Fluoride Action Network

Abstract

Introduction: Excessive intake of fluorides can lead to the development of fluorosis, a serious public health issue in India. The objective of this study was to assess the impact of community defluoridation in preventing fluorosis in Kaiwara village.

Methodology: This community interventional trial was conducted in Kaiwara village, Karnataka, after obtaining ethical clearance. The study included 903 participants; preintervention data were collected by recording the required parameters. The postinterventional study was carried out 2 years after installing the reverse osmosis plant. Data from pre- and post-intervention study were compared.

Results: Dean’s index showed no significant change in the pre- and post-intervention period for its various categories (P = 0.543). However, the mean urine fluoride levels were found to be decreased significantly (Wilcoxon Signed-Rank test, P < 0.001).

Conclusion: This study demonstrates the importance of providing defluorinated water to the village population as a potential solution for fluorosis.


 

INTRODUCTION

Fluorosis is an endemic disease that has affected 70 million individuals and is prevalent in 22 states of India, particularly in parched parts of the country.[1] The process of removal of harmful fluoride from water is called defluoridation.[2] The world’s ground fluoride stores are estimated to be 85 million tons, of which almost 12 million tons are in India.[3] As Kaiwara, a part of Chikkaballapur district, Karnataka, has no alternate source of water, it is dependent solely on groundwater through bore wells for its water supply.[4]

Advanced defluoridation procedures have commenced in India. Nalgonda technique is one of them, which utilizes alum and lime combination in a two-step process. The process has disadvantages like the undesirable taste of treated water, high-cost maintenance, temperature, and the presence of silicate ions.[5] Reverse osmosis (RO) established by Jean-Antoine Nollet in 1748 is presently the most effective method in terms of fluoride removal.[6]

In a study conducted by Arvind et al. in Kaiwara and the villages under Kaiwara Primary Health Center, it was found that of the 1544 children examined, 42.1% and 8.4% had dental fluorosis and genu valgum, respectively,[4] which clearly proved increased consumption of fluoride. This study is aimed to assess the impact of community defluoridation in Kaiwara, a village endemic for hydric fluorosis…

REFERENCES

1. Annadurai ST, Rengasamy JK, Sundaram R, Munusamy AP. Incidence and effects of fluoride in Indian natural ecosystem: A review. Adv Appl Sci Res. 2014;5:173–85. []
2. Taricska JR, Lawrence K, Hung YT, Li KH. Advanced Physicochemical Treatment Processes. Handbook of Environmental Engineering. Vol. 4. Totowa, NJ: Humana Press; 2006. Fluoridation and defluoridation; pp. 293–315. []
3. Teotia SP, Teotia M, Singh KP. Highlights of forty years of research on endemic skeletal fluorosis in India. 4th International Workshop on Fluorosis Prevention and Defluoridation of Water. ISFR, EnDeCo, ICOH. 2004:107–25. []
4. Arvind BA, Isaac A, Murthy NS, Shivaraj NS, Suryanarayana SP, Pruthvish S. Prevalence and severity of dental fluorosis and genu valgum among school children in rural field practice area of a medical college. Asian Pacific Journal of Tropical Disease. 2012;2:465–9. []
5. Meenakshi, Maheshwari RC. Fluoride in drinking water and its removal? J Hazard Mater. 2006;137:456–63. doi:10.1016/j.jhazmat.2006.02.024. [PubMed] []
6. Bose S, Yashoda R, Puranik MP. Novel materials for defluoridation in India: A systematic review. J Dent Res Rev. 2019;6:3–8. []
7. Susheela AK. Treatise on fluorosis. Fluor Res Rural Develop Found. 2001;34:181–3. []
8. CDC, Using Fluoride to Prevent and Control Dental Caries in the United States, Oral Health Resource-Resource Library, Fact Sheet, Centers for Disease Control and Prevention, US Department of Health and Human Services; 07 August, 2002 []
9. CDC, Engineering and Administrative Recommendations for Water Fluoridation, MMWR Recommendation and Reports, Centers for Disease Control and Prevention. Vol. 44. US Department of Health and Human Services. 1995:13. []
10. Kumar N, Gauba K, Goyal A, Kapur A. Comparative evaluation of three different recording criteria of dental fluorosis in a known endemic fluoride area of Haryana. Indian J Med Res. 2018;147:567–72. [PMC free article] [PubMed] []
11. Singh B, Gaur S, Garg VK. Fluoride in drinking water and human urine in Southern Haryana, India. J Hazard Mater. 2007;144:147–51. [PubMed] []
12. Jarquín-Yañez L, de Jesús Mejía-Saavedra J, Molina-Frechero N, Gaona E, Rocha-Amador DO, López-Guzmán OD, et al. Association between urine fluoride and dental fluorosis as a toxicity factor in a rural community in the state of San Luis Potosi. ScientificWorldJournal. 2015;2015:647184. [PMC free article] [PubMed] []
13. Villa A, Anabalón M, Cabezas L. The fractional urinary fluoride excretion in young children under stable fluoride intake conditions. Community Dent Oral Epidemiol. 2000;28:344–55. [PubMed] []
14. Toth Z, Ginter Z, Banoczy J. The effect of ingested fluoride administered in salt, milk, and tablets on salivary and urinary fluoride concentrations. Fluoride. 2005;38:199–204. []
15. Das K, Mondal NK. Dental fluorosis and urinary fluoride concentration as a reflection of fluoride exposure and its impact on IQ level and BMI of children of Laxmisagar, Simlapal Block of Bankura District, WB, India. Environ Monit Assess. 2016;188:218. [PubMed] []
16. Chen S, Li B, Lin S, Huang Y, Zhao X, Zhang M, et al. Change of urinary fluoride and bone metabolism indicators in the endemic fluorosis areas of southern China after supplying low fluoride public water. BMC Public Health. 2013;13:156. [PMC free article] [PubMed] []

*Read full-text study online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877423/