Fluorosis and Iodine Deficiency Disorders in India

Abstract

This review focuses on fluorosis and iodine deficiency disorders, two serious, highly prevalent metabolic disorders that are under-reported. These are caused by the two elements of the halogen family, fluorine and iodine. The former in excess and the latter in deficiency are the cause for concern. Excess fluoride (F -) consumption through untreated groundwater was the main reason for fluorosis and defluoridation of water was the focus to provide safe water with F -< 1.0 mg/l. On the other hand, iodine deficiency in diet was due to agricultural crops grown in iodine-deficient soil, and iodization of cooking salt was identified as the way forward to attain iodine sufficiency (i.e. 15 ppm in iodized salt). The two diseases are addressed through structured national programmes, but the implementation unfortunately is in a compartmentalized manner. The major issue is that both Fexcess and iodine deficiency caused goitre. Besides, other disorders identical in clinical manifestations, also occur. This review discusses the issues to address the diseases with better understanding that has emerged from the scientific information available for correct diagnosis and management of patients in an integrated manner.

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

“…The disease is correctly diagnosed through a well-defined protocol at the earliest onset of the disease, and it fulfilled the needs of the patients as well as the doctors who suspected the disease and referred the patient(s) for diagnosis. Patients get relief from the disease within a short interval when fluorosis diagnosed early345. The recovery is not through prescription of drugs or surgical interventions but through simple, easy to practice dietary interventions6.…”

“…Patients get relief from the disease within a short interval when fluorosis diagnosed early345. The recovery is not through prescription of drugs or surgical interventions but through simple, easy to practice dietary interventions6. Nutrition played a key role in mitigation of the disease.…”

“…During the initial phase of 35 yr in the life of the disease in India (1937-1972), investigations were focussed on calcified tissues, viz . bone and tooth, and the abnormalities, such as discoloured teeth with a pattern and stiff joints with a change in the gait of walking, which led to dental and skeletal fluorosis detection both in human patients and animal models3. However, it was too late for recovery from the disease.…”

Multiple Myeloma-Like Spinal MRI Findings in Skeletal Fluorosis: An Unusual Presentation of Fluoride Toxicity in Human

“…Endemic skeletal fluorosis is widely prevalent in India, China, and in many other countries around the world (1). The primary findings of fluorosis are mottling of teeth, osteosclerosis, soft tissue calcification, and marginal bony overgrowth (2).…”

Validation of ICMR index for identification of dental fluorosis in epidemiological studies

“…1.5 ppm3. As a part of the ICMR's initiative to address the problem of fluorosis, which is affecting over 60 million people in the country45 a Task Force was formulated with four subgroups, one of them being on ‘Dental Fluorosis’. One of the recommendations of the subgroup was to develop a simplified index for identification and grading of dental fluorosis which could be used by the health workers with a basic level of training.…”