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Indian J Endocrinol Metab. 2017 Jan-Feb;21(1):190-195. doi: 10.4103/2230-8210.196013.

Association of dental and skeletal fluorosis with calcium intake and serum vitamin D concentration in adolescents from a region endemic for fluorosis.

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Department of Biotechnology, Hemchandracharya North Gujarat University, Patan, Gujarat, India.
Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom.
Department of Biochemistry, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India.
Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.



Fluorosis is controlled by the duration of fluoride exposure and calcium and Vitamin D nutrition status.


To examine (a) prevalence of dental and skeletal fluorosis in adolescents from upper, middle, and lower socioeconomic strata (SES) and (b) association of fluorosis with calcium intake and Vitamin D status.


A cross-sectional study conducted in 10-13.9 years apparently healthy adolescents (n = 90), from different SES of Patan (Gujarat, India).


Dental fluorosis was graded as mild, moderate, and severe. Radiographs of the right hand and wrist were examined and graded. Serum 25 hydroxyvitamin D3 (25OHD) and parathyroid hormone concentrations were measured. Diet was recorded (24 h recall) and calcium intake was computed (C-diet V-2.1, 2013, Xenios Technologies Pvt. Ltd).


Generalized linear model was used to analyze relationships between fluorosis, SES, serum 25OHD concentration, and calcium intake.


Fluorosis was predominant in lower SES (17% had both dental and radiological features whereas 73% had dental fluorosis); no skeletal deformities were observed. Mean 25OHD concentrations and dietary calcium were 26.3 ± 4.9, 23.4 ± 4.7, and 18.6 ± 4 ng/ml and 441.2 ± 227.6, 484.3 ± 160.9, and 749.2 ± 245.4 mg/day, respectively, for lower, middle, and upper SES (P < 0.05). Fluorosis and SES showed a significant association (exponential β = 2.5, P = 0.01) as compared to upper SES, middle SES adolescents were at 1.3 times while lower SES adolescents were at 2.5 times higher risk. Serum 25OHD concentrations (P = 0.937) and dietary calcium intake (P = 0.825) did not show a significant association with fluorosis.


Fluorosis was more common in lower SES adolescents, probably due to the lack of access to bottled water. Relatively adequate calcium intake and serum 25OHD concentrations may have increased the efficiency of dietary calcium absorption, thus preventing severe fluorosis.


25 hydroxyvitamin D3; adolescents; calcium; dental fluorosis; skeletal fluorosis

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