Haematological changes in fluorotic adults and children in fluoride endemic regions of Gaya district,Bihar, India

Groundwater used for drinking and cooking was analysed for fluoride (F), and health surveys were conducted in Bodh Gaya, Amas and Bankebazaar blocks of the Gaya district, Bihar, India. Amas and Bankebazaar blocks were F endemic areas with mean F = 2.36 ± 0.23 mg/L (N = 27). Bodh Gaya was considered as control area with mean F = 0.59 ± 0.03 mg/L (N = 11). Health survey showed that more than 50 % of adults and more than 55 % of children had complaints of gastro-intestinal (GI) disturbances in the F endemic areas, while less than 20 % of adults and less than 10 % of children complained of GI problems in the control areas. Haematological analyses were conducted on age- and sex-matched fluorotic subjects (N = 93) of F endemic areas, and non-fluorotic subjects (N = 52) of control area showed lowered haemoglobin, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, and mean corpuscular haemoglobin concentration in the fluorotic subjects, suggesting the occurrence of anaemia in the fluorotic subjects.     

Inferring the fluoride hydrogeochemistry and effect of consuming fluoride-contaminated drinking water on human health in some endemic areas of Birbhum district,West Bengal

This research work is carried out to evaluate fluoride (F) hydrogeochemistry and its effect on the population of two endemic villages of Birbhum district, West Bengal. Fluoride concentration in drinking water varies from 0.33 to 18.08 mg/L. Hydrogeochemical evolution suggests that ion-exchange mechanism is the major controlling factor for releasing F in the groundwater. Most of the groundwater samples are undersaturated with respect to calcite and fluorite. Health survey shows that out of 235 people, 142 people suffer from dental fluorosis. According to fluoride impact severity, almost 80 and 94 % people in an age group of 11–20 and 41–50 suffer from dental and skeletal fluorosis, respectively. Statistically drinking water F has a positive correlation with dental and skeletal fluorosis. Bone mineral density test reveals that 33 and 45 % of the studied population suffer from osteopenic and osteoporosis disease. IQ test also signifies that F has a bearing on the intelligence development of the study area school children. The existence of significant linear relationship (R ² = 0.77) between drinking water F and urinary F suggests that consumption of F-contaminated drinking water has a major control over urinary F (0.39–20.1 mg/L) excretion.     

Fluoride contamination in groundwater of central Rajasthan,India and its toxicity in rural habitants

This study was carried out to assess fluoride (Fl) concentration in groundwater in some villages of central Rajasthan, India, where groundwater is the main source of drinking water. Water samples collected from deep aquifer-based hand pumps were analyzed for Fl content. Fluoride in groundwater of 121 habitations of Bhilwara tehsil of Bhilwara district of Rajasthan was determined to examine the potential Fl-induced toxicity in rural locations. Fluoride concentrations in the tehsil ranged from 0.5 to 5.8 mg/l. In the tehsil, 69 villages (57%) were found to have Fl concentration beyond the maximum desirable limit recommended in Bureau of Indian Standards (BIS), 10500, 1991. Fifty-eight percent population of these villages was under the threat of fluorosis. One percent population of tehsil living in two villages ingested more than 5 mg/l Fl in each liter of drinking water and at maximal risk for dental and skeletal fluorosis. 142 individuals of these villages were examined for fluorosis. Data indicated that only four individuals (2.82%) did not exhibit dental fluorosis. Most individuals were found to suffer from mild (34.51% or 49 individuals) and moderate (31.69% or 45 individuals) fluorosis. Severe dental fluorosis was recorded in only 16 individuals (11.27%). In 104 individuals above 21 years of age examined for the prevalence of skeletal fluorosis, 66 were positive for skeletal fluorosis with a maximum 36.5% with grade I skeletal fluorosis. Grade II skeletal fluorosis was recorded in 28 individuals (26.9%). Data in this study demonstrate that there is a need to take ameliorative steps in this region to prevent fluorosis.     

