Fluorosis Control Research Articles

Assessment of knowledge, attitude and practice towards fluorides and fluorosis among rural people in fluoride endemic region of Kondagaon, Central India

Background: Fluoride has advantages but acts as a toxin if consumed in excess. It interferes with the normal process of enamel as well as bone formation leading to an increased risk of dental and skeletal fluorosis. This study was aimed to assess the knowledge, attitude and practices related to fluoride and fluorosis among the residents of fluoride endemic villages of Kondagaon, Central India.Methods: The study was carried out among 600 individuals aged 5 years and above. Each village was considered as a cluster. The number of participants from each village was determined based on proportionate sampling following which households in each village were selected based on systematic random sampling.Results: Among the participants one-fourth of the total participants (26%) had heard the term fluorosis, less than one-fourth (23.3%) responded that fluorosis is preventable, while more than three-fourths (77.7%) had no knowledge about fluoride prevention and mitigation programs of government. Also, the attitude of more than two-third of the individuals (70.3%) is negative towards the fluorosis control program.Conclusions: The knowledge, attitude and practices of the study were found to be very low. This suggests that more efforts have to be made at the grass-root level for creating awareness.

Expounding on the concerns of indian politicians regarding fluorosis: A qualitative analysis of parliamentary questions on fluorosis over two decades.

Fluorosis is a major public health problem in India affecting nearly 20 states. Despite more than three decades of fluorosis prevention efforts, fluorosis continues to be a widely prevalent disease in India. The debilitating effects of skeletal fluorosis are well documented and pose a serious health risk to people who consume excess fluoride. In order to understand whether fluorosis was being given importance as a public health problem by elected politicians, we analyzed parliamentary questions posed in both the houses of the Indian parliament during the question hour. Thematic analysis revealed three major themes, namely health hazards, fluorosis control, and magnitude of fluorosis. The analysis revealed that politicians have posed questions regarding all the aspects that are necessary for fluorosis control in India. However, we have identified the certain key issues which have to be improved and certain obligations that the Government of India has to fulfill for successful fluorosis mitigation in India.

Dental fluorosis of children aged 8-12 in diseased areas in Xi’an City from 2014 to 2018

Objective To evaluate the dynamic prevalence of dental fluorosis of children and levels of fluoride in drinking water after improvement of water in Xi’an City, to provide scientific basis for water fluoridation improvement. Methods A total of 35 fluorosis endemic villages were selected as fixed monitor sites in 2014-2018, the ways of water improvement were surveyed, water fluorine content were detected and the prevalence of dental fluorosis in children aged 8 to 12 years were examined. Results Rates of excess fluoride in drinking water from 2014 to 2018 were 22.86%, 14.29%, 11.43%, 11.43% and 8.57%, the difference were significant ( χ 2 = 16.44, P <0.01).The dental fluorosis detection rates of children aged 8 to 12 years were 20.89%, 18.22%, 17.46%, 18.13% and 16.76% in 2014-2018 which showed a obvious descending trend by year ( χ 2 = 10.02, P <0.01). The detection rate of dental fluorosis in children aged 8 and 9 years showed a decreasing trend by year ( χ 2 = 6.53, 4.54, P <0.05). The difference of total rate of dental fluorisis, rate of mild cases rate of moderate-to-severe cases were statistically between the villages without qualified water and the villages with normal fluorine water ( χ 2 = 179.22, 167.93, 10.35, P <0.01). The rate of detection in the villages with the water fluorine exceed standard in 2014-2018 showed a declining trend year by year ( χ 2 = 28.50, P <0.01). The detection rate were significant different across water improvement methods ( χ 2 = 197.76, P <0.01). Detection rate of dental fluorosis decreased from 2014 to 2018 in the areas with municipal water supply showed a decreasing after year ( χ 2 = 12.16, P <0.01). Conclusion The improvement of municipal water supply shows significant effects on water fluorosis control, the detection rate of water fluoride and children’s dental fluorosis in some villages with the other ways of water improvement are still higher than expected, the continuously monitor of fluoride content in water and dental fluorosis in children should be strengthened. 【摘要】 目的 动态监测西安市饮水型氟中毒病区改水后水氟和儿童氟斑牙病情变化趋势,为改水降氟提供科学依据。 方法 2014—2018年在西安市选择 10 个区县的 35 个病区村作为固定监测点,调査改水方式、水氟含量和 8~ 12岁儿童氟 斑牙病情。 结果 2014—2018 年病区村水氟含量超标率分别为 22.86%, 14.29%,11.43%, 11.43%和 8.57%,差异有统计学 意义( χ 2 = 16.44, P <0.01)。各年度间 8~12岁儿童氟斑牙总检出率依次为 20.89%, 18.22%, 17.46%, 18.13%, 16.76%,且呈 逐年下降趋势( χ 2 趋势 = 10.02, P <0.01)。 8,9岁组儿童氟斑牙检出率各年度间比较,呈逐年下降的趋势( χ 2 趋势 值分别为 6.53, 4.54, P 值均<0.05)。水氟含量超标村儿童氟斑牙总检出率、轻度及以下、中度及以上检出率与水氟含量合格村比较,差异 有统计学意义( χ 2 值分别为 179.22,167.93,10.35, P 值均<0.01)。水氟含量超标病区村各年度间的氟斑牙检出率呈逐年 下降趋势( χ 2 趋势 =28.50, P <0.01)。市政供水、低氟井与除氟处理 3 种改水方式儿童氟斑牙检出率差异有统计学意义( χ 2 = 197.76, P <0.01)。市政供水各年度间儿童氟斑牙检出率呈逐年下降趋势( χ 2 趋势 = 12.16, P <0.01)。 结论 市政供水改水降 氟效果显著,其他改水方式仍有部分病区村水氟及儿童氟斑牙检出率未达标,应继续加强改水后水氟含量和儿童氟斑牙病 情监测。

