Fluorosis in India
Nava Thakuria email : navathakuria@yahoo.com

Contaminated and Crippled for Life
by Nava Thakuria

When Kusum Kalita joined the teaching staff at Tekelangjun High School 12 years ago, she encountered a rather peculiar experience in the classroom. Many of her students would cover their mouths with their fingers while talking to her. As Kalita was soon to learn, the students were embarrassed to smile because their teeth looked 'dirty.'

The students' 'dirty teeth', however, was not a product of poor hygiene. The dental problems were instead a consequence of the high level of fluoride now known to exist in their local ground water.

Water which contains a high level of fluoride creates a disorder known as fluorosis. While there is no doubt that fluorosis affects the teeth, that is not the end of the tragedy, for fluorosis may also affect the functioning of the bones, joints, stomach and kidney.

Assam Province - Endemic to Fluorosis

Assam, a north eastern province of India, is currently experiencing a widespread problem with fluoride contamination of water. Recent estimates suggest that approximately 100,000 people in the state are suffering from fluorosis.

Hundreds of villages in Karbi Anglong, the district where Kusum Kalita lives, along with a few areas in its neighboring district of Nagaon, are reported as being prone to fluorosis. People in these areas are complaining of severe anemia, stiff joints, painful and restricted movement, mottled teeth, muscle degeneration, kidney failure, and premature death. Many in the area have become crippled for life.

Well known for its greenery and scenic beauty, comprising of hills, valleys, rivers, springs and thick rainforest, Karbi Anglong has recently been included in the fluorosis affected map of India. Among Karbi Anglong's 700,000 habitants, one tenth of them are suffering from some form of dental or skeletal fluorosis, the latter of which can lead to paralysis.

The first fluorosis case in the state of Assam was discovered in the middle of 1999 in the Tekelangjun area of Karbi Anglong, where fluoride levels were reported as high as 5-23 mg/liter. (The permissible limit, according to WHO guidelines, is 1.5 mg/liter.) The tragedy, first of its kind in the North-East of India, was revealed following a study conducted by the Public Health Engineering department of Assam.

"In the affected villages of the district, it was found that one in every four persons was suspected to be with fluoride-related diseases," said Amalendu Bikash Paul, additional chief engineer, Public Health Engineering, Diphu. Speaking to this writer at his government residence recently at Diphu, (which is the district headquarters of Karbi Anglong and is around 200 km away from Guwahati, the capital city of Assam), Mr. Paul, the man who first detected the disease in the area, also added that out of 2,300 people spoken to during the survey, more than 600 were found affected.

Independent Studies which have been conducted since this initial survey by organizations such as the Central Ground Water Board ( New Delhi), the All India Institute of Hygiene and Public Health (Kolkata), the School of Environmental Studies ( Jadavpur, Kolkata) and Public Analyst in Guwahat, Assam, have confirmed the findings by Assam's PHED.

That the ground water in various parts of the hill district is highly contaminated with fluoride was also confirmed by the test result of urine samples from the victims.

Up until 1998, however, India's geological and health scientists had declared that the North-East region of the country was safe from fluoride contamination - a claim that was shown to be false by the above-mentioned water samples tested in the PHE Departmental laboratory at Diphu.

"The affected area includes Tekelangjun, Dokmaka, Lungnit, Taradubi, Tuplem, Garampani, Nambar of Karbi Anglong and Ratiagaon, Haldiati, Parakhowa, Neelbagan area of Nagaon district," stated Mr. Paul. "Meanwhile local habitants in the affected areas are asked not to use contaminated water for either drinking or cooking purposes. At least 85 tube wells were painted red as a warning signal there. For the habitants of Tekelangjun now, water from a distant surface source (hill stream) has been tapped and distributed in particular locations," added Mr. Paul.

Some more affected areas in the region have yet to receive a notice, however, as the underdeveloped infrastructure, inaccessibility, and disturbed law and order situation, has limited the studies up to this point. Mr.Paul stated though that "Manipur and Meghalaya( two other provinces in north eastern India) are also vulnerable for fluoride contamination."

Skeletal Fluorosis - The Disease without a Cure

Unfortunate to the hundred thousand victims of the state, fluorosis has no cure. But, of course, it can be prevented if the disease is diagnosed at the early stage. Initially the fluorosis patients suffer from sporadic pain and stiffness of joints, which turns to chronic joint pain, arthritic symptoms and calcification of ligaments. Finally the situation deteriorates to severe anemia, painful and restricted movement, loose muscles and even kidney failure.

