15 years old, Rekha is unable to speak and smile with confidence. The stained and pitted teeth are hindering her spirit & morale.10 years old, Balu is bedridden. Unlike his friends he can’t walk, play, go to school or do his chores. A happy and carefree childhood is a distant dream for this kid.
From cosmetic problems to morbid conditions, there is a wide range of effects caused by fluorosis, reducing the quality of life. So we sat down along with Dr. RVS Krishna Kumar, Professor & Head of the Department of Public Health Dentistry at Narayana Dental College & Hospital, Nellore, Andhra Pradesh, to get an expert opinion on this devastating disease.
Speaking of fluorosis is impossible without mentioning something about fluoride. There is no exaggeration in saying that fluoride is a double-edged sword as it plays a very important role in preventive dentistry due to its anti-caries activity (cariostatic). An excessive intake of fluoride results in a toxic disease called fluorosis.
Dr. Harichandana Kesari (HC): What is fluorosis?
Dr. RVS Krishna Kumar: Fluorosis is a public health problem. It is caused by excess intake of fluoride through drinking water/food products/ industrial pollutants over a long period. It is a crippling disease affecting both the hard (bones) and soft tissues (muscles, nerves) of the body.
HC: How prevalent is fluorosis?
Dr. Kumar: Fluorosis is worldwide in distribution and is endemic in at least 25 countries. Here, I would like to mention about the term fluoride belt. A Fluoride belt is nothing but an area where the fluoride content is high in soil and rocks, resulting in the leaching of fluoride and increasing the fluoride levels in groundwater. There are two such belts in the world. One that stretches from Syria through Jordan, Egypt, Libya, Algeria, Sudan and Kenya, and another that stretches from Turkey through Iraq, Iran, Afghanistan, India, northern Thailand and China. There are similar belts in the Americas and Japan. Studies show that in India, approximately 25 million people are presently affected by fluorosis and 66 million are at risk of developing fluorosis.
HC: How much excess is excess fluoride?
Dr. Kumar: The safe level for daily fluoride intake is 0.05 to 0.07 mg F/Kg/day. Above this level, the risk of developing fluorosis will be evident.
HC: Are there different types of fluorosis?
Dr. Kumar: Yes, there are different types of fluorosis depending on the organs that are affected. It can be dental, skeletal or non-skeletal fluorosis. Dental fluorosis affects children characterized by prominent discolouration and disfiguration of teeth. Skeletal fluorosis affects the bones and joints of the body like the neck, backbone, shoulder, hip and knee joints resulting in severe pain, rigidity or stiffness in joints. Severe forms of skeletal fluorosis result in disability & dysfunction. Non-skeletal fluorosis develops long before the onset of typical changes in teeth and skeletal bones. These are seen as gastrointestinal, and neurological symptoms (depression, nervousness ) and are often misdiagnosed as other diseases.
HC: How to prevent fluorosis?
Dr. Kumar: Fluorosis can be prevented by avoiding excessive intake of fluoride by individuals/community. Excessive fluoride intake and its adverse effects can be minimized by adopting measures like using alternative water sources (surface water, rainwater, low fluoride groundwater), removing excess fluoride in water (defluoridation), and by improving the nutritional status of the population at risk (Intake of calcium, vitamin C, and iron antioxidants). However, primarily sensitizing the community with information on fluorosis, the importance of drinking safe water and a healthy diet is important for the prevention and control of fluorosis.
HC: What is the treatment for fluorosis?
Dr. Kumar: Dental fluorosis can be treated with procedures like tooth whitening, composite bonding and porcelain veneers. There is no treatment for severe cases of skeletal fluorosis, only measures to reduce the disability that has occurred can be taken. However, early diagnosis may help in the prevention of undesirable effects.
MedBound Times is grateful to Dr. RVS Krishna Kumar, for taking the time out to do this interview, which will help spread awareness among the masses.