This document provides information about fluorosis, a disease caused by deposition of fluorides in tissues from excess fluoride intake. It discusses the global and national magnitude of fluorosis, highlighting India as one of the worst affected countries. The epidemiological triad of agent, host, and environmental factors that influence fluorosis are explained. Clinical features including dental and skeletal fluorosis are described. The document also outlines methods to test and treat fluorosis, as well as approaches for fluoride removal including the commonly used Nalgonda technique developed in India.
overview of flouride with detailed information on their pharmacological action, mechanism, uses and adverse effect for both medical and dental students.
Fluoride is often called as sword as an expression for anything that can simultaneously help & hinder .
Accumulated evidence from numerous studies show that the prolonged use of fluoride at recommended levels doesn't produce harmful physiological effects in human.
Inadequate ingestion of fluoride is associated with dental caries & an extensive intake of fluoride can lead to dental & skeletal fluorosis
Acute ingestion of fluoride in large quantities may be followed by rapidly developing signs and symptoms which may result in death
History
Natural Sources Of Fluoride
Physiology and metabolism of fluoride
Fluoride in Dentistry
Control of dental caries
Fluoride toxicity
Dental fluorosis
Fluorosis indices
Water defluoridation
Conclusion
Topical fluorides for home use, Professionally applied fluoride products, Planning a preventive programmes in the practice, Dental fluorosis, Fluoride toxicity,
overview of flouride with detailed information on their pharmacological action, mechanism, uses and adverse effect for both medical and dental students.
Fluoride is often called as sword as an expression for anything that can simultaneously help & hinder .
Accumulated evidence from numerous studies show that the prolonged use of fluoride at recommended levels doesn't produce harmful physiological effects in human.
Inadequate ingestion of fluoride is associated with dental caries & an extensive intake of fluoride can lead to dental & skeletal fluorosis
Acute ingestion of fluoride in large quantities may be followed by rapidly developing signs and symptoms which may result in death
History
Natural Sources Of Fluoride
Physiology and metabolism of fluoride
Fluoride in Dentistry
Control of dental caries
Fluoride toxicity
Dental fluorosis
Fluorosis indices
Water defluoridation
Conclusion
Topical fluorides for home use, Professionally applied fluoride products, Planning a preventive programmes in the practice, Dental fluorosis, Fluoride toxicity,
Fluorosis is a disease caused by the consumption
of excessive amounts of mineral fluorine for long
periods. Fluorine is essential for the development
and maintenance of normal bones and teeth.
However, if it is consumed in excessive amounts
it leads to fluorosis
In India, approximately 25 million people are
presently affected by fluorosis and 66 million
are at risk of developing fluorosis, including
children of age 14 years. India is situated in
the geographical fluoride belt and in areas
where fluoride content is high in rocks or soil,
leaching of fluoride occurs, causing excess
fluoride level in groundwater.
Endemic fluorosis is an important health
problem in some districts in the states of
Andhra Pradesh, Punjab, Karnataka, Tamil
Nadu, Jharkhand and Rajasthan
Fluorosis in India - Prevention and ControlAkash Dass
Fluorosis is a disease caused by the consumption of excessive amounts of mineral fluorine for long periods.
In India, approximately 25 million people are presently affected by fluorosis and 66 million are at risk of developing fluorosis, including children of age 14 years. India is situated in the geographical fluoride belt and in areas where fluoride content is high in rocks or soil, leaching of fluoride occurs, causing excess fluoride levels in groundwater.
THE POWER POINTPRESENTATION IS ABOUT FLOUIDE TOXICITY N DENTISTRY AND IT INCLUDE THE CLASSIFICATION OF FLOURIDE TOXICITY, ACUTE FLUORIDE TOXICITY AND ITS CLINICAL SYMPTOMS AND ITS MANAGEMENT, FACTORS AFFECTING ACUTE FLOURIDE TOXICITY , CHRONIC FLOURIDE TOXICITY, SKELETAL FLOUROSIS , DENTAL FLOUROSIS AND THEIR SYMPTOMS AND MANAGEMENT
Fluorosis is a disease caused by deposition of fluorides in the hard and soft tissues of the body.
It is usually characterised by discoloration of teeth and crippling disorders of fluorine, duration and level of exposure.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2. Contents
• Introduction
• Magnitude of fluorosis
– World and India
• Epidemiological triad
• Permissible limits of fluoride
• Clinical picture and tests
• Treatment and prevention
• Community Fluorosis Index
• Methods for removal(De-fluoridation)
• Nalgonda technique
• References
3. What is Fluorosis
• Fluorosis is a disease caused by
deposition of fluorides in the hard and soft
tissues of the body.
• It is not merely caused by excess intake of
fluoride but there are many other attributes
and variables which determine the onset of
fluorosis in human population.
• It is usually characterised by discoloration
of teeth and crippling disorders.
4. • Worldwide in distribution
• Endemic in 22 countries
• Asia (India and China are worst affected)
• Mexico in North and Argentina in Latin America
• East and North Africa are also endemic
Magnitude of Fluorosis
6. • In some areas, skeletal fluorosis is endemic.
