Krass India :: Fluorosis Publications

"ENVIRONMENTAL HEALTH PERSPECTIVE OF Fluorosis IN CHILDREN". A thesis submitted to University of Rajasthan for the degree of DOCTOR OF PHILOSOPHY (ENVIRONMENTAL SCIENCE) By Dr. Sunil K. Gupta

Gupta SK, Seth AK, Gupta A and Gavane AG. Transplacental passage of Fluorides in Cord Blood . THE JOURNAL OF PEDIATRICS, USA, 1993(July):137-141
Transplacental passage of fluorides was studied in 25 randomly selected neonates. Blood samples collected simultaneously from the mother and the umbilical cord showed that average fluoride concentration in the cord blood was 60% of that in mother’s blood. When concentration in the mother’s blood exceeded 0.4 ppm, the placenta acted as a selective barrier.

Gupta SK, Gupta RC, Seth AK and Chaturvedi CS. Increased incidence of Spina bifida occulta in Fluorosis prone areas. Acta Pediatrica Japonica, 37(4):1995
A case control study of 50 children randomly selected from two communities where mothers consumed fluoride rich water shows that an association exists between spina bifida occulta and high fluoride intake during antenatal period. Group exposed to high fluoride in antenatal period showed a higher incidence of spina bifida occulta.

Gupta SK, Khan TI, Gupta RC, Gupta AB, Gupta KC, Jain P and Gupta A. Compensatory Hyperparathyroidism Following High Fluoride Ingestion - A Clinco - Biochemical Correlation. Indian Pediatrics 2001; 38: 139-146
Objective: To evaluate the effect of varying ingestion of drinking water containing high fluorides and its effect on serum parathyroid hormone. Design: Cross sectional clinical study. Setting: S.M.S. Medical College, Jaipur. Subject: 200 children were selected from four areas (50 from each area) consuming water containing 2.4, 4.6, 5.6 and 13.5 mg/l of fluoride. All children were in an age group of 6 to 12 years. Methods: All children were graded for clinical, radiological and dental Fluorosis and biochemical estimations were made for serum calcium, serum and urinary fluoride and serum parathyroid hormone. Results: Serum calcium levels were well within normal range in the patients of all areas but an increase in serum parathyroid levels (S. PTH) was noted. The increased S. PTH was well correlated with increase in fluoride ingestion. The severity of clinical and skeletal Fluorosis was observed to increase with increase in S. PTH concentration. Conclusions: High Fluoride ingestion has a definite relationship with increased parathyroid hormone secretion, which may be responsible for maintaining serum calcium levels and may have a role in toxic manifestations of Fluorosis.

Gupta SK, Gupta RC, Seth AK and Gupta A. Reversal of Fluorosis in children. ACTA PEDIATRICA JAPONICA, 38, 513-519:1996
A large population per force consumes fluoride contaminated water especially in developing countries. Toxic effects of Fluorosis take three forms: clinical, skeletal and dental. Work done on Fluorosis so far had indicated that the manifestations of Fluorosis were irreversible, though it was noticed that ingestion of calcium, vitamin C or vitamin D individually, was effective in protection from fluoride toxicity to a certain extent. Therefore, a double blind control trial was conducted to examine the effect of a combination of calcium, vitamin D3 and ascorbic acid supplementation in Fluorosis affected children.
In this study 25 children were selected from an area consuming water containing 4.5 ppm of fluoride. All the children were in an age group of 6 to 12 years and weighed 18 to 30 kg. They were graded for clinical, radiological and dental Fluorosis and relevant biochemical parameters. Grade I skeletal Fluorosis and all grades of manifestations for dental and clinical Fluorosis were observed. These children were given ascorbic acid, calcium and vitamin D3 well below the toxic dosages in a double blind manner using lactose as placebo. Follow up revealed a significant improvement in dental, clinical and skeletal Fluorosis and relevant biochemical parameters in these children. Thus, this study indicated that Fluorosis can be reversed, at least in children, by a therapeutic regimen which is fairly cheap, simple and easily available and without any side effects.

Gupta SK, Gupta RC and Seth AK. Reversal of Clinical and Dental Fluorosis. INDIAN PEDIATRICS,31:439-443,1994. A large number of Indians are forced to consume fluoride contaminated water. Toxic effects of chronic fluoride ingestion are hitherto considered irreversible. In this study 20 children were selected from an area consuming water containing 4.5 ppm of fluoride (group A) and a second sample of 20 children from another area consuming water containing 8.5 ppm of fluoride (group B). All the children were in an age group of 3 to 12 years and weighed 12 to 25kg. Both samples were graded for clinical, radiological and dental Fluorosis. All grades of manifestations were observed. These children were given ascorbic acid(500mg), calcium(250mg) and vitamin D3(800 IU) daily. Follow up revealed reversal of clinical and dental Fluorosis after 44 days. Improvement in the group B sample was found to be slower than group A. Dosage of ascorbic acid was increased to 750mg per day,keeping the dosages of other drugs unchanged to group B children . After 15 days of the revised therapy a marked improvement was noticed in clinical and dental Fluorosis in this sample also.