The Contribution of Drinking Water towards Dental Fluorosis: A case study of Njoro Division, Nakuru District, Kenya

This study was carried out to measure the fluoride levels of water consumed in the Njoro division of Nakuru district, Kenya. The sources of drinking water, methods of water storage and utilisation, as well as the perceptions of the local community towards dental fluorosis and the percentage of children with moderate to severe dental fluorosis were also determined. Rainwater had mean fluoride levels of 0.5 mg L^-1, dams 2.4 mg L^-1, wells 4.1 mg L^-1, springs 5.5 mg L^-1, and boreholes 6.6 mg L^-1. Water stored in plastic and cement containers did not show appreciable reduction in fluoride content with storage time; water stored in metal containers reduced fluoride by up to 8.2%; water stored in clay pots had the highest reduction in fluoride content, ranging between 34.3 and 64.7%;. Forty eight point three percent of children observed in the area had moderate to severe dental fluorosis, even though most people in the area did not know the cause of the problem.There is need to educate the community on the causes of fluorosis, and to lay strategies for addressing the issue, such as encouraging more rainwater harvesting, treating drinking water with alum, or using clay pots for storage of drinking water.     

Fluoride distribution in groundwater and survey of dental fluorosis among school children in the villages of the Jhajjar District of Haryana,India

Fluoride concentration of groundwater reserves occurs in many places in the world. A critical area for such contamination in India is alluvial soil of the plain region, consisting of five blocks (Jhajjar, Bahadurgarh, Beri, Matanhail, and Sahalawas) of the Jhajjar District adjacent to the National Capital Territory of India, New Delhi. The purpose of this study was to assess the association between water fluoride levels and prevalence of dental fluorosis among school children of the Jhajjar District of Haryana, India. The fluoride content in underground drinking water sources was found to vary in villages. Hence, the villages were categorized as high-fluoride villages (1.52–4.0 mg F/l) and low/normal-fluoride villages (0.30–1.0 mg F/l). The source of dental fluorosis data was school-going children (7–15 years) showing different stages and types of fluorosis who were permanent resident of these villages. The fraction of dental fluorosis-affected children varied from 30% to 94.85% in the high-fluoride villages and from 8.80% to 28.20% in the low/normal-fluoride villages. The results of the present study revealed that there existed a significant positive correlation between fluoride concentration in drinking water and dental fluorosis in high-fluoride villages (r = 0.508; p < 0.001) and insignificant correlation in low-fluoride villages.     

Dental fluorosis associated with drinking water from hot springs in Choma district in southern province,Zambia

This study was conducted to investigate the high incidence of mottled teeth among residents of an area with hot springs in the Choma District of the Southern Province of Zambia. A survey involving 128 pupils was conducted at a Basic School to collect data on pupil’s backgrounds and their main sources of drinking water between birth and age 7. A dental specialist examined the pupils’ teeth and samples of drinking water were collected from locations where the majority of the pupils lived. It was analysed for fluorides and other drinking water quality parameters. Results of the survey showed a highly significant (P < 0.001) association between pupils’ main sources of drinking water between birth and age 7 and the incidence of discoloured teeth. All (100%) pupils who drank water from hot springs before age 7 had moderate to severe fluorosis, while the majority (96.7%) of the pupils who drank water from other sources had no dental fluorosis. Fluoride concentrations ranged from 5.95 to 10.09 mg/l in water from hot springs, and from 0.03 to 0.6 mg/l in water from other sources. Fluoride levels in water from hot spring water samples exceeded the 1.5 mg/l WHO guideline value for drinking water, while those in water from other sources were significantly (P < 0.05) lower than this. We conclude that the high prevalence of mottled teeth among residents of the study area is a case of endemic dental fluorosis associated with drinking water from hot springs containing high concentrations of fluoride.     

Fluoride Content in Bones of Adelie Penguins and Environmental Media in Antarctica

Fluoride (F) distribution and its effects (fluorosis) were investigated in Antarctica. Droppings (L) excreta selected of aquatic birds, lake water, soil and moss (Polytrichum alpinum) showed a high F concentration. Although bones of Adelie penguin (Pygiscelis adeliae) and skua (Catharacta maccormicki) showed exceptionally very high F concentration in the range of 832 to 7187 mg kg(-1), their radiographs did not show any evidence of skeletal fluorosis. The possible reason and geochemical aspects of F in Antarctica region are discussed.     

