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Year : 2013  |  Volume : 1  |  Issue : 1  |  Page : 65-67

Fluorosis - An update and review

1 Professor, Department of Community Medicine, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
2 Assistant Proefssor, Department of Community Medicine, GMERS, Patan, India

Date of Web Publication13-Aug-2018

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-6486.238986

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How to cite this article:
Pandit N, Jadav P. Fluorosis - An update and review. J Integr Health Sci 2013;1:65-7

How to cite this URL:
Pandit N, Jadav P. Fluorosis - An update and review. J Integr Health Sci [serial online] 2013 [cited 2023 Mar 29];1:65-7. Available from: https://www.jihs.in/text.asp?2013/1/1/65/238986

  Introduction Top

Fluorine, a member of the halogen family, is micro mineral required for normal growth, development and maintenance of human health. Fluoride is encountered in geochemical deposits and is generally released into subsoil water sources by slow natural degradation of fluorine contained in rocks. About 96% of Fluorine found in bones and teeth which is required for mineralisation of bones and formation of enamel of teeth. Various dietary components influence the absorption of fluorides from gastrointestinal tract and the absorbed fluorides are distributed throughout the body. Drinking water and sea food are good sources of fluoride[1],[2].

Fluoride acts as a double edged weapon. At one end Fluoride plays an important role in preventive dentistry due to its cariostatic potential. However, on other end excessive intake of fluoride leads to dental and skeletal fluorosis[3].

Dental fluorosis

Dental fluorosis is a fluoride-induced disturbance in tooth formation, which leads to increased porosity of enamel with hypo-mineralisation. It is due to excessive intake of fluoride but only during the period of tooth development. The most important risk factor of dental fluorosis is the amount of fluoride consumed from all sources during the critical period of tooth development.

Normal fluoride intake should be 0.6-0.8 ppm at 26.3°C- 32.6°C and 0.9-1.7 ppm at 10-12°C.

The relationship of dental fluorosis with fluoride level of drinking water is well established. Three major risk factors for dental fluorosis are fluoridated supplements, fluoridated dentifrices and infant formula before the age of seven.[4],[5],[6],

The dental fluorosis has been classified by World Health Organization under nomenclature of International classification of diseases in the Chapter XI: Diseases of the digestive system, sub -chapter: Diseases of oral cavity, salivary glands and jaws (K00-K14)

Global scenario of dental fluorosis

The latest information shows that fluorosis is endemic in at least 25 countries across the world. The total number of people affected is not known, but a conservative estimate would number in the tens of millions. So the high concentrations of fluoride occurring naturally in groundwater and coal have caused widespread fluorosis - a serious bone disease - among local populations. A range of everyday products, notably toothpaste and drinking water, the fluoride in small doses has no adverse effects on health to offset its proven benefits in preventing dental decay. But more and more scientists are now seriously questioning the benefits of fluoride, even in small amounts. Since some fluoride compounds in the earth’s upper crust are soluble in water, fluoride is found in both surface waters and groundwater. In surface freshwater, however, fluoride concentrations are usually low - 0.01 ppm to 0.3 ppm. In groundwater, the natural concentration of fluoride depends on the geological, chemical and physical characteristics of the aquifer, the porosity and acidity of the soil and rocks, the temperature, the action of other chemical elements, and the depth of wells. Because of the large number of variables, the fluoride concentrations in groundwater can range from well under 1 ppm to more than 35 ppm. In India, a concentration up to 38.5 ppm has been reported in drinking water.[7],[8]

Indian scenario

India is among the many countries in the world where About 62 million people including 6 million children are affected with dental, skeletal and non-skeletal fluorosis .The states of Andhra Pradesh, Bihar, Chhattisgarh, Haryana, Karnataka, Madhya Pradesh, Maharashtra, Orissa, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh and West Bengal are affected by fluoride contamination in water. This involves about 9000 villages affecting 30 million people[9].It must be noted that the problem of excess fluoride in drinking water is of recent origin in most parts. Digging up of shallow aquifers for irrigation has resulted in declining levels of ground water. As a result, deeper aquifers are used, and the water in these aquifers contains a higher level of fluoride[10].The National Oral Health Survey and Fluoride mapping – 2003[11] reported that 72.5% of 12 year old children and 75.4% of 15 year old children had dental caries.

Diagnosis of fluorosis:

Several classifications have been proposed to assess the severity of dental fluorosis.

Dean’s classification[12]: based on clinical appearance of enamel

To determine the severity of dental fluorosis as a public health problem, Dean devised a method of calculating the prevalence and degree of severity in a community, which he termed the community fluorosis index (CFI).

Teotia and Teotia[13],[14] proposed a simplified classification to assess the severity of dental fluorosis. This classification is easy to use, less time-consuming, has only five categories and is therefore more practical for community and epidemiological surveys.

