National Programme For Prevention And Control Of Fluorosis (NPPCF)

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 found in bones & teeth.
• Normally small amount of fluoride is required (0.5 to 0.8mg/lit) in drinking water for good dental health.

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 number of districts, the States/UT’s have been classified as mild, moderate and severe endemic States/UT’s of Fluorosis which effects all ages.

Fluorosis brings about changes in teeth and skeletal system which becomes irreversible in due course of time. Therefore, the focus of management of fluorosis is on prevention, health promotion, deformity correction and rehabilitation.

 

Goal / Objectives

 To prevent and control Fluorosis cases in the country. The Objectives of the National Programme for Prevention & Control of Fluorosis are as follows:

• To Collect, assess and use the baseline survey data of fluorosis contents in drinking water sources.
• Comprehensive management of fluorosis in the selected area.
• Capacity building for prevention, diagnosis and management of fluorosis cases.

 Implementation of NPPCF in the state of Maharashtra

 NPPCF programme started in Maharashtra state in phased manner from year 2009-2010

Manpower support

Deputy Director of Oral Health, Health Services, Mumbai is appointed as a State Nodal Officer to coordinate implementation of NPPCF. 7 District consultants are appointed for all district’s.

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 time.
2. Samples can be kept at room temperature.
3. Report should be sent to State Nodal Officer.

C. Early Detection

Following criteria is used for confirming fluorosis cases

1. Any suspect case with high level 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	Don’ts
ü  Calcium rich food ü  Milk ü  Milk products ü  Green leafy vegetables ü  Vitamin C rich food ü  Iron rich food ü  Citrus fruits ü  Banana, Guava, Brinjal	x                    Black Tea x                    Black/Rock salt x                    Tobacco x                    Supari x                    Fluoridated toothpaste

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 as given below:

• Nagpur
• Nanded
• Chandrapur
• Beed
• Latur
• Washim
• Yavatmal

Beneficiary:

People

Benefits:

To prevent and control Fluorosis cases in the country