While fluorosis is most severe and widespread in
the two largest countries - India and China.
• UNICEF estimates that "fluorosis is endemic in at
least 22 countries across the globe. The total
number of people affected is not known, but a
conservative estimate would number in the tens
of millions."
• WHO estimated that 2.7 million people
in China have the crippling form of skeletal
fluorosis. In India, 20 states have been identified
as endemic areas, with an estimated 60 million
people at risk and 6 million people disabled;
about 600,000 might develop a neurological
disorder as a consequence.(1999)
7. • Fluoride levels in surface waters vary widely
according to geographical location and proximity
to emission sources but are generally low,
ranging from 0.01 to 1.5 mg/L.
• Concentrations in seawater commonly range
from 1.2 to 1.5 mg/L. Freshwater concentrations
are usually lower than seawater ranging from
0.01 to 0.3 mg/L.
• Factor known to influence water fluoride levels
include the presence of natural rock rich in
fluoride (such as granites and sediment of
marine origin).
• Additionally, elevated inorganic fluoride levels
are often seen in regions where there is
geothermal or volcanic activity.
8. • Fluorosis is an endemic disease prevalent in 20
states out of the 35 states and Union Territories
of the Indian Republic.
• Rajasthan and Gujarat in North India and Andhra
in South India are worst affected.
• Bihar, National Capital Territory of Delhi,
Haryana, Jharkhand, Karnataka, M.P. and
Maharashtra are moderately affected.
• T.N., W.B., U.P., Bihar and Assam are mildly
affected.
• Throughout India fluorosis is essentially
Hydrofluorosis except in parts of Gujarat and
Fluorosis in India
11. Fluoride: good or bad for
health?
• Fluoride was first used to fight dental cavities in
the 1940s, its effectiveness defended on two
grounds:
1.Fluoride inhibits enzymes that breed acid-
producing oral bacteria whose acid eats away
tooth enamel. This observation is valid, but some
scientists now believe that the harmful impact of
fluoride on other useful enzymes far outweighs
the beneficial effect on caries prevention.
2.Fluoride ions bind with calcium ions,
strengthening tooth enamel as it forms in
children.
12. • Many researchers now consider this more of an
assumption than fact, because of conflicting
evidence from studies in India and several other
countries over the past 10 to 15 years.
• Nevertheless, agreement is universal that
excessive fluoride intake leads to loss of calcium
from the tooth matrix, aggravating cavity
formation throughout life rather than remedying
it, and so causing dental fluorosis. Severe,
chronic and cumulative overexposure can cause
the incurable crippling of skeletal fluorosis.
14. • Primarily it is Fluoride which is present in drinking
water
• When F in water is more than 1.5 mg/litre, it is
toxic to health
• pH in terms of alkalinity of water promotes the
absorption of F
• Calcium in the diet reduces the absorption of F
• Hard water rich in Calcium reduces the F toxicity
• Fresh Fruits and Vit.C reduces the effect of F
• Trace elements like Molybdenum enhances the
effect of F
Agent factors
15. Sources of fluoride for human
exposure
Main sources of fluoride :
•Water
•Food
•Air
•Medicament
•Cosmetics
16. • In School going children seen as dental fluorosis.
• In third and fourth decade of life seen as Skeletal
Fluorosis.
• Males suffer more than females.
• Migration influences the occurrence depending
on which way people migrate.
• Illiterates suffer more frequently in the fluorotic
belts.
• Where aluminium ores are mined,it is seen as
occupational health hazard.
Host Factors
17. • High Annual Mean Temperature
• Low Rainfall
• Low humidity
• Fluoride rich Natural subsoil rocks
• Vegetables from high F belts
• Fluoridated tooth paste particularly when used by
children
• Tropical climate
• Developing Countries
Environmental Factors
19. Clinical Picture
• Dental Fluorosis in Children
• Skeletal Fluorosis in Adults
• Non Skeletal Fluorosis
20. Dental Fluorosis
• Children living in high fluoride zone are bound to
get dental discoloration which may be seen even
in deciduous teeth.
• Initially glistening white teeth become dull and
yellow-white spots appear on the surface of
teeth.
• Gradually these spots turn brown and presents
itself in brown streaks which are closer to the tip
of the teeth.
• In late stages the whole teeth become black.
Teeth may be pitted or perforated and may even
get chipped off.
21.
22. Skeletal Fluorosis
• It affects young as well as old. The symptoms
include severe pain and stiffness in the
backbone, joints and/or rigidity in hip bones.
• X-ray examinations of the bones reveals
thickening and high density of bones. In some
patients with calcium deficiency, osteomalacia
type changes are seen.
• Constriction of vertebral canal and intervertebral
foramen - pressure on nerves leads to paralysis.
24. Non-Skeletal Fluorosis
• There are convincing evidence of involvement of
skeletal muscles, erythrocytes, G-I mucosa,
ligaments and spermatozoa on consuming more
than optimal intake of fluorides. Detection of
Fluorosis at early stage is possible by
understanding the soft tissue manifestation.
• In the fluorosed muscles, actin and myosin
filaments are destroyed and mitochondria lose
their structural integrity thereby providing
evidence of depletion of muscle energy.