"Fluoride in drinking water, while consumed, replaces hydroxide in bones and this is deposited in the bones and causes a chronic effect called skeletal fluorosis. It affects both young as well as older individuals. As a result of skeletal fluorosis, severe pains in the joints and back bone, hip region stiffness of backbone and joints, increased density of bone, along with calcification of ligaments and paralysis are experienced," told Mr. Paul quoting a health journal.

Fluoride can enter the human body through food, toothpaste, mouth rinses, other eatable products and of course more swiftly through drinking water. A colorless and odorless natural pollutant, fluoride comes in contact with the groundwater via erosion of fluoride bearing rock minerals. Three major sources of fluorine in India are fluorspars, rock phosphates and phosphorities. Most of the fluoride compounds found in the earth's upper crust are soluble in water.

It should be mentioned that at least 20 states of India, including the new creations Uttranchal, Jharkhand and Chattisgarh are endemic to fluorosis. States like Andhra Pradesh (first ever case of fluorosis in India was detected here in early 1930), Gujarat, Rajasthan (where 70-100% districts are affected), Bihar, Punjab, Haryana, Karnataka, Maharashtra, Madhya Pradesh, Tamil Nadu, Uttar Pradesh, some parts of Delhi (40-70% districts affected), Assam, Kerala, Orissa, West Bengal, Jammu & Kashmir (10-40% districts affected) can be identified as significantly affected. India thus has been facing another public health problem after arsenic. But statistics reveal that fluoride poisoning is more wide spread than arsenic in the country.

In the international arena, flourosis is found in more than 23 countries including Japan, China, Thailand, Jordan, Iraq, Iran, Palestine, Bangladesh, Pakistan, Sri Lanka, Algeria, Australia, England, Italy, France, Spain, Portugal, Czechoslovakia, Libya, Morocco, Mexico, New Zealand, Germany, Syria, Turkey, UAE, USA, Argentina, Egypt and African Nations (Senegal, Kenya, Tanzania, Ethiopia, Uganda).

The Life of a Fluorosis Victim

The life a fluorosis victim faces is frustrating, painful and often hopeless. With acute poverty and without hope of recovery, some victims have nothing to do but count their days.

Gita Deb (44), a resident of Tekelangjun area in Karbi Anglong, is suffering from the disease since 1994-95. Now leading a crippled and paralyzed life, (she's been a bed patient for the last three years), Mrs. Deb feels severe pain in her waist, legs, hands and finger joints. Earlier she could move with the help of a stick, but now she cannot stand on her legs at all. She can hardly sit up on her bed for 30 minutes.

While talking to this writer in her hut, Gita Deb showed a few prescriptions of medicine prescribed by a physician named Dr A Bagchi from Nagaon district. The prescriptions however have been stopped as the poverty stricken family cannot afford the cost. No medicines were ever supplied from the nearby government health centers, she lamented.

Gita's husband takes utmost care for her. He had a temporary shop in nearby Baghpani bazaar, which is around 90 km away from Diphu, to run the family. But when his wife had to go for death bed, he had to abandon the shop and serve her. The family has no bedpan and the husband uses a plastic sheet for the purpose. He himself cleans the sheet regularly for re-using later. To get washed at least twice in a month, Gita has to be carried outside. A kind of arrangement has been made outside their hut for these occasions.

Leaving aside all these works, the husband has to look after their son and cook for the three member family. Their son, a student of 4th standard in Tekelangjun High School, is also getting affected slowly with dental problems. Two daughters of theirs, who had already got married to distant villages, have their own families and kids. Unfortunately they are also complaining of pain in several joints, pain which is turning into semi- paralyzing conditions.

Gita Deb and her husband migrated to Karbi Anglong around 25 years back from Tripur, another north eastern province of India. They had five children, but two of them had died of unknown diseases at early ages. The family used to take spring water until around ten yeas ago when the PHE water supply scheme was launched. The family then started taking ground water and continued the practice till fluorosis was discovered in the area in 1999. The PHE then immediately stopped the supply scheme and warned the people not to take ground water for drinking and cooking purposes. Now the department has arranged for spring water that is flown to the village from a nearby hillock. Of course, many families in the villages, including Gita Deb's, prefer the "Kacha" well (depth of around 10 feet) that has been dug in their residential campus.

Similarly Son Sing Ingti (35), the chowkider of Tekelangjun High School, who lives near the institution, has been suffering from waist pain since 1995. His teeth are mottled and cause him pain from time to time. Both of his legs are bending and losing strength. All the time he feels tired.

