Endemic dental and skeletal fluorosis: effects of high ground water fluoride in some North Indian villages

Objectives: To identify the endemic high fluoride areas and to study the effects of high water fluoride in the population residing in these areas. Methods: A water survey from different areas was utilized to identify high fluoride area in some districts of Uttar Pradesh, India. Pretested questionnaires was prepared to record dental fluorosis grades, nutritional and socio-economic status, education, occupation, by house to house survey of 10,000 population. Subjects were clinically examined for dental and skeletal fluorosis. Results: In villages of Unnao district mean water fluoride level in ground water ranged from 1ppm to 10.5ppm. Out of a population of 5024, 43% had fluorosis (dental and skeletal). The prevalence of dental and skeletal fluorosis was 28.6% and 14.2% respectively. Dental fluorosis was highest in 13-15 years age group with boys more commonly affected than girls. Conclusion: Fluorosis incidence is directly related to fluoride intake through drinking water. Fluorosis (both dental and skeletal) was prevalent in the villages with water fluoride levels more than 1ppm. Fluorosis increases from 5 to 15 years of age, highest in 13-15 years age, as water (and hence fluoride) consumption increases in growing age and also because amelogenesis and enamel maturation is also taking place, thus making the enamel more susceptible. Majority of the population above 40 years of age were partially or completely edentulous, emphasizing that dental fluorosis as being one of the primary causes