Groundwater Quality and Its Impact on Health: A Preliminary Evaluation of Dental Fluorosis in Julimes, Chihuahua, Mexico

Medical Geology can be defined as the branch of geology dealing with the relationship between natural geological aspects and health in organisms (humans and animals), trying to determine the influence of ordinary environmental factors on the geographical distribution of health issues. The main goals of this research were: 1) to evaluate the severity of dental fluorosis (DF) and fluoride concentration in groundwater, used for human consumption, as an indicator of overexposure to fluorides, 2) to estimate the Community Fluorosis Index (CFI) in the Julimes municipality in Chihuahua, Mexico. Nine water samples were collected in four locations in the Julimes area: Hacienda Humboldt, La Regina, Colonia San Jose, and Julimes. Samples were collected and stored in accordance with the Mexican standard (NOM-014-SSA1-1993). All the samples exceeded the maximum permissible limit established in the modified Mexican standard (NOM-127-SSA1-1994) of 1.5 mgL-1 for fluoride in water for human consumption. Average concentrations of 2.74 mgL-1 were found in Colonia San Jose, 2.19 mgL-1 in La Regina, 2.17 mgL-1 in Julimes and 2.06 mgL-1 in Hacienda Humboldt. Dental Fluorosis diagnosis was evaluated using the Dean Index and the CFI applied to residents. A total of 100 inhabitants were examined, with interviews and oral examinations also carried out. Dental Fluorosis prevalence was 92% overall for the municipality, while for Colonia San Jose was of 100%, of 88.89% for Hacienda Humboldt, 88.24% for Julimes and 96% for La Regina. Dental Fluorosis’ severity for the Julimes municipality was distributed as follows: 2% normal, 6% questionable, 8% very mild, 13% mild, 19% moderate, and 52% severe. An average CFI was found for the four localities of 3.02 points, with a very notable impact on public health.

Role of Inhibition of Osteogenesis Function by Sema4D/Plexin-B1 Signaling Pathway in Skeletal Fluorosis In Vitro

Summary： Skeletal fluorosis is a chronically metabolic bone disease with extensive hyperostosis osteosclerosis caused by long time exposure to fluoride. Skeletal fluorosis brings about a series of abnormal changes of the extremity, such as joint pain, joint stiffness, bone deformity, etc. Differentiation and maturation of osteoblasts were regulated by osteoclasts via Sema4D/Plexin-B 1 signaling pathway. Furthermore, the differentiation and maturation of osteoclasts are conducted by osteoblasts via RANKL/RANK/OPG pathway. Both of these processes form a feedback circuit which is a key link in skeletal fluorosis. In this study, an osteoblast-osteoclast co-culture model in vitro was developed to illustrate the mechanism of skeletal fluorosis. With the increase of fluoride concentration, the expression level of Sema4D was decreased and TGF-β1 was increased continuously. OPG/RANKL mRNA level, however, increased gradually. On the basis of that, the inhibition of Sema4D/Plexin-B1/RhoA/ROCK signaling pathway caused by fluoride promoted the level of TGF-β1 and activated the proliferation of osteoblasts. In addition, osteroprotegerin （OPG） secreted by osteoblasts was up-regulated by fluoride. The competitive combination of OPG and RANKL was strengthened and the combination of RANKL and RANK was hindered. And then the differentiation and maturation of osteoclasts were inhibited, and bone absorption was weakened, leading to skeletal fluorosis.

