Endemic fluorosis

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 1

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 2

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. 3

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 . 4

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. 5

6. Clinical Picture Dental Fluorosis in Children Skeletal Fluorosis in Adults Genu valgum Non Skeletal Fluorosis 6

7. Dental Fluorosis Water content >1.5 mg/L Exposure during calcification of teeth sp. 1 st 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. 7

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 8

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 9

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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 11

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 ) 12

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 13

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 14

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