© Kamla-Raj 2005
J. Hum. Ecol., 18(2): 105-107 (2005)
Clinical Symptoms of Dental and Skeletal Fluorosis in Gadag and Bagalkot Districts of Karnataka Pushpa Bharati, Annapoorna Kubakaddi, Meera Rao and Rama K. Naik Department of Food Science and Nutrition, University of Agricultural Sciences Dharwad 580 005, Karnataka, India KEYWORDS Endemic. Fluorosis. Patients. Gender ABSTRACT An investigation was undertaken in six endemic villages of Mundargi taluk of Gadag district and two of Hungund taluk of Bagalkot district to assess the clinical symptoms of both dental and skeletal fluorosis and in turn to find out the severity of the disease. A check list developed with the help of available literature and in consultation with nutritionists was used to record clinical symptoms. Among the 832 subjects (532 and 300 from Mundargi and Hungund taluks respectively) surveyed 328 (61.65%) and 194 (64.67%) patients exhibited the symptoms of either dental or skeletal or both types of fluorosis. Browning of teeth was the most common symptom of dental fluorosis observed among subjects of Mundargi taluk (64.29%) followed by pain and pus in teeth (58.79%). Whereas, lack of lustre was the most common symptom of dental fluorosis in Hungund taluk (77.42%) followed by browning of teeth (54.84%). The skeletal symptoms including tingling and numbing of extremities, pain in back and bent stature were high among females of both the talukas whereas, shoulder pain and neck pain were also observed to a higher extent among females of Mundargi taluk.
INTRODUCTION
MATERIAL AND METHODS
Fluorosis is an endemic disease resulting from excess intake of fluoride either through drinking water, food or dentrifices. At concentration of 2.00 ppm or above, fluorosis of teeth has been reported affecting the dental enamel. Chronic fluorine intoxication through drinking water containing above 10 ppm of fluorine results in pathological changes of bone leading to skeletal fluorosis (Pareek, 1994). While dental fluorosis can be easily recognised, the skeletal involvement is not clinically obvious until the advanced stage of crippling is reached. Gadag and Bagalkot districts of Karnataka are reported to be endemic for fluorosis with a fluoride level of upto 18.0 ppm (Anon., 1989). The epidemiological studies depicting the prevalence and etiology have been conducted by a number of investigators (Hunde et al.,1973 and Bharati and Meera Rao, 2001). The documentation of clinical symptoms depicts the severity of the disorder and helps to plan for the corrective measures. Hence in the present investigation an attempt was made to record the clinical features of fluorotic patients in Gadag and Bagalkot districts.
The study was conducted in six endemic villages of Mundaragi taluk (Gadag district) and two of Hungund taluk (Bagalkot district). From each village ten per cent of the households were selected with a criterion that at least one person in the family should be affected with fluorosis. All persons residing in the household served as study sample. To record the clinical symptoms of fluorosis a checklist was developed with the help of available literature and in consultation with nutritionists. The symptoms were recorded by personally interviewing each individual of the family and by observation with the help of local doctors. The symptoms were further tabulated and percentages calculated.