Association of Dietary Carotenoids Intake with Skeletal Fluorosis in the Coal-burning Fluorosis Area of Guizhou Province

Objective To explore whether the intake of dietary carotenoids could protect against skeletal fluorosis in Guizhou province in which coal-burning fluorosis is endemic. Methods A case-control study of 196 patients with skeletal fluorosis and 196 age and gender-matched controls was conducted in Zhijin, Guizhou Province. Face-to-face interviews were conducted to assess habitual dietary intake using a 75-item food frequency questionnaire and various covariates with structured questionnaires. Urinary fluoride was measured using an ion-selective electrode method. The genotype of superoxide dismutase 2（SOD2） rs11968525 was detected by Taq Man method. Results We observed significant dose-dependent inverse associations of skeletal fluorosis with intake of β-carotene, lutein/zeaxanthin, lycopene, and total carotenoids（P-trend = 0.002 to 0.018）, whereas α-carotene and β-cryptoxanthin intakes were not found to be related to skeletal fluorosis, after adjustment for potential confounders. The adjusted ORs and 95% CI of skeletal fluorosis for the highest versus lowest quartile were 0.30（0.10, 0.86） for β-carotene, 0.23（0.08, 0.66） for lycopene, 0.26（0.10, 0.75） for lutein/zeaxanthin and 0.34（0.14, 0.74） for total carotenoids（all P-trend ＆lt; 0.05）. Stratified analyses showed that the protective effects of lutein/zeaxanthin and total carotenoids on skeletal fluorosis were more evident for individuals with the AG＋AA genotypes of SOD2（rs11968525）. Conclusion Increased intakes of β-carotene, lutein/zeaxanthin, lycopene, and total carotenoids are independently associated with a lower risk of coal-burning skeletal fluorosis. SOD2（rs11968525） polymorphisms might modify the inverse associations between dietary carotenoids and skeletal fluorosis.

Relationships between daily total fluoride intake and dental fluorosis and dental caries

Objective： To explore the relationships between the daily total intake of fluoride, dental fluorosis and dental caries. Methods： An epidemiological method was used to investigate the daily total intake of fluoride, dental fluorosis, and dental caries among 236 and 290 children aged 8-13 years in a severe endemic area and in a non-fluorosis control area, respectively. The children were divided into eight subgroups according to each child＇ s estimated daily total intake of fluoride. The prevalence of dental fluorosis and dental caries in each group was calculated. Results： As expected, elevated levels of fluoride intake were significantly associated with a higher prevalence of dental fluorosis and an increasing amount of more severe defect dental fluorosis. When the daily total F intake was 2.78 mg/child/day, the prevalence of dental fluorosis was nearly 100%, with the prevalence of defect dental fluorosis increasing with increasing fluoride intake. There was also a significant negative（inverse） dose-response relationship between the daily total intake of fluoride and the overall prevalence of dental caries, the prevalence of which decreased when the daily total intake of fluoride increased up to 3.32 mg/child/day. However, at higher levels of daily total intake of fluoride the prevalence of dental caries increased, giving rise to a U-shaped dose-response relationship curve. Conclusion： It is important to monitor total fluoride exposure and protect children from excessive fluoride intake, especially during the years of tooth development.

Prevalence of Brick Tea-type Fluorosis in Children Aged 8–12 Years in Qinghai Province,China

Fluorosis is a serious health problem,and an endemic disease in certain areas in China,India,and some countries in Africa[1].There are three types of fluorosis which includes drinking-water type fluorosis,coal-burning pollution type fluorosis,and brick tea-type fluorosis.Coal-burning pollution type fluorosis and brick tea-type fluorosis are found only in China's Mainland mainland.

Investigation and Analysis on Current Situation of Coal-Burning Fluorosis Prevalence

Objective: The purpose of the paper is to provide the result from investigation on the current situation of coal-burning fluorosis prevalence in Chongqing City and make an assessment on the prevention and curing measures. Method: The Dean’s Method is applied to investigate on the fluorotic teeth of locally-born children aged between 8 to 12;investigate how modified cooking stoves are utilized by households and how food maize and hot pepper are being dried;and test the urinary fluorine content and pepper fluorine content. Result: The investigations show that, in the 661 villages with illness history from the 100 townships of 13 districts in Chongqing City, 11.28% (7464/ 66,162) of the children aged between 8 and 12 suffer from dental fluorosis;the stoves modified rate, qualified rate of modified stoves, and correct utilization rate of qualified modified stoves are respectively 100%, 98.82%, and 99.45%;and food maize and hot pepper’s drying rates are respectively 99.88% and 99.75%. Conclusion: The result shows that the coal-burning type fluorosis prevalence in the endemic area of Chongqing City has decreased dramatically, the preventive measure is effectively implemented, and a long-term preventive mechanism has preliminarily been established.

