Fluorosis management in India: the impact due to networking between health and rural drinking water supply agencies
ndia is one of 21 nations with serious health problems due to consumption of fluoride-contaminated drinking water. An estimated 62 million people in India (in 16 of the 32 states) are affected with dental, skeletal, and non-skeletal forms of fluorosis and associated health complaints. Even children of the age of 8 to 10 years have been crippled due to consumption of fluoride-contaminated water. Fluoride concentrations in drinking water vary from 1.5 to 39 ppm. To tackle the problem effectively, an innovative approach has been adopted. Networking between Public Health Engineering, health sector personnel, and nutrition experts of the individual states, and phasing in the activities with well-defined objectives for implementation, resulted in a multidisciplinary approach, with the main goal of providing safe/defluoridated water, preventing fluorosis, and improving the health status of the community through interventions. The information arising from research and development activities on fluorosis patients is translated into well-defined modules for clinicians to use in their outpatient departments while screening the patients. This is very important as the health complaints due to fluoride often overlap with manifestations of other diseases and can lead to incorrect treatment of patients. In the Fluorosis Management Programme, the emphasis is on generating awareness among professionals, developing information, education, and communication packages, involving the community, and devising specific strategies for using the technology for fluoride removal and other approaches for providing safe water and consuming calcium, vitamin C, and an antioxidant-rich diet on a sustainable basis.
http://cat.inist.fr/?aModele=afficheN&cpsidt=1176890
Sunday, August 3, 2008
Control of Fluorosis in India
All India Institute of Medical Sciences
Ansart Nagar, New Delhi - 110 029
A.K. Susheela, Ph.D., F.A.Sc., F.A.M.S.
Professor of Histocytochemistry, Department of Anatomy
Message to: Rotary International,
Oakmont, Pennsylvania
c/o Ellie Rudolph
Fax 412-828-5096
There are 20 nations in the world with health problems due to excess fluoride ingestion through water and food.
India, Africa, China, certain parts of Thailand, Japan, New Zealand, Australia, Israel, Pakistan, Syria, Turkey are severely affected. However, the problem exist in U.K., U.S.A., Canada to a lesser extent possibly due to better nutrition, calcium and Vitamin C in diet which can nullify the toxic manifestations to some extent. But "Water Fluoridation" is a guaranteed danger to health.
The major problem is that, very often, skeletal fluorosis and non-skeletal fluorosis are misdiagnosed and treated wrongly as clinicians do not fully understand the manifestations due to fluoride poisoning/toxicity. These are not described adequately in Medical/Dental text books.
Dental fluorosis, is quite evident from the discolouration of the teeth from white, yellow, brown, to black spots or streaks horizontally aligned on the enamel surface, away from the gums. Even Dentists, quite a large number, do not fully understand fluoride action on teeth. We have problems in India, as Dentists promote fluoride, among patients, who have dental fluorosis and the patients end-up with severe non-skeletal manifestations. Intense scientific debates have helped the Government, to amend our Drugs and Cosmetic Act of 1945, during 1992 to bring-in stipulations in the manufacture of fluoridated toothpaste. We would like to get the fluoridated toothpaste out of our country. But due to vested interests among concerned, it is not an easy task.
To summarise a few scientific facts which concerns the people around the world are: Fluoride ingestion affects adversely:
· muscle structure and function, resulting in muscle weakness.
· red blood cells (erythrocytes) are killed prematurely, lowering haemoglobin content, resulting in anaemia.
· blood vessels are blocked through calcification resulting in cardiac problems.
· the male reproductive organs are affected resulting in defective sperms, leading to infertility in some men, which is again related to the hormonal status of the individual.
· the gastrointestinal tract mucosa is deranged (the lining of the stomach and intestine) resulting in : pain in the stomach, gas formation, nausea, loss of appetite, constipation followed with intermittent diarrhoea.
· people loose their teeth and become edentulous at a relatively young age.
India is the first country in the world to develop two protocols for diagnosing Fluorosis at an early stage, so that prevention of the disease is possible. Radiographs revealing skeletal fluorosis is too late for reversal of the changes. Fluorosis has no treatment or cure. Prevention is the only solution provided the disease is diagnosed early.
· For early detection of fluoride poisoning we use 1) Gastrointestinal manifestations (non-ulcer dyspepsia) 2) a sensitive blood test SA/GAG for detection.
· In view of the enormous health problems due to fluoride, India is now investing massive amounts of funds for removing fluoride from drinking water.
· Dental caries on the contrary, is not a fluoride related disease: it is a bacterial disease. Can be easily prevented, if oral hygiene practises are promoted and calcium and vitamin C in the diet are given in adequate quantum to the child even before birth through maternal diet.
· However, Dentists invariably misguide the public by designating Dental caries as a fluoride deficiency disorder, which is grossly and scientifically incorrect.
· In India, we are educating our people through radio, TV and other print media, the dangers of fluoride and they shall avoid it. In the developed western world, as people are educated. I do not understand why it should be a problem to convince the Government against "water fluoridation" and to stop it.
· In early 1970 and 1980 some of the UN Organisations tried their very best to promote fluoridation of water in India (inspite of prevailing health problems due to excess of fluoride) and the scientific community fought the battle and was able to convey to the concerned Organisation(s) that they shall not enter India with the message for Fluoridation and we won the battle. They were trying to use the developing world to promote fluoridation based on the concepts of the "donor" countries but did not work.
"Peoples Health is the Nations' Wealth" and I hope the Rotary International would do everything possible to stop the cruel method of poisoning people through fluoridating drinking water in the name of prevention of Dental caries.
This truly reveals that no Organisation/Association can be taken for granted. Their intentions while promoting fluoride need to be questioned.
Professor A.K. Susheela
Dated: 24th February, 1996.
http://www.windsofchange.eu.com/fluoride03.html
Ansart Nagar, New Delhi - 110 029
A.K. Susheela, Ph.D., F.A.Sc., F.A.M.S.
Professor of Histocytochemistry, Department of Anatomy
Message to: Rotary International,
Oakmont, Pennsylvania
c/o Ellie Rudolph
Fax 412-828-5096
There are 20 nations in the world with health problems due to excess fluoride ingestion through water and food.
India, Africa, China, certain parts of Thailand, Japan, New Zealand, Australia, Israel, Pakistan, Syria, Turkey are severely affected. However, the problem exist in U.K., U.S.A., Canada to a lesser extent possibly due to better nutrition, calcium and Vitamin C in diet which can nullify the toxic manifestations to some extent. But "Water Fluoridation" is a guaranteed danger to health.
The major problem is that, very often, skeletal fluorosis and non-skeletal fluorosis are misdiagnosed and treated wrongly as clinicians do not fully understand the manifestations due to fluoride poisoning/toxicity. These are not described adequately in Medical/Dental text books.
Dental fluorosis, is quite evident from the discolouration of the teeth from white, yellow, brown, to black spots or streaks horizontally aligned on the enamel surface, away from the gums. Even Dentists, quite a large number, do not fully understand fluoride action on teeth. We have problems in India, as Dentists promote fluoride, among patients, who have dental fluorosis and the patients end-up with severe non-skeletal manifestations. Intense scientific debates have helped the Government, to amend our Drugs and Cosmetic Act of 1945, during 1992 to bring-in stipulations in the manufacture of fluoridated toothpaste. We would like to get the fluoridated toothpaste out of our country. But due to vested interests among concerned, it is not an easy task.
