Prevalence Of Skeletal Fluorosis Research Articles

Health risk modeling and risk factors of fluorosis in the fluoride endemic village of Maharashtra: A cross-sectional study.

Fluorosis, a debilitating disease, causes dental mottling and bone deformities among other adverse health effects. The current epidemiological study focused on the prevalence and risk factors of fluorosis in the fluoride endemic village, Dongargaon, Maharashtra, India. The clinical diagnosis of subjects showed 96.49% prevalence of dental fluorosis, and 63.16% prevalence of skeletal fluorosis. Duration of exposure, age of subjects and physiological symptoms like chronic joint pain were found to be significantly correlated with skeletal fluorosis (p < 0.05). Fluoride in drinking water showed seasonal variation with highest level in winter (6.54 mg/L) and lowest level in monsoon (0.54 mg/L). Consequently, the mean urinary fluoride concentration was also highest in winter (9.37 mg/L) and lowest in monsoon (3.88 mg/L). Multilogit regression analysis demonstrated that subjects excreting urinary fluoride above 4 mg/L had 7.25 times higher odds of developing skeletal fluorosis (p < 0.05). Health risk assessment showed a high value of hazard quotient, indicating a high probability of adverse health effects. The estimated daily ingestion of 8.80 mg F and a predicted bone uptake of 0.19 mg/kg/day raised significant health concerns for the studied population. Exposure and bone F uptake modeling suggested that the predicted mean fluoride concentrations of 4018.77 ± 1762.45 mg/kg bone ash in asymptomatic, and 5535.12 ± 1526.30 mg/kg bone ash in symptomatic subjects were significantly different (p < 0.05). The comprehensive risk evaluation in the study clearly brings out the high risk of fluoride exposure and adverse effects in Dongargaon village for the first time. Further, urinary fluoride was shown to have significant association with the risk of skeletal fluorosis. The study warrants implementation of immediate control measures at the study site.

Association of PPARGC1A gene polymorphism and mtDNA methylation with coal-burning fluorosis: a case–control study

BackgroundCoal-burning fluorosis is a chronic poisoning resulting from the prolonged use of locally available high-fluoride coal for heating and cooking. Prolonged fluoride exposure has been demonstrated to decrease PPARGC1A levels. Therefore, this case-control aims to evaluate the genetic association of PPARGC1A gene polymorphisms and methylation of the mitochondrial D-loop region with coal-burning fluorosis.ResultThe results showed that the TT genotype at rs13131226 and the AA genotype at rs1873532 increased the risk of coal-burning fluorosis (OR = 1.84, P = 0.004; OR = 1.97, P = 0.007), the CT and CC genotypes at rs7665116 decreased the risk of coal-burning fluorosis (OR = 0.54, P = 0.003). The TT genotype at the rs2970847 site and the AA genotype at the rs2970870 site increase the risk of developing skeletal fluorosis (OR = 4.12, P = 0.003; OR = 2.22, P = 0.011). Haplotype AG constructed by rs3736265-rs1873532 increased the risk of the prevalence of coal-burning fluorosis (OR = 1.465, P = 0.005); CG decreased the risk of the prevalence of coal-burning fluorosis (OR = 0.726, P = 0.020). Haplotype CGGT constructed by rs6821591-rs768695-rs3736265-rs2970847 increased the risk of the prevalence of skeletal fluorosis (OR = 1.558, P = 0.027). A 1% increase in CpG_4 methylation levels in the mtDNA D-loop region is associated with a 2.3% increase in the risk of coal-burning fluorosis. Additionally. There was a significant interaction between rs13131226 and rs1873532; CpG_4 and CpG_8.9; rs13131224,rs6821591 and rs7665116 were observed in the occurrence of fluorosis in the Guizhou population (χ2 = 16.917, P < 0.001; χ2 = 21.198, P < 0.001; χ2 = 36.078, P < 0.001).ConclusionPPARGC1A polymorphisms rs13131226 and rs1873532 and the mitochondrial DNA D-loop methylation site CpG_4 have been associated with an increased risk of fluorosis, conversely polymorphism rs7665116 was associated with a decreased risk of fluorosis. Polymorphisms rs2970870 were associated with increased risk of skeletal fluorosis, and polymorphism rs2970847 was associated with decreased risk of skeletal fluorosis. These SNPs and CpG can be used as potential targets to assess fluorosis risk.

