This document discusses fluorosis, a disease caused by excess fluoride intake. It notes that fluoride can enter the body through water, food, toothpaste, and industrial sources. Fluorosis manifests as dental, skeletal, or non-skeletal forms and is a public health problem in 24 countries including India, where around 70 million people are affected. In West Bengal, 7 districts including Bankura are affected. The document outlines testing and diagnosis of fluorosis as well as interventions like providing safe drinking water, improving nutrition, and reducing overall fluoride exposure.

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