The document provides an introduction to endemic fluorosis in India and outlines the National Programme for Prevention and Control of Fluorosis (NPPCF). It discusses how fluorosis is caused by excessive intake of fluoride through drinking water and affects dental, skeletal, and non-skeletal health. The NPPCF aims to prevent and control fluorosis cases through comprehensive management in endemic areas, including collecting baseline data, capacity building for managing cases, and surveillance of communities affected. The goals, objectives, and strategies of the NPPCF are described to guide its implementation in districts across India.
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
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Dental Fluorosis : double sided sword
Overview of this deadly disease in this presentation
Presented by: Shubham Shegokar
Guided by : Dr. Rehan Khan
Pediatric Dentitstry
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
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Dental Fluorosis : double sided sword
Overview of this deadly disease in this presentation
Presented by: Shubham Shegokar
Guided by : Dr. Rehan Khan
Pediatric Dentitstry
Fluorosis is a cosmetic condition that affects the teeth. It's caused by overexposure to fluoride during the first eight years of life. This is the time when most permanent teeth are being formed. After the teeth come in, the teeth of those affected by fluorosis may appear mildly discolored.
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.
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
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
1. ENDEMIC FLUOROSIS &
National Programme for
prvention & control of flurosis
(राष्ट्रीय फ्लोरोसिि प्रतिबंध व तियंत्रण
काययक्रम)
Presented by : DR Sachin Shekde (Taluka health
officer dharur)
Guided by : DR Sangle sir ( DHO BEED)
DR Wadgave sir ( DRCHO BEED)
DEPARTMENT OF PUBLIC HEALTH
BEED 1
2. INTRODUCTION
• Fluorine is the 13th most abundant naturally occurring
element in the Earth’s crust.
• It is the lightest member of the halogens.
• It is the most electronegative and reactive of all the
elements and as a result, elemental fluorine does not
occur in nature but found as a fluoride mineral
complexes.
• Fluorine is more reactive than chlorine> bromine>
iodine.
2
3. • Fluorine is essential for mineralization of
bones & formation of dental enamels
• 96% of fluoride of body found in bones &
teeth.
• Normally small amount of fluoride is
required (0.5 to 0.8 mg/lit) in drinking
water.
4. • Fluorine is often called as two-edged
sword.
• Prolonged ingestion of fluoride through
drinking water in excess of the daily
requirement is associated with dental and
skeletal Fluorosis.
• Similarly, inadequate intake of fluoride in
drinking water is associated with dental
caries.
5. • World Health Organization (WHO) has set the
upper limit of fluoride concentration in
drinking water at 1.5 mg/l .
• The Bureau of Indian Standards, has
therefore, laid down Indian standards as 1
mg/l as maximum permissible limit of fluoride
with further remarks as “lesser the better” .
6. Permissible limit of fluoride in drinking
water
Name of organisation Desirable limit (mg/L)
Bureau of Indian Standards (BIS) 1.0
Indian Council of Medical
Research (ICMR) 1.0
The Committee on Public Health
Engineering Manual and Code of
Practice, Government of India 1.0
World Health Organization
(International Standards for
Drinking Water)
1.5
7. What is Fluorosis ?
• Fluorosis, a public health problem is caused by
excess intake of fluoride through drinking
water/food products/industrial emission over a
long period resulting permanent and
irreversible damages.
• The duration for the clinical manifestation to
appear varies depending on various factors like
age, nutritional status, quantity of fluoride
ingested, efficiency of kidney to excrete fluoride.
8. WORLDWIDE DISTRIBUTION
• Worldwide in distribution.
• Endemic in 22 countries.
• Asia and in Asia,India and China are worst
affected.
• Mexico in North and Argentina in Latin
America.
• East and North Africa are also endemic.
9. • Fluorosis is an important public health problem in
24 countries, including India, which lies in the
geographical fluoride belt that extends from Turkey
to China and Japan through Iraq, Iran and
Afghanistan .
• Of the 85 million tons of fluoride deposits on the
earth’s crust, 12 million are found in India . Hence
it is natural that fluoride contamination is
widespread, intensive and alarming in India.
11. FLUOROSIS IN INDIA
• Endemic fluorosis is prevalent in India since 1937 .
• It has been estimated that the total population
consuming drinking water containing elevated
levels of fluoride is over 66 million .
• Endemic fluorosis resulting from high fluoride
concentration in groundwater is a public health
problem in India .
12. • The available data suggest that 15 States
in India are endemic for fluorosis (fluoride
level in drinking water >1.5 (mg/l) .
• about 62 million people in India suffer from
dental, skeletal and non-skeletal fluorosis.
