This paper presents the application of quantitative chemical risk assessment for assessing and managing fluorosis in 19 schools and 6 villages in Madhya Pradesh, India. A longitudinal study was undertaken with a baseline survey in 2005 and an endline in 2007. Household surveys, water quality and food analysis were undertaken to measure the impact of an Integrated Fluorosis Mitigation programme that included water and nutritional interventions. The baseline survey indicated a maximum fluoride content of 7.8 mg/l in food and 3.7 mg/l in water, equating to a maximum fluoride uptake of 4.8 and 3.7 mg/l in food and water respectively. Mean (actual) daily intake of fluoride for all exposure routes was 0.4 mg/kg of combined adult and child body weight. Intake of fluoride through food was more than 40% of total intake. Calculated guideline values for age groups <18 years and >18 years were 1.7 and 1.9 mg/l respectively. Using WHO methodology, the Guideline Value would be 1.7 mg/l. Fluoride dilution was implemented to reduce the fluoride content to below this level. The endline survey indicated reduction in the prevalence of grade 1 fluorosis of 86%, of grade 2 of 77%, of grade 4 of 60% in all children examined.

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