FLUOROSIS PREVALENCE AT DIFFERENT REGIONS OF THE EARTH (LITERATURE REVIEW)

The aim of the study is to analyze the literature about the fluorosis prevalence and the factors which lead to dental and bone fluorosis. The search for articles published in 2016-2023 was conducted by the authors in Scopus and Web of Science scientific data bases using the keywords “fluorosis”, “dental fluorosis”. To classify the severity of dental fluorosis, the index of developmental defects of enamel (DDE), the index of tooth surface fluorosis (TSIF), and mostly Dean’s index Thylstrup &amp; Fejerskov Index (TFI) are used. The risk factors for dental fluorosis include living in regions with high level of fluoride, drinking water with high level of fluoride or salt fluoridation, drinking bottled water, use of fluoride toothpastes among preschool children, early weaning, and use of infant formula for long time, and, as well as, a hot climate and high fluoride content in soil and food. The studies from India and China demonstrated that the average concentration of dental fluorosis and skeletal fluorosis at fluoride contained 6 mg/l. The prevalence of dental fluorosis in NorthernTanzania, where the fluorine content in daily drinking water is 3.6 mg/l, reaches 75,22%. In Ethiopia, where fluorine content is 5.09 mg/l, the prevalence of skeletal fluorosis ranges from 55.1% to 72.4%. In Kenya, the fluoride content in drinking water reaches 72 mg/l, so the prevalence of dental fluorosis is 80%. The prevalence of dental fluorosis is lower in South Western Saudi Arabia and Iran where fluoride level is lower. In Jordan, the prevalence of dental fluorosis reaches 39.9% due to the high fluoride content in miner rocks. Skeletal fluorosis is wide spread in some areas of Pakistan due to the contamination of ground water by industrial production. The prevalence of mild dental fluorosis is 39% in New castle where water is fluoridated, and 24% in non-fluoridated Manchester in England. Dean’s index and TFI index are mostly used to classify these variety of fluorosis. Various factors affect the appearance of dental and bone fluorosis worldwide, so the prevalence of fluorosis varies from 11,1 up to 100%.

Prevalence of Skeletal Fluorosis in Northern Tanzania: A Follow-Up Study.

Skeletal fluorosis is a metabolic bone disease caused by excessive exposure to fluoride, predominantly through contamination of drinking water. This study aimed to identify all cases of skeletal fluorosis in Tindigani village situated in Northern Tanzania. This was done following changes in drinking water sources after a previous prevalence study in 2009 in this population. In a door-to-door cross-sectional study of Tindigani village, a sample of residents was assessed for skeletal fluorosis and dental fluorosis. Diagnosis of skeletal fluorosis was based on pre-defined angles of deformity of the lower limbs. Dental fluorosis was diagnosed and graded using the Thylstrup and Fejerskov Index. Samples from current drinking water sources underwent fluoride analysis. Tindigani village had a population of 1,944 individuals. Of the 1,532 individuals who were screened, 45 had skeletal fluorosis, giving a prevalence of 3.3% (95% CI=2.4, 4.3). Dental fluorosis was present in 82.5% of those examined (95% CI=79.8, 85.3). Dental fluorosis was present in all individuals with skeletal fluorosis and at higher grades than in the rest of the population. Drinking water samples were collected from 28 sources. These included piped, surface, well, and borehole water sources. Fluoride concentrations ranged from 0.45-38.59 mg/L of fluoride. Skeletal fluorosis is an ongoing but preventable health problem in the current population. The delivery of sustainable low fluoride piped water to this community would be of clear health benefit. This has been addressed at a local level.

Epidemiological, Biological, Physical and Radiological Surveys for the Diagnosis of Adult Skeletal Fluorosis in the Rift Valley Region of Ethiopia: A Single Point Prevalence Study