25. • The erythrocyte membrane loses its calcium
content in presence of high fluoride.
• Non-ulcer dyspeptic complaints are manifested
by consuming high F in water and food.
• Infertility due to oligospermia and azoospermia is
commonly seen in fluorotic belts.
26. Tests for Skeletal Fluorosis
• Affection of the joints can be ascertained through simple
tests which can be carried out at the bed-head side and
in the field:
•
•
COIN TEST: The subject is asked to lift a coin from the
floor without bending the knee. A fluorotic subject would
not be able to lift the coin without flexing the large joints
of lower extremity.
CHIN TEST: The subject is asked to touch the anterior
wall of the chest with the chin. If there is pain or stiffness
•
in the neck, it indicates the presence of fluorosis.
STRETCH TEST: The individual is made to stretch the
arm sideways, fold at elbow and touch the back of the
head. When there is pain and stiffness, it would not be
possible to reach the occiput indicating presence of
Fluorosis.
27. Dental Fluorosis Treatment
• Tooth whitening - For mild fluorosis cases.
• Composite bonding- For severe cases of fluorosis
• Porcelain veneers- provide excellent cosmetic
results.
28. Prevention of Fluorosis
• Since the major source of fluoride is drinking
water, de-fluoridation is the best preventive
measure which can be carried out at domestic as
well as community level.
• Nutritional interventions like high intake of
vitamin C and Calcium also helps reduce the
problem.
29. Food items to be avoided
Rock salt
Black salt (Kala-namak)
Tea (without milk and with lemon)
Salted snacks smeared with black salt viz.
Dalmoth, Channa dal
Pickles smeared with black salt
Masala's smeared with black salt
Chana masala, Jal jeera masala
Fruit juices (Preserved)
Churans (Hajmola, Hingoli, Satmola)
30. Community Flourosis Index
• W.H.O. Monograph on Fluoride and Human Health
(1970) has enumerated the use of Community
•
Fluorosis Index in determining the optimal Fluoride
Intake.
The Community Fluorosis Index (CFI) is a way of
measuring the burden of dental fluorosis in a
population. Instead of measuring the overall
prevalence of fluorosis (i.e., what percentage of
people have fluorosis), it takes into account the
severity of the fluorosis that is occurring. The CFI is
thus a measurement of both prevalence + severity.
An individual's fluorosis score is based on the most severe form
of fluorosis found on two or more teeth.
31.
32.
33. Community Fluorosis Index
• The CFI is calculated based on the following point
scale for the different categories of dental fluorosis:
• Questionable Fluorosis = 0.5 points
• Very Mild Fluorosis = 1 point
• Mild Fluorosis = 2 points
• Moderate Fluorosis = 3 points
• Severe Fluorosis = 4 points
• After determining how many children have these
types of fluorosis, the points are added up and
divided by the number of children examined.
34. Scores and their significance
Range Significance of scores
0.0-0.4
0.4-0.6
0.6-1.0
1.0-2.0
2.0-3.0
Negative
Borderline
Slight
Medium
Marked
3.0-4.0 Very Marked
Only when the CFI value is greater than 0.6,
Fluorosis is considered to be a public health
problem in that area
35. Methods for removal of Fluoride
• Contact precipitation
• Nalgonda technique,
• Activated alumina
and clay
-appropriate in
developing countries.
• Bone charcoal, Advanced treatment
technologies, e.g.
•Reverse osmosis,
•Electrodialysis and
distillation, plus
•Methods based on
patented media and
natural media
•Boiling Water :This will concentrate the fluoride rather than
reduce it.
•Freezing Water: Freezing water does not affect the
concentration of fluoride.
37. • Precipitation methods are commonly used for de-
fluoridation.
•
•
•
Lime treatment, routinely used for hardness removal
can remove F particularly when water is having high
Mg hardness.
Alum is used at domestic level in high doses to
remove the F.
In India scientists have developed a method known
as Nalgonda technique in which, based on the
amount of F in drinking water and alkalinity of the
Water (expressed as mgCaCO3), amount of Alum to
be mixed with water is calculated.
38. Nalgonda technique
• Adapted and developed in India by the National
Environmental Engineering Research Institute
(NEERI) and developed to be used at both the
community and household levels.
• The process is aluminium sulfate based coagulation-
flocculation sedimentation, where the dosage is
designed to ensure fluoride removal from the water
39. • Aluminium sulfate, Al2(SO4)3 18H2O, is dissolved
and added to the water under efficient stirring in
order to ensure initial complete mixing.
• Aluminium hydroxide micro-floccules are produced
rapidly and gathered into larger easily settling
floccules.
• Thereafter the mixture is allowed to settle. During
this flocculation process many kinds of micro-
particles and negatively charged ions including
fluoride are partially removed by electrostatic
attachment to the floccules.
40. The fill and draw type Nalgonda technique for domestic
and community defluoridation
41. References
• WHO Monograph “Fluoride in Drinking-
water”(2006)
• Central Ground Water Board(website)
• Bureau of Indian Standards(BIS)
• UNICEF report on Fluorosis in India(1999)
• http://www.fluorideandfluorosis.com/