Diagnostic difficulties occur mostly with mild forms offluorosis, or when a mix of fluorotic and non-fluoroticconditions is evident. It’s important to emphasize that non-fluoride enamel opacities include all categories of opacities not defined as fluorosis, i.e. dental hypoplasia lesions that are commonly characterized as discrete, demarcated white or discolored opacities ofiten affecting a single tooth and, less frequently, multiple teeth, with a symmetrical distribution and result from a wide variety of systemic or local factors[15].

Prevention and control[15],[16]:

Following measures can be implemented for prevention and control of dental fluorosis

  • Changing the water source with lower fluoride content (0.5 to 0.8 mg/L) if possible. It may be running surface water, rain water or ground water whichcontains lower quantities such as wells.
  • Defluoridation of water by 2 principle approach: precipitation and adsorption.
  • Modified nalgonda technique: By doubling the concentrations of alum and lime, water fluoride levels fell significantly (p<0.001) in tap water and drinking water while pH levels and other inorganic factors remained unaffected.
  • Nutritional approach: vitamin C, calcium may be helpful

  References Top

Den Besten PK. Dental fluorosis: its use as a biomarker. Adv Dent Res. 1994;8:105-10.  Back to cited text no. 1
Akosu TJ, Zoakah AI. Risk factors associated with dental fluorosis in Central Plateau State, Nigeria. Community Dent Oral Epidemiol.2008;36:144-8.  Back to cited text no. 2
Indermitee, E.; Saava, A.; Karro, E. Exposure to high drinking water and risk of dental fluorosis in Estonia. Int. J. Environ. Res. Public Health 2009, 6, 710-721.  Back to cited text no. 3
Hossny E, Reda S, Marzouk S, Diab D, Fahmy H. Serum luoridelevels in a group of Egyptian infants and children from Cairo city. Arch Environ Health 2003;58:306-15.  Back to cited text no. 4
Alvarez JA, Rezende KM, Marocho SM, Alves FB, Celiberti P, Ciamponi AL. Dental luorosis: Exposure, prevention and management. Med Oral Patol Oral Cir Bucal 2009;14:E103-7.  Back to cited text no. 5
Marshall T, Levy S, Warren J, Broit B, Eichenberger J, StuboP.Associations between intakes ofluorides form beverages during infancy and dental luorosis of primary teeth. J Am CollNutr2004;23:108-16.  Back to cited text no. 6
S Saravanan, C Kalyani, MP Vijayarani, P Jayakodi, AJW Felix, S Nagarajan1, P Arunmozhi2, V Krishnan. Prevalence of Dental Fluorosis Among Primary School Children in Rural Areas of Chidambaram Taluk, Cuddalore District, Tamil Nadu, India. IJCM 2008;33(3):146-50  Back to cited text no. 7
World Health Organization. Fluorides and oral health. WHOtechnical report series 846. World Health Organization:Geneva; 1994.  Back to cited text no. 8
Mondal NK, Pal K, KabiS.Prevalence and severity of dental fluorosis in relation to fluoride in ground water in the villages of Birbhum district, West Bengal, India. The environmentalist 2012;32 (1):70-84  Back to cited text no. 9
Kumar HR, Khandare AL, Brahmam GN, Venkaiah K, Reddy G, SivakumarB. Assessment of current status of fluorosis in north- western districtsof Tamil Nadu using community index for dental fluorosis. J Hum Ecol2007;21:27-32.  Back to cited text no. 10
National Oral Health Survey and Fluoride mapping 2002-2003. India:DCI Publication.  Back to cited text no. 11
Dean HT. Classification of mottled enamel diagnosis. JAm Dent Assoc 1934;21:1421-6.  Back to cited text no. 12
Teotia SPS. Teotia M. Environmental studies of endemic fluorosis, goitre and stone and their epidemiological interrelationships. Technical Report, Ministry of Environment and Forest, Government of India, New Delhi,1990:1-120.  Back to cited text no. 13
Teotia SPS, Teotia M. Endemic fluorosis: A challenging national health problem. J Assoc Physicians India 1984;32:347-52.  Back to cited text no. 14
Jenny AbantoAlvarez , Karla Mayra P. C. Rezende , Susana María Salazar Marocho , Fabiana B. T. Alves,Paula Celiberti, Ana Lidia Ciamponi. Dental fluorosis: Exposure, prevention and managementMed Oral Patol Oral Cir Bucal. 2009; 14 (2):103-7.  Back to cited text no. 15
N Suneetha, K Padma Rupa, V Sabitha, K Kalyan Kumar, Shruti Mohanty, AS Kanagasabapathy, PragnaRao. Defluoridation of water by a one step modification of the Nalgonda technique. 2008; 1 (2): 56-58  Back to cited text no. 16

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[Pubmed] | [DOI]


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