Fluoride is often referred to as a double-edged sword, as insufficient intake is associated with dental caries; excessive intake leads to dental and skeletal fluorosis. The toxic effects of fluoride can be classified as acute and chronic. The acute toxicity of fluoride occurs after a single ingestion of a large amount of fluoride. On the other hand, the chronic toxicity of fluoride is caused by long-term ingestion of the chemical element. Skeletal fluorosis is the result of chronic fluoride toxicity. Fluorosis is an endemic disease in several geographic areas of several countries, including the Rift Valley region of Ethiopia. Nevertheless, there are few epidemiological data on skeletal fluorosis. This study was initiated to determine the prevalence of skeletal fluorosis among adults in the Rift Valley region of Ethiopia. A single-point cross-sectional prevalence study was conducted between January 2023 and February 2023 to determine the prevalence of skeletal fluorosis in adults who met the inclusion criteria. Radiologic, biological (serum and urinalysis), and physical examinations were performed to collect the required data. Physical examinations included assessments of Range of Motion (RMO), muscle strength, and dermatomes of the upper and lower extremities' major joints, muscles, and nerve roots. In addition, the stress tests developed by Susheela and Bhatnagar [1] were used as part of the physical examination to diagnose the disease. After analyzing the musculoskeletal, radiological and biological data of the 42 study participants, the prevalence of skeletal fluorosis was calculated to be 21.4% (n=9). This prevalence rate indicates the importance of immediate intervention, including defluoridation and public education.

Effects of water improvement and defluoridation on fluorosis-endemic areas in China: A meta-analysis.

This meta-analysis systematically evaluated the effects of water improvement and defluoridation on fluorosis-endemic areas in North and South China. The study used PubMed, Embase, China National Knowledge Infrastructure, and Wanfang to retrieve relevant research studies published between January 2000 and October 2019. The data included water fluoride levels, dental fluorosis prevalence in children 8-15 years of age, urinary fluoride levels in children and adults, and skeletal fluorosis prevalence in adults. Fixed-effects and random-effects models were used in the meta-analysis. A total of 17 research articles met the inclusion criteria and had an average water improvement period of 15.8 years. With water improvement, water fluoride levels decreased from 2.72mg/L to 0.54mg/L (95% confidence intervals:-2.75,-1.58), which was below the standard for drinking water (1.5mg/L). Additionally, after water improvement, the prevalence of dental fluorosis decreased from 54.5% to 36.2% (95% confidence intervals: 0.12, 0.31) in children, and the prevalence of skeletal fluorosis decreased from 13.7% to 4.2% (95% confidence intervals: 0.16, 0.40) in adults. Urinary fluoride levels decreased from 3.06mg/L to 1.70mg/L (OR=-2.03, 95% confidence intervals:-2.77,-1.30) in children and from 2.29mg/L to 1.72mg/L (OR=-0.57, 95% confidence intervals: 0.65,-0.49) in adults. The results showed that the prevalence of dental fluorosis and skeletal fluorosis and urinary fluoride levels were significantly reduced by water improvement. This study findings revealed that the effects of water improvement and defluoridation were greater in South China than in North China, and it is obviously related to the time of water improvement and reducing fluoride.

ASSESSMENT OF SKELETAL FLUOROSIS AMONG CHILDREN IN TWO BLOCKS OF RURAL AREA, JAIPUR DISTRICT, RAJASTHAN, INDIA

Objective: The objective of the present study was carried out to explore the potential association between fluoride (F) concentration in drinking water and severity of skeletal fluorosis (SF) among the children of rural area.Methods: SF survey was conducted among the children (6-14 years) in two blocks such as (a) Jamwa Ramgarh block in Heerawala, Palera, Nayabas, Saipur, and Birasana and (b) Amber block in Sunder Ka Bas, Chitanukalan, Jugalpura, Peelwa, and Sirsali in Jaipur district of Rajasthan, India, of the study villages. A total of 150 (93 male and 57 female) children were surveyed. The role of fluoride (F) concentration in drinking water in the etiology of SF and the cases of SF was assessed using. The United Nations Children’s Fund three clinical test. The fluoride content in the source of drinking water was estimated by fluoride ion-specific electrode (Thermo Scientific Orion Star A329, USA).Results: The fluoride concentration in hand pump (Hp) water which ranges from 2.1 to 15 parts per million (ppm) and tube well (Tw) water ranges from 0.7 to 6.2 ppm in Jamwa Ramgarh block and Amber block, Hp water which ranges from 0.8 to 5.1 ppm and Tw water ranges from 0.8 to 4.8 ppm. The prevalence of SF 9 (12%) in Jamwa Ramgarh block and 6 (8%) in Amber block out of 75 children were examined in each block. Significantly increase in fluoride level in drinking water is positively correlated with SF.Conclusion: This study has shown the relation of SF to high fluoride levels in the source of drinking water is a major risk factor for SF among the children. SF is a threat among the children in two blocks of rural area, Jaipur district, Rajasthan.

