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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Why women need to be trained and engaged in monitoring and surveillance of water quality at the community level in rural India?

Historically, water is a gendered burden, with women being the primary caregivers responsible for cooking, washing and cleaning chores in the house and in modern times in institutions (teachers, anganwadi and healthcare workers). Women have traditionally been associated with various water related tasks - be it collecting, fetching, or purifying water.

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While the government has passed a draft notification to bar use of Reverse Osmosis (RO) purifiers in cities, what does evidence on the ground tell us?

The Government of India has passed a draft notification to bar membrane based systems such as Reverse Osmosis (RO) to be used as domestic purifiers in cities where the tap water is safe according to the Bureau of Indian Standards (BIS) norms. This is to comply with an order of the National Green Tribunal (NGT) that proposed a ban on RO in the NCR region.

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Fluorosis has turned out to be a chronic public health problem, with millions of people at high risk due to lack of clean drinking water.

I am in the middle of nowhere, out on a field visit to understand how fluoride, a deadly contaminant in groundwater has been afflicting people in some of the worst affected villages in Nalgonda, Telangana. I am thirsty as hell and would do anything to find a seemingly elusive little glass of water, but I can’t.

Restless as I am, with my thoughts running wild, I get out of the car and start walking.

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Regions

Decentralised groundwater governance frameworks that integrate democratic institutional mechanisms are needed to deal with the current groundwater crisis in India.

The challenges to sustain groundwater dependency in India are many where groundwater over extraction is not only leading to rapid depletion of the resource, but also giving rise to water quality issues in a situation where the response at the level of policy continues to be lukewarm.

Attachments

Topics

Sub-Categories

Regions

RO purifiers can lead to huge wastage of water. A draft notification by the Environment Ministry seeks user’s views on banning RO purifiers in areas where water conforms to BIS norms.

The use of reverse osmosis (RO) purifiers has become a contentious issue, mainly because of the amount of water that is wasted following its use. Last May, the National Green Tribunal (NGT) issued an order to ban RO purifiers in cases where the total dissolved solids in the water source were less than 500 mg/litre.

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Regions

The Karnataka Jnana Aayoga (KJA) set up a Task Group to draft a new water policy for Karnataka in December 2017 and the report is now in public domain. What are the suggestions that the report makes?

The water crisis in Karnataka has not only led to severe agrarian distress in the eastern plains region but also created an acute shortage of domestic water, in both rural and urban areas. The 21st century has seen significant changes in demography, economy and agriculture, increasing the demand for water in the state. Expanding irrigation and urbanisation, possibly have also had a negative impact on river basins and water conflicts are seeing a rise in the state. All these developments have substantially complicated and aggravated the water challenges in Karnataka.

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This unique low cost fluoride removal technology is not only affordable, but is also easy to operate as a water treatment filter with high efficiency suitable for rural application.

Groundwater contamination has emerged as an alarming issue in India and a recent UN report reveals that India ranks 120th among the 122 countries in terms of water quality index. As high as 70 percent of the water supply in India is contaminated, resulting in nearly 0.2 million deaths each year.

Poisoned waters: Fluoride contamination of groundwater

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Centre for Water Resources Development and Management (CWRDM) is organizing the Indian National Groundwater Conference (INGWC-2020) to discuss 'Groundwater Resources Management for Sustainable Development with the Special Emphasis on Coastal and Urban Environment’ at CWRDM, Kozhikode, Kerala, India dur

February 18, 2020 12:00PM - February 20, 2020 12:00PM
February 17, 2020 12:00PM

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A young college graduate shares his experience working with Tata Trusts in Assam on water issues.

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INREM Foundation and The Fluoride Network have worked in Chikkaballapur extensively, to battle the problem of fluoride contamination in groundwater.

Chikkaballapur is a district in the state of Karnataka, just north of the capital Bengaluru. A peri-urban area that was once an agricultural centre for this region, today Chikkaballapur is facing a unique problem. 

Decreasing rainfall has meant increasing periods of drought for this area, which in turn has caused residents to dig deeper and deeper in search of water. In this pursuit for groundwater, they have found water… but it is contaminated with fluoride.

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