To summarise a few scientific facts which concerns the people around the world are: Fluoride ingestion affects adversely:
· muscle structure and function, resulting in muscle weakness.
· red blood cells (erythrocytes) are killed prematurely, lowering haemoglobin content, resulting in anaemia.
· blood vessels are blocked through calcification resulting in cardiac problems.
· the male reproductive organs are affected resulting in defective sperms, leading to infertility in some men, which is again related to the hormonal status of the individual.
· the gastrointestinal tract mucosa is deranged (the lining of the stomach and intestine) resulting in : pain in the stomach, gas formation, nausea, loss of appetite, constipation followed with intermittent diarrhoea.
· people loose their teeth and become edentulous at a relatively young age.
India is the first country in the world to develop two protocols for diagnosing Fluorosis at an early stage, so that prevention of the disease is possible. Radiographs revealing skeletal fluorosis is too late for reversal of the changes. Fluorosis has no treatment or cure. Prevention is the only solution provided the disease is diagnosed early.
· For early detection of fluoride poisoning we use 1) Gastrointestinal manifestations (non-ulcer dyspepsia) 2) a sensitive blood test SA/GAG for detection.
· In view of the enormous health problems due to fluoride, India is now investing massive amounts of funds for removing fluoride from drinking water.
· Dental caries on the contrary, is not a fluoride related disease: it is a bacterial disease. Can be easily prevented, if oral hygiene practises are promoted and calcium and vitamin C in the diet are given in adequate quantum to the child even before birth through maternal diet.
· However, Dentists invariably misguide the public by designating Dental caries as a fluoride deficiency disorder, which is grossly and scientifically incorrect.
· In India, we are educating our people through radio, TV and other print media, the dangers of fluoride and they shall avoid it. In the developed western world, as people are educated. I do not understand why it should be a problem to convince the Government against "water fluoridation" and to stop it.
· In early 1970 and 1980 some of the UN Organisations tried their very best to promote fluoridation of water in India (inspite of prevailing health problems due to excess of fluoride) and the scientific community fought the battle and was able to convey to the concerned Organisation(s) that they shall not enter India with the message for Fluoridation and we won the battle. They were trying to use the developing world to promote fluoridation based on the concepts of the "donor" countries but did not work.
"Peoples Health is the Nations' Wealth" and I hope the Rotary International would do everything possible to stop the cruel method of poisoning people through fluoridating drinking water in the name of prevention of Dental caries.
This truly reveals that no Organisation/Association can be taken for granted. Their intentions while promoting fluoride need to be questioned.
Professor A.K. Susheela
Dated: 24th February, 1996.
http://www.windsofchange.eu.com/fluoride03.html
Friday, August 1, 2008
Fluorosis Traetment and Prevention
TREATMENT AND PREVENTION
Considerable work has been done all over the world on treatment of Fluorosis. Unfortunately the results indicated that the effects of Fluorosis are irreversible. According to the author this condition can be cured, at least in children, by a treatment which are inexpensive and easily available. Numerous people have conducted surveys on the problem of fluoridation and treatment options available for defluoridation processes, but however a safe, efficient and cost effective defluoridation technique / process needs to be developed in order to prevent the occurrence of Fluorosis.
To summaries three approaches are suggested:
1. Health education
2. Treatment of the children,
3. Preventive measures.
Health Education
Creating awareness about the disease: The main area of interest will be
1. Creating disease awareness
Creating awareness about the disease should be in form of graphic presentation of the final consequences of the disease to the extent possible. If required live presentation of the patients, who are suffering from the severe form of the disease, in areas where the gravity of problem has not reached to that extent. It may be of use, to demonstrate the most severe extent of the disease and to motivate them to use the preventive or therapeutic measures.
2. Creating awareness about the sources of the fluoride
The creation of awareness will help in implementing the need based preventive measures in the affected community.
Treatment of the disease
Vitamins C and D, and, salts of Calcium, Magnesium or Aluminum were prescribed in an attempt to reverse these effects. Published results were, however, inconclusive and largely negative. Recent studies conducted in Rajasthan under Rajasthan DST sponsored studies indicated that Fluorosis could be reversed, at least in children by a therapeutic regimen (Calcium, Vitamin C and Vitamin D) which is cheap and easily available.
The choice of the reported therapy was logical. The presence of calcium in gut directly affects the absorption of fluoride ions and will also improve serum calcium levels. Vitamin D in low doses enhances calcium absorption and retention without causing hypercalcemia and thus directly affects the absorption of fluoride ions. It also inhibits the excessive release of parathyroid hormone thereby preventing excessive activation of osteoblasts thus preventing hyperosteoidosis and osteopenia. Ascorbic acid controls collagen formation, maintains the teeth structure and also enhances normal bone formation. These structures are adversely affected by higher fluoride intake.
Prevention
a. Providing defluoridated water for drinking purpose
Methods of defluoridation recommended so far are aimed at bringing the fluoride levels to the WHO standards.
Desirable characteristics of defluoridation process
* Cost-effective
* Easy to handle/operate by rural population - the major sufferer
* Independent of input Fluoride concentration, alkalinity, pH, temperature
* Not affect taste of water
* Not add other undesirable substances (e.g. Aluminum) to treated water.
It is estimated that the daily consumption of water for all purposes per capita is about 135 lpcd in urban areas and about 40 lpcd in rural areas, whereas for drinking and food preparing purposes it is only 8 lpcd.Keeping in view the cost involved in defluoridating the water it is desirable that the defluoridation of water should be restricted to drinking water only. Hence the only economical and practicable choice left is Domestic defluoridation.
It is now desirable to test the various domestic defluoridation processes, especially in terms of acceptance by people without the need of any supervising agency, and recommend suitable alternatives so that effective long-term implementation can be achieved.
Surprisingly none of the domestic defluoridation processes available today have been much successful in the field. Relative merits and demerits of some of these processes are as follows:
1) Nalgonda process:It is a cumbersome technique not suitable for use by uneducated rural population - the section that needs it the most. Further, it is difficult to control the alum dose because it is different for each source of water. The process can be used only for water having a fluoride content of less than 10 ppm. If the alum dose is not properly controlled it may result in high residual aluminum content in output drinking water. The IS 10500 sets an absolute maximum limit of 0.2 ppm of Aluminum in drinking water. Excess of alum also renders metallic taste to the water.
2) Activated alumina process:It is an expensive process. Reactivation of filter material is cumbersome and it can be done only with the help of trained persons generally not available in most of our villages. This process also results in high residual aluminum in output water ranging from 0.16ppm to 0.45ppm.
3) Other processes:Processes like Electro-dialysis, Reverse Osmosis etc. require special equipment, electrical energy and especially trained persons to operate these units. Operation and maintenance of these units is also very expensive and hence these are not suitable as domestic defluoridation processes for use in rural areas.
Recently KRASS have comeout with new defluoridation process named KDP (KRASS defluoridation process), which have shown promising results. The silant features are given below:
In this process the fluoride contaminated water passed through the bed of media by any means such as filter to get the defluoridated water. This process differs from the known processes in its simplicity, cost effectiveness and very low traces of residual aluminum in outlet water. There is no limit on fluoride concentration in input water. Temperature, pH, alkalinity and Total Dissolved Solids of input water do not effect this process. The ambient conditions like atmospheric temperature and humidity do not have any effect on this process. It is a practical approach especially for our rural population.
