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Fluorosis is a public health problem in India; to know its prevalence and severity along with its mitigation measures is very important. The present study has been undertaken with the aim to assess the F dose-dependent clinical and subclinical symptoms of fluorosis and reversal of the disease by providing safe drinking water. For this purpose, a cross-sectional study was undertaken in 1934 schoolgoing children, Nalgonda district. Study villages were categorized into control (category I, F = 0.87 mg/L), affected (category II, F = 2.53 mg/L, and category III, F = 3.77 mg/L), and intervention categories (category IV, F = < 1.0 mg/L). School children were enrolled for dental grading by modified Dean Index criteria. Anthropometric measurements (height and weight) were used to assess nutritional status of the children. The biochemical parameters like serum T3, T4, TSH, PTH, ALP, 25-OH vitamin D, and 1,25-(OH) vitamin D were analyzed. The results showed a positive correlation between the drinking water and urinary fluoride (UF) in different categories. However, there was a significant decrease in the UF levels in the intervention category IV compared to affected group (category III). Fluoride altered the clinical (dental fluorosis and stunting) and subclinical indices (urine and blood) of fluorosis in a dose-dependent manner. In conclusion, the biochemical indices were altered in a dose-dependent manner and intervention with safe drinking water for 5 years in intervention group-mitigated clinical and subclinical symptoms of fluorosis.

Prevalence of fluorosis is mainly due to the consumption of more fluoride through drinking water. It is necessary to identify the fluoride endemic areas to adopt remedial measures for the people under the risk of fluorosis. The objectives of this study were to identify the exact location of fluoride endemic areas in Manur block of Tirunelveli District and to estimate fluoride exposure level through drinking water for different age groups. Identification of fluoride endemic areas was performed through Isopleth and Google earth mapping techniques. Fluoride level in drinking water samples was estimated by fluoride ion selective electrode method. A systematic clinical survey conducted in 19 villages of Manur block revealed the rate of prevalence of fluorosis. From this study, it has been found that Alavanthankulam, Melapilliyarkulam, Keezhapilliyarkulam, Nadupilliyarkulam, Keezhathenkalam and Papankulam are the fluoride endemic villages, where the fluoride level in drinking water is above 1 mg/l. Consumption of maximum fluoride exposure levels of 0.30 mg/ kg/day for infants, 0.27 mg/kg/day for children and 0.15 mg/kg/day for adults were found among the respective age group people residing in high fluoride endemic area. As compared with adequate intake level of fluoride of 0.01 mg/kg/day for infants and 0.05 mg/kg/day for other age groups, the health risk due to excess fluoride intake to the people of Alavanthankulam and nearby areas has become evident. Hence the people of these areas are advised to consume drinking water with optimal fluoride to avoid further fluorosis risks.