• Out of these; 6 million are children below
the age of 14 years .
16. Sources of Fluoride
• Contaminated ground
water is the main
source.
• Contaminated
drinking & cooking
water, agricultural &
food products, drugs
and industrial
emissions & pollutants
17. • Primarily it is Fluoride which is present in
drinking water .
• when F in water is more than 1.5 mg per litre,
it is toxic to health .
• 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 .
AGENT FACTORS
18. • In School going children seen as dental
fluorosis.
• In third and fourth decade of life seen as
Skeletal Fluorosis.
• Males suffer more than females.
Host Factors
19. • High Annual Mean Temperature.
• Low Rainfall.
• Low humidity.
• F rich Natural subsoil rocks.
• Vegetables from high F belts.
• Fluoridated tooth paste particularly when
used by children.
• Tropical climate.
Environmental Factors
21. DENTAL FLUOROSIS
• The teeth loose their shiny appearance and
chalk-white patches develop on them.This is
the early sign of dental fluorosis.
• Later the white patches become yellow and
sometimes brown or black.
• In severe cases, loss of enamel gives the teeth
a corroded appearance. Mottling is best seen
on the incisors of the upper jaw.
29. SKELETAL FLUOROSIS
• Associated with lifetime daily intake of 3.0 to 6.0 mg/l
or more.
• It affects young as well as old.
• The symptoms include severe pain and stiffness in
the backbone, joints and/or rigidity in hip bones.
30. A VICTIM OF SKELETAL FLUOROSIS
WITH STIFFNESS OF NECK AND SPINE
32. How to test pain in major joints
(possibly Skeletal Fluorosis)
• 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 to
the occiput indicating presence of Fluorosis.
33.
34. Non Skeletal fluorosis
Neurological Manifestations
1. Nervousness & Depression
2. Tingling sensation in fingers and toes
3. Excessive thirst and tendency to urinate
Frequently ( Polydypsia and polyurea )
35. 2. Muscular manifestations
• Muscle Weakness & stiffness
• Pain in the muscle and loss of muscle power
3.Gastro-intestinal problems:
• Consistent abdominal pain,
• intermittent diarrhea/Constipation,
• bloated feeling,
• nausea,
• loss of appetite.
36. Mitigation of Fluorosis
• Closing contaminated water source
• Arranging alternative safe water source
• Flocculation, sedimentation, coagulation (with lime
& alum), filtration of drinking water before use
• Health education, dietary counseling & nutrition
• Dietary supplementation of calcium, vitamin C, D3 &
iron
37. Mitigation of Fluorosis
• Enhanced surveillance, early detection, proper
treatment & rehabilitation.
• Rain & surface water harvesting for agriculture
& household.
• Supply of pipeline river water from water
treatment plant
38. Do’s & Don’ts in relation to Nutrition
intervention in Fluorosis
Do’s
Calcium rich food
Milk
Milk Products
Green leafy vegetables
Vitamin C rich food
Citrus fruits
Iron rich food
Green leafy vegetables
Banana, Guava, Brinjal
Don’ts
Black Tea
Black/Rock salt
Tobacco
Supari
Fluoridated Tooth Paste
40. Treatment of Fluorosis
• Medical treatment: No specific treatment;
supplementation with vitamin C & D,
antioxidants, calcium & correction of
malnutrition
• Treatment of deformities: Orthoses, surgical
shoes, physiotherapy, reconstructive surgery .
41. Medical
Management of
Fluorosis
Early Detection
Physical Examination
Dental Changes, Pain &
Stiffness in Joints,
Skeletal Deformities
Laboratory Tests
Urine & Water analysis
Radiological Exam
X Ray Forearm / most
affected part
Prompt Intervention
Health Education Safe
Drinking Water
Referral Services
(Village to Dist
Linkages)
Medical Management
Improve Quality of
Life
Ca, Vit C, Anti
oxidents
T/t Malnutrition
Physiotherapy,
Corrective Plaster,
Orthoses
42. NPPCF Programme Framework & Phasing
Year Districts Selected
2009-10
Chandrapur
Nanded
2010-11
Latur
Yavatmal
Washim
2011-12 Beed
2012-13
No New district & No funds
2013-14
2014-15
NPPCF intended to include Nagpur,
Jalgaon, Jalna, Bhandara,
Hingoli&Parbhani
43. GOAL OF NPPCF
• Goal of National Programme for
Prevention and Control of Fluorosis
(NPPCF):
To prevent and control fluorosis cases
in the country.
44. Objectives of NPPCF
• To collect & use baseline survey data of
fluorosis.