Comparative Evaluation of Dental and Skeletal Fluorosis in an Endemic Fluorosed District, Salem, Tamil Nadu.

Background:High levels of fluoride in the drinking water, especially ground water, results in skeletal fluorosis which involves the bone and major joints. This study was conducted to assess the prevalence of skeletal fluorosis to compare with dental fluorosis in an endemically fluorosed population in the District of Salem, Tamil Nadu.Materials and Methods:Institutional ethical clearance was obtained. A total of 206 patients who reported to the Department of Hematology for blood investigations were the participants in this study. Age, sex, place, weight, height, dental fluorosis, and skeletal complaints were noted down. Body mass index was calculated, and statistical analysis was performed.Results:Dental fluorosis was present in 63.1% and absent in 36.9% of the samples reported. Skeletal fluorosis was present in 24.8% and was absent in 75.2%. A large number of the patients had knee pain and difficulty in bending. Chi-square test was used for statistical analysis. Skeletal fluorosis and age were compared and P value was 0.00 and was significant. Dental fluorosis and skeletal fluorosis were compared and P value was found to be 0.000 and significant.Discussion and Conclusion:There is a need to take measures to prevent dental and skeletal fluorosis among the residents of Salem district. Calcium balance should be maintained, and fluoride intake should be minimized to reduce the symptoms. The government should provide water with low fluoride level for drinking and cooking. Once the symptoms develop, treatment largely remains symptomatic, using analgesics and physiotherapy.

A comparative study of skeletal fluorosis among adults in two study areas of Bangarpet taluk, Kolar.

Skeletal fluorosis is a crippling disease resulting from excessive exposure to high fluoride from different sources. To assess the prevalence of skeletal fluorosis in Bangarpet taluk of Kolar, to compare various epidemiological factors influencing the occurrence of skeletal fluorosis among the two groups with differential water fluoride levels, and to estimate fluoride levels in all the sources of drinking water in study areas. A cross-sectional study was conducted among the adults of three randomly selected villages of Bangarpet taluk, Thimmasandra, Batavarahalli, with high (>1.5 mg/L) and Maddinayakanahalli with normal (<1.0 mg/L) fluoride levels. A house-to-house survey was conducted by administering a semi-structured questionnaire. Skeletal fluorosis was assessed by three simple physical tests in the field followed by radiological confirmation among the positives. Fluoride levels of drinking water sources were estimated by the ion-electrode method. Chi-square and Fisher's exact tests were used as tests of association. The prevalence of skeletal fluorosis at field level in both high and normal fluoride groups was 5.0%. Water fluoride levels in Thimmasandra, Batavarahalli, and Maddinayakanahalli were 4.13 mg/L, 2.59 mg/L, and 0.61 mg/L, respectively. Among the subjects with skeletal fluorosis, a significant difference was observed between socioeconomic status and prevalence of skeletal fluorosis in both high and normal fluoride groups (P < 0.05). Skeletal fluorosis is a threat among elderly in Bangarpet taluk, Kolar district.

High fluoride and low calcium levels in drinking water is associated with low bone mass, reduced bone quality and fragility fractures in sheep

SummaryChronic environmental fluoride exposure under calcium stress causes fragility fractures due to osteoporosis and bone quality deterioration, at least in sheep. Proof of skeletal fluorosis, presenting without increased bone density, calls for a review of fracture incidence in areas with fluoridated groundwater, including an analysis of patients with low bone mass.IntroductionUnderstanding the skeletal effects of environmental fluoride exposure especially under calcium stress remains an unmet need of critical importance. Therefore, we studied the skeletal phenotype of sheep chronically exposed to highly fluoridated water in the Kalahari Desert, where livestock is known to present with fragility fractures.MethodsDorper ewes from two flocks in Namibia were studied. Chemical analyses of water, blood and urine were executed for both cohorts. Skeletal phenotyping comprised micro-computer tomography (μCT), histological, histomorphometric, biomechanical, quantitative backscattered electron imaging (qBEI) and energy-dispersive X-ray (EDX) analysis. Analysis was performed in direct comparison with undecalcified human iliac crest bone biopsies of patients with fluoride-induced osteopathy.ResultsThe fluoride content of water, blood and urine was significantly elevated in the Kalahari group compared to the control. Surprisingly, a significant decrease in both cortical and trabecular bones was found in sheep chronically exposed to fluoride. Furthermore, osteoid parameters and the degree and heterogeneity of mineralization were increased. The latter findings are reminiscent of those found in osteoporotic patients with treatment-induced fluorosis. Mechanical testing revealed a significant decrease in the bending strength, concurrent with the clinical observation of fragility fractures in sheep within an area of environmental fluoride exposure.ConclusionsOur data suggest that fluoride exposure with concomitant calcium deficit (i) may aggravate bone loss via reductions in mineralized trabecular and cortical bone mass and (ii) can cause fragility fractures and (iii) that the prevalence of skeletal fluorosis especially due to groundwater exposure should be reviewed in many areas of the world as low bone mass alone does not exclude fluorosis.

