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

Abstract

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.

Assessment of fluoride levels during pregnancy and its association with early adverse pregnancy outcomes

“…[ 11 12 13 14 15 ] Because of more than 90% bioavailability, the consumption of excess of fluoride through drinking water is one of the main causes of fluorosis. [ 16 17 ] We examined a group of 600 pregnant women of reproductive age group from lower socioeconomic strata who were regularly exposed to fluoride by means of drinking water with the aim of detecting the early adverse pregnancy outcomes comprising abortions, IUDs, and congenital abnormalities. This study was done in Faridkot district of Punjab, India and on the examination of groundwater and tap water, it was detected that the mean value of the water fluoride content was 2.4 mg/L that is more than the permissible limits.…”

“…Evidence from some of the human studies suggests that excessive fluoride influences neural development in utero and can lead to neurological malformations. [ 16 24 25 26 27 28 29 ] In a paper published by AK Susheela et al . [ 30 ] it was found that the intake of fluoride free water and food decreased the incidence of preterm deliveries by 4 times and low birth weight babies by 2 times.…”

Defluoridation Potential of Rice Husk, Groundnut Shell as a Conventional Alternative for Fluoride Removal – A Review

“…If fluoride level increases to 6mg/l a day, skeletal manifestation begins [35]. Fluoride has a preferential affinity to accumulate in cancellous (spongy) bones, compared to compact (cortical) bones as cancellous bone has excellent blood supply than the cortical bone [36]. Skeletal fluorosis is a crippling disease and is a threat among elderly [37,38].…”

Assessment of pine cone derived activated carbon as an adsorbent in defluoridation

“…Apart from fluoride toxic effect on bone and teeth, the fluoride has a toxic effect on the functional mechanism of the kidney if intake of fluoride is 4 mg/L or 12 mg/day [8,31,34]. The excess of fluoride intake may also affect the intelligent quotient (IQ) of children due to sleepiness and giddiness [25,30,40] and cause the functional impairment of the nervous system in the development of the infant [37]. The fluoride toxicity is responsible for the destruction of the RBCs and in lowering the hemoglobin levels as well as has the toxic effects on gastro-intestinal mucosa due to loss of microvilli [17,22].…”