Contact
  • E-ISSN:

    2454-9584

    P-ISSN

    2454-8111

    Impact Factor 2024

    6.713

    Impact Factor 2023

    6.464

  • E-ISSN:

    2454-9584

    P-ISSN

    2454-8111

    Impact Factor 2024

    6.713

    Impact Factor 2023

    6.464

  • E-ISSN:

    2454-9584

    P-ISSN

    2454-8111

    Impact Factor 2024

    6.713

    Impact Factor 2023

    6.464

INTERNATIONAL JOURNAL OF INVENTIONS IN ENGINEERING & SCIENCE TECHNOLOGY

International Peer Reviewed (Refereed), Open Access Research Journal
(By Aryavart International University, India)

Paper Details

Impact of Fluoride Contamination in Drinking Water on Human Bone and Dental Health

Nehal Kumar

Research Scholar, Department of Zoology Veer Kunwar Singh University, Ara

Dr. Rajesh Verma

Assistant Professor Department of Zoology Veer Kunwar Singh University, Ara

108 - 126 Vol. 11, Issue 1, Jan-Dec, 2025
Receiving Date: 2025-06-02;    Acceptance Date: 2025-08-31;    Publication Date: 2025-10-19
Download PDF

http://doi.org/10.37648/ijiest.v11i01.013

Abstract

Fluoride contamination in drinking water is a major public health concern in India, particularly in rural regions dependent on groundwater. While low fluoride concentrations (0.5–1.0 mg/L) are beneficial for dental health by enhancing enamel remineralization, chronic exposure above the permissible limit of 1.5 mg/L leads to dental fluorosis, skeletal fluorosis, and systemic health effects. Epidemiological studies indicate that states such as Rajasthan, Bihar, Andhra Pradesh, and Telangana are severely affected, with groundwater fluoride levels ranging from 2.0 mg/L to over 20 mg/L. Dental fluorosis is highly prevalent among children, manifesting as enamel mottling, brown stains, and structural weakness, whereas skeletal fluorosis predominantly affects adults, causing joint stiffness, bone deformities, and spinal complications. Fluoride toxicity also impacts soft tissues, leading to endocrine disruption, neurological impairment, renal dysfunction, and potential reproductive effects. Mitigation strategies require a multifaceted approach, including technological interventions like the Nalgonda alum-lime process, activated alumina filters, bone char adsorption, reverse osmosis, and rainwater harvesting. Nutritional supplementation with calcium, vitamin C, vitamin D, and antioxidants further reduces fluoride absorption and toxicity. Community awareness, school-based dental screening, and national programs such as the National Programme for Prevention and Control of Fluorosis (NPPCF) are essential for early detection and prevention. An integrated strategy combining safe water access, nutritional support, and public health initiatives is crucial to reduce the burden of fluorosis, protect vulnerable populations, and improve overall health outcomes. Region-specific interventions and sustained community participation are key to achieving long-term mitigation of fluoride-related health risks in India.

Keywords: Fluoride contamination; drinking water; dental fluorosis; skeletal fluorosis; bone health; groundwater; public health; India; WHO; mitigation strategies.

