Case-controlled cohort health indicator study of an integrated fluorosis mitigation program in India.

The population affected by dental fluorosis in India due to fluoride in drinking water has been estimated by Fewtrell et al. (2006) as 18 197 000. Of these 18.1 million people, further studies highlight that children are the most affected demographic group. One of the worst affected geographical areas is Madhya Pradesh, in which more than 11% of the population is consuming water with elevated levels of fluoride. In order to mitigate the negative affects of excess fluoride, an Integrated Fluorosis Management (IFM) program has been implemented in the state of Madhya Pradesh. The approach involves dilution of fluoride-affected water sources with non fluoride contaminated rainwater and promotion of the calcium-rich crop Cassia Tora. This paper outlines findings from an impact evaluation study where, using the Student T-test, a cohort of 2 000 children from 19 residential boarding schools were selected. A baseline survey was undertaken in 2005 and then an impact survey of the IFM activities was repeated on the same cohort in 2007. In both surveys the 2 000 children were examined by pedodontists in the field using the Deans classification test for dental fluorosis. The survey indicates a reduction in the prevalence of grade 1 fluorosis of 86%, of grade 2 of 77%, and of grade 4 of 60%.