Fluoride contamination in groundwater of central Rajasthan, India and its toxicity in rural habitants

This study was carried out to assess fluoride (Fl) concentration in groundwater in some villages of central Rajasthan, India, where groundwater is the main source of drinking water. Water samples collected from deep aquifer-based hand pumps were analyzed for Fl content. Fluoride in groundwater of 121 habitations of Bhilwara tehsil of Bhilwara district of Rajasthan was determined to examine the potential Fl-induced toxicity in rural locations. Fluoride concentrations in the tehsil ranged from 0.5 to 5.8 mg/l. In the tehsil, 69 villages (57%) were found to have Fl concentration beyond the maximum desirable limit recommended in Bureau of Indian Standards (BIS), 10500, 1991. Fifty-eight percent population of these villages was under the threat of fluorosis. One percent population of tehsil living in two villages ingested more than 5 mg/l Fl in each liter of drinking water and at maximal risk for dental and skeletal fluorosis. 142 individuals of these villages were examined for fluorosis. Data indicated that only four individuals (2.82%) did not exhibit dental fluorosis. Most individuals were found to suffer from mild (34.51% or 49 individuals) and moderate (31.69% or 45 individuals) fluorosis. Severe dental fluorosis was recorded in only 16 individuals (11.27%). In 104 individuals above 21 years of age examined for the prevalence of skeletal fluorosis, 66 were positive for skeletal fluorosis with a maximum 36.5% with grade I skeletal fluorosis. Grade II skeletal fluorosis was recorded in 28 individuals (26.9%). Data in this study demonstrate that there is a need to take ameliorative steps in this region to prevent fluorosis.

Fluorotoxicosis in Diverse Species of Domestic Animals Inhabiting Areas with High Fluoride in Drinking Water of Rajasthan, India

Chronic fluorotoxicosis in the form of dental and skeletal fluorosis was observed in 443 immature and 2,155 mature domestic animals inhabiting tribal rural areas of southern Rajasthan, India. Their drinking water contained fluoride in the range between 3.1 and 6.1 ppm. These animals included cattle (Bos taurus), buffaloes (Bubalus bubalis), horse (Equus caballus), donkeys (Equus asinus), dromedary camels (Camelus dromedarius), sheep (Ovis aries) and goats (Capra hircus). Of these immature and mature animals 172 (38.8 %) and 826 (38.3 %) showed evidence of dental fluorosis with varying grades, respectively. Their incisor teeth were bilaterally and vertically or horizontally brown to deep yellowish in colour. Also present, as indication of more severe dental fluorosis, were irregular wearing and excessive abrasions of teeth, deep yellowish discoloration of exposed cementum and/or remaining enamel surface and pronounced loss of teeth supporting bone with recession of gingiva. On clinical examination 12.1 % immature and 28.4 % mature animals revealed periosteal exostoses in mandibular regions, ribs, metacarpus and metatarsus, intermittent lameness, hoop deformities and stiffness of tendons in the legs as signs of severe skeletal fluorosis. In the fluorosed animals other signs of chronic fluoride intoxication as colic, intermittent diarrhoea, excessive urination, irregular reproductive cycles, repeated abortions, sterility and still birth were seen. No significant variation in prevalence of dental fluorosis was found between mature and immature animals. However, mature animals showed relatively higher (28.4 %) prevalence of skeletal fluorosis as compared to their counterparts (12.1 %). Among these animal species, buffaloes revealed the maximum prevalence of dental (96.8 %) and skeletal (66.9 %) fluorosis and minimum of 17.02 and 8.7 %, respectively, was observed in goats. However, prevalence and severity of osteo-dental fluorosis greatly varied from species to species and between grass-eaters or grazers (cattle, buffaloes and equines) and plant-eaters or browsers (camels and flocks). Causes for variation in prevalence and severity of fluoride toxicity in different species and between animals of different feeding habits are discussed.