Geochemical provenance and spatial distribution of fluoride in groundwater of Mayo Tsanaga River Basin, Far North Region, Cameroon: implications for incidence of fluorosis and optimal consumption dose

The 500,000 inhabitants of Mayo Tsanaga River Basin are vulnerable to a “silent” fluorosis from groundwater consumption. For the first time, the groundwater is investigated for the purpose of identifying the provenance of fluoride and estimating an optimal dose of fluoride in the study area. Based on the fluoride content of groundwater, fluorine and major oxides abundances in rocks from the study area, mean annual atmospheric temperature, and on-site diagnosis of fluorosis in children, the following results and conclusions are obtained: Fluoride concentration in groundwater ranges from 0.19 to 15.2 mg/l. Samples with fluoride content of <1.5 mg/l show Ca–HCO₃ signatures, while those with fluoride >1.5 mg/l show a tendency towards Na-HCO₃ type. Fluor-apatite and micas in the granites were identified as the main provenance of fluoride in the groundwater through water-rock interactions in an alkaline medium. The optimal fluoride dose in drinking water of the study area should be 0.7 mg/l, and could be adjusted downward to a level of 0.6 mg/l due to the high consumption rate of groundwater, especially during drier periods.     

Fluoride content and distribution pattern in groundwater of eastern Yunnan and western Guizhou, China

For study, the fluoride (F) content and distribution pattern in groundwater of eastern Yunnan and western Guizhou fluorosis area in southwestern China, the F content of 93 water samples [groundwater (fissure water, cool spring, and hot springs), rivers water] and 60 rock samples were measured. The result shows the F content of the fissure water and cold spring water is 0.027–0.47 mg/L, and river water is 0.048–0.224 mg/L. The F content of hot spring water is 1.02–6.907 mg/L. The drinking water supplied for local resident is mainly from fissure water, cool spring, and river water. And the F content in all of them is much lower than the Chinese National Standard (1.0 mg/L), which is the safe intake of F in drinking water. The infected people in eastern Yunnan and western Guizhou fluorosis area have very little F intake from the drinking water. The hot spring water in fluorosis area of eastern Yunnan and western Guizhou, southwest China has high F content, which is not suitable for drinking.     

Monitoring,mapping and health risk assessment of fluoride in drinking water supplies in rural areas of Maku and Poldasht,Iran

The aim of this study was to investigate and determine fluoride concentrations in drinking water supplies in rural areas of Maku and Poldasht in West Azerbaijan Province, the northwest of Iran. Fluorosis risk assessment and characterization was also investigated. Fluoride concentrations mapping was accomplished by using the GIS system. Totally, 356 water samples, including one sample in each season, were collected from 89 water supplies providing water for 95 and 61 rural areas of Maku and Poldasht, respectively. According to the results, in Maku and Poldasht, 25 and 30 rural areas had contaminated water sources, respectively. Average annual fluoride concentrations ranged from 3.04 to 7.31 mg/l in the contaminated villages of Maku, which is about 2–4.8 times higher than the maximum standard level of the Iranian drinking water standard, and 4.52–8.21 mg/l in the contaminated areas of Poldasht, which is about 3–5.47 times higher than the maximum standard level. The maximum fluoride level was determined 11.12 mg/l and 10.98 mg/l in one of villages of Maku and Poldasht Counties in summer, respectively. Neither in Maku nor in Poldasht, water resources showed dental cavity risk, while dental fluorosis risk and skeletal fluorosis risk were very significant in some villages of both cities. Children were at most risk of fluorosis. New alternative water supplies for the contaminated villages if possible, consumption of bottled water and application of reverse osmosis are recommended as remedial actions in the contaminated areas.

     

Fluoride in Ceylon tea and its implications to dental health

The purpose of this study was to assess the fluoride content of Ceylon Tea, which is a popular beverage throughout the world. The fluoride content of tea infusions prepared from different grades of tea leaves collected from different parts of the tea-growing regions (25 samples) of Sri Lanka was measured using a fluoride-selective electrode. Fluoride leaching was found to vary from 0.32 to 1.69 mg F/l, but there were no significant differences in terms of fluoride leaching between tea from different tea-growing regions or between tea of different grades. Dental fluorosis is widespread throughout the dry zone of Sri Lanka, and drinking water has traditionally been considered to be the main contributory factor to the development of fluorosis. However, diet, the consumption of tea in particular, may also contribute to the manifestation of dental diseases.     