Effect of Endemic Fluorosis on Cognitive Function of School Children in Alappuzha District, Kerala: A Cross Sectional Study.

Background:Exposure to high fluoride levels in drinking water can lead to a number of adverse effects in children, including cognitive dysfunction. Despite being endemic for fluorosis, studies on its effect on the cognitive function of children are lacking in Kerala.Aims:The aim of this study was to compare the cognitive function of school children with fluorosis with that of normal children and to correlate between the severity of dental fluorosis and cognitive function.Settings and Design:Cross-sectional study, conducted in collaboration with the National Fluorosis Control Programme, among school children in Alappuzha district, Kerala.Methods:Children aged 8–10 years, studying in 2 lower primary schools in Alappuzha district with confirmed fluorosis were selected, and compared with healthy age- and sex-matched children from the same school. Raven's Standard Progressive Matrices and MISIC digit span subtest were used to assess the cognitive function.Statistical Analysis:Continuous variables were assessed by independent samples t test and categorical variables by Chi-square test. The relationship between severity of dental fluorosis and grade of cognitive impairment was assessed using Spearman's correlation.Results:There were 60 children each in fluorosis and control groups. The mean age of the children was 8.95 ± 0.50. Only 15% of the children with fluorosis scored Grade I and II Raven's SPM grades (Intellectually superior/above the average) versus 30% in the control group. None of the children without fluorosis scored Grade V (intellectually impaired) category versus 20% in the fluorosis group. The mean digit span was significantly higher in the control group. A strong positive correlation between severity of dental fluorosis and Raven's SPM grades was found (Spearman's correlation coefficient = 0.740).Conclusions:Fluorosis is associated with impaired cognition in children. There is a positive correlation between severity of dental fluorosis and the grade of cognitive impairment.

Prevention & control of fluorosis & linked disorders: Developments in the 21st Century - Reaching out to patients in the community & hospital settings for recovery.

The review on fluorosis addresses the genesis of the disease, diagnostic protocols developed, mitigation and recovery through nutritional interventions. It reveals the structural and functional damages caused to skeletal muscle and erythrocytes, leading to clinical manifestations in fluorosis. Hormonal derangements resulting in serious abnormalities in the health of children and adults are discussed. Fluoride toxicity destroys the probiotics in the gut, resulting in vitamin B12 depletion, an essential ingredient in haemoglobin (Hb) biosynthesis. The article provides an overview of National Technology Mission on Safe Drinking Water and its contributions to fluorosis control. National Programme for Prevention and Control of Fluorosis is presently in operation in India and its focus cited. Major emphasis has been laid on a variety of disorders surfacing in India due to fluoride toxicity/fluorosis as ‘fluorosis-linked disorders’, viz. anaemia in pregnancy, schoolchildren, thyroid hormone abnormalities, hypertension, iodine deficiency disorders/goitre, renal failure and calcium+vitamin D-resistant rickets in children. The major action taken by the Indian Council of Medical Research (ICMR), Government of India in establishing a Centre of Excellence for Fluorosis Research in India and its contributions are highlighted.

