Modern life styles even among people in rural areas have created an increased demand for dental cosmetology. Dental fluorosis due to its cosmetic effect gains more public health importance today. In the scenario of increasing awareness of environmental health hazards, among people, the research into the biology of fluorosis conducted in the endemic area could be helpful to prove with evidence that fluoride in drinking water causes health hazards like dental and skeletal fluorosis, and also non skeletal manifestation of the disease. The problem has reached alarming proportions affecting at least 17 States in India. Of the fourteen Revenue Districts in Kerala, two districts, Alappuzha and Palakkad are endemic for fluorosis. A study was conducted in Alappuzha district and in Kollam, a nearby district, a non endemic area for the fluorosis, to assess and compare the various effects of fluoride in drinking water, on dental and skeletal systems of school children. The present study was conducted among 706 children of 9-12 year age group and sub samples of water collected from these areas for fluoride estimation.
Results:The prevalence of dental fluorosis in the endemic region 66.4% where as it was nil in the non endemic region. The results also indicated that the level of fluorosis could be graded in respect of children of as : 14.8% grade I; 41.1% grade II; 10.3 % grade III and 0.2% grade IV. Dental fluorosis. There was a statistically significant (p=0.000) association between fluoride level in the water and dental fluorosis. It was found that nearly one third of the children clinically examined for the study had non specific symptoms of skeletal fluorosis in Alapuzha district. This association was found to be statistically significant (x2= 7.99, P value=.0.018). The prevalence of nonspecific symptoms like, backache 3.8%; neck pain 16% and history of skeletal fracture 12.1% was observed among the children in Alappuzha district, where as all these symptoms were observed only among 1% of children of Kollam district,non endemic area. The prevalence of dental fluorosis and non specific symptoms of skeletal fluorosis was high among the school children in the district [with] endemic fluorosis.