Folow up

PFPC Daily - June 6, 2004

Today the Statesman News Service posted two follow-up articles written by Dr. Raman, offering further insight into the fluorosis problem in India. They are posted below.

RE: Fluorosis burst bares green secrets

The fluorosis problem is widespread across the country. For instance, it is prevalent in a very serious form in Rajasthan, Haryana, Punjab, Madhya Pradesh, Greater Delhi, Gujarat, Assam, Andhra Pradesh ... I don’t really know whether any part of India is free of it. The problem is greatly aggravated by certain IDIOTIC practices, sanctioned or implemented by civic authorities. In Delhi, for instance, domestic water supply is usually a mixture of Yamuna water and tubewell water: i.e., after treating the fluoride-free river water to render it microbiologically safe, the Delhi Jal Board is deliberately making it dangerous by mixing it with tubewell containing excessive levels of fluoride. I suspect that most of the so-called spondylosis in Delhi is actually skeletal fluorosis.

"Fluoridated" toothpastes are another aberration. They are widely used by the unwary and unaware, because of the advertisement hype saying that fluoride is good for your teeth. The fact that the toothpaste contains fluoride is not very prominently displayed on the carton or tube, and it is likely to be missed by the buyer unless he is looking for it. We even have a so-called "anti-cavity fluoride rinse” (see http://www.colgate.co.in/ourproducts/oralcare/toothpa ste2.shtm), containing 1000 ppm of fluoride. The fluoride toothpastes are not merely unnecessary, they are a patent health hazard, especially for children.The most ironical part of the whole story is that there is no *definitive* scientific evidence that fluoride has any beneficial effect in preventing tooth cavities.Poor nutrition, and especially calcium deficiency, is another aggravating factor, but most of our countrymen suffer from it.

GOD HELP US (if there is a God, which I doubt).
T.S. Raman, Ph.D.
tsraman96@rediffmail.com

RE: Fluorosis burst bares green secrets

I forgot to include the fact that tea, especially the poorer qualities which are often manufactured from fallen leaves, is a source of dietary fluoride. Tea has been implicated as a major cause of fluorosis in Tibet.
T S Raman, Ph.D
tsraman96@rediffmail.com

