FLOUROSIS PPT.pptx overintake of flurine,double edeged sword

flurosis powerpoint presentation

1. FLUOROSIS 1

2. Overview Introduction Causes Clinical features Management National Programme References 2

3. Background Flourine : Most abundant element in nature 96% Fluorine in body found in bones and teeth Essential for: Mineralisation of bone Formation of dental enamel Recommended fluoride level in drinking water in India - 0.5-0.8 mg/L 3

4. Introduction Fluorosis : Public health problem caused by deposition of fluorides in hard and soft tissues of the body 4

5. Causes Ingestion of large amounts fluorine: Through drinking water( Fluoride in water >1.5 mg/L – toxic to health) Food products (Tobacco, sea fish,cheese,black tea, salted snacks, preserved fruit juices) Cosmetics Toothpastes, Mouth washes These harmful effects are permanent and irreversible When drinking water contains flourine in excess of 3-5 mg/L – Endemic fluorosis 5

6. Magnitude of Fluorosis Worldwide in distribution Endemic in 22 countries Asia (India and China worst affected) Mexico – North America Argentina – Latin America East and North Africa 6

7. India Rural districts of Andra Pradesh ( Nellore,Nalgonda , Prakasham districts) Karnataka Tamil Nadu Kerala Haryana Punjab Rajastan Gujarat Jharkhand 7

8. Manifestations Dental fluorosis Skeletal fluorosis Non skeletal fluorosis 8

9. Clinical Features Dental fluorosis : Occurs when excess fluoride is ingested during years of tooth calcification(1 st 7 years of life) “Mottling of dental enamel” - fluorine > 1.5 mg/L ‘Mottling’ best seen on incisors of upper jaw Teeth lose its shiny apperance and chalky white patches develop- Early sign of dental fluorosis 9

10. Later white patches – yellow /brown/ black Severe cases- loss of enamel gives the teeth - corroded apperance Almost entirely confined to the permanent teeth Dental fluorosis : Not usually associated with skeletal fluorosis or impairement of health 10

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12. Skeletal fluorosis 3 rd - 4 th decade of life Associated with life time daily intake of 3- 6 mg/L Heavy fluoride deposition in the skeleton 12

13. Clinical features Severe pain, stiffness in neck,backbone , shoulder, knee (Restricted mobility of cervical , lumbar spine) Rigidity in hip bones Advanced stages: Inability to squat Ugly gait and posture Also affects small joints of hands and feet 13

14. X rays: Thickening and high density of bones Calcification of ligaments – “poker back” Tendinous insertion of muscle may be ossified – “rose thorn” shadow in X-rays Calcium deficiency , osteomalacia – some cases Constriction of vertebral canal and intervertebral foramen- Pressure on nerves- Paralysis 14

15. Fluorine concentration> 10 mg/L – Crippling skeletal fluorosis – leads to permanent disability Heavy deposition of fluoride in bone - Sclerosis 15

16. Tests for Skeletal Fluorosis Coin test: Subject asked to lift a coin from the floor without bending knee A fluorotic subject –cannot lift coin without flexing large joints of lower extremity 16

17. Chin test: Subject asked to touch anterior wall of chest with chin If pain or stiffness in neck- Fluorosis 17

18. Stretch test: Subject asked to stretch the arm sideways, fold at elbow, touch back of head When pain and stiffness present –Difficult to touch occiput - Fluorosis 18

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20. Genu valgum and Osteoporosis of Lower limbs Reported in some districts of Andra Pradesh and Tamil Nadu Observed in people whose staple was jowar Further studies showed – jowar promoted a higher retention of ingested fluoride in the body 20

21. Non skeletal fluorosis Gastro intestinal problems: Consistent abdominal pain Intermittend diarrhoea /constipation Bloated feeling Nausea Loss of apetite 21

22. Neurological manifestations: Nervousness Depression Tingling sensation fingers and toes Excessive thirst Tendency to urinate frequently 22

