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Fluoride contamination, health problems and remediation methods in Asian groundwater: A comprehensive review

Yadav KK, Kumar S, Pham QB, Gupta N, Rezania S, Kamyab H, et al.

Ecotoxicol Environ Saf, 2019 Oct 30;182:109362.
PMID: 31254856 DOI: 10.1016/j.ecoenv.2019.06.045

In low concentration, fluoride is considered a necessary compound for human health. Exposure to high concentrations of fluoride is the reason for a serious disease called fluorosis. Fluorosis is categorized as Skeletal and Dental fluorosis. Several Asian countries, such as India, face contamination of water resources with fluoride. In this study, a comprehensive overview on fluoride contamination in Asian water resources has been presented. Since water contamination with fluoride in India is higher than other Asian countries, a separate section was dedicated to review published articles on fluoride contamination in this country. The status of health effects in Asian countries was another topic that was reviewed in this study. The effects of fluoride on human organs/systems such as urinary, renal, endocrine, gastrointestinal, cardiovascular, brain, and reproductive systems were another topic that was reviewed in this study. Different methods to remove fluoride from water such as reverse osmosis, electrocoagulation, nanoﬁltration, adsorption, ion-exchange and precipitation/coagulation were introduced in this study. Although several studies have been carried out on contamination of water resources with fluoride, the situation of water contamination with fluoride and newly developed technology to remove fluoride from water in Asian countries has not been reviewed. Therefore, this review is focused on these issues: 1) The status of fluoride contamination in Asian countries, 2) health effects of fluoride contamination in drinking water in Asia, and 3) the existing current technologies for defluoridation in Asia.

Matched MeSH terms: Fluorosis, Dental/epidemiology
Fulltext The prevalence of dental fluorosis and its associated factors in Salem district

Ramesh M, Narasimhan M, Krishnan R, Chalakkal P, Aruna RM, Kuruvilah S

Contemp Clin Dent, 2016 6 17;7(2):203-8.
PMID: 27307668 DOI: 10.4103/0976-237X.183061

CONTEXT: There are various regions in India that have high levels of fluoride in drinking water sources. Many people residing in such places suffer from dental fluorosis (DF).
AIMS: To evaluate the prevalence of DF in children residing in Salem and also to find any correlation between DF and other related factors.
MATERIALS AND METHODS: One school from each block of Salem (total 21 blocks) was selected for the study. A single examiner had evaluated untreated caries, lesions, and DF (for permanent anterior teeth and molars) using the Dean's fluorosis index, in all children. Water fluoride level determination at each school was done using the Tamil Nadu Water Fluoridation and Drainage Board field kit. Other factors that may have contributed to DF were assessed using a questionnaire, which was provided to each student. The data obtained were statistically analyzed using the SPSS software version 11.5.
STATISTICAL ANALYSIS: Chi-square test was used for statistical analysis.
RESULTS: DF was present in 56.9% of the children examined. It was mostly seen in 9 years old (72%) and male (59%) children. A positive correlation was found between the occurrence of DF and the duration of residence in a place with high water fluoride content, consumption of borewell water (64%), the parts per million of fluoride in drinking water, consumption of black tea (59%). However, no correlation was found between DF, dental caries, consumption of milk, or consumption of foods cooked in aluminum vessels.
CONCLUSION: There was a correlation between DF and factors such as male gender, bore well water consumption, black tea consumption and the duration of residence in a place with high water fluoride content.

Matched MeSH terms: Fluorosis, Dental
Fulltext Mothers’ knowledge of fluoride toothpaste usage by their preschool - children

Tay HL, Jaafar N

Malaysian Dental Journal, 2008;29(2):140-148.
MyJurnal

Background: Mothers play an important role in preventing fluorosis due to inadvertent swallowing of fluoridated toothpaste and enhancing the effectiveness of toothbrushing amongst preschool children through proper supervision.
Aim: To investigate the knowledge of mothers with regards to the benefits and risks of fluoride toothpaste usage among preschool children and to assess the level of parental supervision during toothbrushing. In additional, we wish to investigate the toothpaste purchasing behaviour of mothers in relation to brand, price, flavour, fluoride content and the influence of advertisement.
Methodology: Cross-sectional study of a representative random sample of 373 mothers of 5-6 year old preschool children through self-administered questionnaires.
Result: The response rate was 90.3% (337). The majority (61.7%) of the mothers reported that the amount of toothpaste their children used was half-length. Most mothers (70.6%) claimed they usually apply toothpaste for their child. About one-half (50.4%) reported the children applied the toothpaste themselves. Only 41.2% of the respondents supervised their children every time during toothbrushing. The mean age at which the child started brushing and using toothpaste was about 34 months (S.D. 14.9) and 37 months (S.D.14.8) respectively. Almost all (95.8%) reported that their children rinsed their mouth after toothbrushing. The mothers’ choice of toothpaste for their child was influence by brand (91.4%), flavour (91.4%) and fluoride content (84.6%) with price being the least of the factors. The majority of the respondents (82.7%) had average to good overall knowledge scores. There was significant association (P=0.034) between the level of education of the mothers and their level of knowledge on fluoride toothpaste usage.
Conclusion: Future oral health messages for preschool children and mothers in Perlis should target areas found lacking in terms of knowledge and practices with regards to fluoride toothpaste usage. This includes regular supervision of preschool children during toothbrushing by parents and using only a small amount of toothpaste for young children.

Matched MeSH terms: Fluorosis, Dental
Psychological impacts of dental fluorosis among malaysian school children

Mohd Nor, M., Sheiham, A., Tsakos, G.