Relationship between the Contents of MDA, the Activity of SOD in Serum of the Milk Goat with Fluorosis and the Erythrocytic Membrane Liquidity

To research the relation among the erythrocytic membrane.liquidity and the contents of MDA, the activity of SOD in serum of the milk goat with fluorosis. An animal model with fluorosis was constructed, and the fluorescent probe technique of DPH was used to measue the erythrocytic membrane liquidity. At the same time, the contents of MDA and the activity of SOD in serum were measured. The results showed that the erythrocytic membrane liquidity in the control group and flurosis group were 5.6742 ± 0.4417 and 3.7248 ± 0.4521 （P 〈0.01） respectively, the contents of MDA in serum were 2.0408 ± 0.198 and 4.494± 0.438 （P 〈0.01） respectively, the activities of SOD were 175.638 ± 22.201 and 113.714 ± 34.258 （P 〈0.01） respectively. The correlation analysis indicated that the relation between the activity of SOD and the liquidity of erythrocytic membrane was positive correlation （ r= 0.7321, P 〈0.05）, whereas the relation between the contents of MDA and the liquidity of erythrocytic membrane was negative correlation （r = -0.6438, P 〈0.01）. The erythrocytic membrane liquidity decreased in milk goat with fluorosis, which played a role in the occurrence and development of the fluorosis. There was correlation among the erythrocytic membrane liquidity and the contents of MDA, the activity of SOD.

Pathological evaluation of pancreatic exocrine glands in experimental fluorosis

Objective:To monitor the pathological alterations in pancreas of rat during experimental fluorosis. Methods:Sixty Sprague Dawley albino rats of both sexes were divided into 12 experimental groups and one control group.The rats of control group were administered subcutaneously double distilled water 1 mL/kg bw daily.The experimental groups were injected with 30,45,and 75 mg NaF/kg bw/day.The experimental period was divided into 4 phases at interval of 15,22,30,and 36 days.Animals were sacrificed from each group at the end of 16,23,31,and 37 days.Results: The following changes were observed in this study:(1) Pathological examination of pancreas after 15 days of fluoride treatment revealed:hypertrophy of acini,leucocytes infilteration and pycnouc nuclei due to necrosis of acini in group 1;uremic alterations,invulsion and infoldings of reticular layer of islets of Langerhans in group 2;and a decrease in number of acini and interlobular connective tissues resulted in an increase in intercellular spaces in pancreas of rats in group 3.(2)Hyalinization and hypertrophy in the lobules of acini and hyperplasia and hypertrophy in intercalated duct with mucinous secretion in pancreas of rat of group 4;squamous metaplasia of pancreatic duct,adenoma of pancreas,hemorrhagic necrosis in group 5;and hyperplasia of acini and reduction in number of pancreatic islets in group 6.(3) Disorganization and atrophy of pancreatic lobules and presence of vacuoles in a group of six were visible in pancreas of rats in group 7;acute pancreatic and lamellated inflammatory cells in test rats of group 8;and islet adenoma and decrease in number of islets cells,and exudation in acini were noticed in experimental rats of group 9.(4) In the last phase of experimentation,atrophic alterations in pancreatic acini,invulsions,and necrosis was prominent in group 10,deep inflammation and proliferation of connective tissue of pancreas in experimental group 11,and periodical fibrosis, hyperplasia of acini,degenerative changes in pancreas of rats in group 12.Conclusion:The histopathological examination of pancreas of fluoridated rats exhibited structural alterations in the exocrine glands.The acini revealed hypertrophy,pyknotic nucleus,necrosis and uremic alterations.Acini became lobulated and reveal increased pigmentation.

