Fluoride and health hazards: community perception in a fluorotic area of central Rajasthan (India): an arid environment

India is among the 23 nations around the globe where health problems occur due to excess ingestion of fluoride (> 1.5 mg/l) by drinking water. In Rajasthan, 18 out of 32 districts are fluorotic and 11 million of the populations are at risk. An exploratory qualitative survey was conducted to describe perception of the community regarding fluoride and related health problems in Central Rajasthan. A study on distribution and health hazards by fluoride contaminate in groundwater was performed in 1,030 villages of Bhilwara district of Central Rajasthan. One thousand thirty water samples were collected and analyzed for fluoride concentration. Fluoride concentration in these villages varies from 0.2 to 13.0 mg/l. Seven hundred fifty-six (73.4%) villages have fluoride concentration above 1.0 mg/l. Sixty (5.83%) villages have fluoride concentration above 5.0 mg/l with maximum numbers (24, 19.5%) from Shahpura tehsil. A detailed fluorosis study was carried out in 41 villages out of 60 villages having fluoride above 5.0 mg/l in the study age, sex, and occupation data were also collected. Four thousand, two hundred fifty-two individuals above 5 years age were examined for the evidence of dental fluorosis, while 1998 individuals above 21 years were examined for the evidence of skeletal fluorosis. The overall prevalence of dental and skeletal fluorosis was found to be 3,270/4,252 (76.9%) and 949/1,998 (47.5%), respectively. Maximum of 23.9% (1,016) individuals have mild grade of Dean's classification. Three hundred seventy-four (8.8%) individuals have severe type of dental fluorosis. The Dean's Community Fluorosis Index for the studied area in total is 1.62. Maximum CFI 3.0 was recorded from Surajpura of Banera Tehsil. Five hundred sixty-six (28.3%) individuals have Grade I type of skeletal fluorosis while only 0.6% (12) individuals have Grade III skeletal fluorosis. In conclusion, the prevalence and severity of fluorosis increased with increasing fluoride concentration. It was interesting to note that in some villages, the prevalence and severity of fluorosis were highest in subjects belonging to the economically poor community. Similarly, male laborers showed highest prevalence of fluorosis. Prevalence and severity of fluorosis were observed higher in subjects using tobacco, bettle nuts, and alcoholic drinks. In contrast, subjects using citrus fruits and having good nutritional status showed low prevalence.