NATIONAL PROGRAMME

FOR PREVENTION AND CONTROL OF

FLUOROSIS

Dr. Jagannath Dinda Dibyendu Dutta

Chief Medical Officer of Health District consultant(NPPCF)

Bankura Bankura

INTRODUCTIONF L U O R O S I S :

A N E W P U B L I C H E A L T H P R O B L E M

Fluorosis is a slow, progressive and

crippling malady affecting most of the

organs in the body where flouride in

drinking water is > 1.0ppm.

More than 90% of rural drinking water

supply programmes are based on

ground water available, which is being

overexploited for agriculture, causing

a high influx of fluoride into water.

Endemic fluorosis has been steadily

increasing ever since the disease was

discovered in India during the 1930s .

In West Bengal Birbhum , Bankura,

Purulia are grossly effected.

F L U O R O S I S I N I M M A G E

Fluorosis : An endemic burden World Wide

3

Magnitude of the problem

25 countries around the

world.(DARK AREAS)

A crippling Disease

1. Slow –Progressive Cripple

2. Affect all aged person.3. Health Complain-Overlapping many

disease

4. Impact depends on

a. Age

b. Hormonal Status

c. Nutritional Status

d. Efficiency of Kidney

Arunachal

Pradesh

Kerala

21

Tamil Nadu

28

Karnataka

67

Andhra Pradesh

70

Maharashtra

31

Madhya Pradesh

36Orissa

56

West Bengal

22

Gujarat

95

Rajastha

n

100.0

Punjab

82Haryana

63

Delhi

31

Uttar Pradesh

22

Sikkim

Nagaland

Manipur

MizoramTripura

Himachal Pradesh

Jammu &

Kashmir

7

Bihar

15

Assam

9

Andaman

Nicobar

70-100 % Districts affected

40-70 % Districts affected

10-40 % Districts affected

<10% Districts affected

Endemicity not known

Source:A Treatise on Fluorosis by Dr. A.K. Susheela

No of affected

District 204 (21

States /UT)

people affected, 62

million ( 6 million

children)

Causative factor,

excess consumption

of fluoride through

drinking water

(>1.0ppm) and diet.

BIS- Burro of Indian

Standard

BIS= Permissible Limit of

Fluoride: 1.5 mg/L or PPM

Problem in India

Fluorosis : An endemic burden in West Bengal

In West Bengal

Malda, Birbhum, Bankura,

Purulia and South 24

Paraganas,Malda are affected.

Of them Purulia, Bankura,

Birbhum & Daxin Dinajpur are

worst affected.

Scenario in W.B: 45 Blocks in District

Total People affected: 2.20 Lakhs

PREAMBLE

Persons suffers from Fluorosis in India : 6 Million

(Dr. Raja Reddy , NIN , Hyderabad)

Persons suffers from Fluorosis in West Bengal: 2.20 Lakh

Persons Suffers from Fluorosis in Bankura: 90,742

Current Status of Fluorosis In Bankura District

Tot.

B

lock

s

Pop.

Aff

ecte

d

Blo

ck

Tot.

Pop.

Aff

ecte

d P

op.

Tot.

Vil

lage

in B

ankura

Tot.

Pop.

Aff

ecte

d V

ill.

Aff

ecte

d.

Pop.

Tot.

Hab

itat

ion

Aff

ecte

d

Hab

itat

ion

(Appro

x)

Aff

ecte

d P

op.

(Appro

x)

22 31,92,695 15 20,21,341 90,742 3832 31,92,695 271 90,742 7778 100590,742

PREVALANCE IN BANKURA

Most affected groups are:

Age Group between 4-11 and > 40 aged people.

Dental Fluorosis Present in Age group 4-11

Dental and Skeletal Fluorosis Present in age group >40

In children mainly Dental Fluorosis are present

Initial symptoms : Headache, constipation, vague body

pains, backache, joint rigidity & general weakness.

These were followed by multiple joint pains, mostly in the

feet, knees, and back.

Difficulty in walking

Limitation of joint movement. Inability to close the fist

Spinal stiffness and kyphosis developed in a few patients.

Flexion of spine

Neurological complication

Clinical symptoms

IMPACT ON HEALTH

Types of Fluorosis

Dental Skeletal Non skeletal

Dental fluorosis

Normal:

The enamel surface is smooth,

glossy and usually a pale creamy

white in color.

Mild: The white opacity of the

enamel of the teeth is more

extensive, but covers less than

50% of the tooth surface .