GEOGRAPHICAL ENVIRONMENTAL CHARACTERISTICS OF ENDEMIC FLUOROSIS IN CHINA

Endemic fluorosis is given rise to by human intake of excess fluorine from environment by way of food chain. In China it is one of the extensively prevalent endemic diseases and its distribution shows clearly regional characteristics. In macroscopic sight, three large fluorosis zones may be divided: (1) The arid and semi-arid plains in the north of China. These regions have a dry climate, making fluorine accumulation in the Quaternary deposits. Thus, the drinking water with high content of fluorine is the main cause of the disease formation. (2) The Yunnan-Guizhou Plateau. In the region, rocks and soils rich in fluorine bring about fluorine excess in crop food. This plays an important role in the disease formation. (3) Southeast hills. The hot spring with high content of fluorine leads to fluorosis.The fluorine absorbed by people from the environment is firstly from the drinking water and secondly from the crop food originating from soil. The fluorine in the air can be accumulated in crop leaves to

Complete oral rehabilitation in a case with severe dental fluorosis

The authors have presented a technique of full occlusal rehabilitation in a case of severe dental fluorosis. In this technique, maxillary and mandibular anterior teeth were simultaneously prepared and restored first. This was followed by simultaneous preparation of maxillary and mandibular posterior teeth that were restored in canine guided occlusion. The technique and sequence followed here is unique and is not available in dental literature. This technique reduces number of appointments while fulfilling all objectives. Periodontal followup over 3 years was satisfactory. A restorative treatment protocol has been devised for fluorosis which will act as a guide for the dental practitioners.

Changes of Serotonin content and Turnover Rate in Hypothalamus of Female Rat during Fluorosis

The animal models of subacute and chronic fluorosis were devel-oped with injection of large doses of NaF (IP)and drinking water containing100 ppm F^- in female rats respectively. Serotonin content and turnover rate inhypothalamus of rat were determined with spectrofluorometry combined degra-dation blockade. 5-HT turnover rate in hypothalamus decreased during bothsubacute and chronic fluorosis. 5-HT content in hypothalamus increased duringsubacute fluorosis, but decreased during chronic fluorosis. These results suggestthat the influences on 5-HT metabolism of two kinds of fluorosis are not com-pletely identical. The decrease of 5-HT turnover rate in hypothalamus may be one of thepossible mechanisms of deficiency of pituitary prolactin and milk secretion dur-ing fluorosis.

An Integrated Approach to Address Endemic Fluorosis in Jharkhand, India

This paper presents the grounds for an integrated approach to address endemic fluorosis in Jharkhand, India, an approach that encompasses health monitoring, community-based water systems management, and locally synthesized hydroxyapatite, a sustainable water treatment technology. The results of this study, focusing on kinetics and sorption isotherms, demonstrate that an inexpensive, locally synthesized hydroxyapatite effectively removes fluoride from water and that the Dean Index, a measure of dental fluorosis, of school children provides a sensitive, rapid biometric to track the success of a fluoride water treatment intervention. Previous efforts to manage the fluoride problem in Jharkhand were unsuccessful, largely due to lack of accountability and inadequate community involvement. This paper explores how integrating the production of a locally synthesized hydroxyapatite with community health monitoring via the Dean Index fits into a management strategy with robust accountability mechanisms and community participation that, as historical examples suggest, is likely to succeed in Jharkhand.

High Fluoride, Modest Fluorosis: Investigation in Drinking Water Supply in Halaba (SNNPR, Ethiopia)

In Halaba district in Southern Ethiopia fluoride levels from boreholes are high (2.6 to 7.0 mg/l), yet the incidence of fluorosis is modest. Drinking water users living in the vicinity of four drinking water systems that have been in operation for more than 35 years were surveyed. Out of 625 persons 5 percent had severe dental fluorosis and 42 percent had mild forms—which is considerably less than results of other areas with comparable fluoride levels. The incidence was highest in the older age groups. Possible explanations were explored. A likely reason may be the continued large dependence on rain water harvesting ponds for human consumption alongside the use of water from the public borehole systems, but more investigations would be required to confirm this proposition.