The importance of the process is a defluoridation process, which is easy, to use by illiterate villagers, requires minimal involvement of technical personnel, is harmless and is cost effective.In the process, once the filter are laid at a door step, the inflow of the fluoride rich water is without further expenditure in terms of cost except recharging according to the capacity of filter. The exhausted media bed can be easily recharged again without replacing the material at least upto 40 cycles. As a product, the process achieves better removal of suspended matter, betters clarity and maintains taste of water. The treatment cost is about 0.6 - 0.8 paisa per liter at 10 ppm of influent fluoride.
b. Changing the dietary habits
defluoridation of drinking water alone shall not bring the fluoride level to a safe limit. It would be necessary to overcome the toxic effects of the remaining fluoride ingested through other source. This can be done by effecting minor changes in the diet and dietary habits of the population compatible with their social system and available resources. The main aim should be to
* Restrict use of fluoride rich food and fluoride rich water
* Avoiding use of fluoride rich cosmetics
* Use of food rich in calcium, vitamin C and proteins
c. Water harvesting (alternative water source)
Fluoride not only affects the people but it also affects the animals. Therefore it is desirable that the animals should also be provided with fluoride free water for maintaining their longevity. Defluoridation of drinking water for animals will be too costly and not feasible, and therefore the only solution of this problem is water harvesting. The water harvesting technologies should be aimed not only to provide fluoride free water to human beings but also to animals.Rainwater storage can be a major source of fluoride free drinking water for the animals.
This three pronged attack can prove to be a blessing for the population especially for the younger generation living in fluoride rich areas having no choice except to drink the water contaminated with fluoride and suffer the inevitable consequences including permanent deformities.
http://www.krassindia.org/fluoride_tre.htm
Considerable work has been done all over the world on treatment of Fluorosis. Unfortunately the results indicated that the effects of Fluorosis are irreversible. According to the author this condition can be cured, at least in children, by a treatment which are inexpensive and easily available. Numerous people have conducted surveys on the problem of fluoridation and treatment options available for defluoridation processes, but however a safe, efficient and cost effective defluoridation technique / process needs to be developed in order to prevent the occurrence of Fluorosis.
To summaries three approaches are suggested:
1. Health education
2. Treatment of the children,
3. Preventive measures.
Health Education
Creating awareness about the disease: The main area of interest will be
1. Creating disease awareness
Creating awareness about the disease should be in form of graphic presentation of the final consequences of the disease to the extent possible. If required live presentation of the patients, who are suffering from the severe form of the disease, in areas where the gravity of problem has not reached to that extent. It may be of use, to demonstrate the most severe extent of the disease and to motivate them to use the preventive or therapeutic measures.
2. Creating awareness about the sources of the fluoride
The creation of awareness will help in implementing the need based preventive measures in the affected community.
Treatment of the disease
Vitamins C and D, and, salts of Calcium, Magnesium or Aluminum were prescribed in an attempt to reverse these effects. Published results were, however, inconclusive and largely negative. Recent studies conducted in Rajasthan under Rajasthan DST sponsored studies indicated that Fluorosis could be reversed, at least in children by a therapeutic regimen (Calcium, Vitamin C and Vitamin D) which is cheap and easily available.
The choice of the reported therapy was logical. The presence of calcium in gut directly affects the absorption of fluoride ions and will also improve serum calcium levels. Vitamin D in low doses enhances calcium absorption and retention without causing hypercalcemia and thus directly affects the absorption of fluoride ions. It also inhibits the excessive release of parathyroid hormone thereby preventing excessive activation of osteoblasts thus preventing hyperosteoidosis and osteopenia. Ascorbic acid controls collagen formation, maintains the teeth structure and also enhances normal bone formation. These structures are adversely affected by higher fluoride intake.
Prevention
a. Providing defluoridated water for drinking purpose
Methods of defluoridation recommended so far are aimed at bringing the fluoride levels to the WHO standards.
Desirable characteristics of defluoridation process
* Cost-effective
* Easy to handle/operate by rural population - the major sufferer
* Independent of input Fluoride concentration, alkalinity, pH, temperature
* Not affect taste of water
* Not add other undesirable substances (e.g. Aluminum) to treated water.
It is estimated that the daily consumption of water for all purposes per capita is about 135 lpcd in urban areas and about 40 lpcd in rural areas, whereas for drinking and food preparing purposes it is only 8 lpcd.Keeping in view the cost involved in defluoridating the water it is desirable that the defluoridation of water should be restricted to drinking water only. Hence the only economical and practicable choice left is Domestic defluoridation.
It is now desirable to test the various domestic defluoridation processes, especially in terms of acceptance by people without the need of any supervising agency, and recommend suitable alternatives so that effective long-term implementation can be achieved.
Surprisingly none of the domestic defluoridation processes available today have been much successful in the field. Relative merits and demerits of some of these processes are as follows:
1) Nalgonda process:It is a cumbersome technique not suitable for use by uneducated rural population - the section that needs it the most. Further, it is difficult to control the alum dose because it is different for each source of water. The process can be used only for water having a fluoride content of less than 10 ppm. If the alum dose is not properly controlled it may result in high residual aluminum content in output drinking water. The IS 10500 sets an absolute maximum limit of 0.2 ppm of Aluminum in drinking water. Excess of alum also renders metallic taste to the water.
2) Activated alumina process:It is an expensive process. Reactivation of filter material is cumbersome and it can be done only with the help of trained persons generally not available in most of our villages. This process also results in high residual aluminum in output water ranging from 0.16ppm to 0.45ppm.
3) Other processes:Processes like Electro-dialysis, Reverse Osmosis etc. require special equipment, electrical energy and especially trained persons to operate these units. Operation and maintenance of these units is also very expensive and hence these are not suitable as domestic defluoridation processes for use in rural areas.
Recently KRASS have comeout with new defluoridation process named KDP (KRASS defluoridation process), which have shown promising results. The silant features are given below:
In this process the fluoride contaminated water passed through the bed of media by any means such as filter to get the defluoridated water. This process differs from the known processes in its simplicity, cost effectiveness and very low traces of residual aluminum in outlet water. There is no limit on fluoride concentration in input water. Temperature, pH, alkalinity and Total Dissolved Solids of input water do not effect this process. The ambient conditions like atmospheric temperature and humidity do not have any effect on this process. It is a practical approach especially for our rural population.
The importance of the process is a defluoridation process, which is easy, to use by illiterate villagers, requires minimal involvement of technical personnel, is harmless and is cost effective.In the process, once the filter are laid at a door step, the inflow of the fluoride rich water is without further expenditure in terms of cost except recharging according to the capacity of filter. The exhausted media bed can be easily recharged again without replacing the material at least upto 40 cycles. As a product, the process achieves better removal of suspended matter, betters clarity and maintains taste of water. The treatment cost is about 0.6 - 0.8 paisa per liter at 10 ppm of influent fluoride.
b. Changing the dietary habits
defluoridation of drinking water alone shall not bring the fluoride level to a safe limit. It would be necessary to overcome the toxic effects of the remaining fluoride ingested through other source. This can be done by effecting minor changes in the diet and dietary habits of the population compatible with their social system and available resources. The main aim should be to
* Restrict use of fluoride rich food and fluoride rich water
* Avoiding use of fluoride rich cosmetics
* Use of food rich in calcium, vitamin C and proteins
c. Water harvesting (alternative water source)
Fluoride not only affects the people but it also affects the animals. Therefore it is desirable that the animals should also be provided with fluoride free water for maintaining their longevity. Defluoridation of drinking water for animals will be too costly and not feasible, and therefore the only solution of this problem is water harvesting. The water harvesting technologies should be aimed not only to provide fluoride free water to human beings but also to animals.Rainwater storage can be a major source of fluoride free drinking water for the animals.
