Fluorosis: Epidemiology
Dr. Prasanta Singha MahapatraAsst. Professor Cum Clinical Tutor
, Dept. of BiochemistryB. S. Medical College & Hospital,
BankuraFluorosis: A Global ProblemTHANKS TO ALL FOR ATTENDING TODAY
ININTER DEPARTMENTAL SENSITIZATIONON
FluorosisA 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.
Fluoride: MythFluoride inhibit enzymes breeding acid producing
oral bacteriaFluoride ion binds with calcium ions making teeth
enamel strongHarmful effect of Fluoride on other useful enzymes
outweighs the benefitExcessive fluoride displaces calcium from
tooth matrixChronic & cumulative exposure cause skeletal
fluorosis
MagnitudeFluorosis- 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
Indian scenarioFluorosis 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, Ktaka, 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
West BengalFluorosis is a Public Health Problem in 7 districts
of West Bengal.Worst affected districts: Birbhum, Bankura.17 blocks
of Bankura are affected.
AgentPrimarily, Fluoride is present in drinking waterWhen F in
water is more than 1.5 mg/L, (WHO) 1 mg/l (BIS) ,it is toxic to
healthAcidic pH promotes absorption in stomach like M.Tuberculosis
(Casing TB)Ca in the diet reduces the absorption of FHard water
rich in Ca reduces the F toxicityFresh Fruits and Vit.C reduces the
effect of FTrace elements like Molybdenum enhances the effect of
F
HostDental Fluorosis seen in school going childrenSkeletal
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.
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
urineThyroid hormone levels T3 and T4Test for Diagnosis Fluorosis :
SPOT URINE
Time-trendQuality 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.
InterventionsNo definite treatment available.Intervention 1:
Stop fluoride entrySafe drinking water: Surface water/
defluoridationAvoid fluoride containing foods.Avoid drugs and
dental products.Intervention 2: Promote adequnkura later on)Diet
rich in cereals, fruits & vegetablesPharmaceutical products
What to do ?Promoting better understanding of the
problemAdvocacy & raising awareness of all stake
holdersStrengthening the system of risk assessmentProvision &
consumption of safe water & foodReduction of exposure to
fluorides from other sources