Surveillance analysis of drinking water borne fluorosis in Tibet autonomous region in 2009

Objective To find out the dynamics of drinking water borne fluorosis in Tibet's, to evaluate the effect of control measures, and to provide a scientific basis for the timely adjustment of control strategies. Methods During september to october 2009, according to the 2008 Central Government Special Funds to Subsidize Local Public Health in Drinking Water Borne Fluorosis in Tibet, Xigaze Xietongmen and Nyingchi Zayu were selected as project counties, three project villages were selected with simple random sampling method in each county, the functioning of water improvement projects, drinking water fluoride content, children's dental fluorosis and adult skeletal fluorosis were investigated. Water fluoride was detected by the standard examination methods for drinking water the non-metallic targets(GB/T 5750.6-2006) determination of fluoride; urinary fluoride was tested by ion selective electrode (WS/T 89-1996); dental fluorosis was diagnosed using Deans method; adult skeletal fluorosis was diagnosed by endemic skeletal fluorosis clinical diagnostic criteria (WS 192-2008). Results Mean water fluoride was 0.18 - 0.34 mg/L in drinking water changed areas, and 0.70 - 2.13 mg/L in not changed areas; prevalence of dental fluorosis of children 8 - 10 was 50.78% (65/128), dental fluorosis index was 1.04,mean urinary fluoride was 1.64 mg/L in drinking water changed areas; prevalence of dental fluorosis of children 8 -10 years old was 80.65%(25/31 ) in not changed areas, dental fluorosis index was 1.50, mean urinary fluoride of children was 2.08; adult clinical skeletal fluorosis was 38.7%(104/269) in drinking water changed areas, the mean urinary fluoride was 1.61 mg/L, prevalence of skeletal fluorosis was 15.4% (18/117) in not changed areas, mean urinary fluoride was 3.54 mg/L. Conclusions The method of change the water to reduce fluoride decreases dental fluorosis to control levels, and severity is also reduced, urinary fluoride is decreased. However, the prevalence of skeletal fluorosis is higher than that of drinking water not changed areas. Key words: Fluoride poisoning; Change the water; Data collection

Prevalence of fluorosis in an endemic village in central India

Endemic fluorosis is an important public health problem in certain parts of the Durg district of Chhattisgarh. The aim of the study was to find out the prevalence of dental and skeletal fluorosis among the population and to assess the relation between drinking water fluoride level and prevalence of fluorosis. A cross-sectional survey was undertaken in Gureda Village, of the Durg district of Chhattisgarh state in October 2009. The survey covered 805 individuals - 362 males and 443 females. The prevalence of dental and skeletal fluorosis was assessed based on clinical examinations of individuals. Drinking and eating habits of individuals were recorded as per checklist. Water fluoride levels of prime water sources were also determined by lab examination. The prevalence of dental fluorosis was 8.2%. Both skeletal and dental fluorosis were more common in males. Dental fluorosis was higher in the 8-45 age group, whereas the prevalence of skeletal fluorosis increased with age. Genu varum (38.1%) and genu vulgum (6.3%) were the common skeletal deformities. Water fluoride levels ranged from 0.2 to 7.8 ppm.

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

An epidemiological study on fluorosis in an urban slum area of Nalgonda, Andhra Pradesh, India

Fluorosis is an important public health problem in certain parts of India. Nalgonda is one of the fluorosis endemic districts of Andhra Pradesh. A cross-sectional study was undertaken to assess the prevalence of dental and skeletal fluorosis in Panagal, one of the urban slum areas of Nalgonda town of Andhra Pradesh. 265 individuals residing in 92 households of five colonies of Panagal were selected by multi-stage random sampling. Fluorosis was assessed by standard clinical methods and water samples were tested for fluoride level. It was observed that mean fluoride level in ground water samples in the area was 4.01 mg/l and that of Nagarjunsagar water was 0.74 mg/l. The mean age of the study subjects in the area was 34.73 years. The overall prevalence of skeletal fluorosis was 24.9% and that of dental fluorosis was 30.6%. The prevalence increased with age. Skeletal and dental fluorosis is endemic in the study area.