Son Sing argued that he never saw his parents suffer from such kinds of diseases. "My parents had good teeth and no problems with bone," claimed Son Sing.

His wife Kaku Singnarpi, who hailed from a nearby village, enjoys good health of teeth, which are clean and bright, but she complains of waist pain. While Kaku was in good health when she came to the village 14 years ago, she is now experiencing stiffness in her hand movement along with pains in her waist while sitting. The medicine which Son and Kaku used to take to treat their condition provided relief for a few hours at a time. Now, however, they have stopped the medicine for good as it is difficult for them to afford.

Son and Kaku have three children (two sons and a daughter). Unfortunately all of them have mottled teeth.

Revati Rohangpi (35), a poor woman from Thoiso Timung village (which is around 100 km away from Diphu), told this writer that all of her four children are now suffering from physical problems. The family mostly depends on tube well water and they hardly get the chance to use the PHE scheme. Not aware of the quality of the tube well water, the family is still using the ground water for daily house hold works including drinking and cooking. The PHE statistics, however, show that the ground water of the area is contaminated with high levels of fluoride.

Rohangpi herself has been suffering from dental and skeletal fluorosis since long back. Her children have had mottled teeth since childhood and have been suffering from pain in their joints. Even their youngest daughter, Geeta, who is barely four years old, is complaining of stomach trouble and pain in her hands and legs.

Another victim of skeletal fluorosis in Ratiagaon, Paulina Lakra (60), cannot walk without a stick. The sixty year old woman is suffering from a series of troubles with her digestion, as well as a stiff neck, and severe pain in her legs and hands. Her three sons and three daughters are also suffering from dental and skeletal fluorosis. Her daughters had already been sent to other villages after marriages. But now they too are complaining of pain in the waist and other joints. All of the sons are with stiff neck and pain in the joints. The poor family used to drink water from springs and later shifted to a tube well. They have not received any medicine from government hospitals and they are too poor to buy the same.

So the suffering continues. Ratiagaon, which is 100 km away from Diphu, inhabits more than 150 "Adivasi" families. All are farmers by profession and too poor to survive. Affected villagers alleged that they were receiving neither treatment nor medicine from the government doctors and no doctors had ever visited their village.

Contact info for author:

Nava J. Thakuria
c/o Amar Asom,
Laachit Nagar, Guwahati 781 005,
Assam, India.
Phone 0091 0361 544356,
Fax: 0091-0361-521620,
E-mail: navathakuria@yahoo.com

Recent articles discussing fluorosis in Assam:

"High-fluoride water takes toll in Assam District" India Times, June 2000

GUWAHATI: Thousands of villagers have been affected, many of them crippled for life, by drinking water containing excessive levels of fluoride, in some parts of Assam's Karbi Anglong district, a report said...

Paul said the slow poisoning caused by contaminated groundwater was spreading in remote parts of the state. Many people have been suffering from severe anaemia, stiff joints, painful and restricted movement, mottled teeth and kidney failure leading to premature death while many have been crippled for life.

Fluorosis is a non-curable disease and fluoride a deadly chemical. So far, scientists claimed that the north-eastern region was safe from fluoride.

"High fluoride level in water causes havoc in Assam areas" Hindustan Times, June 2, 2000

Bed-ridden most of the time, she spends her days in pain and misery. A victim of fluoride poisoning, Geeta needs help from others even to perform her routine chores.

She is not alone. Hundreds of others in Assam's hill district of Karbi Anglong are suffering due to fluoride contamination from drinking water.

The effects of poisoning is clearly visible. People in their 30s look aged and withered and children barely in their teens have lost their teeth...

A survey of 2,300 people of the area confirmed that more than 600 were suffering from dental and skeletal fluorosis, two types of fluoride poisoning.

Recent articles discussing fluorosis in other areas of India

"Fluorosis makes Amreli villagers stoop" -- Indian Express, May 11, 2001

Hatathigad (Amreli), May 10: Sandhiben can't sit up on the bed without an effort. She uses a rope tied to the ceiling to pull herself up and finally manages to get out of the bed with a little help from her grandson. Not many will believe that she is just 45. Fluorosis has added years to her age..

Doctors say consumption of water with perilously high levels of dissolved fluorides has caused calcification of ligaments that bind her joints. As a result, Sandhiben's joints in the elbows, knees, ankles, wrists, knuckles and the spinal column have hardened, bent and become stiff.