• Comprehensive management of fluorosis in
endemic areas.
• Capacity building for prevention, diagnosis &
management of fluorosis cases.
45. Strategies of NPPCF
• Capacity Building
oTraining of field level health personnel
oManpower Support
• Surveillance of Fluorosis in the community
including schools.
o Resurvey after 3 months of intervention activities
• Establishment of Diagnostic facilities in District
Hospitals & Medical Colleges
46. Activities under NPPCF at Community
(Village Level Activities)
• Provisional community diagnosis by consultant with
the help of Field investigator.
• Verification of Community Diagnosis by PHC Doctors.
• Training about General Symptoms and preventive
management of MOs PHCs and Mukhya Sevika of ICDS.
• Line listing of sources reduction activity, Reconstructive
Surgery Cases, Rehabilitative Intervention
Activities,local action & referral.
• Appropriate IEC.
• Inter-sectoral Co-operation.
• Measures for prevention and health promotion.
47. Community Health Centre / FRU
Level Activities
• Training for Clinical Examination and
Management.
• Training of Block staff & ICDS staff.
• Preliminary Diagnostic Parameters
Assessment.
• Monitoring of Village / PHC Level Activities.
• Referral.
48. District Level Activities
• Training of MO for Management of Cases.
• Training of Dist staff, ICDS & Educational Personnel.
• Fully Equipped Lab.
• Diagnostic support for all kinds of Fluorosis.
• Monitoring.
• Basic medical, surgical & rehabilitative activities for
diagnosed cases by dist level specialist.
• Referral of difficult cases to near by Medical College.
50. Guidelines for Surveillance
• Permissible limit of fluoride in drinking water: One mg. /
liter or one ppm in drinking water as per Bureau of Indian
Standard (BIS)
• The magnitude of Fluorosis problem in endemic area need
to assessed based on appropriate surveillance-case
definitions, adequate & proper sampling & survey
methodology.
• District Laboratory established/strengthened for
confirmation of Fluorosis cases.
• District Nodal Officer & Staff with Consultant & Field
Investigators are to be created.
• Funds are provided for mobility support for undertaking
community based surveillance.
51. CASE DEFINATION
1) Suspected Cases of Dental Fluorosis
Any case with a history of residing in an endemic area along
with one/both of the followings-
• Chalky white teeth
• Transverse yellow brown or dark brown bands
or spots on the enamel surface (Discoloration
away from the gums & bilaterally symmetrical)
52. 2) Suspected Cases of Skeletal Fluorosis
Any case with a history of residing in an endemic area along with one/more of the
followings-
• Severe pain & stiffness in the neck & back bone (lumber
region), shoulder, knee & hip region.
• Increased girth , thickening & density of bone by x - ray
• Knock knee / Bow leg (In children, adolescents)
• Inability to squat (Advanced stage)
• Ugly gait & posture ( Advanced stage)
53. 3) Suspected cases of Non – skeletal Fluorosis
Any case with a history of residing in an endemic area along with one/more
of the followings-
• Gastro –intestinal problems: Consistent abdominal
pain, intermittent diarrhoea /constipation, bloated
feeling,nausea, loss of appetite
• Neurological manifestations: Nervousness &
depression, tingling sensation in fingers & toes,
polydypsia, polyurea
• Muscular manifestations: Muscle weakness &
stiffness, pain in the muscle, loss of muscle
power,unable to walk or work
54. Confirmation of Fluorosis
Any suspect case with one or both of the
followings ;
• Any suspect case with high level of fluoride in
urine (>1mg/L)
• Any suspect case with interosseius membrane
calcification in the forearm confirmed by X-ray
55. Sampling Procedure
Fluoride level is to be obtained from PHED.
Fluoride level in all drinking water sources is to be estimated by
PHED.
Villages will be stratified in the 3 strata.
Strata Fluoride Level
I 1-3 ppm
II 3.1-5 ppm
III > 5 ppm
10% villages of each strata will be selected randomly (if villages
in each stratum >20).
6 to 11 yrs.(Std 1-5) children will be surveyed for prevalence of
dental Fluorosis.
Survey for Skeletal & Non Skeletal carried out in 20 household
randomly selected villages where dental flurosis is prevalent in
school children .
56. Survey Methodology
• SCHOOL SURVEY – This survey is for Dental Fluorosis
(DF) & visible Bone deformities. (BD)
• COMMUNITY SURVEY - Survey for skeletal & non
skeletal fluorosis cases would also be carried out in at
least 20 households of each of the randomly selected
villages of the district where DF is prevalent in school
children.