23. Muscular manifestations: ( due to depletion of actin , myosin filament – mitochondria lose the structural integrity- depletion of muscle energy ) Muscle weakness and stiffness Muscle pain Loss of muscle power Unable to walk/work 23

24. Others: Infertility Abortions Still births 24

25. Ideal fluoride in drinking water: 0.5-0.8 mg/L Mottling of Dental Enamel - > 1.5 mg/L Endemic fluorosis – > 3-5 mg/L Skeletal Fluorosis - >- 3-6 mg/L Crippling skeletal sclerosis - >10mg/L 25

26. Management Early diagnosis: Suspected case confirmed by Xray/ Urine/ Serum/ drinking water fluoride level Disease preventable if diagnosed early and steps taken to prevent excess fluoride intake Dental /skeletal fluorosis – Irreversible/no treatment exists Only remedy – Prevention by keeping fluoride intake within safe limits 26

27. Preventive Measures Preventive Measures 27

28. Chemical Treatment 2) Defluoridation : Technique for removing fluoride by chemical treatment “ NALGONDA TECHNIQUE ” Developed by The “National Environmental Engineering Research Institute ,Nagpur” Used for community and domestic water supplies Economical and simple method 28

29. Sequentially adding (2 chemicals )lime and alum (AlSo4,AlCl2) to water Based on amount of fluoride in drinking water and alkalinity of water, amount of alum to be mixed with water is calculated Flocculation Sedimentation Filtration of water Disinfection 29

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32. 3)Restricting intake of fluoride rich items: To children who drink fluoridated water Tobacco, tea, cheese, sea fish, salted snacks, black salt, pickles, preserved fruit juices Avoid fluoride rich cosmetics/drugs (Fluoridated toothpastes, Mouthwashes) 32

33. 4)Use foods rich in Calcium, Vitamin D, Vitamin C , Anti oxidants( Vit E) 5)Create awareness about the disease , safe and unsafe sources of drinking water 6) Rainwater harvesting 33

34. Treatment Dental fluorosis – Tooth whitening –mild cases Nutritional intervention: Calcium and Vitamin D Vitamin C Reduces the absorption of fluorides 34

35. Treatment of deformities: Goal : Deformity reduction, Rehabilitation , Physiotherapy Conservative management – Plasters/ Orthopaedic appliances- Children Surgical interventions - selected cases of knee deformities, pathological fractures, compressive myelopathy 35

36. Fluorine deficiency Dental caries: Deficiency of fluorine in diet and drinking water leads to dental caries 36

37. Boiling water: Will concentrate fluoride rather than reducing it Freezing water: Does not affect the concentration of fluoride 37

38. National programme National Programme for Prevention and Control of Fluorosis (NPPCF): Initiated in 2008-2009 Under The “Ministry of Health and Family Welfare” Goal: Prevention and control of fluorosis in the country 100% - Central Government sponsored 38

39. Objectives To collect, assess and use the baseline survey data for starting the project Comprehensive management of fluorosis in selected areas Capacity building for prevention, diagnosis, and management of fluorosis cases 39

40. Important strategies Surveillance of fluorosis in the community and school children Capacity building in the form of training and man power support Diagnostic facilities in the form of laboratory support and equipments in the district/medical hospitals (ion meter – monitor fluoride content in water and urinary levels) 40

41. Health education for prevention and control of fluorosis cases Management of fluorosis cases by: Providing corrective surgeries Rehabilitation 41

42. References 1) K.Park.Nutrition and Health.Textbook of Preventive and Social Medicine.23.Bhanot;2015.p.644 2)Sunder Lal,Textbook of Community Medicine.4.CBS;2019. 3)AH Suryakantha.Community Medicine with Recent Advances.2017. 42

43. THANK YOU 43

44. Endemic fluorosis Manifestations of fluorosis Management of fluorosis Prevention of fluorosis ( Nalgonda technique) National Programme Fluorosis (Objectives, Strategies) 44