    References

  1. Aoba, T., & Fejerskov, O. (2002). Dental fluorosis: chemistry and biology. Critical Reviews in Oral Biology & Medicine, 13(2), 155–170. doi:10.1177/154411130201300206
  2. Ayoob, S., & Gupta, A. K. (2006). Fluoride in drinking water: A review on the status and stress effects. Critical Reviews in Environmental Science and Technology, 36(6), 433–487. doi:10.1080/10643380600678112
  3. Ayoob, S., Gupta, A. K., & Bhatnagar, A. (2019). Fluoride toxicity: A systemic review of mechanisms and management strategies. Environmental Science and Pollution Research, 26(2), 1222–1236.
  4. Barbier, O., Arreola-Mendoza, L., & Del Razo, L. M. (2010). Molecular mechanisms of fluoride toxicity. *Chemico-Biological Interactions, 188*(2), 319–333.
  5. Bhatnagar, R., Singh, A., & Sharma, P. (2020). Neurotoxicological impact of fluoride exposure: Evidence from animal and human studies. Toxicology Reports, 7, 1112–1120.
  6. Central Groundwater Board (CGWB). (2021). Groundwater quality in India. Ministry of Jal Shakti, Government of India.
  7. Choi, A. L., Sun, G., & Zhang, Y. (2019). Association between fluoride exposure and cognitive function in children: Evidence from Indian case studies. Environmental Health Perspectives, 127(8), 87002.
  8. Choubisa, S. L., et al. (2018). Fluoride contamination in drinking water and its impact on human health. Environmental Monitoring and Assessment, 190(8), 1–15.
  9. Dean, H. T. (1942). The investigation of physiological effects by the epidemiological method. Public Health Reports, 57(32), 1155–1179.
  10. EFSA Panel on Nutrition. (2020). Tolerable upper intake levels for fluoride. EFSA Journal, 18(5), e06133.
  11. Faccini, J., et al. (2022). Bone tissue alterations induced by chronic fluoride exposure: A systematic review. Toxicology Reports, 9, 1460–1472.
  12. Fejerskov, O., et al. (2015). Dental fluorosis: A handbook for health professionals. Community Dentistry and Oral Epidemiology, 43(2), 97–109.
  13. Gizaw, B. (2020). Groundwater fluoride occurrence in Ethiopia and its health effects. Applied Water Science, 10(2), 1–12.
  14. Green, R., Lanphear, B., & Hornung, R. (2019). Association between maternal fluoride exposure during pregnancy and IQ scores in offspring in Canada. JAMA Pediatrics, 173(10), 940–948.
  15. Gupta, P., Singh, A., & Mishra, R. (2022). Community-level defluoridation strategies and their effectiveness in Rajasthan. Journal of Environmental Management, 308, 114538.
  16. Gupta, P., Singh, A., & Mishra, R. (2022). Dental fluorosis prevalence among children in endemic areas of North India. Indian Journal of Public Health Research & Development, 13(4), 102–110.
  17. Gupta, R., et al. (2019). Nutritional factors and fluorosis susceptibility. Indian Journal of Public Health, 63(4), 290–295.
  18. Gupta, R., et al. (2019). Nutritional and psychosocial correlates of fluorosis in children. Indian Journal of Public Health, 63(4), 290–296.
  19. Jain, R., Meena, V., & Rathore, S. (2021). Prevalence and severity of fluorosis in Rajasthan: A cross-sectional study. Environmental Monitoring and Assessment, 193(7), 451.
  20. Jha, S., Mishra, R., & Kumar, V. (2020). Renal complications due to fluoride exposure: Clinical insights from Indian dialysis patients. Indian Journal of Nephrology, 30(3), 215–222.
  21. Khan, S. (2020). Assessment of fluoride intake through food chain and mapping of endemic areas of Gaya district, Bihar, India. Bulletin of Environmental Contamination and Toxicology, 104(5), 1–9.
  22. Kheradpisheh, Z., Mahvi, A. H., & Yunesian, M. (2018). Fluoride and thyroid dysfunction: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 15(11), 2430.
  23. Kumar, S., Yadav, A., & Tiwari, R. (2022). Groundwater fluoride contamination in India: Status, health impacts and remediation. Environmental Science and Pollution Research, 29(2), 1500–1514.
  24. Kumari, P., & Misra, A. K. (2023). Potential health risk assessment and distribution of fluoride in groundwater of Munger, Bihar, India. Human and Ecological Risk Assessment, 29(3–4), 757–776.
  25. Meena, V., Jain, R., & Singh, P. (2020). Fluoride contamination in groundwater: A review of occurrence, impacts and mitigation in Rajasthan, India. Applied Water Science, 10(5), 125.
  26. Mohd, S., Ali, F., & Khan, M. (2022). Oxidative stress and renal pathology in fluoride-intoxicated rats. Journal of Applied Toxicology, 42(1), 35–44.
  27. National Toxicology Program (NTP). (2021). Systematic review of fluoride exposure and neurodevelopmental effects. Research Triangle Park, NC: U.S. Department of Health and Human Services.
  28. Neeti, K., & Singh, R. (2023). Groundwater quality assessment and health risks from fluoride exposure in Bihar. Sustainable Water Resources Management, 9(2), 45.
  29. Neeti, K., & Singh, R. (2023). School-based interventions for reducing fluoride exposure in Bihar. Sustainable Water Resources Management, 9(2), 45.
  30. Patel, N., Sharma, D., & Yadav, P. (2020). Endemic fluorosis in Central India: A community-based survey. Clinical Epidemiology and Global Health, 8(4), 1216–1221.