Chronic Alcohol Consumption and the Development of Skeletal Fluorosis in a Fluoride Endemic Area of the Ethiopian Rift Valley

This study compared the occurrence of skeletal fluorosis in chronic consumers of locally brewed alcoholic beverages and their matched controls in the Ethiopian Rift Valley. The study revealed that chronic alcohol consumers developed severe forms of crippling skeletal fluorosis quite early in life. The controls were either symptom-free or exhibited mild forms of the fluorosis. The study showed that crippling skeletal fluorosis was directly associated with the large volumes of the locally brewed beer and honey-mead consumption on a daily basis. Chemical analysis of the alcoholic beverages showed that high concentration of fluoride which was much higher than the fluoride in the water was used for the brewing process. From this study one would conclude that in communities residing in high fluoride areas, there should be awareness creation campaigns to point out the relationship of excessive consumption of locally brewed alcoholic drinks and skeletal fluorosis. Regulations should also be put in place to require producers of local alcoholic beverages to use low fluoride water for brewing.

Fluorine in Water and Dental Fluorosis in a Community of Queretaro State Mexico

The community La Llave, Queretaro State, Mexico, has not been identified by the sanitary authorities as living in a hazard area related to dental fluorosis. However;a high concentration of fluoride is found in their drinking water causing them dental fluorosis. Physical-chemical analysis was carried out in the groundwater sources to determine the prevalence of dental fluorosis risk and caries accordingly to criteria of The World Health Organization, and 154 school children of ages 10 to 13 years were examined. As a result, 1.9 mg/L of fluorine concentration in drinking water was obtained;dental fluorosis presence was detected in the school children with an incidence of about 98%, in 47% of cases severe fluorosis with a dental caries index of 3.06 was traced. The groundwater sources in La Llave community contains fluorine above the limits dictated by Mexican regulations, producing serious repercussions on the health of school children, with an unnaturally high incidence of dental fluorosis.

Analysis the Results of Control and Elimination of Coal-Burning-Borne Endemic Fluorosis in Chongqing City

Objective: Discuss the analysis of the results of control and elimination of coal-burning fluorosis in Chongqing, and evaluate the effect of prevention and control. Methods: Dean’s method was used to investigate the fluorosis for the local children whose ages ranged from 8 to 12 years old, the use of improved stoves in residential households, the drying of corn and pepper for human consumption, and the results were evaluated and discussed according to the national standard for the control and elimination of coal-burning fluorosis. Results: The prevalence rate of dental fluorosis borne-disease in children whose ages ranged from 8 to 12 years old was about 11.28% in 661 historically diseased villages in 100 townships and in 13 districts and counties of Chongqing city. The correct utilization rates of improved stoves, qualified improved stoves, and qualified stoves were 100%, 98.82%, and 99.45%, respectively. The correct drying rates of corn and pepper for human consumption were 99.88% and 99.75% respectively. There are 24 uncontrolled villages, 225 controlled villages, and 412 villages in eliminated disease zones in administrative villages. There are 4 villages and counties in uncontrolled, 4 in controlled, and 5 eliminated areas in districts and counties. Conclusion: Fluorosis borne-disease caused by coal-burning in Chongqing has reached the control and elimination targets of the twelfth Five-year plan.

