National Programme For Prevention And Control Of Fluorosis (NPPCF)

Introduction

Fluorosis, a public health problem, is caused by excess intake of fluorosis through drinking water/food products/industrial pollutants, over a long period. It results in major health disorders like dental fluorosis, skeletal fluorosis, and non-skeletal fluorosis besides inducing ageing. These harmful effects, being permanent and irreversible in nature, are detrimental to the health of an individual and the community, which in turn, has an impact on growth, development, economy, and human resource development of the country.

Sources of Fluoride

The main source of fluoride intake are drinking water, food, drugs & industrial emissions. Permissible limit for fluoride, as per Bureau of Indian Standards (BIS), is 1.5 ppm in drinking water.Fluorine is abundant in nature, found in compound form like fluoride. Fluorine is essential for mineralization of bones & formation of dental enamels. Fluorine deficiency leads to dental caries. 96% of fluoride of body is found in bones & teeth. Normally small amounts of fluoride are required (0.5 to 0.8mg/lit) in drinking water prevalence.Fluoride endemicity has been reported in 7 districts of Maharashtra namely Yavatmal, Washim, Nanded, Beed, Latur, Chandrapur & Nagpur. Based on excess level of fluoride content in a number of districts, the States/UT’s have been classified as mild, moderate, and severe endemic States/UT’s of Fluorosis, which affects all ages.Fluorosis brings about changes in teeth and the skeletal system, which become irreversible in due course of time. Therefore, the focus of management of fluorosis is on prevention, health promotion, deformity correction, and rehabilitation.

Goal / Objectives

The objectives of the National Programme for Prevention & Control of Fluorosis are as follows:

1) To collect, assess and use the baseline survey data of fluorosis contents in drinking water sources.
2) Comprehensive management of fluorosis in the selected area.
3) Capacity building for prevention, diagnosis, and management of fluorosis cases.

Implementation of NPPCF in the state of Maharashtra

The NPPCF programme started in Maharashtra state in a phased manner from the year 2009-2010.

Old 6 Districts:
Chandrapur, Nanded – Phase 2-August 2010
Latur, Yavatmal, Nashik – Phase 3-July 2011
Beed – Phase 4-May 2012
(In Phase 1, Maharashtra was not included.)

Manpower support

The Deputy Director of Oral Health, Health Services, Mumbai, is appointed as a State Nodal Officer to coordinate the implementation of NPPCF.

7 District consultants are appointed for each district.

Guidelines for comprehensive management of fluorosis cases

Analysis of urine samples

A. Sample collection

1. 15ml spot urine sample in 25 ml plastic screw cap bottles.
2. Put 1-2 drops of Toluene (AR Grade).
3. Properly labeled.

B. Transportation of samples

1. Urine sample should be sent to district lab within a week’s time.
2. Samples can be kept at room temperature.
3. Report should be sent to State Nodal Officer.

Early Detection

The following criteria are used for confirming fluorosis cases:

1. Any suspect case with high levels of fluoride in urine (>1mg/L).
2. Any suspect case with interossieus membrane calcification in the forearm confirmed by X-Ray.

Prompt Intervention

Health Education

Do’s & Don’ts in relation to nutrition intervention in fluorosis

Do’s and Don’ts for Nutrition Intervention

Do’s	Don’ts
Calcium rich food	Black Tea
Milk	Black/Rock salt
Milk products	Tobacco
Green leafy vegetables	Supari
Vitamin C rich food	Fluoridated toothpaste
Iron rich food
Citrus fruits
Banana, Guava, Brinjal

Treatment

• Medical treatment: No specific treatment; treatment supplementation with vitamin C & D, antioxidants, calcium & correction of malnutrition.
• Treatment of deformities: Orthoses, surgical shoes, physiotherapy, reconstructive surgery.

7 Districts under NPPCF for the year 2024-25

1) Nagpur
2) Nanded
3) Chandrapur
4) Beed
5) Latur
6) Washim
7) Yavatmal

Beneficiary:

as mentioned above

Benefits:

as mentioned above