Fluorosis burst bares green secrets

ANJAN CHAKRABORTY
STATESMAN NEWS SERVICE

KOLKATA, June 5. — The chief minister and others wearing the cap of
“green” activists – leaders, officials, NGOs et al – spent World Environment
Day going hammer and tongs for a cleaner and disease-free environment. But
few, if any, cared to lend an ear to patients of dental fluorosis, caused by high
flouride content in water from tube wells, just off city limits.
Incidence of dental fluorosis have been reported from Rajpur, Sonarpur,
Tegharia, Kamrabad and Kendarpur areas of South 24 Parganas.
Practising dentists have identified several cases of dental fluorosis which
district health officials maintain could be a new phenomenon, never reported
before. Their only explanation is that if this be true, they would be conducting
a preliminary investigation of the areas to find out the extent of the prevalence.
“If local dentists have found such cases, then they should report them to us so
that we can study their data and if necessary launch a first-hand investigation
into the cases. We will have to look at the severity of the problem and also its
extent first and then we can come to any conclusion. We can then take
necessary steps to stop its spread,” said Dr Dipankar Maji, Deputy CMOH
II, South 24 Parganas.
Here lies the catch. The only two state agencies, Public Health Engineering
Directorate and the State Water Investigation Directorate involved in carrying
out surveys to find out chemical contamination of drinking water in the state
have remained ignorant about the problem. Their investigations are restricted
to Nalhati and Rampurhat blocks of Birbhum district, which were identified as
flourosis-prone decades back.
“We only carry out such surveys in Birbhum where flourosis has already been
reported but we have no information about flouride contamination in drinking
water in any tubewells in South 24 Parganas. So we have not done any
surveys there,” said Mr Prabir Duta, chief engineer (HQ), PHE department.
However, the Geological Survey of India first reported flourosis contamination
at a well in Rajpur 40 years ago and more recently in 1998 when they were
conducting a survey in the Sonarpur and Rajpur areas for arsenic
contamination in drinking water. During that exercise, they found excessive
flouride content in many tubewells and suggested that the state government
immediately study its impact on public heath. Spurred by these findings, the
State Water Investigation Directorate carried out tests on water samples
collected form tubewells in the area, three years back. “Chemical tests of the
samples of water collected from those tubewells found excess flouride content
but that report was never made public as the directorate decided that the tests
were not comprehensive enough. And health surveys of people affected with
dental fluorois because of the flouride contamination in drinking water were
not done. So, at that time it was decided that a further survey would be
carried out in these areas on a larger scale,” said Mr S. N. Lahiri,
Superintendent Engineer of SWID. Unfortunately that survey is yet to kick off.
An NGO, however, came forward for this survey last year and their report
finds appreciable increase in dental fluorosis cases in the five areas of South
24 Parganas. Ardem Centre for Resource Development and Environment
Management carried out the survey with help from local dentist Dr Sujata
Mukherjee and Dr. S.R. Mitra. “In Sonarpur, I found several cases of dental
flourosis, which means that people here are exposed to flouride contaminated
water,” said Dr Mukherjee.
They now fear that prolonged exposure could lead to the more severe form of
flourosis, which is Skeletal Flourosis. “We found several cases of dental
flourosis especially in Rajpur and Sonarpur areas. We have also found that
people in these areas are also vulnerable to bone fracture, which means that
people in the area are also showing primary signs of Skeletal Flourosis, which
causes crippling of bones and has no cure. Since the state authorities have
shown little interest in this matter, we sent our report to the Rajiv Gandhi
Drinking Water Mission based in New Delhi, who later asked us to send a
detail survey of the areas,” said Dr PB Taron, director of Ardem Centre.
KMC to seal deep tube wells: To arrest arsenic contamination in the
metropolis, Kolkata Municipal Corporation has decided to seal all its 430
deep tube wells and offset the shortage with fresh surface water supply of 100
million gallons from Palta works from next month. City mayor Mr Subrata
Mukherjee said today that the KMC-operated deep tubewells would be
sealed to stop arsenic contamination, while fresh move would be taken to
create awareness about drawing ground water by about 5,000 private tube
wells, which amounted to about 15 million gallons per day. The KMC, he
said, had spent Rs 250 crore for augmenting of supply from Palta works.
He said that KMC had received reports about arsenic poisoning and various
other ailments due to intake of water from the deep tube wells. The mayor,
who visited KMC’s water projects along with state’s municipal affairs minister
Mr Ashok Bhattacharya, told reporters that while the Palta waterworks cater
to the daily need of 220 million gallons in north Kolkata, the Garden Reach
works meets the requirement of south and central parts of metropolis.
http://www.thestatesman.net/page.arcview.php?clid=6 &id=73302&usrsess=1
=

‘Walking corpses’ cry out for safe drinking water

dipankar roy
STATESMAN NEWS SERVICE

GUWAHATI, May 24. — Kania Singnar is 24 but looks much older. His
teeth are mottled. Stiff joints force him to take help of others to walk.
Seven-year-old Purnima Rongharpi may be slightly better off. She can walk
around on her own although not like any other seven-year-old. But like Kania,
she too has mottled teeth and suffers from a chronic and acute backache.
They belong to the “doomed generation” of Karbi Anglong district, crippled in
various degrees by fluorosis.
Kania and Purnima — along with several others like them from Tekelangjun,
the primary fluoride zone in the picturesque hill district — sat in a dharna today
at Last Gate in Dispur, the seat of power in Assam. They were demanding
what by right should have been theirs long ago: safe drinking water. Kania,
who was struck by the disease when he was 14, said the journey of several
hours by bus from his village to Guwahati was excruciatingly painful.
So, why did he have to undertake the journey at all? “What to do? The sahibs
don’t go from here to see our plight, so we decided to come here and tell
them what we’re going through. Our generation is doomed. We’re like
walking corpses, but we want our next generation to get safe drinking water,”
he said.
Entire families are crippled for life and have to depend on others for their
existence. An estimated 70,000 people in Karbi Anglong district — a tenth of
the total population — are wasting away silently but painfully because of
fluorosis. The first case in the state was detected in mid-1999 at Tekelangjun,
where fluoride levels in water were found to be as high as 23.4 mg per litre
(the permissible limit laid down by WHO is only one mg per litre).Before the
official declaration that the disease was fluorosis, villagers attributed their
unexplained miseries to evil spirits. Mr Dharamsing Teron, an MLA from the
district, complained that the state had done precious little in the last four years
since studies found the fatally high content of fluoride in the water.