Malaysian Dental Journal, 2008;29(1):20-24.
MyJurnal

The objectives were to assess the prevalence, severity, the psychological and social impacts of fluorosis among school children and their parents in the Kuala Pilah area, Negeri Sembilan, Malaysia. Methods: A convenience sample of 431 students aged 16-17 years old from 3 secondary schools in Kuala Pilah, Negeri Sembilan were selected. The students were assessed for presence of dental fluorosis using Dean’s Index and to assess impacts. Questionnaires were administered to all the dental fluorosis students and selected matched students with no fluorosis. They constituted a control group for the case control study. Questionnaires were sent to the parents of dental fluorosis and control non fluorosis cases. Results: The prevalence of dental fluorosis was 27.8%; 82% of the fluorosis cases were questionable to mild and 18% moderate to severe fluorosis. 16.1% of students with dental fluorosis and 8.5% of non-fluorosis students had psychological impacts. 12.8% of the parents of children with fluorosis reported that their child had an impact. More girls with fluorosis (35.7%) had psychological impacts compared than boys (25.0%). In the 16.1% of fluorosis cases who had psychological impacts, difficulty smiling and showing teeth, affected 35.7% of girls and 25 % of boys. The percentage of students with dental fluorosis who had psychological impacts on carrying out school work was 2.7%, and 3.6% had impacts related to going out with friends. Conclusions: There were considerable psychological impacts on smiling and showing teeth among Malaysian teenagers with dental fluorosis and some of their parents were concerned about the fluorosis. But the impacts were mild and do not have a major impact on students’ lives. Dental fluorosis is not aesthetically displeasing to most subjects but does have psychological and social impacts on a small percentage with fluorosis.

Matched MeSH terms: Fluorosis, Dental
Fulltext Dental Fluorosis And Caries Status Among 12-13 Year-old School Children In Klang District, Malaysia

Esa, R., Razak, I.A.

Ann Dent, 2001;8(1):-.
MyJurnal

Several national studies have been undertaken to assess the prevalence of fluorosis utilizing the Dean's Index. However, the latest national study undertaken in 1997 (1) had utilized the DDE Index and hence does not allow comparisons to be made with the earlier set of national data. This cross-sectional study was undertaken to evaluate the prevalence of dental fluorosis using the Dean's Index in a sample of 12-13 year-old schoolchildren and to assess the relationship between fluorosis and their caries status. The sampling procedure involved a multistage, clustered and stratified random sampling. The sample comprised of 1519 schoolchildren attending 20 secondary government and governmentaided schools in fluoridated urban and rural areas of Klang District in Peninsular Malaysia. There were 772 males and 747 females. Each subject was administered a questionnaire to elicit the demographic information. Intra-oral examination for dental fluorosis and caries was performed for each subject. The results demonstrated that more than half of the subjects (54 %) had no fluorosis, 13.2% had questionable fluorosis, 31.3% had very mild to mild fluorosis, 1.4% had moderate fluorosis and only 0.1 % exhibited severe fluorosis. The mouth prevalence was 32.8 %. The Community Fluorosis Index was 0.48 indicating a borderline score for public health significance. Fifty-two percent of the children were caries free. The mean DMFT for all subjects was 1.1, F(0.6) being the main component. Although girls had a higher mean DMFT score as compared to boys this difference was not significant. Significant differences in DMFT scores were observed by urbani rural distributions and ethnic groups (p < 0.01). No significant correlation was found between fluorosis and caries status. It is concluded that dental fluorosis does not appear to be a public health problem. Further coordinated in-depth research using similar criterias for assessing dental fluorosis is highly recommended.

Matched MeSH terms: Fluorosis, Dental
Comparative Evaluation of Dental and Skeletal Fluorosis in an Endemic Fluorosed District, Salem, Tamil Nadu

Ramesh M, Malathi N, Ramesh K, Aruna RM, Kuruvilla S

J Pharm Bioallied Sci, 2017 Nov;9(Suppl 1):S88-S91.
PMID: 29284943 DOI: 10.4103/jpbs.JPBS_77_17

Background: High levels of fluoride in the drinking water, especially ground water, results in skeletal fluorosis which involves the bone and major joints. This study was conducted to assess the prevalence of skeletal fluorosis to compare with dental fluorosis in an endemically fluorosed population in the District of Salem, Tamil Nadu.
Materials and Methods: Institutional ethical clearance was obtained. A total of 206 patients who reported to the Department of Hematology for blood investigations were the participants in this study. Age, sex, place, weight, height, dental fluorosis, and skeletal complaints were noted down. Body mass index was calculated, and statistical analysis was performed.
Results: Dental fluorosis was present in 63.1% and absent in 36.9% of the samples reported. Skeletal fluorosis was present in 24.8% and was absent in 75.2%. A large number of the patients had knee pain and difficulty in bending. Chi-square test was used for statistical analysis. Skeletal fluorosis and age were compared and P value was 0.00 and was significant. Dental fluorosis and skeletal fluorosis were compared and P value was found to be 0.000 and significant.
Discussion and Conclusion: There is a need to take measures to prevent dental and skeletal fluorosis among the residents of Salem district. Calcium balance should be maintained, and fluoride intake should be minimized to reduce the symptoms. The government should provide water with low fluoride level for drinking and cooking. Once the symptoms develop, treatment largely remains symptomatic, using analgesics and physiotherapy.

Matched MeSH terms: Fluorosis, Dental