Occurrence and problems of high fluoride waters in Turkey: an overview

Endemic dental fluorosis was first observed in Turkey in Isparta Province, located in the SW of Anatolia, with mottled enamel related to the high levels of fluoride (1.5–4.0 ppm) in drinking waters, about 55 years ago. The origin of fluoride was attributed to the contents of minerals in volcanic rocks, consisting of pyroxene, hornblende, biotite, fluorapatite and glassy groundmass minerals. It was also reported about 35 years ago that severe dental and skeletal fluorosis has been observed in human beings and livestock in Dogubeyaz?t and Caldiran areas, located around Tendurek Volcano in eastern Turkey, where natural waters contained fluoride levels between 2.5 and 12.5 ppm. It was hypothesised that fluoride, which might be transported by fumaroles or escaped from devitrified lavas, could be held on the surface of some minerals and then exchanged with OH^- in ground waters with high pH at the foothills of the young Tendurek Volcano. Endemic dental and skeletal fluorosis was also observed in the inhabitants in Kizilcaoren Village of Beylikova Town in Eski?ehir Province situated in the midwest of Turkey, where the fluoride content of the drinking waters ranged from 3.9 to 4.8 ppm. The origin of high fluoride in the natural waters was related to the fluorspar deposits, occurring in the catchment area near the village. During the survey in the Güllü Village of Esme-Usak, located in south-midwest of Turkey, it was observed that most of the inhabitants born and raised in the village and aged between 10 and 30 years, showed mild to moderate levels of mottled enamel. The fluoride contents of the deep well waters used for drinking in the village, varied from 0.7 to 2.0 ppm. Amorphous microscopic fluorite existing in the Pliocene lake limestones was considered as a possible origin of fluoride in the waters.     

Preliminary assessment of surface soil lead concentrations in Melbourne,Australia

Urban soils in many cities have been found to be contaminated with lead from past usage of leaded petrol, deteriorating lead-based exterior paints and industrial sources. Currently, the spatial distribution of soil lead concentrations in the Melbourne metropolitan area is unknown. The objective of this study was to perform a preliminary assessment of the spatial distributions of the surface soil lead (Pb) concentrations in the Melbourne metropolitan area, Australia. Fifty-eight surface soil samples were collected at a depth of 0–2 cm along three linear transects oriented across the Melbourne metropolitan area. Surface soil samples were also collected at a higher density in five Melbourne suburbs. Soil cores (0–50 cm) were collected in four locations, soil transects were collected at intervals with distance away from the roadway (0–50 m) in two inner city parks, and one control soil sample was collected in a rural setting. The median soil Pb concentration of the soil transect samples was 173 mg/kg (range 32–710 mg/kg), and the median soil Pb concentration of the five suburbs was 69 mg/kg (range 9–1750 mg/kg). The suburb of Footscray had the highest soil Pb concentration with a median soil Pb concentration of 192 mg/kg (range 40–1750 mg/kg). Soil Pb concentrations were generally higher nearest the centre of the Melbourne metropolitan area and in the west of Melbourne and lower in the outer suburbs to the east and north of the city centre. Soil Pb concentrations decreased with distance from roadways in the two transects taken from urban parks, and soil lead decreased with depth in the four soil cores. The soil Pb concentrations in the Melbourne metropolitan area appear to be lower than soil lead concentrations observed in inner city areas of Sydney New South Wales (NSW) and Newcastle NSW. The spatial extent of the soil Pb hazard remains undefined in portions of the Melbourne metropolitan area.     

Hair burning and liming in tanneries is a source of pollution by arsenic,lead, zinc,manganese and iron

Heavy metals in the environment may be toxic for human and animals. Tanneries are a source of pollution by heavy metals. There is little information on heavy metals pollution in tanneries, especially on metals produced by the process of hair burning and liming. Liming is the first stage of chemical treatment where animal hair or wool is removed with sodium sulphide and calcium oxide. Here we studied cow, goat, buffalo and sheep hair, conventional liming agents and liming wastewaters from several sources. Samples were acid-digested and aliquots were analysed by atomic absorption spectroscopy following APHA standard method to measure concentrations of arsenic, lead, cadmium, zinc, manganese and iron. Results show that the range of metal contents in hair or wool and liming agents are 1.3–8.2 mg/kg for arsenic, 0.02–21.8 mg/kg for lead, 17.7–121.0 mg/kg for manganese, 7.3–141.1 mg/kg for zinc and 119.6–10613.8 mg/kg for iron. Liming wastewaters contain 1.9–5.6 µg/L arsenic, 0.03–6.05 µg/L lead, 38.6–139.0 µg/L manganese, 144.0–171.5 µg/L zinc and 399.5–1069.0 µg/L iron. Cadmium was below detection limits. This is the first investigation that reveals that hair burning liming operation is a potential source of heavy metals in the environment.     

