TREATMENT AND PREVENTION

Considerable work has been done all over the world on treatment of Fluorosis. Unfortunately the results indicated that the effects of Fluorosis are irreversible. According to the author this condition can be cured, at least in children, by a treatment which are inexpensive and easily available. Numerous people have conducted surveys on the problem of fluoridation and treatment options available for defluoridation processes, but however a safe, efficient and cost effective defluoridation technique / process needs to be developed in order to prevent the occurrence of Fluorosis.

To summaries three approaches are suggested:
1. Health education
2. Treatment of the children,
3. Preventive measures.

Health Education

Creating awareness about the disease: The main area of interest will be

1. Creating disease awareness
   Creating awareness about the disease should be in form of graphic presentation of the final consequences of the disease to the extent possible. If required live presentation of the patients, who are suffering from the severe form of the disease, in areas where the gravity of problem has not reached to that extent. It may be of use, to demonstrate the most severe extent of the disease and to motivate them to use the preventive or therapeutic measures.
2. Creating awareness about the sources of the fluoride
   The creation of awareness will help in implementing the need based preventive measures in the affected community.

Treatment of the disease

Vitamins C and D, and, salts of Calcium, Magnesium or Aluminum were prescribed in an attempt to reverse these effects. Published results were, however, inconclusive and largely negative. Recent studies conducted in Rajasthan under Rajasthan DST sponsored studies indicated that Fluorosis could be reversed, at least in children by a therapeutic regimen (Calcium, Vitamin C and Vitamin D) which is cheap and easily available.

The choice of the reported therapy was logical. The presence of calcium in gut directly affects the absorption of fluoride ions and will also improve serum calcium levels. Vitamin D in low doses enhances calcium absorption and retention without causing hypercalcemia and thus directly affects the absorption of fluoride ions. It also inhibits the excessive release of parathyroid hormone thereby preventing excessive activation of osteoblasts thus preventing hyperosteoidosis and osteopenia. Ascorbic acid controls collagen formation, maintains the teeth structure and also enhances normal bone formation. These structures are adversely affected by higher fluoride intake.

Prevention

a. Providing defluoridated water for drinking purpose

Methods of defluoridation recommended so far are aimed at bringing the fluoride levels to the WHO standards.

Desirable characteristics of defluoridation process

• Cost-effective
• Easy to handle/operate by rural population - the major sufferer
• Independent of input Fluoride concentration, alkalinity, pH, temperature
• Not affect taste of water
• Not add other undesirable substances (e.g. Aluminum) to treated water.

It is estimated that the daily consumption of water for all purposes per capita is about 135 lpcd in urban areas and about 40 lpcd in rural areas, whereas for drinking and food preparing purposes it is only 8 lpcd.Keeping in view the cost involved in defluoridating the water it is desirable that the defluoridation of water should be restricted to drinking water only. Hence the only economical and practicable choice left is Domestic defluoridation.

It is now desirable to test the various domestic defluoridation processes, especially in terms of acceptance by people without the need of any supervising agency, and recommend suitable alternatives so that effective long-term implementation can be achieved.

Surprisingly none of the domestic defluoridation processes available today have been much successful in the field. Relative merits and demerits of some of these processes are as follows:

1) Nalgonda process:It is a cumbersome technique not suitable for use by uneducated rural population - the section that needs it the most. Further, it is difficult to control the alum dose because it is different for each source of water. The process can be used only for water having a fluoride content of less than 10 ppm. If the alum dose is not properly controlled it may result in high residual aluminum content in output drinking water. The IS 10500 sets an absolute maximum limit of 0.2 ppm of Aluminum in drinking water. Excess of alum also renders metallic taste to the water.

2) Activated alumina process:It is an expensive process. Reactivation of filter material is cumbersome and it can be done only with the help of trained persons generally not available in most of our villages. This process also results in high residual aluminum in output water ranging from 0.16ppm to 0.45ppm.

3) Other processes:Processes like Electro-dialysis, Reverse Osmosis etc. require special equipment, electrical energy and especially trained persons to operate these units. Operation and maintenance of these units is also very expensive and hence these are not suitable as domestic defluoridation processes for use in rural areas.

Recently KRASS have comeout with new defluoridation process named KDP (KRASS defluoridation process), which have shown promising results. The silant features are given below:

In this process the fluoride contaminated water passed through the bed of media by any means such as filter to get the defluoridated water. This process differs from the known processes in its simplicity, cost effectiveness and very low traces of residual aluminum in outlet water. There is no limit on fluoride concentration in input water. Temperature, pH, alkalinity and Total Dissolved Solids of input water do not effect this process. The ambient conditions like atmospheric temperature and humidity do not have any effect on this process. It is a practical approach especially for our rural population.

The importance of the process is a defluoridation process, which is easy, to use by illiterate villagers, requires minimal involvement of technical personnel, is harmless and is cost effective.In the process, once the filter are laid at a door step, the inflow of the fluoride rich water is without further expenditure in terms of cost except recharging according to the capacity of filter. The exhausted media bed can be easily recharged again without replacing the material at least upto 40 cycles. As a product, the process achieves better removal of suspended matter, betters clarity and maintains taste of water. The treatment cost is about 0.6 - 0.8 paisa per liter at 10 ppm of influent fluoride.

b. Changing the dietary habits

defluoridation of drinking water alone shall not bring the fluoride level to a safe limit. It would be necessary to overcome the toxic effects of the remaining fluoride ingested through other source. This can be done by effecting minor changes in the diet and dietary habits of the population compatible with their social system and available resources. The main aim should be to

• Restrict use of fluoride rich food and fluoride rich water
• Avoiding use of fluoride rich cosmetics
• Use of food rich in calcium, vitamin C and proteins

c. Water harvesting (alternative water source)

Fluoride not only affects the people but it also affects the animals. Therefore it is desirable that the animals should also be provided with fluoride free water for maintaining their longevity. Defluoridation of drinking water for animals will be too costly and not feasible, and therefore the only solution of this problem is water harvesting. The water harvesting technologies should be aimed not only to provide fluoride free water to human beings but also to animals.Rainwater storage can be a major source of fluoride free drinking water for the animals.

This three pronged attack can prove to be a blessing for the population especially for the younger generation living in fluoride rich areas having no choice except to drink the water contaminated with fluoride and suffer the inevitable consequences including permanent deformities.