Fluoride

Fluoride and fluorosis in India

Have you traveled in rural India and seen children with stained teeth wondering how they could get tobacco-like stains at a young age? Have you seen adults in their mid-40s and 50s with bent shoulders complaining of extreme pain and being bed ridden for years? Or have you asked why the toothpaste adds fluoride whereas we hear of a disease called fluorosis in India caused by high fluoride?

The discovery of high consumption of fluoride being harmful for humans and animals was made in India in 1937  and since then, there has been a long history of observation of fluorosis in many parts of India and across the world. Though mainly occurring due to high consumption of  fluoride from water, it has also been reported to occur through consumption of food, inhalation of fumes and other toxic environments.  

When we first hear about this problem of fluoride and fluorosis, it seems quite strange. How can clear looking water without any taste or odour cause something like this to happen? Also, even a small amount as 1 to 1.5 mg per litre of fluoride in water can be harmful. What makes it stranger is that why do only children get affected with dental stains of fluorosis (and not adults or even children beyond a certain age)? What really happens to our bones that they get twisted, deformed and people get crippled at relatively early age? View the details regarding flurosis on Fluoride and Fluorosis by Fluorosis Research and Rural Development Foundation.

Dental and skeletal fluorosis

Skeletal fluorosis of legs

There are two main types of fluorosis, namely dental and skeletal fluorosis. Dental fluorosis is caused by continuous exposures to high concentrations of fluoride during tooth development, leading to enamel with low mineral content and increased porosity. The critical period for risk to dental fluorosis is between 1 and 4 years of age. After the age of 8 when permanent teeth have established, there is lesser risk to dental fluorosis.

Skeletal fluorosis is developed by the disturbance of calcium metabolism in the formation of bones of the body. It results in softening and weakening of bones resulting in deformities leading to crippling. It can also aggravate calcium related disorders such as rickets in children and osteoporosis mainly in adults. For people who are exposed to high fluoride levels for decades, severe cases of crippling can occur. View the details on Fluoride and Fluorosis by INREM Foundation.

Harmful levels of fluoride and their effect on the body

So, coming back to our earlier questions, let us understand that fluoride in very small amount like what we get from toothpastes cannot lead to the kind of skeletal fluorosis we see in India today. A daily intake of around 10-20 mg/day for adults and as low as 3-8 mg/day for children has been found to be harmful. Using these limits, the rough water safety limits of 1 mg/l of 1.5 mg/l have been arrived at in the context of India.

In 20 states of India, more than 100 districts across the country and probably more than 60 million people are consuming drinking water which has fluoride greater than 1 mg/l. Since local food can also get irrigated by the same water, food also contains fluoride in these places. This makes the total daily consumption of fluoride more than 10 mg/day which is always harmful for adults and more so for children.

What makes excess fluoride bad for us is also that it affects many processes in the body. Firstly, the body requirement for calcium increases. This makes specific people such as women in pregnancy and lactation, growing children and adults beyond the age of 40, more prone to calcium related problems. Apart from this, iron absorption is reduced due the fluoride. This is really important to all of us and especially for pregnant women for whom iron deficiency anemia and related problems are a serious cause of under-weight and unhealthy children at birth.

Does this all make the situation worse and too complex difficult to act on? The answer should be ‘yes’ and ‘no’. On one hand, ‘yes’ because when we think of it, water scarcity itself is a big problem for people. Just getting thirsty throats quenched itself is a big task. Looking at this as a health problem, fluorosis does not yet present itself as a problem of national importance. Also in front of calorie and protein deficiency, calcium and iron come lower down, but still are important.

What can be done to deal with the problem

However, when we put all these together and the possibility of irreversible deformities for large number of people, the only answer can be that we have to act on this and ‘Now’. What can really be done about this?

  • The very first beginning is from simple detection. This can be done by simple testing of water for fluoride in an indicative manner with field kits and observation of children’s teeth for stains. For example, most of us do not know that it is very simple to test for fluoride in few seconds with a field kit that would cost just a few rupees to test each time. Imagine saving yourself from fluorosis with just a small investment as that. Definitely there are more complex instruments such as an Ion electrode which can measure fluoride more accurately. It is also possible to test for fluoride in urine and blood, but very few labs in the country exist today for that. View the details of the Water quality testing kits for field use to know more.

  • Finding safer local sources of water with lesser or no fluoride. In many fluoride affected places, there is a nearby source of water which is free from fluoride. It is just that we don’t know about it, or that it is not accessible to all, or that it may be affected by other forms of contamination such as poor sanitation practices. So the first level solution could just be to identify such a source, have the community come together to make available for all, use it judiciously and improve the quality in a simple way.
  • Basic diet improvement to include calcium rich green leaves, milk, eggs, and rich sources of Vitamin C and antioxidants such as Amla, Lemon, Spinach and local sources such as Moringa and Cassia Tora. View some of the Solutions for safe water and nutrition  to know more about efforts that can be undertaken to prevent fluorosis in the community.
  • As they say, a good beginning is a job well done. Much more can be done on fluoride and fluorosis such as removal of fluoride (activated alumina and reverse osmosis), saving rainwater directly from rooftops or through dams and wells, advanced detection of water and health, and so on. This film on Rainwater harvesting to tackle fluoride provides an example of how rainwater harvesting can be useful to deal with the problem of fluoride contamination of water. View the frequently asked questions on fluorosis and fluorosis mitigation here.

