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Endemic Fluorosis

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Endemic Disease in China

Part of the book series: Public Health in China ((PUBHECH,volume 2))

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Endemic fluorosis refers to that individuals living in a region characterized by high levels of fluorine in the drinking water; food and/or air are thereby exposed to excessive amounts of this ion that resulted in general chronic accumulated fluorosis among many of them. In addition to its typical dental and skeletal symptoms, fluorosis extensively damages the whole body, including the brain, liver, kidney, heart, thyroid, etc. The three types of endemic fluorosis resulting from drinking water, coal-burning, or drinking tea types have been identified in China that affect 130 million people, and for these years, this situation has been addressed by key national programs for research, prevention, and treatment supported by the Chinese government. Through the admirable efforts of scientific researchers and medical professionals, the causes, epidemiology, pathological impairment, and pathogenesis of endemic fluorosis are now basically understood. Importantly, the strategy of prevention and control to the disease has been carried out successfully. Thus, endemic fluorosis has been effectively controlled in China, and the prevalence of both dental and skeletal fluorosis has been significantly reduced.

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  1. Fawell J, Bailey K, Chilton J, Dahi E, Fewtrell L, Magara Y. Fluoride in drinking-water. London: World Health Organization, IWA; 2006.

    Google Scholar 

  2. Black GV, McKay FS. Mottled teeth: an endemic developmental imperfection of the enamel of the teeth heretofore unknown in the literature of dentistry. Dent Cosmos. 1916;58(01):129–56.

    CAS  Google Scholar 

  3. Shortt HE, McRobert GR, Barnard TW, Nayar ASM. Endemic fluorosis in the Madras presidency. Indian J Med Res. 1937;25:553–68.

    CAS  Google Scholar 

  4. Lyth O. Endemic fluorosis in Kweichow, China. Lancet. 1946;247(6390):233–7.

    Article  Google Scholar 

  5. Wei ZD, Zhou LY, Bao RC. Endemic food-borne fluorosis in Guizhou, China. Fluoride. 1981;14(2):91–3.

    Google Scholar 

  6. Zheng B, Wu D, Wang B, Liu X, Wang M, Wang A, Xiao G, Liu P, Finkelman RB. Fluorosis caused by indoor coal combustion in China: discovery and progress. Environ Geochem Health. 2007;29(2):103–8.

    Article  CAS  Google Scholar 

  7. Guan ZZ, Yang PS, Pan S, Yu LD. An experimental study of blood biochemical diagnostic indices for chronic fluorosis. Fluoride. 1989;3(2):112–5.

    Google Scholar 

  8. Guan ZZ, Xiao KQ, Zeng XY, Long YG, Cheng YH, Jiang SF, Wang YN. Changed cellular membrane lipid composition and lipid peroxidation of kidney in rats with chronic fluorosis. Arch Toxicol. 2000;74(10):602–8.

    Article  CAS  Google Scholar 

  9. Gao Q, Liu YJ, Guan ZZ. Oxidative stress might be a mechanism connected with the decreased alpha 7 nicotinic receptor influenced by high-concentration of fluoride in SH-SY5Y neuroblastoma cells. Toxicol In Vitro. 2008;22(4):837–43.

    Article  CAS  Google Scholar 

  10. Guan ZZ, Wang YN, Xiao KQ, Dai DY, Chen YH, Liu JL, Sindelar P, Dallner G. Influence of chronic fluorosis on membrane lipids in rat brain. Neurotoxicol Teratol. 1998;20(5):537–42.

    Article  CAS  Google Scholar 

  11. Gao YH, Sun DJ, Zhao LJ, An D, Deng JY, Yang XJ, et al. Division of endemic fluorosis areas. The State Standard of the People’s Republic of China, GB17018–2011.

    Google Scholar 

  12. Sun DJ. Endemiology. Beijing: People’s Medical Publishing Press; 2011.

    Google Scholar 

  13. Sun DJ, Gao YH. Endemic fluorosis prevention manual. Beijing: People’s Medical Publishing Press; 2012.

    Google Scholar 

  14. COWI. Review of practical experience with defluoridation of rural water supply programmes part 11. Copenhagen: Ministry of Foreign Affairs, Danida; 1998. 73 pp.

    Google Scholar 

  15. Dahi E. Contact Precipitation for defluoridation of water. Paper presented at 22nd WEDC Conference, New Delhi, 1996; September 9–13, 1996.

    Google Scholar 

  16. Dahi E. Small community plants for low cost defluoridation of water by contact precipitation. In Proceedings of the 2nd International Workshop on Fluorosis and Defluoridation of Water, Nazareth, November 19–22, 1997.

    Google Scholar 

  17. Fink GJ, Lindsay FK. Activated alumina for removing fluorides from drinking water. Ind Eng. 1936;28(9):947–8.

    Article  CAS  Google Scholar 

  18. Moges G, Zwenge F, Socher M. Preliminary investigations on the defluoridation of water using fired clay chips. J Afr Earth Sci. 1996;21(4):479–82.

    Article  Google Scholar 

  19. An D. The picture anthology about control of endemic fluorosis caused by burning coal. Guizhou: Guizhou Science and Technology Press; 2012.

    Google Scholar 

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Correspondence to Zhizhong Guan .

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Guan, Z., Wang, L., Sun, D. (2019). Endemic Fluorosis. In: Sun, D. (eds) Endemic Disease in China. Public Health in China, vol 2. Springer, Singapore.

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-2528-1

  • Online ISBN: 978-981-13-2529-8

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