In southern India Tamil Nadu state, its groundwater is seriously polluted with fluoride. Due to consumption of fluoride contaminated water over everyday life, most of the inhabitants in this district are suffering from the world’s oldest known disease fluorosis, but its actual prevalence has been remained unknown. Since 2008 Japan International Cooperation Agency (JICA) has been added assistance to reduce fluoride contamination in drinking water under the Hogenakkal water supply and fluorosis mitigation project to be completed by 2014 and Osaka medical college dispatched Japanese experts on this project for medical, dental, chemical and nutritional ad hoc survey. In 2011 our dental experts carried out the evaluation for the implementation of basic education policy to prevent fluorosis, hospital inspections, and face-to-face screening examination for dental fluorosis prevalence at various Tamil Nadu villages as the project progress mid-term review team.

 Our team confirmed that training manual booklet for doctors, school children dental program and dental fluorosis identification card were provided for the project participants. These manual and module were developed by joint work of JICA, a non-profit organization (NPO) of center for symbiosis of technology environment and management (STEM) and Tamil Nadu water supply and drainage board (TWAD). Although the contents of these manual and module were approximately adequate and appropriate, the effective promotion and distribution for utilization will be a key element of future project success plan. Our team visited several primary health centers (PHC) and high schools to assess the prevalence of dental fluorosis among school children and village inhabitants subjected to fluoride contaminated public water supply. Although the current village population status or school student population is unknown, our team conducted face-to-face screening examination for dental fluorosis and there was an impression that the condition had a prevalence of about 80%. Brown teeth (tooth stains) also can be caused by poor oral hygiene, foods and drinks. Many other tooth stains can result in similar to dental fluorosis appearance. Conditions such as these must be ruled out before dental fluorosis diagnosis. Our screening examination also gives the impression of scarcely low dental caries prevalence among Indian school children. Dental caries preventive effect of fluoride may contribute to this condition and necessary action plan should be taken after the establishment of new waterworks and services with fluoride free water. Serious shortage of manpower and equipment at government general hospitals made it difficult to conduct the baseline survey of dental fluorosis or active diagnosis. The strategic increase in medical personnel and medical facilities will be essential in strengthening the project activities.

 As the historical fact from the process of the developed world revealed that water supply network system solved dental fluorosis, our mid-term review team found that water supply network distribution, closing the demand supply gap in health manpower and dental fluorosis prevention campaign is urgent business in India to achieve the project’s goals by 2014.

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