Assessment of skeletal and non-skeletal fluorosis in endemic fluoridated areas of Vidharbha Region, India: A survey

Objectives:To evaluate skeletal and non-skeletal fluorosis in patients living at endemic fluoridated areas and also the morphological changes in red blood cells (R.B.C.’s).Materials and Methods:The cross-sectional study was conducted at Vidharbha region of Maharashtra, India. An ethical clearance was obtained from the concerned authorities. Fifty families were screened and 204 subjects who had dental/skeletal fluorosis were included in the study. The aims and objectives were explained to the study subjects of the village and biochemical, hematological and radiological assessment was done. The main source of drinking water in this area was tube well. The concentrations of fluoride in two different areas of same village were 4 and 4.5 ppm.Results:Prevalence of skeletal fluorosis and non-skeletal fluorosis in male patients was 56.87% (116) and in female patients (88) it was 43.13%. RBC count in male patients was 5.03 ± 0.49 while in female patients it was 4.70 ± 0.47. With significant difference between male and female patients, P value was 0.003. Hb% in male patients was 12.44 ± 1.76 and in female patients it was 11.31± 1.34, showing significant difference between male and female patients P value 0.038. Alkaline phosphate level in male patients was 289.68 ± 149.09 and in female patients it was 276.68 ± 164.97. ESR count in male patients was found 11.41 ± 8.75 and in female patients it was 13.29 ±7.37. Radiological finding of fluorosis patients shows thickening of inner and outer tables of skull bone in 83.92% of patients and only 7.84% of the patients were suffering from barrowing of long bone.

Endemic fluorosis:prevalence and prevention in Liaoning Province

Objective To investigate the status of control of endemic fluorosis in Liaoning Province.Methods To investigate the prevalence rate of endemic fluorosis and water fluoride content in regions with different extent of endemic fluorosis,dental fluomsis among 8-12 years old children and clinical fluorosis at adult above 16 years old were extensively surveyed,urinary fluoride among 8-12 years old children was detected.Results We surveyed 842 undefluorided drinking water in endemic fluorosis villages and 1234 projects of improving drinking water in 1829 endemic fluorosis viflages.Water fluoride content was 0.01-7.10 mg/L in unimproved drinking water in endemic fluorosis resions,averaging(0.96±0.64)mg/L;29.2%(246/842)of the endemic fluorosis regions had a fluoride content more than 1.2 mg/L In 1234 projects of improving drinking water.drinking water fluoride content was between 0.06-7.67 mg/L.The project normally operated and having a fluoride content≤1.2 mg/L accounted for 68.31%(843/1234),while 31.69%(391/1234)of the projects did not function well.The prevalence of dental fluomsis in 8-12 years old child ren in endemic fluorosis regions was 24.4%(2960/12 127),the prevalence of clinical fluorosis among adults was 2.22%(1900/85 636).The prevalente of dental fluorosis in slight,moderate and serious fluorosis regions had remarkable statistics differences(X2＝19.25,P＜0.01).The prevalence of dental fluorosis of children in serious fluorosis regions was the highest,reaching 100%,while the prevalence of skeletal fluorosis wns 18.03%(97/538).The median of urinary fluoride was 2.01.2.00mg/L in serious and slight fluomsis regions,respectively.Conclusions Endemic fluorosis is still serious.so we need urgently to improve water in serious fluorosis regions without defluoridaton of drinking water.Endemic fluomsis resions where worn-out and closed defluoriding projects exist need defluoriding management. Key words: Fluoride poisoning; Water; Fluorosis,dental; Osteofluorosis; Data collection

Incidence of skeletal deformities in endemic fluorosis

An investigation was undertaken in three endemic fluorotic areas of Punjab State, India, to assess the prevalence of skeletal deformities. The concentration of fluoride in drinking water varies from 2.3 to 22.5 mg/L. The patients affected with skeletal fluorosis revealed joint pain in both upper and lower limbs, numbing and tingling of the extremities, back pains and knock-knees. Prevalence of skeletal fluorosis was found to be 29% of grade-I, 51% of grade-II and 20% of grade-III and was higher in males (63%) compared with females (37%).

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