Dr. Jagannath Dinda Chief Medical Officer of Health.Bankura Office of the Chief Medical Officer of Health Tamlibandh Post + District : Bankura Pin-722101

1. NATIONAL PROGRAMME
FOR PREVENTION AND CONTROL OF
FLUOROSIS
Dr. Jagannath Dinda
The Chief Medical Officer of Health .
Bankura
Govt. of West Bengal
Mob No-

2. FLUOROSIS:
INTRODUCTION
A N E W P U B L I C H E A LT H
PROBLEM FLUOROSIS IN IMMAGE
 Fluorosis is a slow, progressive and
crippling malady affecting most of the
organs in the body where flouride in
drinking water is > 1.0ppm.
 More than 90% of rural drinking water
supply programmes are based on
ground water available, which is being
overexploited for agriculture, causing
a high influx of fluoride into water.
 Endemic fluorosis has been steadily
increasing ever since the disease was
discovered in India during the 1930s .
 In West Bengal Birbhum , Bankura,
Purulia are grossly effected.

3. Fluorosis : An endemic burden
World Wide
Magnitude of the problem
25 countries around the
world.(DARK AREAS)
A crippling Disease
1. Slow –Progressive Cripple
2. Affect all aged person.
3. Health Complain-Overlapping many
disease
4. Impact depends on
a. Age
b. Hormonal Status
c. Nutritional Status
d. Efficiency of Kidney
3

4. Problem in India
 No of affected
District 204 (21
States /UT)
Jammu &
Kashmir
7
Himachal Pradesh
 people affected, 62
Arunachal
Punjab
Delhi Pradesh
million ( 6 million
82
Haryana
31 children)
63
Rajastha Sikkim
Uttar Pradesh Assam
Nagaland
n 22 Bihar 9
Manipur
 Causative factor,
100.0
Gujarat 15 Tripura Mizoram excess consumption
Madhya Pradesh
95
36 West Bengal of fluoride through
Orissa 22
Maharashtra 56 drinking water
31 70-100 % Districts affected (>1.0ppm) and diet.
Andhra Pradesh
40-70 % Districts affected
Karnataka
67
70
10-40 % Districts affected BIS- Burro of Indian
<10% Districts affected Standard
Tamil Nadu Endemicity not known BIS= Permissible Limit of
Kerala
28
Andaman Fluoride: 1.5 mg/L or PPM
21 Nicobar
Source:A Treatise on Fluorosis by Dr. A.K. Susheela

5. Fluorosis : An endemic burden in
West Bengal Scenario in W.B: 45 Blocks in District
Total People affected: 2.20 Lakhs
In West Bengal
Malda, Birbhum, Bankura,
Purulia and South 24
Paraganas,Malda are affected.
Of them Purulia, Bankura,
Birbhum & Daxin Dinajpur are
worst affected.

7. PREAMBLE
Persons suffers from Fluorosis in India : 6 Million
(Dr. Raja Reddy , NIN , Hyderabad)
Persons suffers from Fluorosis in West Bengal: 2.20
Lakh
Persons Suffers from Fluorosis in Bankura: 90,742
Current Status of Fluorosis In Bankura
District
Affected Pop.
Affected Pop.
Affected Vill.
Tot. Blocks
Tot. Village
in Bankura
Habitation
Habitation
Affected.
(Approx)
(Approx)
Tot. Pop.
Tot. Pop.
Affected
Affected
Block
Pop.
Pop.
Tot.
22 31,92,695 15 20,21,341 90,742 3832 31,92,695 271 90,742 7778 1005
90,742

8. PREVALANCE IN BANKURA
Most affected groups are:
Age Group between 4-11 and > 40 aged
people.
Dental Fluorosis Present in Age group 4-11
Dental and Skeletal Fluorosis Present in age
group >40
In children mainly Dental Fluorosis are
present

9. Clinical symptoms
Initial symptoms : Headache, constipation, vague body
pains, backache, joint rigidity & general weakness.
These were followed by multiple joint pains, mostly in the
feet, knees, and back.
Difficulty in walking
Limitation of joint movement. Inability to close the fist
Spinal stiffness and kyphosis developed in a few patients.
Flexion of spine
Neurological complication

10. IMPACT ON HEALTH

11. Types of Fluorosis
Dental Skeletal Non skeletal

12. Dental fluorosis
Normal:
The enamel surface is smooth,
glossy and usually a pale creamy
white in color.
Mild: The white opacity of the
enamel of the teeth is more
extensive, but covers less than
50% of the tooth surface .

