Dental Fluorosis and Fluoride in Urine in School Students Living In a Rural Area of West Bengal, India

Background: Excessive fluoride in drinking water causes dental, skeletal and non-skeletal fluorosis which is encountered in endemic proportions in several parts of the world including India. As per WHO guide line and the Bureau of Indian Standard (BIS), the permissible upper limit of fluoride in drinking water is 1.5 mg/L. Presence of Dental fluorosis along with elevated urinary fluoride level is generally accepted as one of the best and reliable indicator of fluoride exposure. Objective: To determine the prevalence of Dental Fluorosis among school children taking water with fluoride concentration above permissible limit, to determine the urinary fluoride level of school children having Dental fluorosis and to provide supportive and symptomatic treatment of children suffering from Fluoride toxicity. Materials and Methods: A cross sectional study was conducted in February 2019 in Gobindanagar Primary School and Bhagabandh Primary School of Purulia District of West Bengal to assess the occurrence of Dental Fluorosis among school children taking water with fluoride concentration above permissible limit and to determine the urinary fluoride level of school children having Dental fluorosis. Total 136 school children in both the schools were examined and screened for Dental fluorosis. Urine of school students having Dental fluorosis were collected for urinary fluoride analysis. Counseling, advice and treatment of Fluoride toxicity were also given to school children. Results: Out of 136 children 33.82% children had Dental fluorosis (80% mild and 20%- Mod) in both the schools. Overall Dental Fluorosis was found to be more common in the age group of 12-14 yrs (36.9%) and males (52.2%) are more commonly affected than females (47.8%).Fluoride level in urine of school children having Dental fluorosis was 0.08 – 6.7 mg/L and 1.5 – 7.9mg/L in Gobindanagar and Bhagabandh primary school which exceeds the limits stipulated by national and international norms. Conclusion: Prevalence of Dental fluorosis was quite high among school students. Water and Urine fluoride concentration of this population exceeds the limits stipulated by national and international norms and urinary fluoride concentration is also high and it is related with Dental fluorosis.. Immediate actions are needed to decrease the exposure of Fluoride to prevent the potential of adverse health effects among children