Dr.Goswami Dy CMOH-II Bankura and Consultant NPPCF Bankura Thanks to Dr.Khandre Dy. Director NIN A.P for his valuable training

1. Consultant NPPCF Bankura

2.  Fluorine is the an element (F-)
In nature it is not available as fluorine ,it is an strong oxidizing agent
and always found in compound form with other element.
 Inorganic fluorine containing compounds are called fluorides.
 Inorganic chemicals : Cryolite (Na3AlF6)
Sulfuryl fluoride (SO2F2)
Sulfur hexafluoride
Organic chemicals : Organofluorine
polytetrafluorethylene(Teflon)
polychlorotrifluoroethylene (moisture barriers),
Efavirenz (pharmaceutical used for treatment of HIV)
fluoxetine (an antidepressant) 5-fluorouracil(an anticancer drug),
hydrochlorofluorocarbons and hydrofluorcarbons (refrigerants, blowing
agents and propellants).
 Fluoride is usually found naturally in low concentration in drinking water
and In foods

3.  Fluorosis is a slow, progressive and crippling malady affecting
most of the organs in the body where fluoride in drinking water is
> 1.5 ppm (WHO)
 BIS=1.0 ppm (We follow BIS)
 Fluorosis is a crippling Disease
Slow –Progressive -Cripple
Affect all age.
Health Complain-Overlapping many disease
Impact depends on
a. Age
b. Hormonal Status
c. Nutritional Status
d. Efficiency of Kidney
 Fluorosis is three types: 1) Dental Fluorosis
2) Skeletal Fluorosis
3) Non Skeletal Fluorosis

4. Scenario of West Bengal

5. TOTAL AFFECTED BLOCKS : 17
District Scenario
Minimum village Affected
Medium village Affected
Maximum village Affected

6. 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 (5-8 yrs)

7.  Headache, cconstipation, 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
Clinical symptoms
Clinical Symptoms

8. • Affected Countries : 25
countries in the worldWorld
• No of affected District 204 (21 States /UT)
• people affected, 62 million ( 6 million
children)
India
• 45 Blocks in 7 Districts
• Total People affected: 2.20 Lakhs
West
Bengal

9. Fluoride contaminated Blocks of Bankura District & Its
maximum fluoride concentration:
Name of the Blocks Fluoride (PPM)
Simlapal 12.69
Hirbandh 10.80
Taldangra 10.45
Khatra 5.12
Bankura-II 4.90
Bankura-I 4.62
Raipur 4.55
Chhatna 4.00
Mejia 3.90
Indpur 4.41
Sonamukhi 3.40
Onda 3.03
Saltora 3.00
G.Ghati 2.67
Barjora 2.51
Ranibandh 2.16
Sarenga 1.98
Affected 17
Blocks out of 22
Blocks of
Bankura District

10. Types of Fluorosis
Dental Skeletal Non skeletal
Affection starts mostly when fluoride level is 3to 8 Mg/Lit in drinking water

11. 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.

12. 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.

13. 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.
Types of skeletal fluorosis

14. Tingling sensation in fingers and toes
Excessive thirst
Polydypsia and polyurea
Nervousness & Depression
Non Skeletal Manifestation

15. Fluorosis: Adverse Health Affect & its causes
1. Patient complain fatigue / Weakness due to destruction of
muscle structure by fluoride decomposition in muscle
2. Patient complain tiredness ,unenthusiastic and a feelings
of depression due to destroying RBC resulting anemia and
eventually depression.
3. Stomach & intestine inner mucosal membrane destroy by
decomposition of fluoride resulting the GI mucosal
destruction.
4. Ant- diuretic hormone and kidney disfunction cause
polydipsia & polyurea
5. A female patient complain of repeated miscarriage /
still birth due to deposition of fluoride - foetal blood
vessel blocking.
6. Anemia patient complain of not being able to
conceive due to husband sperm count is being low
(Oligospermia) / non (azospermia) and blunt end of
sperm

16. Fluorosis Diagnostic Test
In Adult :
Fluoride to be tested in
Drinking Water ( to collect in plastic
bottle only )
Blood (Serum) [ fasting not required]
Urine (spot urine sample)
Confirmative Test:
Radiograph of the fore-arm
Hemoglobin
In Children:
Fluoride in the drinking water of the
child / OR if an infant or new born.
Fluoride in the drinking water of the
mother.
Blood (serum) of the child; if an infant
or new born, the blood serum of the
mother.
Urine of the child / infant.
Additional Tests:
Thyroid Stimulating Hormone (TSH)
Iodine in urine
Thyroid hormone levels T3 and T4

17. 1.Safe Water Supply bellow 1.5 mg/L of fluoride
2. Use of 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 (Urine & Blood)
c.Identification
d.Surgery and Medication
7. IEC & BCC

18. Take Proper Nutrition and Diet
1. Green Vegetable should be taken in large amount
2. Carrot and Tomato are the main source of antioxidant .
3. Milk and Small –fish are the rich source of Calcium.

