Anti-fluorosis drive is yet to take off

The Hindu
May. 27, 2006

Campaign faces roadblocks by way of misconceptions, low awareness
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# Studies show that caries is prevalent even among children exposed to fluoride
# Fluoride can affect bones and skeleton unleashing severe pain in major joints
# One main reason for contracting the disease is consumption of untreated groundwater
# 66 million people in India, including 6 million children, either affected or at high risk of fluorosis
# This includes 6 million children in the 6-14 age group
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CHENNAI: The campaign against fluorosis, an excess of fluoride that has dental and general health ramifications, continues to be stymied by misconceptions and low awareness among the public and medical fraternity.

While at one level, fluoride intake has been associated with dental and skeletal fluorosis and tissue damage, at another level fluoride (toothpaste) continues to be prescribed as a proactive element in the prevention of dental caries.

"It is surprising how this popular misconception about fluoride benefiting dental health has managed to survive against strong clinical evidence to the contrary," said N. Gnana Sundaram, professor, Oral Medicine and Radiology, Saveetha Dental College. Studies have shown that caries was prevalent even among children exposed to fluoride, he said.

Fluoride can affect the bones and the skeleton unleashing severe pain in the major joints, rigidity, inability to walk and eventually paralysis. Unchecked fluorosis can affect soft tissues — stomach, intestine, muscles, blood cells, ligaments — and organs such as kidney and brain.

As a focus group requiring urgent sensitising, pregnant women and breastfeeding mothers represent one of the most important segments. This segment should stop consumption of fluoride containing foods to avoid anaemia and eliminate risk of low birth weight babies.

One of the most common reasons for contracting the disease is the consumption of untreated groundwater with excessive fluoride levels. In some parts of India, the contamination is as high as 48 mg/l. Other sources of fluoride include black tea, canned foods laced with preservatives, masala powders, dental products and certain drugs.

203 districts hit

According to a UNICEF report, an estimated 66 million people in India are either afflicted or at high risk of fluorosis, which includes 6 million children in the 6-14 age group. It is reported that 203 districts in 19 States in India are seriously affected by the problem. In Tamil Nadu, districts such as Dharmapuri and Salem, are endemic to fluoride contamination of groundwater.

On Saturday, fluoride experts will address practitioners of various disciplines and medical students at the Stanley Medical College on the magnitude of the problem and the need to suspect, diagnose and prevent fluorosis. The resource persons include A. K. Susheela, executive director, Fluorosis Foundation of India, and Rekha Bhatnagar, professor, Department of Community Medicine, RNT Medical College, Udaipur.

Diagnostic facility sought

Experts press the need for Governments to invest in diagnostic facility for fluorosis in all hospitals. The diagnostic procedure involved testing blood, urine and drinking water for fluoride, along with haemoglobin testing and a forearm x-ray. Children require additional tests in the form of thyroid hormone/thyroid stimulating hormone assay and urinary iodine levels.

Prevention is the bedrock of fluorosis management. It involves identifying the source of fluoride entry, cutting out the source and promoting intake of vegetables, fruits and dairy products rich in essential nutrients(calcium, iron, vitamins and other antioxidants).