Corresponding author: Dr. Pushpa Bharati, Ph.D. Diploma in Nutrition and Dietetics, Associate Professor, Department of Food Science and Nutrition, University of Agricultural Sciences, Dharwad 580 005, Karnataka, India Phone: (O) : 2448512, Extn. 259 Fax: 091-0836-2443714; E-mail:
[email protected]
RESULTS AND DISCUSSION In Mundargi taluk, out of 532 subjects surveyed 328 (61.65%) suffered from either dental (25%), skeletal (5.45%) or both (31.20%) the fluorosis, which included 182 men and 146 women. In Hungund taluk of the 300 subjects surveyed 194 (64.67%), suffered from either dental (35%), skeletal (17%) or both (12.67%) the fluorosis, including 143 men and 157 women. Clinical symptoms of fluorotic patients from Mundaragi and Hungund taluk are presented in Tables 1 and 2. Browning of teeth was the most common symptom of dental fluorosis observed among subjects of Mundargi taluk followed by
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Table 1: Symptoms of dental fluorosis among the fluorotic subjects from Mundargi and Hungund taluk Symptoms
Number of patients/cases Male
Female
Total
Mundargi
Hungund
Mundargi
Hungund
Mundargi
Hungund
Lack of luster 68(37.36) White patches 4(2.20) Browning of teeth 117(64.29) Pitting and swelling 59(32.42) Browning with pain Browning with pain 107(58.79) and pus Itching and loose teeth 2(1.10) Loss of teeth 41(22.53)
72(77.42) 42(45.16) 51(54.84) 3(3.23) 1(1.07)
43(29.45) 1(0.69) 85(58.22) 36(38.71) 66(45.21)
88(87.13) 54(53.47) 55(54.46) 4(3.96) 2(1.98)
111(33.84) 5(1.52) 202(61.58) 95(28.96) 173(52.74)
160(82.47) 96(49.49) 106(54.64) 7(3.61) 3(1.55)
-
4(2.74) 45(30.82)
2(1.98) 6(5.94)
6(1.83) 86(26.22)
2(1.03) 6(3.09)
Figures in parenthesis indicate percentages ‘–’ Indicates none of the subjects suffered from that symptom Table 2: Symptoms of skeletal fluorosis among fluorotic subjects from Mundargi and Hungund taluk Symptoms
Number of patients/cases Male Mundaragi
Tingling and numbing of extremities Joint pain Back pain Knee pain Shoulder pain Neck pain Pain in limbs Stiff limbs Stiff vertebral column Bent/kyphosis Unable to walk properly Bowed legs Can’t do normal work Difficult to sit in squatting position Knots on legs Can’t cross legs Can’t fold hands Can’t getup when sits
Female
Hungund
Mundaragi
21(11.53)
9(9.68)
28(19.18)
58(31.87) 58(31.87) 74(40.66) 5(2.75) 6(3.30) 8(4.40) 21(11.54) 22(12.09) 5(2.75) 15(8.24) 2(1.10)
21(22.58) 9(9.68) 29(31.18) 2 (2.16) 2(2.16) 1(1.08) 1(1.08) 2(2.16) -
39(26.71) 96(65.75) 57(39.04) 15(10.27) 12(8.22) 1(0.69) 7(4.80) 23(15.75) 21(14.38) 10(6.85) 4(2.74) 1(0.68)
2(1.10) 1(0.55) 1(0.55) 9(4.95)
1(1.08) -
1(0.68) 8(5.48)
Total
Hungund 11(10.89) 30(29.70) 24(23.76) 39(38.61) 2(1.98) 5(4.95) 1(0.99) 2(1.98) 7(6.93) 3(2.97) -
Mundaragi 49(14.94)
Hungund 20(10.31)
97(29.57) 154(46.95) 131(39.94) 20(6.10) 18(5.49) 9(2.74) 28(8.54) 45(13.72) 26(7.93) 25(7.62) 4(1.22) 3(0.92)
51(26.29) 33(17.01) 68(35.05) 4(2.06) 6(3.09) 2(1.04) 3(1.55) 9(4.64) 3(1.55)
2(0.61) 1(0.31) 2(0.61) 17(5.18)
1(0.52) -
Figures in parenthesis indicate percentages ‘–’ Indicates none of the subjects suffered from that symptom
pain and pus in teeth. While 95 subjects had pitting and swelling, 86 subjects had lost their teeth. Higher percent of males had browning on their teeth in addition to pain and pus in the gums. Lack of luster (77.42%) was the most common symptom of dental fluorosis experienced by the subjects of Hungund taluk followed by browning of teeth (54.84%). About six subjects had lost their teeth. The dental fluorosis was more severe in Mundargi compared to
Hungund taluk, which can be attributed to the differences in fluoride content of water in these two areas. Fluoride content in drinking water of Mundargi taluk ranged from 4.0 to 10.5 ppm (Bharati and Meera Rao, 2001), while that of Hungund taluk ranged from 2.04 to 3.2 ppm (Kubakaddi, 2001). Das and Wahab (1995) have also reported various grades of discolouration of teeth ranging from chalky white to yellow or brown with pitting. This difference being attributed to fluoride content of drinking water,
