH OF CLD)
• For Children - 15mg/kg
• CLD – 5- 10 mg/kg of NaF
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78. RECOMMENDATION
• Parental supervision of brushing or mouth rinsing
• The use of small amounts of tooth paste
• The use of products with lower fluoride levels
• Teaching children not to swallow tooth paste or mouth rinse
• Strict adherence to current recommendation by professionals
who prescribe fluoride dietary supplement.
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79. • When used appropriately fluoride is a safe and effective agent
that can be used to prevent dental caries.
• In Indian Senario to ensure maximum results fluoridation
techniques should be used in combination.
• As majority of population reside in rural areas in india water
fluoridation may not be appropriate technique .
• Fluoride dentrifices and mouth rinses can be advised for the
general population.
• Introudction of school water fluoridation benefits the children
who are at higher risk.
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80. REFERENCES
• Hussain J and Sharma KC. Environmental Monitoring and Assessment.March
2010, Volume 162, Issue 1, pp 1-14.
• Textbook of community Dentistry, TR Gururaja Rao. 2004 edi.
• Rajan et al 1987,1988, Use of fluoridated toothpaste Blood fluoride levels in
children, International society of fluoride research.
• American Academy of pediatric dentistry,1967, revised in 2014. Refernce manual ,
Vol 37 No.6.
• Murray et al, Fluorides in caries prevention, 3rd edit, chapter 17 page 337. •
Hussain, I. Hussain, J., Sharma, K.C. and Ojha, K.G.: In: Environmental Scenario
of 21st Centaury, APH Pub. Co.,NewDelhi, pp. 355 –374 (2002). • Hussain, J.,
Sharma, K.C. andHussain, I.: Ind. J. Environ. Health, (2004). Communicated. •
Connett, P.: Fluoride, 35(4): 245-24 (2002). • Lavy, S.M.: J.Can. Dent.Associ.,
69(5): 286-291 (2003).
• Lu,Y., Sun, Z.R. andWu,L.N.: Fluoride, 33(2): 74-78 (2000). • Robinson, R.F.,
Griffith, J.R.,Wolowich,W.R. andNahata, M.C.:Vet. Hum. Toxicol., 44(2): 93-95
(2002).
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81. Previous year questions
• Fluorides and general health (rguhs 2004 -20 marks )
• Fluorides in dental health style andoral health
(1998;100marks)
• "Fluorides and Dental public health inIndia".(1994-20 marks)
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