  31. Rango, T., et al. (2012). Fluoride exposure from groundwater and the prevalence of dental fluorosis in Ethiopian Rift Valley. Science of the Total Environment, 433, 151–160.
  32. Rango, T., et al. (2012). Groundwater fluoride exposure and prevalence of skeletal fluorosis in Ethiopian Rift Valley. Science of the Total Environment, 433, 151–160.
  33. Rao, K., Reddy, P., & Prasad, G. (2021). Hydrogeochemical assessment of fluoride contamination in Karnataka and its health impacts. Groundwater for Sustainable Development, 13, 100578.
  34. Rao, N., Reddy, B. S., & Reddy, Y. R. (2020). Fluoride contamination and mitigation approaches in Andhra Pradesh, India. Groundwater for Sustainable Development, 10, 100333.
  35. Reddy, B. V., et al. (2016). Skeletal fluorosis in Andhra Pradesh: Clinical and epidemiological perspectives. Indian Journal of Orthopaedics, 50(5), 548–554.
  36. Reddy, B. V., Rao, G. S., & Reddy, K. (2019). Endemic fluorosis and groundwater contamination in Andhra Pradesh and Telangana. Environmental Geochemistry and Health, 41(3), 1091–1105.
  37. Reddy, Y. R., Rao, G. S., & Reddy, K. (2019). Nutritional strategies for preventing fluoride toxicity in endemic areas. Indian Journal of Public Health, 63(3), 215–222.
  38. Ruan, J., et al. (2019). Mechanisms of bone changes in skeletal fluorosis. Environmental Pollution, 252, 524–532.
  39. Ruan, J., et al. (2019). Psychosocial impacts of dental and skeletal fluorosis. Environmental Pollution, 252, 524–532.
  40. Saxena, R., Gupta, A., & Kumar, N. (2022). Skeletal fluorosis prevalence among rural populations of Bihar. International Journal of Environmental Health Research, 32(5), 1002–1014.
  41. Shashi, A., Gupta, R., & Singh, J. P. (2019). Fluoride-induced reproductive toxicity in male rats: Biochemical and histopathological evidence. Reproductive Toxicology, 85, 65–72.
  42. Sharma, A., Verma, P., & Yadav, R. (2021). Defluoridation technologies and community-based approaches in India. Journal of Water and Health, 19(6), 867–880.
  43. Sharma, A., Verma, P., & Yadav, R. (2021). Fluoride contamination in groundwater and its health implications in India. Journal of Environmental Biology, 42(1), 15–25.
  44. Shen, X., Wang, J., & Zhang, Q. (2021). Fluoride exposure impairs ovarian function and fertility in mice. Ecotoxicology and Environmental Safety, 213, 112055.
  45. Singh, P., Kumar, S., & Verma, A. (2018). Thyroid disorders associated with endemic fluorosis: An epidemiological study. Journal of Clinical Endocrinology and Metabolism, 103(9), 3405–3411.
  46. Singh, R., et al. (2020). Fluoride contamination and fluorosis in India: An overview. Journal of Environmental Health Science & Engineering, 18(2), 367–377.
  47. Susheela, A. K. (2018). Fluorosis management in India: Strategies for prevention and control. New Delhi: Fluorosis Research & Rural Development Foundation.
  48. Susheela, A. K., Gupta, R., & Mondal, N. K. (2019). Fluoride toxicity and human health: Emerging evidence for systemic effects. Environmental Research, 176, 108538.
  49. Susheela, A. K., Mondal, N. K., & Gupta, R. (2018). Endemic fluorosis in India: A long-term challenge for public health. Indian Journal of Medical Research, 148(5), 539–547.
  50. Tang, H., Wang, M., Li, G., Wang, M., Luo, C., Cui, Y., Liu, H., Zhou, G., Zhao, Q., Dong, L., Liu, L., & Zhang, S. (2023). Association between dental fluorosis prevalence and inflammation levels in school-aged children with low-to-moderate fluoride exposure. Environmental Pollution, 320, 120995. doi:10.1016/j.envpol.2022.120995
  51. Tang, Q., Xu, J., & Zhang, H. (2019). Neurodevelopmental toxicity of fluoride: A systematic review and meta-analysis. Science of the Total Environment, 653, 446–454.
  52. Whelton, H., et al. (2019). Water fluoridation and dental caries: A global review. Community Dentistry and Oral Epidemiology, 47(2), 110–116.
  53. World Health Organization (WHO). (2017). Guidelines for drinking-water quality (4th ed.). Geneva: WHO Press.
  54. Yadav, J., Singh, S., & Kumar, R. (2020). Groundwater fluoride distribution and endemic fluorosis in India: A systematic review. Environmental Reviews, 28(4), 431–443.
  55. Yadav, J., Singh, S., & Kumar, R. (2020). Groundwater fluoride mitigation strategies in India: A systematic review. Environmental Reviews, 28(4), 431–443.
  56. Zhao, W., He, Y., & Wang, Y. (2020). Drinking water fluoride and thyroid dysfunction in endemic fluorosis areas of China. Environmental International, 134, 105306.
  57. Zhao, Y., et al. (2019). Epidemiology of endemic fluorosis in China. Environmental Health Perspectives, 127(3), 037001.
Back

Disclaimer: Indexing of published papers is subject to the evaluation and acceptance criteria of the respective indexing agencies. While we strive to maintain high academic and editorial standards, International Journal of Inventions in Engineering & Science Technology does not guarantee the indexing of any published paper. Acceptance and inclusion in indexing databases are determined by the quality, originality, and relevance of the paper, and are at the sole discretion of the indexing bodies.