CLINICAL SYMPTOMS OF DENTAL AND SKELETAL FLUOROSIS IN GADAG
poor nutritional and economic status in addition to the consumption of locally grown foods. With regard to skeletal symptoms tingling and numbing of extremities, back pain and bending were high among females of both the talukas. Whereas, shoulder pain and neck pain were observed to a higher extent among females of Mundargi taluk. Higher percentage of females were unable to walk properly and could not do normal work compared to males in Hungund taluk but reverse was the case in Mundargi taluk. Higher percentage of males in Mundargi taluk suffered from pain and stiffness of limbs along with joint pain compared to their female counterparts. A number of scientists have also reported similar symptoms like vague pains in hands, feet and knee, numbing of extremities, tingling sensation, restricted movements of trunk, hips and neck, stiff and useless body (Pareek, 1994), kyphosis (Tamboli et al., 1980), inability to close fists, stiffness, rigidity of spine, difficulty in walking, crippling (Teotia et al., 1979) with varied severity and percentage. Between the two talukas, Mundargi taluk of Gadag district had higher severity of the disorder compared to those from Hungund taluk of Bagalkot district. The fluoride content of drinking water in Mundargi taluk ranged from 4.00 to 10.5 ppm (Bharati, 1996) that in Hungund taluk ranged from 2.04 to 3.20 ppm (Kubakaddi, 2001). The difference in fluoride content of water, intake of fluoride, temperature are the major factors responsible for the accumulation of higher fluoride leading to increased severity of the disease as quoted by Choubisa et al. (1996). From the present study, it can be concluded that people of Mundargi and Hungund taluk consuming water containing more than 2 ppm of fluoride are suffering from both dental and skeletal fluorosis. Major symptoms of dental
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fluorosis included lack of luster, browning, pain, pus and untimely loss of teeth. Skeletal fluorotic symptoms observed included tingling and numbing of extremities, pain in joints and knee, bending, stiff limbs, stiff vertebral column and unable to carryout the routine duties. There is an urgent need to impose preventive measures in these villages in the form of supply of safe drinking water and/or defluoridation of available water. REFERENCES Anonymous: Control of Fluorosis. A Study Report Schemes of submission under National Water Technology Mission, Zilla Parishad Dharwad, p.112 (1989). Bharati, P. and Rao, Meera: Epidemiology of fluorosis in Dharwad district. Journal of Human Ecology, 14(1): 3742 (2001). Bharati, P.: Nutritional Status and Occurrence of Fluorosis in Selected Villages of Mundaragi Taluk, in Dharwad District. Ph.D. Thesis, University of Agricultural Sciences, Dharwad, (1996). Choubisa, S.L., Sampura, K., Choubisa, P.K. and Sharma, O.P.: Fluoride in drinking water sources of Udaipur district, Rajasthan. Indian Journal of Environment and Health, 38: 286-292 (1996). Das, P.K. and Wahab, S.N.: Study of prevalence and some epidemiological factors related to fluorosis in two villages in Chandrapur district, Maharashtra. Gondwana Geological Magazine, 9: 133-137 (1995). Hunde, H. S. Maiya, M. and Jithuri: Endemic fluorosis in Dharwad district, Karnataka state. Seventh All India Conference of Indian Medical Association, Hubli (1973). Kubakaddi, A.B.: Epidemiology of Fluorosis and Educational Intervention in Hungund Taluk. M.H.Sc. Thesis, University of Agricultural Sciences, Dharwad (2001). Pareek, A.: A study on skeletal deformities due to fluorosis. The Indian Journal of Nutrition and Dietetics, 31: 121125 (1994). Tamboli, B.L., Mathuir, G.M., Mathur, A.P., Lalla, S.K. and Goyal, O.P.: Prevalence of fluorosis in Pratadpura and Surajpura villages of Ajmer (Rajasthan). Indian Journal of Medical Research, 71: 57-67 (1980). Teotia, M., Teotia, S.P.S. and Singh, R.K.: Skeletal fluoride toxicity in children. Indian Journal of Pediatrics, 46: 389396 (1979).