Neglected health literacy undermining fluorosis control efforts: A pilot study among schoolchildren in an endemic village of rural Rajasthan, India.

Background:Ingestion of excess fluoride can cause fluorosis which adversely affects teeth and bones. Fluorosis is a major public health problem in the state of Rajasthan with all its 32 districts having variable fluoride contamination, and many initiatives are currently implemented in this region to mitigate the fluorosis burden.Objective:The objective of this study was to assess fluorosis, its risk factors, and the awareness among school students and teachers in endemic villages of Jodhpur district, Rajasthan.Materials and Methods:A representative sample of 300 students of age 12–15 years were enrolled for cross-sectional study in selected villages. Data were collected regarding awareness, behavioral and preventive practices about fluorosis and clinical assessment and fluoride estimation in water and urine samples was done.Results:Dental fluorosis through Dean's index was observed in 24.5% of students. The awareness and practices for fluorosis prevention and its risk factors were poor among both students and teachers. Intake of piped water supply was reported by majority of students (95.8%). High fluoride concentration was found in 35 (81.3%) out of 43 urine samples.Conclusion:Improvement in drinking water supply in the endemic village of Rajasthan has decreased the burden of fluorosis, but low level of awareness and prevailing dietary and behavioral practices still pose them at risk of high fluoride intake. This signifies the need to address nonconventional sources of fluoride intake (diet and toothpaste) and early screening of disease by involving teachers and family physicians in fluoride mitigation efforts.

Low-fluoride Toothpastes May Not Lead to Dental Fluorosis But May Not Control Caries Development. Standard Fluoride Toothpastes Can Control Caries Development But May Lead to Dental Fluorosis

Article title and bibliographic information Effects of low and standard fluoride toothpastes on caries and fluorosis: systematic review and meta-analysis. Santos APP, Oliveira BH, Nadanovsky P. Caries Res 2013;47(5):382-90. Reviewers Marilia Afonso Rabelo Buzalaf, PhD, Cristiane de Almeida Baldini Cardoso, PhD, Ana Carolina Magalhaes, PhD Purpose/Question The authors attempt to study the effect of low-dose and standard fluoride toothpastes on caries and fluorosis development Source of funding Santos received a PhD scholarship from the Research Support Foundation of the State of Rio de Janeiro (FAPERJ) ( E-26/101.250/2008 ); B.H. Oliveira receives financial support from FAPERJ ( E-26/102.248/2009 ) and P. Nadanovsky receives financial support from the Brazilian National Research Council (CNPq) (grant No. 310807/2009-3 ) Type of study/Design Systematic review with meta-analysis of data Level of evidence Level 2: Limited-quality, patient-oriented evidence Strength of recommendation grade Grade B: Inconsistent or limited-quality patient-oriented evidence

Analysis on the present running status of water-improving project in Anda city,Heilongjiang province in 2008

Objective To understand the running status and distribution of water-improving pmjects in Anda city.Methods The running and management of the water-improving projects were investigated and located the position by Global Positioning Systerm(GPS)in Anda city.Results Among 317 water-improving projects,16.09%were either long-term projects or in poor management or had already stopped usage,77 projeets were broken,accounting for 24.29%;all inadequate supply of equipment and pipeline,83 projects had never been started,accounting for 26.18%;now,106 projects were running,accounting for 33.44%.In only 46 projects,the water fluoride concentration was lower than 1.00 mg/L,accounting for 14.51%,as a result 36 thousand people benefited.Conclusions The running status of water-improving projects was unacceptable,most of them stopped running and endemic fluorosis control was still severe in Anda city. Key words: Fluorides; Drinking; Data collection