A review of global outlook on fluoride contamination in groundwater with prominence on the Pakistan current situation

Several million people are exposed to fluoride (F^?) via drinking water in the world. Current review emphasized the elevated level of fluoride concentrations in the groundwater and associated potential health risk globally with a special focus on Pakistan. Millions of people are deeply dependent on groundwater from different countries of the world encompassing with an elevated level of fluoride. The latest estimates suggest that around 200 million people, from among 25 nations the world over, are under the dreadful fate of fluorosis. India and China, the two most populous countries of the world, are the worst affected. In Pakistan, fluoride data of 29 major cities are reviewed and 34% of the cities show fluoride levels with a mean value greater than 1.5 mg/L where Lahore, Quetta and Tehsil Mailsi are having the maximum values of 23.60, 24.48, > 5.5 mg/L, respectively. In recent years, however, other countries have minimized, even eliminated its use due to health issues. High concentration of fluoride for extended time period causes adverse effects of health such as skin lesions, discoloration, cardiovascular disorders, dental fluorosis and crippling skeletal fluorosis. This review deliberates comprehensive strategy of drinking water quality in the global scenario of fluoride contamination, especially in Pakistan with prominence on major pollutants, mitigation technologies, sources of pollution and ensuing health problems. Considering these verities, health authorities urgently need to establish alternative means of water decontamination in order to prevent associated health problems.     

Distribution and Risk Assessment of Fluoride in Drinking Water in the West Plain Region of Jilin Province, China

The west plain region of Jilin province of northeast China is one of the typical endemic fluorosis areas caused by drinking water for many years. Investigations of hydrogeological and ecoenvironmental conditions as well as endemic fluorosis were conducted in 1998. Results show that the ground water, especially, the water in the unconfined aquifer is the main source of drinking water for local residents. The fluoride concentration in groundwater in the unconfined aquifers is higher than that in the confined aquifer in the west plain of Jilin province. The fluoride concentration in the unconfined aquifer can be used to classify the plain into fluoride deficient area, optimum area and excess area, which trend from west to east. High fluoride (>1.0 mg L(-1)) in drinking water resulted in dental and skeletal fluorosis in local residents (children and pregnant women). There exists a positive correlation between fluoride concentration in the drinking water and the morbidities of endemic fluorosis disease (r1 = 0.781, r2 = 0.872). Health risks associated with fluoride concentration in drinking water are assessed. It has been determined that fluoride concentration in excess of 1.0 mg L(-1) exposes residents to high health risks based on risk identification. The study area is classified into five health risk classes as shown in Figure 4. The risk indexes of this area more than 1.0 are accounted for 68% of the total west plain region.     

An incidence of skeletal fluorosis associated with groundwaters of the maritime carboniferous basin,Gaspé region,Quebec, Canada

Consumption of unusually high concentrations of F^– in groundwaters of the Maria area in the Gaspé peninsula of Quebec have resulted in symptoms of skeletal fluorosis in two members of the population. One of these individuals consumed approximately 50 mg of fluoride per day over a 6 year period before being hospitalized and later diagnosed with skeletal fluorosis. It is estimated that, until this case came to light, approximately 15–20% of the rural population (total approximately 1,600) in the area were consuming groundwaters with F^– levels between 5 and 28 mg L^–1 for at least 6 years. The high concentrations of F^– in well waters of the Maria area occur only in wells completed in Carboniferous sandstone-siltstone-conglomerate sediments that underlie a thick blanket of alluvial-colluvial-glacial overburden. These fluoriferous groundwaters exhibit high Na and HCO₃ ^– contents and low Ca and Mg concentrations compared to those associated with the overburden sediments. The high F levels greatly increase the risk for fluorotic diseases such as skeletal fluorosis and skeletal radiculomyopathy. Wells completed in overburden, although having suboptimal F^– levels are safer for the health of individuals in this region. Effective regulations for well drilling need to be formulated for regions underlain by Carboniferous formations in the Maritime provinces of Canada. In some regions, high F^– levels (10–25 mg L^–1) in groundwaters will seriously affect how, and to what extent, groundwater supplies can be developed for domestic use.To whom correspondence should be addressed.     