This three pronged attack can prove to be a blessing for the population especially for the younger generation living in fluoride rich areas having no choice except to drink the water contaminated with fluoride and suffer the inevitable consequences including permanent deformities.
http://www.krassindia.org/fluoride_tre.htm
Fluorosis
Fluorosis is a disease caused due to excessive ingestion of fluoride. Fluoride are the compounds of fluorine. Fluorine is the 13th most abundant element available in the earth crust. As the surface water passes through the fluoride rich rocks it carries fluoride with it, hence most of the fluoride is found in ground water than surface water.
Permissible limit of fluoride:WHO and IS 10500 (1991) standards permit only 1.5 mg/L and 1.0 mg/L respectively as a safe limit for human consumption whereas several districts of Rajasthan India are consuming water with fluoride concentrations of up to 24 - 44 mg/l.
Krass India's Role:
The information on Fluorosis provided on this site shall be of phenomenal value in providing education and support for prevention of this disease to:
* Patients,
* Public Health Engineers and Water Chemists,
* Policy Makers and Administrators,
* Local governments, general public,
* Dentists, scientists, researchers, physicians,
* non-governmental bodies, and
* Worldwide Non-Profit organization working towards the cause.
Krass India is registered as a charitable, non-profit making organization with a objective of researching ways to deal with most endemic diseases facing our community including all aspects of Fluoride and Fluorosis to provide initiatives to mitigate the disease worldwide. We are working with government agencies in India in making them aware of our work and attract funds from overseas to carry on with its activities to benefit those in need.
We welcome all individual or philanthropist from any part of the globe who would like to support our activities by way of providing funds to the organization. Please email us if you'd like more information or click here to get more information on contributing.
Spread & Source
International Status: The following countries have been identified for the problem of Fluorosis: Pakistan, Bangladesh, Argentina, United States of America, Morocco, Middle East countries, Japan, South African Countries, New Zealand, Thailand etc.
In India: The problem has reached alarming proportions affecting at least 17 states of India. Out of those 5 are hyper endemic, where 50-100% districts are affected viz. Andhra Pradesh, Tamil Nadu, Uttar Pradesh, Gujarat, Rajasthan. In Rajasthan the Banka Patti area has been identified in Nagaur district.
Major sources of fluoride for human exposures are water, Food, Air, Medicament, and Cosmetics. It is roughly estimated that 60% of the total intake is through drinking water. In India it have been observed that Tea, Fluoridated tooth paste and high fluoride water make a major contribution for human ingestion.
Chemobiokinetics and Metabolism
Ingested fluoride is rapidly absorbed through gastrointestinal tract and lungs. The peaks are reached after 30 min in blood. The rapid excretion takes place through renal system over a period of 4 to 6 hrs. In children less than three years of age only about 50% of total absorbed amount is excreted, but in Adults and children over 3 years - about 90% is excreted. Approximately 90% of the fluoride retained in the body is deposited in the skeleton and teeth. The biological half-life of bound fluoride is several years. Fluoride also passes through the placenta and also appears in low concentrations in saliva, sweat, and milk.
Long back it was believed that Fluorosis is a problem of elderly age group but it have been found that children in the age group of 0 to 12 years are most prone to Fluorosis as their body tissues are in formative / growth stage during this period. The problem is so severe that if expectant mothers ingest high fluoride water, it can create many problems with developing fetus. It not only affects the body of a person but also renders them socially and culturally crippled.
Clinical Menifestation
Toxic effects on human beings: Fluorosis may cause Skeletal Fluorosis, Clinical Fluorosis, Dental Fluorosis, Non Skeletal manifestations, or any combination of the above and in final stages it causes premature aging.
Dental Fluorosis: White opacities, Faint yellow stain, Pitting, chipped off, Black discoloration, Enamel hypoplasia, Delayed eruption. Incidences of mottled teeth were observed even with range of 0.7-1.5 mg F/l in drinking water. The minimal daily fluoride intake in infants that may cause very mild or mild Fluorosis in human beings was estimated to be about 0.1 mg per kg body weight.
Skeletal Fluorosis: Radiological presentations: Osteosclerosis, Periosteal bone formation, Calcification of interosseous membrane, ligaments, capsules, muscular attachments, tendons. Exostoses, Osteophytosis, Associated metabolic bone disease.
Clinical presentation: Heel pain, Painful and restricted joint movements, Deformities in Limbs, Hunch back
In extreme cases: Paralysis, Mucular wasting, Premature aging
Non skeletal manifestations
1. Neurological manifestation: Nervousness & Depression, Tingling sensation in fingers and toes, Excessive thirst and tendency to urinate Frequently (Polydypsia and plyurea): The Control by brain appears to be adversely affected.
2. Muscular manifestations: Muscle Weakness & stiffness, Pain in the muscle and loss of muscle power
3. Urinary tract manifestations: Urine may be much less in volume, Yellow red in colour, Itching in the region of axilla.
4. Allergic manifestation: Very painful skin rashes, which are peri vascular inflammation. Prevalent in women and children. Pinkish red or bluish red spot, round or oval shape on the skin that fade and clear up within 7-10 days.
5. Gastro - intestinal problems: Acute abdominal pain, Diarrohea, Constipation, Blood in Stool
6. Headache
7. Edentate (Losses Teeth at an early age)
8. Red Blood cells: causes formation of echinocytes hence early destruction of the RBCs in form of ecchynocytes causes anemia.
9. Ligaments and Blood Vessel Calcification: Early calcification of blood vessels.
10. Fluoride and mental efficiency: reduce mental work capacity (MWC) and hair zinc content.
11. Fluoride and thyroid: Fluoride has inhibitory effect on iodine uptake hence causing thyroid enlargement.
12. Fluoride and Cancer: The results of the studies suggested that sodium fluoride promoted the growth of precancerous lesions of the liver.
13. Fluoride and diabetes:The study showed that chronic fluoride toxicity in humans could result in significant abnormalities in glucose tolerance, which are reversible upon removal of the excess fluoride.
14. Fluorosis and lactation: The effect of Fluorosis on lactation, lactotroph function and ultrastructure were studied in lactating rats. The results were as follows:
1. Inhibition of lactation in lactating rats
2. During chronic Fluorosis serum prolactin level was decreased.
http://www.krassindia.org/fluorosis.htm
Permissible limit of fluoride:WHO and IS 10500 (1991) standards permit only 1.5 mg/L and 1.0 mg/L respectively as a safe limit for human consumption whereas several districts of Rajasthan India are consuming water with fluoride concentrations of up to 24 - 44 mg/l.
Krass India's Role:
The information on Fluorosis provided on this site shall be of phenomenal value in providing education and support for prevention of this disease to:
* Patients,
* Public Health Engineers and Water Chemists,
* Policy Makers and Administrators,
* Local governments, general public,
* Dentists, scientists, researchers, physicians,
* non-governmental bodies, and
* Worldwide Non-Profit organization working towards the cause.
Krass India is registered as a charitable, non-profit making organization with a objective of researching ways to deal with most endemic diseases facing our community including all aspects of Fluoride and Fluorosis to provide initiatives to mitigate the disease worldwide. We are working with government agencies in India in making them aware of our work and attract funds from overseas to carry on with its activities to benefit those in need.
