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

1. Fluorosis in
India
Submitted by – Akash Dass

2. About
Fluorosis
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.

3. Prevalence
 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.

4. Aetiology
 The main source of fluoride in India is drinking water Endemic fluorosis is common in areas
where drinking water contains more than 1 mg per litre of naturally occurring fluoride.
 In areas where fluorosis is endemic, the fluoride content of water is as high as 3-12
mg/litre. In these areas, the population depends on well water as the source of drinking water

5. Clinical
Feature
 The clinical manifestations of fluorosis are seen in
teeth and bones. Fluorosis manifestations showing
changes in the teeth are referred to as dental
fluorosis and the changes in bones are grouped
under skeletal fluorosis.

6. Dental Fluorosis
 The teeth lose their shine, and chalky and white patches appear on them. This is known as
mottling of teeth. Dental mottling is considered as an early sign of fluorosis. Later, these white
patches become yellowish.
 In severe cases of fluorosis, the enamel (the hard, glistening substance covering the crown of the
teeth) gets eroded, ultimately leading to depressions on called a the teeth. This is known as pitting.
 Mottled enamel is best seen on the upper cutting teeth known as incisors.

8. Skeletal Fluorosis
 Initially, the individual will complain of pain in the
neck and stiffness of the back. This progressively
leads to difficulty in the movement of the neck and
back.
 In severe skeletal fluorosis, the patient will be so
incapacitated as to be completely bed-ridden.
 A new manifestation of fluorosis has been
recognised in which we see changes in legs
particularly of young adults, which look like a
severe form of knock knees. This manifestation of
fluorosis is called genu valgum (outward bending
at distal portion of knee)

11. Biochemical Manifestation
 Gastrointestinal symptoms: Abdominal pain, excessive saliva, nausea and vomiting are seen
after acute high-level exposure to fluoride.
 Neurological manifestation: Nervousness and depression, tingling sensation in fingers and toes,
excessive thirst and tendency to urinate.
 Muscular manifestations: Muscle weakness & stiffness, pain in the muscle and loss of muscle
power, inability to carry out normal routine activities.
 Allergic manifestation: Skin rashes, Perivascular inflammation: pinkish red or bluish red spot,
round or oval shape on the skin that fade and clear up within 7-10 days.
 Urinary tract manifestations: Urine may be much less in volume; yellow-red in colour and itching
in the region may occur.
 Ligaments and blood vessel calcification: A unique feature of the disease is soft tissues like
ligaments, blood vessels tend to harden and calcify and the blood vessels may be blocked.

12. Prevention
Fluorosis can only be
prevented and cannot be
cured. The best method to
prevent fluorosis is to
consume water which has
less than 1 mg per litre (1
ppm) of fluoride.
Defluorination (removal of
excess fluorine) of water is
the only alternative. This
can be done at the
household level.

13. Defluorination
at household
level
A simple method is to first add the lime powder to
the pot of drinking water. Then alum is added. It is
stirred for about 10 minutes. The water is then
decanted off and stored in clean vessels. Such
water will have fluoride in safer levels.

14. Therapeutic Measures
Dental fluorosis treatment: whitening of the teeth, veneers, or
other cosmetic dentistry techniques can be used to correct any
permanent discoloration.
Better nutrition: measures to improve nutritional status (intake
of calcium and vitamin C, iron, antioxidants) of affected
population particularly children are an effective solution.
Mothers in affected areas should be encouraged to breastfeed
since breast milk is usually low in fluoride.

15. National Programme for Prevention & Control
of Fluorosis (NPPCF)
Goal and Objectives:- The NPPCF aims to prevent and control Fluorosis cases in the country. The
Objectives of the National Programme for Prevention & Control of Fluorosis are as follows:
 To collect, assess and use the baseline survey data of fluorosis of Ministry of Drinking Water and
Sanitation for starting the project;
 Comprehensive management of fluorosis in the selected areas;
 Capacity building for prevention , diagnosis and management of fluorosis cases

16. Strategy
 Surveillance of fluorosis in the community;
 Capacity building (Human Resource) in the form of training and manpower support;
 Establishment of diagnostic facilities in the medical hospitals;
 Management of fluorosis cases including treatment surgery, rehabilitation
 Health education for prevention and control of fluorosis cases.

17. Activities
 Diagnosis of individual cases and providing its management.
 Public health intervention on the basis of community diagnosis.
 Behaviour change by Information, Education & Communication (IEC) Training