Moderate:The enamel surface of the teeth

shows marked wear and tear with brown stain

and is frequently a disfiguring feature .

Severe: The enamel surface is badly

affected and hypoplasia is so marked that

the general form of the tooth may be

affected. There are pitted/worn out areas

and widespread brownish discoloration

with the teeth often having a corroded

appearance.

Skeletal Fluorosis

Identification

COIN TEST: The subject is

asked to lift a coin from the floor

without bending the knee. A

fluorotic subject would not be

able to lift the coin without flexing

the large joints of lower extremity

CHIN TEST: The subject is

asked to touch the chin with

the chest. A fluorotic subject

would not be able to do so, if

there is pain or stiffness in the

neck.

STRETCH TEST: The individual is

made to stretch the arms

sideways, fold the arm and try to

touch the back of the head. If

there is pain or stiffness in the

shoulder joint and backbone, the

exercise will be difficult,

suggesting possibility of fluorosis

Confirmation with X-ray

Ossified Interosseous

Membrane

Types of skeletal fluorosis - I

Genu valgum,

Genu varum,

Anterioposterior bowing of tibia (Saber

tibia),

Scoliosis,

Paraplegia are severe forms of skeletal

fluorosis

RECENT NIN STUDY CONDUCTED IN BIHAR

CHILDREN OF 2-3 YEAR WERE AFFECTED WITH SEVER FORMS OF CRIPPLING BONE

DEFORMITIES

Children affected from fluorosis

Skeletal fluorosis in Assam

SKELETAL FLUOROSIS IN BANKURA

Genu valgum (KNOCK KNEES)

Legs are bowed inwards in the

standing position. The bowing usually

occurs at or around the knee, and

when standing with knees together,

the feet are far apart.

Genu Varum

Legs are bowed outwards in the

standing position. The bowing

usually occurs at or around the

knee. When standing with the feet

together, the knees remains far

apart.

Types of skeletal fluorosis - II

Kyphosis: – Forward bending of spine.

Fixed and rigid thoracic cage as well as

spinal cord compression occur

Anterioposterior

bowing of tibia

Types of skeletal fluorosis - III

Types of skeletal fluorosis - IV

Paraplegia: Spinal

cord compression due

to osteosclerosis with

paraplegia as a result

of endemic skeletal

fluorosis

Tingling sensation in fingers and toes

Excessive thirst

Polydypsia and polyurea

Nervousness & Depression

NON SKELETAL MANIFESTATIONS

INTERVENTION

1.Safe Water Supply bellow<1.5 mg/L

2. Domestic Filter

3. Small defluoridation Plant

4. Nutrition and Proper Diet

5. Supplementary Medicine

vit- C

vit- D

Ca

Antioxident

6. Clinical Intervention

a. Screening

b.Diagnostic Test

c.Identification

d.Surgery and Medication

INTERVENTION

Proper Nutrition and Diet

1. Green Vegetable should be taken large amount in a day.

2. Carrot and Tomato are the main source of antioxidant .

3. Milk and Small –fish are the rich source of Calcium.

Avoid Fluoride containt food, Cosmetics and tooth-pest.

ROLE OF P.H.E.D

1.Surface Water Utilization for Drinking

2.Aluminum Sulfate Filter Distribution

3.Long Term Water Plant , based on

Surface Water

4.Rain water Harvesting

More Over Distribution of Pure Fluoride

free water supply

ROLE OF DISTRICT HEALTH AND FAMILY

WELLFARE SAMITY(DH&FWS)

Survey

1. At least 20 House Hold survey for identification of Dental as

well as skeletal fluorosis

2. School Survey for identification of Dental Fluorosis among

school children.

Screening and Symptomatic Identification

Diagnostic Test

1. Water- Fluoride 2. Urine-fluoride 3. Blood-fluoride

* Medical Intervention by Surgery and Medication

*Behavioral changes through IEC

*Most of all Make People Awareness to come at nearest BPHC and

PHC for primary Screening and Supplementary Medication

*Possible referral services will be made to the Medical College and

Hospital .

CO-OPERATION BETWEEN

HEALTH AND P.H.E.D

*Identification and Treatment of Fluorosis

Affected People

*Provide them Pure fluoride free Water

*Treatment of malnutrition

*Surgery

*Good Health promotion and Pure water

*Sort and Long Term Measurement of

water supply

THANK YOU

Have a Good Day