http://www.thestatesman.net/page.arcview.php?clid=2 &id=40727&usrsess=1

http://makeashorterlink.com/?Z46521188

The article below was published today in The Nation and offers insight into the dental health situation affecting people in Kenya.

When reading the article, please keep the following in mind:

*Although there are many areas with very high fluoride content in water supplies, dental fluorosis affects most of the children in Kenya and is found even in areas where water supplies are very low in fluoride (0.2 to 0.4 ppm). As is the case in India, many people are still entirely unaware that it is the fluoride intake which is causing their ill health and mottled teeth.

*Fluorides are an acknowledged cause of gingivitis which is affecting 90% of the population, according to the article. (SEE: Newsletter #9: http://64.177.90.157/pfpc/html/newsletter_9.html )

*Because of the high prevalence of fluorosis in Kenya fluoride toothpaste was a hotly debated item in Kenya in the 1980s, leading to the introduction of no-fluoride toothpastes. Apparently there was also a ban on TV advertisements of fluoride toothpastes during the same time.

=============

“Modern Foods, New Epidemic”

The Nation (Nairobi)

Jeff Otieno, Nairobi

Dental problems will increase sharply in Kenya inthe next decade due drastic changes in diet, the dental association has warned.

Research done by the umbrella dentists body has discovered that the complaints, also referred to as oral health problems, are the result of an increased consumption of sugary foods and drinks.

Consumption of sugar in recent years has risen threefold as Western foods, which are full of refined sugars, replace the otherwise nutritious traditional dishes.

Leading the pack is tooth decay, which affects people as young as three years in both the rural and the urban areas.

"This is not only concentrated in the urban areas, but has also become a major problem in rural areas where three-quarters of the country's poor live," says Dr Tom Ochola, the chairman of the Kenya Dental Association.

He argues that consumption of sweets, biscuits and cakes among the young is worrying as over 70 per cent of them suffer from tooth decay.

"How will the children of our children be if the current situation continues unabated?" the medic wonders.

Tooth decay results in tooth loss and reduces one's ability to eat a varied diet. In fact, it is the organic acids formed by bacteria in the dental plaque through the anaerobic metabolism of sugars derived from diet that demineralises the hard tissues of the teeth.

Many young children visit dentists every month to have their temporary teeth removed following massive decay.

But tooth decay is not the only headache the association has to grapple with. According to Dr Ochola, the gum disease, mainly among adults, is another major problem. "Almost every Kenyan suffers from the gum disease at one stage or another. However, the difference is the severity," he adds.

The medic says that approximately 90 per cent of Kenyan adults suffer from one form of gum disease or another.

"But since most of them are not painful, people don't see the need to seek medication and only consult the doctor when the pain becomes unbearable," Dr Ochola says.

Fluorosis, which is caused by excessive intakes of fluoride, is another common dental problem in the country.

Scientifically known as clinical dental fluorosis, it is characterised by staining and pitting of the teeth. In the more severe cases, all the enamel may be damaged.

"The teeth lose their natural white colour and completely turn brown, and this might affect one's psychological well-being as many sufferers are made fun of and looked down up," says Dr Ochola.

The problem is common in the Rift Valley area where ground water has a fluoride content higher than the recommended World Health Organisation figure of 1.5 milligrammes per litre.

"Most people in Kiambu, Ruiru, Muranga and Baringo have brown teeth because the fluoride content in the ground water is much higher than the recommended WHO figure."

But what is more worrying is the increase in oral cancer cases, currently representing two per cent of all body cancers.

The association says that dentists are receiving more patients now than in the past.

Research done by the association has found out a direct relation between oral cancer and tobacco usage.

"Tobacco chewing and sniffing and reverse cigarette smoking, where the burning end is placed inside the mouth, are to blame for the new phenomenon," Dr Ochola says.