Investigation on status of endemic fluorosis control in Gansu province in 2006

Objective To understand distribution of the endemic fluorosis areas and running status of water-improving defuoridation projects in Gausu province. Methods In 2006, Gansu province endemic fluorosis areas, the content of fluoride in drinking water was measured in villages where water was not improved, running status of delluoridation projects was investigated and the content of fluoride in drinking water were determined in villages where water was improved. Dental fluorosis and skeletal fluorosis prevalence were examined in children in identified high-fluorlde villages. The fluorine content in drinking water was determined by F-ion selective electrode, dental fluorosis of children was diagnosed using Dean method, and adults skeletal fluorosis was diagnosed according to National Standard for Clinical Diagnosis of Endemic Skeletal Fhiorosis (GB 16396-1996). Results Water samples were examined in 1997 villages of 26 countries, among which water fluoride content was higher than 1.0 mg/L in 598 villages, accounting for 29.94%(598/1997). All 1215 water-improving and defluoridation projects had been investigated, among which 94.90%(1153/1215) of the projects were functioning well, and intermittent and abandoned projects accounted for 2.96%(36/1215) and 2.14%(26/1215). Mean fluoride of treated water of 1084 water-improving and defluoridation projects had water fluoride content ≤ 1.0 mg/L, accounted for 90.79%(1084/1194) ; mean fluoride of water from 1068 water-improving and defluoridation projects had water fuoride content ≤ 1.0 mg/L, accounting for 91.75%(1068/1164). Total 86 390 children of 8 to 12 year-old were examined, the detectable rate of dental fluorosis was 22.47%(19 414/86 390) and 142 211 adults above 16 year-old were examined, the detectable rate of skeletal fluorosis was 4.20%(5967/142 211). Conclusions Some villages yet have water fluoride content exceeding the standard. Some projects are abandoned and running badly, leading to fluoride content exceeding the standard. In a few areas, the prevalence of children dental fluorosis and adult skeletal fluorosis still exists in Gansu province, the task of prevention and control for endemic fluorosis is still arduous. We must raise the effect of prevention and treatment of this disease. Key words: Drinking; Fluorides; Fluorosis, dental; Ostcofluorosis; Data collection

Endemic fluorosis surveillance in Qinan County of Gansu Province from 2004 to 2007: an outcome analysis

Objective To investigate the prevalence of endemic fluorosis and the progress acchieved through control measures in Taian County of Gansu Province so as to provide basis and technique support for endemic fluorosis control. Methods The survey was carried out according to the National Surveillance Scheme of Endemic Fluorosis. Fulfillment of control measures and the quality of water improving projects were surveyed. Samples of household water and urine in children aged 8-12 years were collected and fluoride content was detected by iron selective electrode method. Children's dental fluorosis were examined with Dean method. Results In Qinan County, water was improved in a rate of 100%. In water-improving and defluoridation projects investigated, 81.15% (99/122) projects worked well, 18.85% (23/122) projects were closed or abandoned. The number of water improvement projects monitored were 24,81,9,8,respectively in the year through 2004 to 2007, revealing 13 projects having water fluorine content(>1.0-2.0 mg/L) in 2004, 15 and 5 projects having water fluorine content higher that 1.0-2.0 and 2.0-4.0 mg/L respectively in 2005, 2 projects having water fluorine content(>1.0-2.0 mg/L) in 2006, and no projects above 4.0 mg/L. In Anfu Village, the fluorine content of source and drinking water were all below 1.0 mg/L in 2006 and 2007. The urinary fluoride content of 8-12 years old children was equal and higher than 1.5 mg/L, dental fluorosis rate was 34.47% (354/1027), and dental fluorosis index was 0.65 in 2004-2007. Conclusions Projects running out of status and excessive levels of water fluorine are frequently seen, dental fluorosis is not controlled in Taian County of Gansu Province Key words: Drinking; Fluoride poisoning; Surveillance

Investigation on water fluoride content and water-improving defluoridation projects in endemic fluorosis areas in Jining City, Shandong Province in 2005