Fluorosis and Dental Caries in the Hydrogeological Environments of Southeastern Communities in the State of Morelos, Mexico

Objectives: 1) To identify the hydrogeological characteristics and fluoride (F-) concentration in drinking water in the southeast of the state of Morelos, Mexico, and 2) to estimate the association between the prevalence and severity of fluorosis, dental caries, and water F-?concentration. Methods: A hydrogeological model was developed to determine the vertical distribution of lithostratigraphic units, rocks’ hydraulic conductivities, and groundwater flow characteristics. A total of 649 schoolchildren from two communities received oral examinations. One community was located in an area with 0.75 mg F-/L in the water supply and the other in an area with 1.6 mg F-/L. Fluorosis was assessed using the Thylstrup & Fejerskov Index (TFI) and the dental caries were assessed with the decayed, missing, and filled teeth (DMFT) index. The region groundwater was extracted from an inter-granular aquifer consisting of volcano clasts of intermediate volcanic chemical composition. Results: Oral examinations showed that 32.35% of the children had severe forms of fluorosis (TFI ≥ 4) in the community with 1.60 mg F-/L and 7.8% in the 0.75 mg F-/L community (p < 0.0001). DMFT = 0.53 (±1.28) and 0.42 (±0.95) in the community with 1.60 mg F-/L and 0.75 mg F-/L, respectively (p = 0.2259). Conclusions: The increasing extraction of underground water was associated with deeper water flows and higher F-?concentration. In the community with high F-concentration, a third of the children showed objectionable levels of fluorosis. Adequate groundwater management actions are required to reduce fluorosis risk.

Advances in TCM Treatment of Skeletal Fluorosis

By consulting and collating the relevant literatures on the treatment of fluorosis in Traditional Chinese medicine, the research progress of TCM in the treatment of fluorosis was summarized. This paper summarizes the treatment of fluorosis in traditional Chinese medicine from the aspects of the traceability of TCM theory, etiology and pathogenesis, syndrome differentiation and cure, special disease specialty and foreign medicine, so as to guide clinical practice. TCM treatment of fluorosis more use of tonifying kidney and bone, activating blood circulation stasis, cold moisturizing, Tongluo pain relief and other methods, based on dispelling evil and tonifying kidney, combined with a variety of treatment methods, in relieving clinical symptoms and improving the quality of life of patients have an irreplaceable role, has been widely recognized, but most of the research reports are their own work experience summary, Lack of uniform diagnosis and treatment standards, and small sample size, data repeatability is weak, future research needs to further enhance the scientific and objective of the experiment, for TCM treatment of fluorosis to provide a scientific and reasonable diagnosis and treatment program, give full play to the advantages of TCM therapy.

Prevalence of Dental Fluorosis in Mianwali and Mardan Districts

This study was conducted to assess the level of dental flourosis and Decaying, Missing, Filled Tooth (DMFT) of selected patients, in district Mardan village Rustam and District Mianwali village Harnoli. Study was conducted among people of age 10 - 60 years. The regions of Rustam and Harnoli are known to have high value of fluoride in drinking water. A cross sectional study was conducted among the subjects and the grade of fluorosis was calculated according to Deans Fluorosis Index. DMFT of each subject was also calculated. Total of 100 subjects were selected by simple random sampling technique among the population of Rustam and Harnoli and they were observed for the extent of fluorosis they had along with the number of decayed, missing and filled teeth they had Most of the population uses underground water, the water people commonly used was collected and was tested for amount of fluoride. The results show that there is a strong relationship between fluoride level and extent of fluorosis. Populations of both areas have dental fluorosis due to high concentration of fluoride in drinking water and also comparatively low DMFT because fluoride has caries protective effect.

Fluoride Contamination of Groundwater and Skeleton Fluorosis in Central India

In country like India, the groundwater is widely used for drinking purposes. In central India, the groundwater is hard and contaminated with F- and other elements above the permissible limits and found to be linked with prevalence of the fluorosis diseases. In this work, the groundwater quality Balod district, Chhattisgarh, India is investigated for assessment of water quality for drinking purposes. The concentration (n = 50) of F- was ranged from 1.5 - 14.0 mg/L with mean value of 3.9 ± 0.8 mg/L. The causes of prevalence of skeleton fluorosis in human of the studied area are described.