Curse of Fluorosis
- 475 Downloads
Fluoride was identified to have caries preventive properties and was widely used for fluoridation of water since 1940, especially in developed countries. After this there was sudden increase in the use of fluorides in food items and in oral medicinal products like toothpastes and mouth washes. Inadvertent use of above has lead to increase in fluorosis as a public health problem. In many places high fluorides are naturally present in earth crust leading to high water fluoride content increasing the risk of fluorosis. Maintaining a fine balance of fluorides in the body is mandatory for exploiting its advantages. World Health Organization (WHO) has fixed permissible limit of fluorides in water to 1.5 mg/L as a preventive step to contain fluorosis. Fluorosis has three clinical components: Dental, Skeletal and Non-Skeletal Fluorosis. It occurs with increasing level of fluorides in the body. Acute toxicity due to fluorides is also known and occurs as a result of sudden exposure to high levels of fluorides, usually by ingestion. Once fluorosis occurs it is irreversible without any cure. Only symptomatic and supportive management is possible. Hence prevention is the mainstay of management. Prevention is by using alternative sources of water or its de-fluoridation. National Program for Prevention and Control of Fluorosis (NPPCF) was launched in 2008–9 to identify areas with high fluoride content of water, manage the water bodies, screen schools and community for fluorosis and comprehensive management of cases. Improving quality of drinking water as per standards and improving nutritional status of children are also important components of prevention of fluorosis.
KeywordsFluoridation Anthropogeny Fluoride toxicity Fluoroapatite
The authors acknowledge Prof Kushal K Das for his valuable guidance.
MMP drafted the article. BBL revised the draft critically for important intellectual content, made a contribution to the concept and design. SSP edited and helped with the article. All authors approved the final manuscript. MMP will act as guarantor for the paper.
Compliance with Ethical Standards
Conflict of Interest
- 1.Peterson PE. The world oral health report 2003: continuous improvement of oral health in the 21st century – the approach of the WHO global oral health program. Geneva: World Health Organization; 2003. Available at: http://www.who.int/oral_health/media/en/orh_report03_en.pdf. Accessed 13 July 2017.
- 2.Permissible limits of fluoride in drinking water prescribed by various organization. Hydrology and water resources information system for India. Available at: http://www.nihrookee.gov.in/rbis/india_information/fluoride,htm. Accessed 12 July 2017.
- 5.Tewari A, Dubey A, Chaturvedi MK. Assessment of exposure, intake and toxicity of fluoride from ground water sources. Rasayan J Chem. 2012;5:199–202.Google Scholar
- 6.World Health Organization. Guidelines for drinking water quality, 3rd ed. Geneva: WHO; 2004. Available at: http://www.who.int/water_sanitation_health/dwq/GDWQ2004web. Accessed 12 July 2017
- 7.Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India. National program for prevention and control of fluorosis (nppcf) revised guidelines (2014). Available at: http://www.mohfw.nic.in/WriteReadData/l892s/569857456332145987456.pdf. Accessed on 10 July 2017.
- 8.Ugran V, Desai NN, Chakraborti D, et al. Groundwater fluoride contamination and its possible health implications in Indi taluk of Vijayapura district, Karnataka, India. Environ Geochem Health. 2016. Available at: https://link.springer.com/article/10.1007/s10653-016-9869-2; Accessed 11 July 2017
- 9.Jha SK, Mishra VK, Sharma DK. Damodaran T. Fluoride in the environment and its metabolism in humans. Reviews of Environmental Contamination and Toxicology, vol. 211. New York: Springer; 2011. p. 121–42.Google Scholar
- 10.World Health Organization. Guidelines for Drinking-Water Quality, 4th ed. Geneva: WHO; 2011. p. 94–373.Google Scholar
- 13.Kebede A, Retta N, Abuye C, et al. Dietary fluoride intake and associated skeletal and dental fluorosis in school age children in rural Ethiopian Rift Valley. Int J Environ Res Public Health. 2016;13:756.Google Scholar
- 16.Chaudhry M, Prabhakar I, Gupta B, Anand R, Sehrawat P, Thakar SS. Prevalence of dental fluorosis among adolescents in schools of Greater Noida, Uttar Pradesh. J Indian Assoc Public Health Dent. 2017;15:36–41.Google Scholar
- 18.Thangapandiyan S, Prabu SM. Molecular mechanism of fluoride induced oxidative stress and its possible reversal by chelation therapy. RRJoT. 2013;3:1–19.Google Scholar
- 19.Shanthi M, Thimma Reddy BV, Kohli S. Health impact to different concentrations of fluoride in drinking water of South India. Int J Sci Stud. 2014;2:2–5.Google Scholar
- 20.Gupta SK. Fluorosis. In: Gupta P, Menon PSN, Ramji S, Lodha R, editors. PG Textbook of Pediatrics, 1st ed. New Delhi: Jaypee Brothers; 2015. p. 873–8.Google Scholar
- 21.Peter S. Dental Fluorosis. Essentials of Preventive and Community Dentistry, 4th ed. New Delhi: Arya Publications; 2006. p. 279–371.Google Scholar
- 22.Meena C, Toteja GS, Bala K, Mohanty SS. Prevalence of dental, skeletal and non-skeletal fluorosis in children of Jaipur district of Rajasthan. Indian J Appl Res. 2016;6:8–11.Google Scholar
- 23.Roy S, Dass G. Fluoride contamination in drinking water – a review. Resources Environ. 2013;3:53–8.Google Scholar
- 25.Goenka P, Marwah N. Fluorides. In: Marwah N, editor. Textbook of Pediatric Dentistry, 3rd ed. New Delhi: Jaypee Brothers; 2014. p. 344–7.Google Scholar
- 26.Susheela AK. Ministry of Rural Development, India. Rajiv Gandhi National Drinking Water Mission. Prevention and control of fluorosis. New Delhi: Health aspects; 1993. p. 77–82.Google Scholar
- 27.Ministry of Health and Family Welfare, Govt. of India. Operational guidelines for National Oral Health Programme; 2012. Available at: www.mohfw.nic.in. Accessed 10 July 2017.
- 28.National Health Portal, India. Available at: https://www.nhp.gov.in/disease/non-communicable-disease/fluorosis. Accessed 12 July 2017.
- 29.Piddennavar R, Krishnappa P. Review on defluoridation techniques of water. Int J Eng Sci. 2013;2:86–94.Google Scholar
- 30.Razbe N, Kumar R, Pratima, Kumar R. Various options for removal of fluoride from drinking water. Int Organ Sci Res J Appl Phys. 2013;3:40–7.Google Scholar