Abstract

An epidemiological investigation was undertaken in the villages of Tilaipani and Hirapur located in Mandla District of Central India to determine the cause and extent of a peculiar skeletal deformity characterised by knock knee (genu valgum) occurring mainly among children. In Tilaipani, 74.4% of children and adolescents below age 20 had dental mottling, and 51.2% were afflicted with genu valgum. In Hirapur the figures were 56.9% and 6.25%, respectively. Radiological examination revealed extensive osteosclerosis with coarse trabecular pattern. In a few cases juxta-articular bone resorption, periosteal reaction, and bony exostoses were also present. Bio-chemical parameters were generally within normal limits, but dietary surveys indicated that calcium and vitamin C intakes were significantly below recommended levels. In Tilaipani the fluoride content of the drinking water ranged from 9.22 to 10.83 ppm and in Hirapur from below 1 ppm to 13.5 ppm. The mean urinary fluoride concentration in the cases of skeletal deformities was 4.42 ppm. The typical fluorotic dental mottling, the radiological findings, and the high fluoride content in the urine and drinking water all point to high fluoride, probably enhanced by deficient nutrition, as the cause of the genu valgum and other bone deformities.

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