Gupta SK, Gupta RC and Seth AK. Reversal of Clinical and Dental Fluorosis. FLUORIDE 30 (1) 1997, pp 68-69 Large populations consume fluoride-contaminated water, especially in developing countries. The toxic effects of Fluorosis take three forms: clinical, skeletal and dental. Research thus far indicates that the manifestations of Fluorosis are irreversible. However, it has been observed that the ingestion of calcium, vitamin C or vitamin D, individually, is effective in protection from fluoride toxicity to a certain extent. Therefore, a double blind control trial was conducted to examine the effect of a combination of calcium, vitamin D, and ascorbic acid supplementation in Fluorosis-affected children. In the present study, 25 children were selected from an area consuming water containing 4.5 ppm. of fluoride, All the children were in the age group 6-12 years and weighed 18-30 kg. They were graded for clinical, radiological and dental Fluorosis and relevant biochemical parameters. Grade I skeletal Fluorosis and all grades of the manifestation of dental and clinical Fluorosis were observed. The children were given ascorbic acid, calcium and vitamin D, well below the toxic dosages in a double blind manner using lactose as a placebo. Follow up revealed a significant improvement in dental, clinical and skeletal Fluorosis and relevant biochemical parameters in these children. Thus, the study indicated that Fluorosis can be reversed, at least in children, by a therapeutic regimen that is fairly cheap, simple and easily available and without any side effects.

Gupta SK A Process for defluoridation of water by a filter bed using indigenous material. INDIAN JOURNAL OF ENVIRONMENTAL SCIENCES 1 (2): 149 - 156,1997.
The present study is an attempt to develop a defluoridation process which is superior from the known processes in its simplicity, cost effectiveness and results in traces of residual aluminium in treated water. There is no limit of fluoride concentration in input water and temperature, pH, alkalinity, humidity, and total dissolved solids of input water do not affect this process

Agrawal KC, Gupta SK and Gupta AB. Development of New Low Cost Defluoridation Technology (Krass). WATER SCIENCE AND TECHNOLOGY, UK 40 (2), Sept 1999 : 167-173
Systemic Fluorosis is an endemic problem in several developing countries. In India 15 states are endemic for Fluorosis, of which 5 have indicated hyperendemicity for Fluorosis in all districts. WHO standards permit only 1 mg/1 ass a safe limit for human consumption. People in several districts of Rajasthan are forced to consume water with fluoride concentrations of up to 44 mg/1 which has resulted in permanent deformities, joint pains, general debility and misery. About 60% of fluoride intake is through water. Considerable work on fluoride removal from water has been done all over the world. However, a safe, efficient free from residual aluminium in treated water, and cost effective defluoridation technique/process is not available and needs to be developed in order to prevent the occurrence of Fluorosis. This paper describes the development of a defluoridation process which differs from the known processes in its simplicity, cost effectiveness and results in traces of residual aluminium in treated water. The parameters like fluoride concentration, temperature, pH, alkalinity, humidity and total dissolved solids of input water do not affect this process.

Gupta SK, Gupta AB, Dhindsa SS, Seth AK, Agrawal KC and Gupta RC. Performance of a Domestic filter based on KRASS defluoridation process. Journal of IWWA 3(XXXI), 193 – 200, 1999
Systemic Fluorosis is an endemic problem in several developing countries. In India 15 states are endemic for Fluorosis. Out of these 15 states, 5 states have indicated hyperendemicity for Fluorosis in all districts. WHO standards permit only 1 mg/l as a safe limit for human consumption. People in several districts of Rajasthan are forced to consume water with fluoride concentrations of up to 44 mg/l, which has resulted in permanent deformities, joint pains, general debility and misery. About 60 % of fluoride intake are through water. Considerable work on fluoride removal from water has been done all over the world. However a safe, efficient, free from residual aluminum in treated water, and cost effective defluoridation technique / process is not available and needs to be developed in order to prevent the occurrence of Fluorosis. This paper addresses itself to the testing of the performance of a domestic filter based on a newly developed KRASS defluoridation technology at the PHED laboratory of the Chief chemist, Gandhi nagar, Government of Rajasthan, Jaipur. The performance of the filter indicated that the process differs from the known processes in its simplicity, cost effectiveness and results in traces of residual aluminum in treated water. Fluoride could be removed effectively for influent concentration up to 26 mg/l. Variation in raw water parameters like, pH, alkalinity, and total dissolved solids of input water did not affect this process.

Thesis under the guidance of Dr. AB Gupta and Dr. Sunil K. Gupta
Study of Dental Fluorosis in Rampura village and new low cost Defluoridation Technology By Kailash Chandra Agarwal, Department of Civil Engineering, MREC, Jaipur, 1996-97.