We welcome all individual or philanthropist from any part of the globe who would like to support our activities by way of providing funds to the organization. Please email us if you'd like more information or click here to get more information on contributing.
Spread & Source
International Status: The following countries have been identified for the problem of Fluorosis: Pakistan, Bangladesh, Argentina, United States of America, Morocco, Middle East countries, Japan, South African Countries, New Zealand, Thailand etc.
In India: The problem has reached alarming proportions affecting at least 17 states of India. Out of those 5 are hyper endemic, where 50-100% districts are affected viz. Andhra Pradesh, Tamil Nadu, Uttar Pradesh, Gujarat, Rajasthan. In Rajasthan the Banka Patti area has been identified in Nagaur district.
Major sources of fluoride for human exposures are water, Food, Air, Medicament, and Cosmetics. It is roughly estimated that 60% of the total intake is through drinking water. In India it have been observed that Tea, Fluoridated tooth paste and high fluoride water make a major contribution for human ingestion.
Chemobiokinetics and Metabolism
Ingested fluoride is rapidly absorbed through gastrointestinal tract and lungs. The peaks are reached after 30 min in blood. The rapid excretion takes place through renal system over a period of 4 to 6 hrs. In children less than three years of age only about 50% of total absorbed amount is excreted, but in Adults and children over 3 years - about 90% is excreted. Approximately 90% of the fluoride retained in the body is deposited in the skeleton and teeth. The biological half-life of bound fluoride is several years. Fluoride also passes through the placenta and also appears in low concentrations in saliva, sweat, and milk.
Long back it was believed that Fluorosis is a problem of elderly age group but it have been found that children in the age group of 0 to 12 years are most prone to Fluorosis as their body tissues are in formative / growth stage during this period. The problem is so severe that if expectant mothers ingest high fluoride water, it can create many problems with developing fetus. It not only affects the body of a person but also renders them socially and culturally crippled.
Clinical Menifestation
Toxic effects on human beings: Fluorosis may cause Skeletal Fluorosis, Clinical Fluorosis, Dental Fluorosis, Non Skeletal manifestations, or any combination of the above and in final stages it causes premature aging.
Dental Fluorosis: White opacities, Faint yellow stain, Pitting, chipped off, Black discoloration, Enamel hypoplasia, Delayed eruption. Incidences of mottled teeth were observed even with range of 0.7-1.5 mg F/l in drinking water. The minimal daily fluoride intake in infants that may cause very mild or mild Fluorosis in human beings was estimated to be about 0.1 mg per kg body weight.
Skeletal Fluorosis: Radiological presentations: Osteosclerosis, Periosteal bone formation, Calcification of interosseous membrane, ligaments, capsules, muscular attachments, tendons. Exostoses, Osteophytosis, Associated metabolic bone disease.
Clinical presentation: Heel pain, Painful and restricted joint movements, Deformities in Limbs, Hunch back
In extreme cases: Paralysis, Mucular wasting, Premature aging
Non skeletal manifestations
1. Neurological manifestation: Nervousness & Depression, Tingling sensation in fingers and toes, Excessive thirst and tendency to urinate Frequently (Polydypsia and plyurea): The Control by brain appears to be adversely affected.
2. Muscular manifestations: Muscle Weakness & stiffness, Pain in the muscle and loss of muscle power
3. Urinary tract manifestations: Urine may be much less in volume, Yellow red in colour, Itching in the region of axilla.
4. Allergic manifestation: Very painful skin rashes, which are peri vascular inflammation. Prevalent in women and children. Pinkish red or bluish red spot, round or oval shape on the skin that fade and clear up within 7-10 days.
5. Gastro - intestinal problems: Acute abdominal pain, Diarrohea, Constipation, Blood in Stool
6. Headache
7. Edentate (Losses Teeth at an early age)
8. Red Blood cells: causes formation of echinocytes hence early destruction of the RBCs in form of ecchynocytes causes anemia.
9. Ligaments and Blood Vessel Calcification: Early calcification of blood vessels.
10. Fluoride and mental efficiency: reduce mental work capacity (MWC) and hair zinc content.
11. Fluoride and thyroid: Fluoride has inhibitory effect on iodine uptake hence causing thyroid enlargement.
12. Fluoride and Cancer: The results of the studies suggested that sodium fluoride promoted the growth of precancerous lesions of the liver.
13. Fluoride and diabetes:The study showed that chronic fluoride toxicity in humans could result in significant abnormalities in glucose tolerance, which are reversible upon removal of the excess fluoride.
14. Fluorosis and lactation: The effect of Fluorosis on lactation, lactotroph function and ultrastructure were studied in lactating rats. The results were as follows:
1. Inhibition of lactation in lactating rats
2. During chronic Fluorosis serum prolactin level was decreased.
http://www.krassindia.org/fluorosis.htm
Thursday, July 31, 2008
Less fluoride in water weighed
Federal panel wants current level reduced
By: Jen Skerritt
Updated: July 31 at 02:00 AM CDT
ProvinciaL health officials are considering reducing the amount of fluoride in drinking water after a Health Canada expert panel concluded the current level of the chemical should be cut to limit any potential risk to health.
Health Canada commissioned a panel of experts in January 2007 to review the potential adverse effects of exposure to fluoride through drinking water. The panel recommended that the level of fluoride in drinking water be cut to 0.7 milligrams per litre to prevent excessive intake of the chemical. It can cause fluorosis -- an overdose of the chemical that causes tooth enamel to flake, become chalky, or in severe cases, stain black or brown.
By: Jen Skerritt
Updated: July 31 at 02:00 AM CDT
ProvinciaL health officials are considering reducing the amount of fluoride in drinking water after a Health Canada expert panel concluded the current level of the chemical should be cut to limit any potential risk to health.
Health Canada commissioned a panel of experts in January 2007 to review the potential adverse effects of exposure to fluoride through drinking water. The panel recommended that the level of fluoride in drinking water be cut to 0.7 milligrams per litre to prevent excessive intake of the chemical. It can cause fluorosis -- an overdose of the chemical that causes tooth enamel to flake, become chalky, or in severe cases, stain black or brown.
The report and its recommendations were completed last year, but a summary was not posted on Health Canada's website until the end of June.
Dr. Joel Kettner, Manitoba's chief medical officer, said health officials are looking at the issue, but won't move ahead on lowering the fluoride level until Health Canada formally adopts the recommendations and tells the provinces to follow suit.
Under Manitoba's current drinking-water guidelines, fluoride levels must be within a range of 0.8 and 1.2 milligrams per litre. The maximum allowable concentration of fluoride in drinking water in Canada is 1.5 milligrams per litre.
Adding the chemical to municipal water supplies isn't mandatory, but Kettner said that as of 2007, 52 water treatment plants in 89 communities added fluoride to drinking water. Ninety-five per cent of Manitobans receive water treated with fluoride.
"The argument has always hinged on does the benefit outweigh the risk and the cost," Kettner said.
"Not only is there an absence of evidence of serious harmful effects, there's very good evidence of the benefits in terms of reducing the rates of dental cavities between 20 and 40 per cent -- which has very significant implications not just for dental health but for general health."
In an e-mail statement to the Free Press, a Health Canada spokesman said the expert panel was struck as part of a periodic review of the science behind complex fluoride issues.