Objective To investigate water fluoride content and the current status of water-improving project in Jining,Shandong Province in 2005.Methods Water fluoride content and the status of water-lmprovlng project were havestigated in Bencheng Ditrict,Liangshan and Jiaxiang Couties of Jining City.The fluoride content in drinking warer was assessed by F-ion selective electrode.Results Water fluoride contents of 671 fluorosis villages were determined.One hundred and seventy villages had water fluoride content less than or equal to 1.00 mg/L(accounting for 25.34%)and 501 villages water fluoride content higher that 1.00 mg/L(accounting for 74.66%),with the highest being 11.33 mg/L.Four hundred and ninty.seven projects were surveyed,in which 161 Projects were discarded (accounting for 32.39%),334 projeets worked well(accounting for 67.20%),and 2 pmjects worked fitfully(accounting 0.40%).Two hundreds and eighty-one projects had water fluoride content≤1.00 ms/L and 55 projects had water fluofide cantent>1.00 mg/L(aceounting for 26.82%),with the highest being 4.28 ms/L.Conclusions The situation of endemic fluorosis control is still serious in Jining City.Countermeasures for endemic fluorosis must be carried out as sppm as possible and surveillance of water-improving and defluoridation projects must be strevIsthend. Key words: Dringking water; Fluoride poisoning; Engineering; Epidemiologic studies

Outcome analysis of endemic fluorosis control in Guangxi in 2006

Objective To investigate the distribution of water fluoride and the status of water-improving defluoridation projects,thus to explore the condition of endemic fluorosis in Guangxi Province.Methods According toThe National Technical Scheme for Endemic Disease Contml in 2005,the fuorine content in water Was determined by F-ion selective electrode,children's dental fluorosis was checked by Dean method.and the skeletal fluorosis was checked by the standard of clinical scale of skeletal fluorosis.Results 305 water samples in 61 villages were examined,among which 71 waters were exceeded the standard,accounting for 23.28%(71/305).The projects of defluoriding drinking water were running well except one was discarded.The prevalence of dental fluorosis was 13.55%(356/2627),the prevalence of skeletal fluorosis was 4.02%(65/1615).Conclusions The situation of endemic fluorosis control is not optimistic in Guangxi,which needs fuaher prevention and controls. Key words: Endemic diseases; Fluoride poisoning; Water

Expression of c-fos and Caspase 8 in cerebral cortex of rats with experimental fluorosis

Objective To explore the effects of chronic fluorosis on neurons in the cerebral cortex of rats,and to provide some morphological evidence of damage in the central nervous system induced by chronic fluorosis.Methods Male Wistar rats 40 days after birth were fed with high fluoride contented water(100 mg/L)for inducing chronic fluorosis.Immunocytochemistry and in situ hybridization were used to detect c-fos and Caspase 8 at cerebral cortical neurons respectively.Results c-fos positive cells rate and gray scale in the cerebral cortex of chronic fluorosis were 35.8%and 0.2756±0.0241,respectively,and that of control group were 32.1%and 0.2774±0.0331with statistical difference(χ2=0.305,t=0.826,P＞0.05).Caspase 8 positive cells rates of fluorosis group and control group were 18.7%and 14.1%,respectively,the difference being statistically significant(χ2=0.419,P＞0.05).The gray scale of fluorosis group and control group were 0.3874±0.0329 and 0.3884±0.0323,respectively,the difference being statistically significant(t=0.641,P＞0.05).Conclusion Chronic fluorosis had no significant influence on apoptosis of cerebral cortical neurons. Key words: Fluoride poisoning; Neurons; Immunohistochemistry; In situ hybridization

Outline of control practice of endemic fluorosis in China

Endemic fluorosis is prevalent in China covering 29 provinces, municipalities and autonomous regions. The endemically affected areas can be divided, according to the sources of fluoride, into three types: high fluoride water, pollution from coal burning, and drinking brick tea in excess. Since the 1960's, several pilot surveys of the disease have been made and control programmes carried out in some of the areas. An Expert Consultation Committee on Endemic Fluorosis Control of the Ministry of Public Health was formally established in 1979. A national survey programme and series of working criteria for the disease were drawn up at the First National Congress of Endemic Fluorosis Control in 1981. Under the Central Government of China, administrative organizations and institutions concerned at all levels have been set up, forming a nation-wide network of control. Cooperation and coordination among such departments as health, water conservancy, geology and finance have been achieved in the planning and implementation of control programmes. Since 1980, many projects for improving drinking water quality through de-fluoridation have been completed. At the same time, new methods and technologies for improving stove and grain baking have become widely used in some of the areas where environmental fluoride pollution exists from burning coal. After all the control programmes had been introduced, the incidence of the illness was reduced with some patients making a complete recovery.