Skeletal Fluorosis and Natural Fluoride In India

Excessive consumption of fluoride results in the crippling bone disease called Skeletal Fluorosis. The two largest countries affected by fluorosis are India and China. The most common cause of fluorosis in India is fluoride-laden water derived from deep bore wells. Over half of ground water sources in India have fluoride above recommended levels.[1] But they are not alone as UNICEF estimates that "fluorosis is endemic in at least 25 countries across the globe. The total number of people affected is not known, but a conservative estimate would number in the tens of millions."[2] The most common ways causes of skeletal fluorosis include:
  • consumption of fluoride from drinking water
  • use of coal as an indoor fuel source
  • inhalation of fluoride dusts/fumes by workers in industry
In China, the World Health Organization recently estimated that 2.7 million people have the crippling form of skeletal fluorosis, while in India, 17 of its 32 states have been identified as "endemic" areas, with an estimated 66 million people at risk and 6 million people seriously afflicted.

According to scientific surveys, skeletal fluorosis in India and China occurs when the fluoride concentration in water exceeds 1 part per million (ppm), and has been found to occur in communities with only 0.7 part per million (SOURCE: Singh 1961; Singh 1963; Jolly 1970; Siddiqui 1970; Susheela 1993; Choubisa 1997; Xu 1997; Bo 2003).

The Chinese government now considers any water supply containing over 1 ppm fluoride a risk for skeletal fluorosis (SOURCE: Bo 2003).

In the United States, an average of 1 ppm of fluoride is purposely added to water supplies for water fluoridation, while the Maximum Contaminant Level (as established by the US Environmental Protection Agency) is 4 ppm.

How Does this Relate to Water Fluoridation?

While the elevated consumption of water in southern climates (which produces a higher intake of fluoride) and the increased incidence of malnutrition (which increases the susceptibility to fluoride toxicity) make comparing the Indian and Chinese experience to the United States difficult, it is still striking to observe how narrow the margin is between the doses which cause advanced skeletal fluorosis in India/China and the doses that people are now regularly receiving in the United States.

For instance, in three recent studies from India, China, and Tibet, the average daily doses found to cause advanced skeletal fluorosis ranged from 9 mg/day to 12 mg/day (SOURCE: Teotia 1998; Bo 2003; Cao 2003). To put these findings in perspective, the US Government has estimated that the daily dose of fluoride in fluoridated communities now ranges from 1.6 to 6.6 mg/day (SOURCE: DHHS 1991).

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