Although the panel concluded there is still little evidence to link excessive fluoride exposure to bone cancer, lower intelligence and reproductive or developmental problems, it also recommended promoting low-fluoride toothpaste for children and lowering the concentration in some baby formulas.
In Winnipeg, mechanical pumps feed an acidic liquid form of fluoride into drinking water. Kelly Kjartanson, manager of environmental standards for the city, said the fluoride level fluctuates, but doesn't exceed the provincial guidelines. Last year, Winnipeg's water averaged 0.85 milligrams per litre of fluoride.
jen.skerritt@freepress.mb.ca
What is fluoride?
A chemical compound that occurs naturally in air, water, soil and almost all foods, and is also released into the environment by fertilizers, aluminum smelting and chemical manufacturing.
Why is it in water?
Many governments and health organizations endorsed the idea of adding fluoride to drinking water decades ago to prevent tooth decay.
What are the risks?
Over the years, there has been a concern that excess fluoride exposure could cause low bone density, cancer, lower intelligence, bone fractures, reproductive and neurological problems. However, Health Canada's expert panel said there is still no evidence to support these concerns.
Excess fluoride can also cause fluorosis, a condition that causes teeth to flake and stain brown.
What can I do to lower my exposure?
Children under six should not use fluoridated mouthwash and parents should make sure that children use no more than a pea-size amount of toothpaste on a toothbrush.
Children who can't spit toothpaste and are therefore in danger of swallowing it should have their teeth brushed by an adult without using any toothpaste.
http://www.winnipegfreepress.com/subscriber/local/story/4206443p-4798732c.html
Concerns over flouride in water
Written by Dianne Colgan and Kristylee Varley
Controversy is erupting over whether too much fluoride can actually be harmful to children.
A panel of experts commissioned by Health Canada recently released recommendations to lower the amount of fluoride added to municipal water and in toothpaste.
Public Health Nurse Sherie Dolmage with the Huron County Health Unit says the most common concern with children and too much fluoride is a condition called dental fluorosis.
It can create white or beige markings on their teeth, but it is strictly a cosmetic problem and doesn't harm the teeth.
Dolmage says Goderich is the only municipality in Huron County that adds fluoride to their water (0.6 milligrams per litre) and the amount is well within the range set out by Health Canada.
As for toothpaste, Dolmage says adults should supervise children under the age of six while they're brushing their teeth and only use a pea-sized amount.
She says children under the age of three should skip the toothpaste all together.
Fluoride is a chemical that helps prevent tooth decay and many municipalities across Ontario and Quebec add it into their drinking water.
The current maximum acceptable concentration is 1.5 milligrams per litre.
Health Canada has stated that they will accept the recommendations of the panel, but implementation will hinge on individual municipalities.
http://www.radioowensound.com/news.php?id=13342
Controversy is erupting over whether too much fluoride can actually be harmful to children.
A panel of experts commissioned by Health Canada recently released recommendations to lower the amount of fluoride added to municipal water and in toothpaste.
Public Health Nurse Sherie Dolmage with the Huron County Health Unit says the most common concern with children and too much fluoride is a condition called dental fluorosis.
It can create white or beige markings on their teeth, but it is strictly a cosmetic problem and doesn't harm the teeth.
Dolmage says Goderich is the only municipality in Huron County that adds fluoride to their water (0.6 milligrams per litre) and the amount is well within the range set out by Health Canada.
As for toothpaste, Dolmage says adults should supervise children under the age of six while they're brushing their teeth and only use a pea-sized amount.
She says children under the age of three should skip the toothpaste all together.
Fluoride is a chemical that helps prevent tooth decay and many municipalities across Ontario and Quebec add it into their drinking water.
The current maximum acceptable concentration is 1.5 milligrams per litre.
Health Canada has stated that they will accept the recommendations of the panel, but implementation will hinge on individual municipalities.
http://www.radioowensound.com/news.php?id=13342
Wednesday, July 30, 2008
Fluorosis In AndhraPradesh
1. What is the history of fluorides and fluorosis in Andhra Pradesh?
1771 AD: C.W. Scheele identified the fluorine element
1886 AD: Henri Moissan isolated the element fluorine
1925 AD: Cristiani and Gautier coined the term fluorosis
1930 AD: Feil mentioned fluorosis in humans as occupational disease
1932 AD:
Moller and Gudjonsson reported cases of skeletal fluorosis from Denmark in Cryolite Miners
1937 AD:
Shortt and his colleagues described the cases of endemic fluorosis from Podili, Darsi and Kanigiri areas of Andhra Pradesh
1945 AD: Daver reported cases of fluorosis from Nalgonda
1955 AD:
Siddiqui described cases of fluorosis from Nalgonda subsequently cases of fluorosis described by others from 18 districts of Andhra Pradesh
2. What are fluorides?
Fluorine as an element was first detected by Scheele in 1771 and was first isolated by Moissan in 1886. Fluorine is a highly reactive element and hence does not occur in free form in nature but it forms compounds with other elements, which are ubiquitous in nature. Fluorides are the 13th commonest element in the earth’s crust and hence present in every thing we eat, drink and breath.
3. What is fluorosis?
Fluorosis is a disease caused by excessive ingestion of fluoride through water and or food. The upper limit of optimum fluoride level in drinking water for a tropical country like India is 0.5 PPM or 0.5 Mg/l. China fixed 0.7 PPM as upper safe limit in drinking water. It is the total daily intake through water and food that determines the development of fluorosis. Nearly all foods contain fluoride and the upper limit of safe total intake of fluoride from water and food per day for an adult is 8 mg.
4.What are the stages of fluorosis?
Fluorosis takes 4 forms dental, genu valgum, skeletal and neurological.
5. What is dental fluorosis and who develops it?
All children living in endemic areas of fluorosis consuming water containing more than 1.5 PPM of fluoride would develop dental fluorosis. Those exposed to excess ingestion of fluoride beyond the age of 10 years would not develop dental fluorosis. Dental fluorosis mainly involves enamel and mottling is one of the earliest recognizable features. Permanent teeth are affected which become rough, opaque and chalky white. Pitting and chipping of the teeth are also same. Brown, black or yellow pigmentation is deposited on the teeth.
6. How does fluoride reduce dental caries?
Firstly fluoride inhibits enzymes that breed acid producing oral bacteria whose acid eats away the tooth enamel. Secondary fluoride ions bind with calcium ions strengthening tooth enamel as it forms in children.
7. What is genu valgum?
These are the deformities of limb bones, which are notably seen in weight bearing lower limbs in children in endemic areas of fluorosis. These occur only in poorly nourished children whose diet is low in calcium intake. These changes are not seen in endemic regions in Punjab and adjacent Rajasthan where intake of dairy products containing calcium is higher. The average amount of calcium in the daily diet of Nalgonda Villager is 300 mg while it is 900 mg in residents of Punjab.
8. How does calcium help?
Calcium is very essential for humans. 99% of calcium in the body is in the bones and it constitutes 2% of body weight. At birth the body content of calcium is 30 grams and in adults it is 1200 grams. 180 milligrams a day should be retained during growth. Calcium binds with fluoride in the GI tract and such a compound is eliminated through the feces. A diet poor in calcium increases body’s retention of fluoride. Fluoride increases bone metabolism and the diets deficient in calcium intake provokes parathyroid hyperactivity. This in turn mobilizes calcium from bone to keep the serum levels, which causes weakening of bones by causing osteoporosis. Weight bearing lower limb bones suffers leading to grotesque deformities. These deformities in lower limb bones are called as ‘genu valgum’ and these are not seen in individuals living in high endemic regions of fluorosis in Punjab since their diet contains adequate calcium. Daily calcium requirements of preschool children are 500-800 milligrams and for adolescents it is 1200-1500 milligrams a day.