In parched Liliya, Amreli district, water is drawn from such depth that it is heavily contaminated with fluorides. Water with as low as one part per million (ppm) of fluorides is considered unfit for human consumption. According to a Dutch survey, the fluoride content here is 5ppm...

"Over the years, cases of stiffened joints, extra bone formations, twisted spinal columns and spondylitis have become common among villagers of all ages. Babies are born with extra formations and children's teeth start decaying early,'' says Tomar.

"Think before you drink A bad ground water" -- Times of India July 7, 2001

AHMEDABAD: Water, the proverbial elixir of life can actually be a threat to your health, if you are one of the million odd residents of the Ahmedabad Urban Development Authority areas surviving on the water drawn from bore-wells...

The investigations specially carried out by the Central Ground Water Board (CGWB) and the Consumer Education Research Society (CERS) suggest that the fluoride levels at many places do not meet the requirements specified by the Bureau of Indian Standards (first revised 1991) at 1 mg per litre.

Dr KH Shah [Dean of the Government Dental College at Ahmedabad] opines, "Levels above 0.9 can cause dental fluorosis, brittle and yellow teeth, cavities and other problems which are quite common in North Gujarat and Saurashtra. However, no specialised studies have been carried here.

"Excess fluoride in water wreaks havoc in Jharkhand village" India Abroad News Service January 11, 2001

Tragedy has struck many a family in the Bakhari village of Jharkhand's Daltanganj district, where excess fluoride in water has left several with severe physical deformities and even paralyzed some...Two-thirds of the villagers have reportedly developed physical deformities as all the sources of drinking water in Bakhari have excess fluoride content.

Kaushalya Devi's husband, her only son and four daughters have all fallen victim to excess fluoride. Her daughter-in-law too suffers from severe backaches.

Mangaru Ram's wife, two sons and three daughters have also developed physical deformities. His 12-year-old son Tundnu Ram has been left completely paralyzed and his body is bent out of shape.

"Fluorosis, the unnoticed scourge" Times of India, June 18, 2001

NEW DELHI: With 66.62 million people afflicted, fluorosis has surprisingly attracted little more than a cursory attention from experts and health planners, says a new publication on the subject.

"It is rather striking to note that even after six decades, the disease characteristics reported in the early reports are still valid, though we now have a wealth of additional information based on the extensive researches carried out in India since then", writes Dr A K Susheela in a treatise on fluorosis.

Fluorosis, which is an endemic public health problem in 22 countries around the globe, has become fairly widespread, and multiplying in India, says the treatise, claimed by the author as the first in available medical literature.

"Underground water harming teeth" Tribune News Service, Oct 29, 2000

Higher fluoride content in underground water is causing tooth decay at an alarming rate among people of Fazilka and Jalalabad towns of this border district...

The administration and the medical authorities admit that the problem is acute in this part of the state and attribute it to the presence of high fluoride content in underground water. It is also causing joint pains among middle aged persons.

"Villagers In Unnao Floored By Fluoride" Times of India, August 31, 1999

High percentage of fluoride in water has wrought havoc in a cluster of villages in Unnao district, says a report prepared by the Jal Nigam. The report quotes WHO specifications which place the permissible limit at only 1 mg per litre.

In these villages, however, the presence is as high as 7 mg at the highest level and 2.90 mg at the lowest. Steady consumption of fluoride water, says Arati Lalchandani, a city based doctor, affects both nerves and the bones and gradually makes movement and bending of limbs extremely difficult.

In fact the situation is so bad in Siraha Khera, a village 70 kilometres from here, that angry villagers initially refused to speak to this correspondent.

"Indian Government: India seeks Swedish cooperation in environmental technology on water front" M2 Communications, October 31, 2000

[T]he ground water is gradually decreasing due to over exploitation of resources for human consumption. In many cases, he further said the ground water is contaminated by arsenic and fluoride chemicals which cause health hazards to the population.

"No plan to restore daily water supply" The Hindu, Sept 20, 2000

People living in these areas have been demanding protected water supply for many years in view of the fluoride content in groundwater. But, their request was put on the backburner for one reason or the other. Now, with all the three reservoirs brimming with water, the Board has planned to supply water to Ghatkesar and Hayathnagar.

"Residents facing hardship due to lack of basic civic amenities" The Hindu, January 11, 2001

The fluoride content in the water is acting on the bones of the people and other chemicals in the water has led to the people developing rashes on the skin. A 50-plus woman, Mrs. Noorjehan, points out that she has acute pain in the knee-joints because of the water.

For further information on fluorosis see UNICEF's report "Fluoride in Water" at