Endemic Fluorosis- A public health problem

1. Endemic Fluorosis
Dr. Moumita Pal
MBBS,DPH, MD
Dept. of Community Medicine
College of Medicine and Sagar Dutta Hospital
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2. FLUORINE
• Micronutrient;
• Permitted levels in drinking water: 0.5-o.8 mg/l
SOURCES
Drinking water, seafood, cheese, tea
Double-edged sword
Dental caries Dental &
Skeletal
fluorosis
Deficiency
Excess
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3. What is Fluorosis?
• Fluorosis is a disease caused by deposition of
fluorides in the hard and soft tissues of the
body.
• It is usually characterized by discoloration of
teeth and crippling disorders.
• Depending upon Water content of Fluorine,
duration and level of exposure.
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4. Magnitude of the problem
• Worldwide in distribution
• Endemic in 22 countries
• Asia (India and China are worst affected)
• Fluoride levels in surface waters are generally low,
ranging from 0.01 to 1.5 mg/L and its lower than
ground water.
• Water fluoride level increases in presence of natural
rock rich in fluoride and regions with volcanic
activity.
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5.  Affected 20 states out
of the 35 states and UTs
of the India.
 Maximum -
Rajasthan and Gujarat
,Andhra pradesh
Mod -Bihar, Delhi,
Haryana, Jharkhand,
Karnataka, M.P. and
Maharashtra.
Mild-T.N., W.B., U.P.,
Bihar and Assam.
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6. Clinical Picture
• Dental Fluorosis in Children
• Skeletal Fluorosis in Adults
• Genu valgum
• Non Skeletal Fluorosis
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7. Dental Fluorosis
• Water content >1.5 mg/L
• Exposure during calcification of teeth
sp. 1st 7 years of life
• 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.
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8. Skeletal Fluorosis
• >10 mg/L fluorine content.
• Deposition of fluoride in Bone ( sclerosis)
• 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- thickening and high density of bones, Calcified
ligaments of spine (Poker back), Tendinous insertions
of ms ossified( Rose Thorn)
• Constriction of vertebral canal and inter-vertebral
foramen - pressure on nerves leads to paralysis
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9. Genu valgum
• Reported in AP and TN
• Crippling of lower limb
• Seen in people whose staple diet is
SORGRAM/JOWAR- promotes higher
retention of fluorine in body
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11. Non skeletal fluorosis
• 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
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12. Prevention
1.Changing water source
• From ground water ( wells) to surface running water (
river)
2.Avoiding additional fluoride- use of fluoride tooth paste
for children up-to age 7
3.De-fluoridation- Nalgonda Technique
4. Others- high intake of vitamin C and Calcium also helps
reduce the problem.
• Avoid some food like- Rock salt,Black salt (Kala-
namak),Tea, Salted snacks n Pickle smeared with black
salt, Churans (Hajmola, Hingoli)
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13. 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
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14. Aluminium sulfate, Al2 (SO4)3 18H2O+ Water
Mixing
Flocule formation of Aluminium hydroxide and settling
down
Many kinds of microparticles and negatively charged
ions including fluoride are partially removed by
electrostatic attachment to the floccules
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