9. What is the role of magnesium?
Magnesium has peculiar relationship with fluoride. Magnesium forms 0.05% of body weight and is essential for humans. Magnesium helps in elimination of fluoride from the body by competing with calcium. Daily requirement of magnesium is 350-500 milligrams. Fluorosis incidence is less in villages whole water content of magnesium is high compared to those with lower levels with similar fluoride in drinking waters. Adequate magnesium lessens the fluoride toxicity and vice versa. Hence fluoride supplementation should help in endemic regions.
10. What is the role of vitamin C?
Epidemiological studies of Pandit and his colleagues proved that fluorosis incidence was high in individuals whose diet was poor in vitamin C intake. Daily requirement of Vitamin C is 40 milligrams and vitamin supplementation should be beneficial for individuals living in endemic regions.
11. What is the treatment of genu valgum?
Once these deformities develop, very little can be done to rectify them. These deformities are to be prevented by providing adequate diet containing optimum amounts of calcium in growing children. Milk is a good source of calcium but it is expensive. There are many vegetables which are rich of source of calcium like Thotakura and Chamakura etc.,. The details of the vegetables rich in calcium are given separately.
12. What is skeletal flurosis?
96-99% of fluoride which is retained in the body besides in the bones and hence they suffer. Bony changes occur due to excessive ingestion of fluoride over a long period of time. They manifest with pain and stiffness of the back. Stiffness increases steadily and leads to restriction of back movements. Soon stiffness spreads to various joints of the limb bones. This becomes crippling in people in endemic regions beyond the age of 30 years.
13. What is neurological stage of fluorosis?
This is a late stage of skeletal fluorosis where in spinal nerves and spinal cord are compressed causing paralysis. This is a crippling stage and some of them can only be help them by surgery.
14. What are the beneficial uses of fluoride?
Fluoride is an effective agent for preventing dental caries if taken in ‘optimal’ amounts. The relation ship between fluoride and dental caries was first noted in the early part of the 20th century when it was observed that residents of certain areas of USA developed brown stains on their teeth. These stain teeth though unsightly were highly resistant to dental decay and caries. In the 1930’s it was discovered that the prevalence and severity of this type of mottled enamel was directly related to the amount of fluoride in water. Subsequently it was recognized that fluoride consumption in optimal amounts in the water supply imparted protection against the development of dental caries with out staining the teeth. Hence water fluoridation has been initiated in the water supplies of cities and towns, which are low in fluoride content. Another benefit of fluoride is that the incidence of osteoporosis seems to occur less frequently in regions with high fluoride content in water then those in which the inhabitants consumed little fluoride.
15. What are the benefits and problems with water fluoridation?
Optimum Water Fluoride Concentration & The Fluoridation Controversy
The fluorides are ubiquitous in nature and are present in foods, water, plants, rocks, soil and even air. The main contribution of fluoride to human beings is from water and only in some endemic areas significant amounts also come from food. The relationship between fluoride and dental caries was first noted in the early part of the 20th century when it was observed that residents of certain areas of U.S.A. developed brown stains on their teeth. These stained teeth, though unsightly were highly resistant to dental decay and caries. In the 1930's it was discovered that the prevalence and severity of this type of mottled enamel was directly related to the amount of fluoride in the water. Subsequently it was recognized that fluoride consumption in optimal amounts in the water supply imparted protection against the development of dental caries without staining the teeth. Another benefit of fluorides is that the incidence of osteoporosis seems to occur less frequently in regions with high fluoride content in water than in those in which the inhabitants consumed little fluoride. Although, the importance of this element to normal mineralization of hard tissues and formation of caries resistant enamel has been recognized, there has been as yet been no conclusive evidence proving that it is an essential element for human health. Indeed, the fluoride deficiency syndrome is yet to be described. This may be due to the fact that human body requirement of this micronutrient must be small, which is met with naturally through food and water.
Fluoridation of water supplies was undertaken after careful clinical studies, backed by epidemiological surveys and supplemented by experimental work, which proved beyond doubt that fluoride ingestion through water in optimal levels is beneficial for oral hygiene by reducing the caries incidence and has no proven deleterious effects in human beings. It is also very cost effective. Optimum fluoride concentration is the one at which maximum caries reduction is achieved while limiting dental fluorosis to acceptable levels of prevalence and severity. This knowledge is important for countries intending to begin fluoridation or for those with excessive natural fluoride, which requires partial defluoridation. Water fluoride level of 1PPM was tried first but it was realized that this level might be high for countries with tropical climate. Subsequently, a formula was devised whereby water fluoride concentration could be regulated according to the mean temperature of the region. In recent years it became clear that these standards were not appropriate for all parts of the world. It is accepted that 0.5 PPM is the optimum level in the drinking water sources for India.
Proponents of fluoridation overlook one aspect i.e. the people with renal disease especially those who are on dialysis. Patients with chronic kidney diseases and those on dialysis with fluoridated water run the risk of contacting skeletal fluorosis. These patients and those with transplanted kidneys do excrete fluoride, though in small quantities but they are vulnerable to fluorosis. Hence provision must be made so that dialysate does not contain excess fluoride by improving dialysis membrane and people with kidney disease should be warned about their total daily intake of fluoride and to keep off those foods and beverages, which are rich in fluoride. The opponents of fluoridation seem to be a vocal intellectual group who considers that fluoride is a poison. They attribute all kinds of ailments stating from congenital anomalies, allergic illnesses, repetitive bony injury and fractures, degenerative diseases like Alzheimer to even cancers and their list is endless. If allergy to fluoride present in drinking water is true, it should have been found in billions of people around the world drinking fluoride rich beverage, tea. If it were true of claims of cancers caused by fluorides, such a happening would not have gone unnoticed in millions of people living in endemic regions in India, China etc. Any major carcinogenic effect of heavy fluoride exposure would be unlikely in humans as well as in animals. In support of their claims, opponents of fluoridation produce experimental evidence in animals, which were given very massive doses of fluoride. Rabbits weighing 1 kilogram were fed 50 mg/kg of fluoride for weeks and months while adult humans in endemic regions do not consume more than 20 mg of fluoride a day. Hence the results of such experiments are not tenable.
It is true that there is a need to reduce water fluoride concentration to 0.2-0.4 PPM because of overall increase in intake of fluoride in recent years. This is related to increase of fluoride in food chain, the unintentional use of fluoride containing dental health products and consumption of beverages rich in fluorides. In India there is no need to fluoridate water supplies since such levels of fluoride are found in water supplies all over the country except the northeastern states. There is also no need to supplement fluoride intake by using fluoride rich toothpaste's or other dental products in our country.
5. What is the fluoride content of different sources of water supplies in the endemic regions of Nalgonda district of Andhra Pradesh?
