An epidemiological investigation of endemic fluorosis in Shandong Province in 2013

Objective To investigate the current status of endemic fluorosis in Shandong province,and to provide a scientific basis for the development of preventive strategies.Methods In accordance with the requirements of the national Technical Implementation Plan for Endcmic Disease Control Project in 2009 and Drinking-Water-Borne Endemic Monitoring Program (trial),ten counties were selected to carry out the epidemiological investigation,to understand the progress and the effect of the water improvement projects; three villages were selected in each county,to determine fluoride content of drinking water,to check dental fluorosis of children aged 8 to 12 and skeletal fluorosis of adults over the age of 25.Water fluoride content was determined by fluoride ion selective electrode method,children dental fluorosis was diagnosed with Dean method and adults skeletal fluorosis by the National Standard for Diagnosis of Endemic Skeletal Fluorosis (WS 192-2008).Results There were a total of 687 improved-water defluoridation projects of the 10 counties,the improved-water rate was 83.34％ (3247/3896).The investigation was taken place in 84 improved-water projects of the 10 counties,the projects running normally accounted for 98.81％ (83/84); 41 projects had water fluoride concentration ≤1.20 mg/L,and the pass rate was 48.81％(41/84),with the maximum water fluoride as 5.76 mg/L.In the 26 villages with improved-water projects of the 10 counties,villages with a mean water fluoride ≤ 1.20 mg/L were 15,which accounted for 57.69％ (15/26),＞ 1.20 mg/L were 11,which accounted for 42.31％ (11/26),with the maximum water fluoride as 5.58 mg/L.In the 4 yet to improve water quality villages of the 10 counties,1 village had mean water fluoride ≤ 1.20 mg/L,3 villages had mean water fluoride ＞ 1.20 mg/L,with the maximum water fluoride as 2.92 mg/L.A total of 1331 children aged 8 to 12 were checked in the 26 improved water villages,the detection rate of dental fluorosis was 59.73％ (795/1331),the index of dental fluorosis was 1.17 and the defect rate was 10.14％ (123/1331).A total of 138 children aged 8 to 12 were checked in the 4 yet to improve water quality villages,the detection rate of dental fluorosis was 51.45％(71/138),the index of dental fluorosis was 0.95 and the defect rate was 0.72％ (1/138).In water quality improved villages and yet to improve water quality villages,X-ray detection rates of skeletal fluorosis were 8.80％ (113/1284) and 3.05％ (6/197),respectively,in adults over the age of 25.Conclusions The water fluoride content of improved-water defluoridation projects exceeds the national standard seriously and fluorosis has not been effectively controlled in Shandong province. Key words: Endemic diseases; Fluorosis, dental; Osteofluorosis; Data collection