The chewing of bitten nuts which is common among Asians, is also another major cause of oral cancer. Dr Ochola advises people aged 50 and above who notice unhealing wounds and swellings in their mouths to seek early treatment.

The task to ensure disease-free teeth and gums will not be easy as the burden in the African countries is bound to continue to rise.

"As a result of lack of awareness, people do not value oral health and still see it as a cosmetic issue," adds Dr Ochola.

The argument stands in health insurance where many schemes lack packages for dental treatment.

In Kenya, sky-rocketing dental costs is not only the issue hindering the people from developing a culture
of healthy teeth.

Besides, there is severe shortage of dentists- only 600 in a country of 30 million people.

"This means that there is only one doctor for every 50,000, a figure which is far below the WHO-recommended figure of one for 5,000," says Dr Ochola.

As a result of the problems bedevilling the African countries, WHO wants the governments to increase budgetary allocations to oral health programmes.

"We foresee a situation where dental problems will be a heavy burden for the African countries unless dental health is taken seriously," says Dr Erick Petersen, a WHO dental expert.

Dr Petersen adds that the marginalisation of oral health is hampering programmes aimed at combating the diseases. "The budgetary allocations must be increased if Africa is to win the war on oral health," he says.

Health minister Charity Ngilu supports the sentiments: "It is true budgetary allocations of the African countries to oral health programmes has all along been minimal."

She argues that education on oral health and prevention programmes in many African countries have also been minimal.

In Kenya, Mrs Ngilu says, the allocation for dental healthcare is only 0.0016 per cent of the total health budget, which is Sh14 billion.

"Indeed, the orientation of dental practice in Africa has been more towards curative rather than preventive care," the minister says.

The importance of oral health in general health programmes, she urges, should not be underestimated.

According to Dr Petersen, the global health body is concerned about the sweeping dietary changes taking place in Africa among, not only the affluent, but also the poor.

For many years oral health problems were minimal in many African countries, but due to the increased consumption of refined sugar foods, they are emerging as a major sources of worry, he adds.

He says that Africa is currently one of the leading continents on which the people do not have the full set of teeth due extractions caused by decay.

WHO also wants governments to step up campaigns to raise awareness on dental health and nutrition.

Dr Petersen urges countries with a low intake of sugars not to increase their consumption. "When the sugar intake is between 15 and 20 kg per year, or represents 6 per cent to 10 per cent of the energy intake, dental problems are low."

To WHO, oral means more than just good teeth as it is integral to health and essential to a person's general well-being. This implies being free of chronic oro-facial pain, oral and pharyngeal (throat) cancer, oral tissue lesions, birth defects such as a cleft lip and palate and other diseases and disorders that affect the oral, dental and craniofacial tissues.

To improve private-public participation, Prof Denis Bourgeois, a France-based dental expert, proposes the establishment of micro-insurance organisations to help the poor to acquire quality healthcare.

He says that such organisations can cushion the African poor who pay more for healthcare than the rich.

http://allafrica.com/stories/200406070296.html

WHO Data: Kenya (very dated!)
http://www.whocollab.od.mah.se/afro/kenya/data/keny afluoro.html

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PFPC Daily - June 8, 2004

News of a deadly accident in Japan.

“1 killed, 3 badly burned in chemical plant blast”

Yomiuri Shimbun, June 8, 2004

One person died and three were badly burned Tuesday when a tank containing fluorine exploded at a chemical plant in Akita, police said.

According to Akita Police Station, a tank at an electrochemical fluorination plant in an industrial zone near the mouth of the Omonogawa river, which is run by Akita-based chemicals manufacturer Jemco Inc., exploded at about 11:25 a.m., severely burning four men who were doing welding work nearby.

One of the four--59-year-old Takeshi Imano, also from Akita, who worked for a Jemco affiliate--suffered burns over his body and died after being taken to a hospital.

The other three--a colleague of Imano's and two Jemco
employees--suffered burns to their thighs, the police said.

"It's possible that a spark from the welding ignited hydrogen in the tank," said a spokesman for Jemco, a wholly owned subsidiary of Mitsubishi Materials Corp.