19. Black salt (Kalanamak)
Rock salt
Different names of rock salt are:
Sandha namak
Lahori namak
Vrat ka namak
Pakistani namak
Tea
(without milk and with lemon)
Salted snacks smeared
with black salt viz. Dalmoth

20. Channa dal
Navratan
Papri Chat
Bhel puri
Pani puri
Pickles smeared with black salt
Masala's smeared with black salt
Chana masala
Sabzi masala
Meat / Chicken masala
Chunky chat masala
Tava fry
Jal jeera masala

21.  Survey to locate & ensure the fluorosis affected population as
per fluoride listed village by PHED Bankura.
 Arrange training of M.O , BPHN/ PHN ,HS , ANM , BSI ,
Paramedicos , ASHA , AWW , Teachers etc. to promote the further
root level investigation in the field with PIC (Personal Inter
Communication) & IEC , BCC.
 Arrange advocacy meeting at District level & remittance of fund
for block level advocacy meeting and its supervision.
 Arrange monitoring & review meeting in District PH MIES
regarding fluorosis & remittance of fund for block level meetings
meeting and its supervision.
 IEC & BCC (Under BCC ASHA/AWW/PRI/Teachers/School, College
Students to be sensitize)
 Medicinal treatment including nutritional advice to the fluorosis
suffered cases.
 Possible surgery & rehabilitation .

22.  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

23.  *Identification and Treatment of Fluorosis
Affected People
 *Provide them safe fluoride free Water
 *Treatment of malnutrition
 *Surgery
 *Good Health promotion and Potable
water
 *Short and Long Term Measures of safe
water supply

26. Recent NIN study conducted in Bihar
Children of 2-3 year were affected with sever forms of crippling bone deformities
Children affected from fluorosis

27. Skeletal fluorosis in Assam

28. 1. Proper diet and Nutrition
2. Control of Malnutrition
3. Fluoride free food intake
4. Chana masala ,Black Salt , Rock Salt avoid
5. Lemon tea with Black Salt avoid
6. Fluoridated cosmetics ,drugs ,toots pest avoid

29.  Rain water Harvesting
 Aluminum –sulfate domestic filter distribution
 Fluoride free water supplement , Long term
,Short-term measurement
 IEC
 Educational Camp
 Media Mangement
 Surface water utilization etc.

30. This is very simple and inexpensive
method conceived by staff of ICOH and
WHO
Bore well water with 3.8 ppm fluoride
after passing through this defluoridator
reduced to 0.18 ppm
The pipe is 75 cm feet long and 90 cm
diameter with 1kg Bone Char activated
by heating

31. Inauguration of Community Bone Char Defluoridator
at
endemic village of Nalgonda District

33. 1.Roof catchment
2.Gutters
3.Downpipe and first flush pipe
4.Storage tank
5.Filter unit
The roof catchments are relatively
cleaner when compared to the
ground level catchments
Built and maintained by the local
communities
Available at their door steps
with least cost

34. Activity 1
Prevalence
assessment
Exposure
assessme
nt
Risk
determ
ination
Risk
manage
ment
Activity 2
Strengthening
infrastructure
-Labs
-Health system
-Collaborating
centres
Activity 3
Capacity
building
Human
resource

35. Case
management
1. Diagnosis
2. Management
3. Surgery
4. Rehabilitation
Case
surveillance
1. Active -> H-t-H
2. Passive -> OPDs
Exposure
assessment
PHE lab data

36. Strengthening of
infrastructure
Laboratory
Collaborating centres
Health system

37. Capacity
building
Human
resource
1. Sensitizations / training of MOs
2. Sensitizations / training of Lab Techs
3. Sensitizations / training of paramedics
4. Capacity building- PRI/ community/
ASHA/ AWWs/ etc (IEC/ BCC)

38.  To provide safe house hold water to every citizen of
Fluoride affected areas of Bankura, a constant
pursuance is planned to be under taken through
“Intersectoral co-ordination” with the NGOs,
General Administration, PRIs, PHED and related
agencies.
 And get rid of Fluorosis……by 2015!

39. Have a Good Day