NPPCF Fluorosis

1. Dr. Prasanta Singha Mahapatra
Asst. Professor Cum Clinical Tutor , Dept. of
Biochemistry
B. S. Medical College & Hospital, Bankura
Fluorosis: A Global Problem
THANKS
TO ALL FOR ATTENDING TODAY IN
INTER DEPARTMENTAL SENSITIZATION
ON

2. Fluorosis
 A crippling & painful disease caused by excess
intake of / exposure to fluorides.
 Fluorides can enter through Water, Food,
Toothpaste, Mouth rinses & Drugs.
 Fluoride dust & fumes from aluminium/ smelting
industries.
 Fluoride in groundwater in India discovered in
1930 & first reported in 1937.
 Fluorosis can manifest as dental, skeletal, non-
skeletal fluorosis.

3. Fluoride: Myth
 Fluoride inhibit enzymes breeding acid
producing oral bacteria
 Fluoride ion binds with calcium ions making
teeth enamel strong
 Harmful effect of Fluoride on other useful
enzymes outweighs the benefit
 Excessive fluoride displaces calcium from
tooth matrix
 Chronic & cumulative exposure cause skeletal
fluorosis

4. Magnitude
 Fluorosis- an
important Public
Health Problem in 24
countries including
India.
 Fluoride belt extends
from Turkey to China
& Japan through Iraq,
Iran & Afghanistan.
 Around 70 millions are
affected

5. Indian scenario
 Fluorosis is endemic in 20 states of India out of 35
states & UTs.
 70-100% districts affected: AP, Guj, Raj.
 40-70% districts affected: Bih, Del, Har, Jhar, K’taka,
Mah, MP, Orissa, TN & UP.
 10-40% districts affected: Assam, J&K, Kerala, CG &
WB.
 25 million people suffering from Dental/ Skeletal/ Non-
skeletal Fluorosis incl. 1 million incapacitating skeletal
fluorosis.
 Nearly 66 million people consuming fluoride
containing drinking water

7. West Bengal
 Fluorosis is a Public
Health Problem in 7
districts of West
Bengal.
 Worst affected
districts: Birbhum,
Bankura.
 17 blocks of Bankura
are affected.

8. Agent
 Primarily, Fluoride is present in drinking water
 When F in water is more than 1.5 mg/L, (WHO)
1 mg/l (BIS) ,it is toxic to health
 Acidic pH promotes absorption in stomach like
M.Tuberculosis (Casing TB)
 Ca in the diet reduces the absorption of F
 Hard water rich in Ca reduces the F toxicity
 Fresh Fruits and Vit.C reduces the effect of F
 Trace elements like Molybdenum enhances the
effect of F

9. Host
 Dental Fluorosis seen in school going children
 Skeletal Fluorosis seen in third and fourth
decade of life.
 Females suffer more than males. (due to poor
nutrition rather than males)
 Migration influences the occurrence depending
on which way people migrate.
 Illiterates suffer more frequently in the fluorotic
belts.
 In aluminium ores mines, it is an occupational
health hazard.

10. In Adult :
Fluoride to be tested in
Drinking Water ( to collect in plastic
bottle only )
Blood (Serum) [ fasting not required]
Urine (spot urine sample)
Confirmative Test:
Radiograph of the fore-arm
Hemoglobin
In Children:
Fluoride in the drinking water of the
child / OR if an infant or new born.
Fluoride in the drinking water of the
mother.
Blood (serum) of the child; if an infant
or new born, the blood serum of the
mother.
Urine of the child / infant.
Additional Tests:
Thyroid Stimulating Hormone (TSH)
Iodine in urine
Thyroid hormone levels T3 and T4
Test for Diagnosis Fluorosis
:
SPOT
URINE

11. Time-trend
 Quality of ground water depends on lithology &
soil.
 Fluoride concentration increases through
weathering of rocks & leaching of fluoride bearing
minerals.
 Evaporation also increases fluoride
concentration.
 Amount of fluoride increased with lowering of
ground water level.

12. Interventions
 No definite treatment available.
 Intervention 1: Stop fluoride entry
- Safe drinking water: Surface water/ defluoridation
- Avoid fluoride containing foods.
- Avoid drugs and dental products.
 Intervention 2: Promote adequnkura later on)
- Diet rich in cereals, fruits & vegetables
- Pharmaceutical products

13. What to do ?
 Promoting better understanding of the
problem
 Advocacy & raising awareness of all stake
holders
 Strengthening the system of risk assessment
 Provision & consumption of safe water & food
 Reduction of exposure to fluorides from other
sources