There are three kinds of water sources available namely rainwater, surface water and ground water. Rainwater is clean and ideal for drinking and cooking. Since rainfall is uneven storage becomes a major problem. Large storage reservoirs are needed which are very expensive to build and maintain. Rainwater harvesting in bunds and tanks will help in keeping ground water levels higher. Surface water sources are tanks, dams, canals and rivers. The fluoride content of Nagarjunasagar reservoir and its canals is low and suitable for drinking and cooking since the fluoride content ranges between 0.4-0.5 PPM. Tank waters are usually contaminated with biological and chemical pollutants. Such water should not be used without treatment and disinfection. Fluoride content of tank water is higher than rainwater and is in the range of 1.4 PPM. Rivers are not perennial and their fluoride content varies from 1.0 PPM in Alair vagu to 7 PPM in stream near Sivannagudem. It is surprising that fluoride content river waters in Nalgonda like Peda Vagu, Chandur Vagu, Chinnakaparthi stream, Kodabakshupalli vagu etc are higher and are not suitable for drinking.
Ground water sources are wells and boreholes. Fluoride content of well water can vary greatly depending on the geological structure of the aquifer and the depth at which water is drawn. The fluoride content is unevenly distributed in ground water both vertically and horizontally and hence every sample has to be tested before use. The fluoride content of granite rocks in Nalgonda varies between 325 to 3200 PPM with a mean of 1440 PPM. The fluoride content of soils in this district varies between 28 to1780 PPM. The fluoride content of ground waters in Nalgonda ranges between 0.4 to 20 PPM. The reasons adduced for this high level of fluoride in ground waters of this district are the low calcium content of rocks and soils and the presence of high levels of bicarbonate in soils and waters. Borehole content of fluoride is even higher and they may have abnormal concentrations of trace elements and hence may not be suitable for drinking. If all the sources of waters in the region are not suitable for use one has to consider defluoridation of waters to reduce its fluoride content. The experience with the use of defluoridation plants was not satisfactory in the past. Part of the problem may be poor maintenance due to lack of skilled help and also the cost. The majority of these plants clogs up after sometime and become ineffective in lowering the fluoride content of the water in the long run. Adding alum as done in Nalgonda technique may not be ideal because aluminum is being incriminated in the causation of Alzeimers disease in the west.
Among the three sources of water best is rainwater followed by Nagarjunasagar water supply through canals. Majority of ground waters in this endemic regions are not suitable for human consumption.
17. How to prevent endomic Fluorosis?
Alleviation of endemic Fluorosis - an action plan (Dr.D.Raja Reddy & Dr.Srikanth Deme)
Introduction:
Fluorosis is a disease caused by excessive ingestion of fluoride through water and or food. The upper limit of optimum fluoride level in drinking water for a tropical country like India is 0.5 PPM or 0.5 milligram per liter. The upper limit of safe total intake of fluoride per day for an adult is 8 milligram. It is the total daily intake through water and food that determines the development of fluorosis.
First ever Shortt and his colleagues recorded cases of endemic skeletal fluorosis and its neurological manifestations in the world from Podili, Darsi and Kanigiri areas of Andhra Pradesh in 1937. Next cases of fluorosis have been reported from Nalgonda district of A.P. in 1945. Subsequently cases of fluorosis have been recorded from 18 districts of A.P. It is obvious that fluorosis is a major public health problem in our state.
Biological effect of fluoride intoxication are related to the total amount of fluoride ingested, whatever the source be it food, water or both. The factors, which govern the development of fluorosis, are:
a) The prevalence of high levels of fluoride intake
b) Continued exposure to fluoride
c) Strenuous manual labor
d) Poor nutrition especially deficient intake of calcium, magnesium and vit.C
e) Impaired renal function due to disease
f) Presence abnormal amounts of trace elements like Uranium, Strontium which may aggravate fluoride toxicity.
Fluorosis takes four forms: dental, genu valgum, skeletal and crippling due to compression of the nerves and spinal cord, the later occurring in advanced stages of fluorosis.
Alleviation of fluorosis:
Aim should be to prevent fluorosis wherever possible and to relieve or lessen the suffering of the people in established cases.
Step-1
.
Detection of fluorotic villages and towns
.
AP Villages (28,123) Towns (210)
Check the teeth of school children Brown / Yellow Pigmentation
All children living in endemic areas of fluorosis consuming water containing more than 1.5 PPM of fluoride would develop dental fluorosis. Those exposed to excess ingesion of fluoride beyond the age of 10 years would not develop dental fluorosis.
Step–2
One has to differentiate fluorotic villages and towns into those with low and high endemicity. Low endemicity is those villages, which have only cases of dental fluorosis. In addition if there are cases of Genu valgum, Skeletal and Crippling forms, they should be considered as the villages with high endemicity. Low endemicity cases only need calcium and vitamin supplementation to children and adolescents to prevent Genu valgum deformities occurring.
Step–3
Investigation of cases of High Endemicity.
A) Fluoride estimation of all water sources in every village:
Even in villages with high endemic areas there may be water sources, which are good for drinking according to WHO guidelines. For example – 10 water sources were examined in Yellareddyguda and the results are shown in the table below:
Step–4
B) Trace element estimation of all water sources:
It is very important to know the trace element concentration in water sources of high endemic villages. Out of the 60 trace elements tested in Podili, Darsi and Kanigiri areas about 15 trace elements were in abnormal concentration. Their role in aggravation of fluoride toxicity is not known at present. Some with very high contents should be avoided for drinking purposes.
Step-5
C) Estimate the contribution of water and food to the total daily intake of fluoride:
It is very important to estimate how much fluoride is coming from water and food to the daily intake of fluoride in these villages. For example – in three villages viz., Naibai, Yellareddyguda and Yedavalli of Nalgonda district majority of their fluoride intake came from food. Following tables show the average diet of these villages and the amount of fluoride coming from food and water.
Average daily diet of a villager in Endemic areas
Rice 450 Grams
Pulses 110 Grams
Jowar 200 Grams
Vegetables 200 Grams
Oil 20 Grams
Water 1200 ML
Amount of Fluoride in daily Diet as detailed above
Village
Fluoride in Milligrams
Naibai (2.0 – 6.2 PPM)
75.76
Yellareddyguda (2.6 – 10.0)
54.66
Yedavalli (4.4 – 7.5)
62.20
Note: In brackets are given fluoride levels in water samples of the villages
Average of water fluoride content in 1200 ml of water was calculated. For example – in Naibai fluoride from water 4.92 mg out of 75.76 total.
One has to decide whether water or the food is the predominant fluoride source in individuals residing in endemic areas. Both need safe water supplies but those with predominantly food related fluorosis they also need water for irrigation to lessen the amount of fluoride in the foodstuffs grown in these villages.
Step – 6
Planning the optimum diet content of calcium, magnesium and vitamin-C
As per the treatment of Genu Valgum deformities, which are mainly due to the deficiency of calcium and probably of magnesium and vitamin C, their supplementation becomes mandatory. It is easy to get enough calcium by drinking milk which is very expensive hence local food should be selected which have high content of these elements. Tablets containing optimum amounts of calcium for a growing child, magnesium and vit.C may be a practicable solution.
An outline of the overall management is given below:
Summary of Management
* Provide surface water from nearby dams if any.
* Harvest rainwater.
* Look for sources of water, which are good as per WHO guidelines for drinking and cooking.
* Provide nutritious food to children and adolescents preferably from local foodstuffs.
* Need to establish a laboratory to estimate Fluoride levels in every district. This laboratory should be within easy reach of villagers.
* Setup a major laboratory to estimate trace elements and Fluoride levels in Foodstuffs. There is also a need to have a ward for studying the fluorosis cases. This ward must be attached to a major hospital like NIMS.
http://www.fluorosisinandhra.org/faqs_page.htm
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