But to begin with it is more important to recognize that this is a problem. To recognize that this is a problem of the current and future. If we look away, we are to lose. So let us act on it ‘Now’.

The Fluoride Knowledge and Action Network

The Fluoride Knowledge and Action Network is a dynamic network of partner organisations and individual members that aims at providing a platform for sharing and interchanging of information related to fluorosis, building upon each other’s experiences, and spreading information on emerging lessons and solutions to encourage action to bring about a significant change in the fluorosis situation in the country.

The network aims at:

  • Bringing people together on a shared platform
  • Collating, analysing and updating all information on fluorosis available till now
  • Building on this information further
  • Getting people to direct their efforts in a focused manner in executing flourosis awareness and mitigation related activities

To join the network, please mail us at contact@indiawaterportal.org or visit us at www.fluorideindia.org.

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Safer water and better nutrition were key in mitigating fluorosis problem in parts of the state.

Farhanuddin was just five years old when a pain in his knee began bothering him. It was 2013. Slowly, his legs began to change shape. They got so badly deformed that it began to affect his everyday life. He was gloomy and tired most times and had trouble walking. His parents thought that lengra bhoot or evil spirit was tormenting them like hundreds of others who were becoming crippled in the village of Tapatjuri in Nagaon district in Assam. Little Farhan could barely eat, wash or take a stroll without assistance.

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Engaging with the fluorosis problem in Nalgonda gave the FKAN a chance to understand the problem and apply the solutions nationally.

Fluorosis continues to be a regional issue in Telangana to this day, even decades after the first cases were discovered in Nalgonda in 1937. More than three lakh people in the district are affected with skeletal and dental fluorosis, a stigma that has stuck for generations. Excessive fluoride intake leads to fluorosis, a chronic condition marked by mottling of the teeth and, if severe, calcification of the ligaments.

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INREM Foundation’s work helped develop protocols on designing proactive action on safe water and nutrition to help mitigate fluorosis in Jhabua.

In 2010, nine-year-old Kailash from Miyati village, Jhabua developed symptoms of skeletal fluorosis. Fluorosis, which affects millions of people in India, is a health issue caused due to high fluoride content in drinking water. Skeletal fluorosis is marked by deformed bones. It affected all aspects of Kailash's life including his education, physical functioning, social acceptance, etc.

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Topics

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Regions

FKAN’s work on preparing an action plan for the fluoride-affected Remuna block in Balasore shows how proactive policy work can help highlight the issue.

Rabindra Kumar Jena, the Member of Parliament (MP) from Balasore, Odisha knew that something was wrong with the health of people in a part of his constituency but he could not put his finger to it. By sheer chance, in 2015, he got to know that this seemed to be related to excessive fluoride in water, which caused a disease called skeletal fluorosis.

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Regions

While millions of people in India still wait for their share of water and toilets, this year's budget fails to give them any hope.

GoI allocations for the Ministry of Drinking Water and Sanitation is Rs. 22,357 crores

For the first time in the last four years, the allocation for the sanitation programme Swachh Bharat Mission (SBM) has gone down from Rs 19,248 (RE 2017-18) to Rs 17, 843 crore (2018-2019).

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Topics

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Regions

The theme for the Conclave this year is “Water Use Efficiency: An Imperative for India” to highlight the imperative of water use efficiency in the industry, agriculture and urban contexts

November 28, 2017 10:00AM
November 27, 2017 12:00PM

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A village affected by fluorosis understands the importance of drinking fluoride-safe water with help from experts.

Shilpi Bai was just 18 when she got married to Magan Singh Solanki in Jamnia village, in Dhar district, Madhya Pradesh. She had dreams in her eyes of a great life ahead. She was healthy and soon became a mother of two children. Her husband was a farmer and she would help him in the field after completing the errands at home. Life was going on, leaving behind some good memories. But as the years passed, she felt as if she was losing her physical stamina. She would feel body ache and pain in her legs, especially in her knees.

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Fluoride contamination is leaving Assam villagers crippled. While a solution is not difficult to reach, authorities are not doing enough to eradicate the problem.

Sadhani Kalita is only 35 years old but looks like she could be 50 years or older. She has lost her teeth and both her legs are misshapen with the ankles twisted. A resident of Tapatjuri village in Assam's Hojai district, Sadhani is one of the many people in the region who are living with dental and/or skeletal fluorosis--a deformity of teeth and bones from consuming water contaminated with fluoride. 

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How Balasore became recognised as a fluorosis-affected district in Odisha

Back in 2015, the Member of Parliament (MP) from Balasore, Odisha got to know about a strange problem in his constituency. There were reports of a number of bone deformities and crippled people in areas surrounding Patripal village of Remuna block. They seemed to be related to fluoride in water, causing a disease called Skeletal Fluorosis.

The problem was that Government data seemed to indicate the entire Balasore district to be free from fluoride (See above figure). But how then were people getting crippled? This started a journey for the MP from Balasore, Rabindra Kumar Jena.

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Illegal slums on Maharashtra mudflats cause loss to state

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