13. Moderate:The enamel surface of the teeth
shows marked wear and tear with brown stain
and is frequently a disfiguring feature .
Severe: The enamel surface is badly
affected and hypoplasia is so marked that
the general form of the tooth may be
affected. There are pitted/worn out areas
and widespread brownish discoloration
with the teeth often having a corroded
appearance.

14. Skeletal Fluorosis
Identification

15. COIN TEST: The subject is
asked to lift a coin from the floor
without bending the knee. A
fluorotic subject would not be
able to lift the coin without flexing
the large joints of lower extremity
CHIN TEST: The subject is
asked to touch the chin with
the chest. A fluorotic subject
would not be able to do so, if
there is pain or stiffness in the
neck.

16. STRETCH TEST: The individual is
made to stretch the arms
sideways, fold the arm and try to
touch the back of the head. If
there is pain or stiffness in the
shoulder joint and backbone, the
exercise will be difficult,
suggesting possibility of fluorosis
Confirmation with X-ray
Ossified Interosseous
Membrane

17. Types of skeletal fluorosis - I
 Genu valgum,
 Genu varum,
 Anterioposterior bowing of tibia (Saber
tibia),
 Scoliosis,
 Paraplegia are severe forms of skeletal
fluorosis

18. RECENT NIN STUDY CONDUCTED IN BIHAR
CHILDREN OF 2-3 YEAR WERE AFFECTED WITH SEVER FORMS OF CRIPPLING BONE
DEFORMITIES
Children affected from fluorosis

19. Skeletal fluorosis in Assam

20. SKELETAL FLUOROSIS IN BANKURA

22. Types of skeletal fluorosis - II
Genu valgum (KNOCK KNEES)
Legs are bowed inwards in the
standing position. The bowing usually
occurs at or around the knee, and
when standing with knees together,
the feet are far apart.
Genu Varum
Legs are bowed outwards in the
standing position. The bowing
usually occurs at or around the
knee. When standing with the feet
together, the knees remains far
apart.

23. Types of skeletal fluorosis - III
Kyphosis: – Forward bending of spine.
Fixed and rigid thoracic cage as well as
spinal cord compression occur
Anterioposterior
bowing of tibia

24. Types of skeletal fluorosis - IV
Paraplegia: Spinal
cord compression due
to osteosclerosis with
paraplegia as a result
of endemic skeletal
fluorosis

25. NON SKELETAL MANIFESTATIONS
 Tingling sensation in fingers and toes
 Excessive thirst
 Polydypsia and polyurea
 Nervousness & Depression

26. INTERVENTION
1.Safe Water Supply bellow<1.5 mg/L
2. Domestic Filter
3. Small defluoridation Plant
4. Nutrition and Proper Diet
5. Supplementary Medicine
vit- C
vit- D
Ca
Antioxident
6. Clinical Intervention
a. Screening
b.Diagnostic Test
c.Identification
d.Surgery and Medication

27. INTERVENTION
Proper Nutrition and Diet
1. Green Vegetable should be taken large amount in a day.
2. Carrot and Tomato are the main source of antioxidant .
3. Milk and Small –fish are the rich source of Calcium.
Avoid Fluoride containt food, Cosmetics and tooth-pest.

28. ROLE OF P.H.E.D
1.Surface Water Utilization for Drinking
2.Aluminum Sulfate Filter Distribution
3.Long Term Water Plant , based on
Surface Water
4.Rain water Harvesting
More Over Distribution of Pure Fluoride
free water supply

29. ROLE OF DISTRICT HEALTH AND FAMILY
WELLFARE SAMITY(DH&FWS)
Survey
1. At least 20 House Hold survey for identification of Dental as
well as skeletal fluorosis
2. School Survey for identification of Dental Fluorosis among
school children.
Screening and Symptomatic Identification
Diagnostic Test
1. Water- Fluoride 2. Urine-fluoride 3. Blood-fluoride
* Medical Intervention by Surgery and Medication
*Behavioral changes through IEC
*Most of all Make People Awareness to come at nearest BPHC and
PHC for primary Screening and Supplementary Medication
*Possible referral services will be made to the Medical College and
Hospital .

30. CO-OPERATION BETWEEN
HEALTH AND P.H.E.D
*Identification and Treatment of Fluorosis
Affected People
*Provide them Pure fluoride free Water
*Treatment of malnutrition
*Surgery
*Good Health promotion and Pure water
*Sort and Long Term Measurement of
water supply

31. THANK YOU
Have a Good Day