Fluorine in the UK environment

Relatively low concentrations of fluorine in drinking water ( 1 mg F/l) have been shown to significantly reduce the degree of dental caries in children and fluorine would also appear to have a beneficial effect on bone formation in both humans and farm animals. However, it is apparent that elevated levels of fluorine in the diet have sometimes resulted in problems of increased dental caries and of the development of bone deformities. Much of the fluorine in rocks and soils occurs in apatite and hydroxysilicate minerals, fluorite being the only relatively common rock forming mineral containing fluorine as an essential constituent.Little systematic data are available on fluorine concentrations in soils, plants and natural waters in the UK. General background soil concentrations lie in the range 200 – 400 mg F/kg. For waters the average fluorine content is low, <0.1 mg F/l.In the British Isles there are several areas where there are enhanced levels of fluorine. In the northern Pennines, Derbyshire, northeast Wales and Cornwall, fluorite occurs as a significant component of mineralisation and much fluorine has been added to the environment from mining waste dumps. Soils in northeast Wales contain up to 3,650 mg F/kg and in the northern Pennines up to 20,000 mg F/kg. Waters contain up to 2.3 mg F/l. In southwest England, the granites are generally fluorine-rich with the fluorite granites of the St Austell pluton containing as much as 1 percent fluorine. These rocks are frequently kaolinised and intensively worked as a source of china clay. Soils in the vicinity of the waste tips contain up to 3,300 mg F/kg and grasses up to 2,950 mg F/kg. Surface waters in the St Austell area contain up to 1.25 mg F/l.Atmospheric fluorine pollution around brickworks in the Peterborough and Bedford areas has resulted in fluorosis in farm animals. Other sources of atmospheric fluorine pollution are aluminium smelters, steelworks and fossil fuel burning.     

Hydrogeochemistry and statistical analysis applied to understand fluoride provenance in the Guarani Aquifer System, Southern Brazil

High fluoride concentrations (up to 11 mg/L) have been reported in the groundwater of the Guarani Aquifer System (Santa Maria Formation) in the central region of the state of Rio Grande do Sul, Southern Brazil. In this area, dental fluorosis is an endemic disease. This paper presents the geochemical data and the combination of statistical analysis (Principal components and cluster analyses) and geochemical modeling to achieve the hydrogeochemistry of the groundwater and discusses the possible fluoride origin. The groundwater from the Santa Maria Formation is comprised of four different geochemical groups. The first group corresponds to a sodium chloride groundwater which evolves to sodium bicarbonate, the second one, both containing fluoride anomalies. The third group is represented by calcium bicarbonate groundwater, and in the fourth, magnesium is the distinctive parameter. The statistical and geochemical analyses supported by isotopic measurements indicated that groundwater may have originated from mixtures of deeper aquifers and the fluoride concentrations could be derived from rock/water interactions (e.g., desorption from clay minerals).     

Evaluation of acidity in late Permian outcrop coals and its association with endemic fluorosis in the border area of Yunnan,Guizhou, and Sichuan in China

The junction area of Yunnan, Guizhou, and Sichuan provinces is the heaviest coal-burning endemic fluorosis zones in China. To better understand the pathogenicity of endemic fluorosis in this area, 87 coal samples from the late Permian outcrop or semi-outcrop coal seams were collected in eight counties of the junction area of Yunnan, Guizhou, and Sichuan provinces. The total fluorine and sulfate content, etc. in the coal was determined using combustion-hydrolysis/fluoride-ion-selective electrode method and ion chromatography, respectively. The results show that the total fluorine concentrations in the samples ranged from 44 to 382 µg g^?1, with an average of 127 µg g^?1. The average pH of the coals is 5.03 (1.86–8.62), and the sulfate content varied from 249 to 64,706 µg g^?1 (average 7127 µg g^?1). In addition, the coals were medium- and high-sulfur coals, with sulfur mass fraction ranging from 0.08 to 13.41%. By heating the outcrop coals, HF release from the coal was verified quantitatively without exception, while simulated combustion directly confirmed the release of sulfuric acid (H₂SO₄). The acid in coal may be in the form of acidic sulfate (\({\text{HSO}}_{4}^{ - }\)/H₂SO₄) because of a positive relationship between pH and \(p\left( {{\text{SO}}_{4}^{2 - } } \right)\) in the acidic coal. The possible reaction mechanism would be that a chemical reaction between the acid (H₂SO₄ or \({\text{HSO}}_{4}^{ - }\)) and fluorine in the coal occurred, thereby producing hydrogen fluoride (HF), which would be the chemical form of fluorine released from coal under relatively mild conditions. The unique chemical and physical property of HF may bring new insight into the pathogenic mechanism of coal-burning endemic fluorosis. The phenomenon of coal-burning fluorosis is not limited to the study area, but is common in southwest China and elsewhere. Further investigation is needed to determine whether other endemic fluorosis areas are affected by this phenomenon.