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Children with stained teeth, women bent double, men crippled — this is the harsh reality for several village residents in Budhikhamari panchayat of Mayurbhanj district, Odisha, where high fluoride levels in drinking water are causing severe health issues and relentless pain.
Water testing by the INREM Foundation in hamlets of this panchayat, including two government schools (primary and upper primary) and an anganwadi (early care centre for kids in 0-6 years age group), has found fluoride levels up to eight times above the acceptable limit.
Residents, including schoolchildren, who rely on hand pumps (groundwater) for drinking water, are exhibiting clear symptoms of dental and skeletal fluorosis. Some patients have become immobile due to acute skeletal fluorosis (bone deformities and painful joints), found INREM Foundation, which works at the intersection of climate, water, and public health to build water-safe communities across India.
“The prescribed level of fluoride in drinking water is 1 milligram per litre, but we tested water samples way above these limits and heavily contaminated with fluoride levels between 2.4 mg/l and 8.2 mg/l,” Sunderrajan Krishnan, Executive Director of INREM Foundation, told Down To Earth. He led a three-member team which visited three villages in Budhikhamari panchayat on November 27 and conducted water testing.
The Government of India’s Bureau of Indian Standards (BIS) prescribes a desirable (acceptable) limit of 1 milligram per litre (mg/l) for fluoride in drinking water and a maximum permissible limit of 1.5 mg/l. High fluoride intake, typically through drinking water, can lead to fluorosis, which primarily affects teeth and bones, and can also lead to deformities and immobility. It is an extremely painful and debilitating health condition.
The INREM Foundation team used its field-testing kits to check a total of 10 water samples in three villages — Budhikhamari village, Hatasahi habitation (Joka village), and Badamtalia village. The kit uses zirconium alizarin reagent, developed by the Bhabha Atomic Research Centre (BARC), which gives an indicative level of fluoride in water. Thereafter, it also got water samples tested in an accredited laboratory to reconfirm the presence of high levels of fluoride.
“When using a field testing kit, we add one millilitre of reagent in four millilitres of water sample. If the water colour changes to pink, fluoride is within 1-1.5 mg/l, which is a permissible limit. If the colour changes to orange, then it can be 1.5-3 mg/l of fluoride. Light yellow indicates above 3 mg/l fluoride, and dark yellow colour indicates above 5 mg/l,” explained Suman Chatterjee, programme officer with INREM Foundation, who conducted these tests.
“Of the 10 drinking water samples that we tested, six were found in the dark yellow category, indicating above 5 mg/l fluoride levels. Five of these were from hand pumps and one from an open dug well,” said Chatterjee. “The most shocking bit was that the hand pumps being used by schools and anganwadi were found to be contaminated high with fluoride,” he added.
High fluoride water can negatively impact children’s health, leading to dental fluorosis (discoloured or stained teeth) and potential skeletal fluorosis, which causes bone and joint issues. INREM Foundation’s team found several school children showing dental fluorosis.
New research shows that higher levels of fluoride exposure beyond 1.5 ppm in drinking water is also associated with lower IQ in children. Apart from physical ailments, high ingestion of fluoride through drinking water also affects the intellectual abilities and leads to cognitive impairment in children.
According to Krishnan, test results from an accredited laboratory confirm the presence of high fluoride. “The water sample from a primary school in Hatasahi habitation in Joka village showed 8.2 mg/l of fluoride. The water sample from the anganwadi centre in Badamtalia had 5.2 mg/l fluoride. A water sample from a tube well in Joka village showed 4.2 mg/l fluoride.”
On November 27, the team of INREM Foundation visited an upper primary school in Budhikhamari village where it found several students exhibiting dental fluorosis. The team then decided to test drinking water in and around Budhikhamari village, which falls under Budhikhamari panchayat covering a total of 7,445 people in nine villages.
“The upper primary school from Class 6-8 in Budhikhamari village has 50 students. We tested water from a hand pump within the school premises using the field testing kit and its colour changed to dark yellow indicating high levels of fluoride. School students drink that water,” said Chatterjee.
“However, another hand pump, which is about 200 metres from the school, had fluoride within safe levels. A sample of piped water supply in the village was also found to be safe. But all the village residents do not have access to piped water, and its supply is also not reliable, which pushes people to drink hand pump water,” he said.
After Budhikhamari village, INREM Foundation’s team visited Hatasahi habitation in Joka village, which is about 500 metres from Budhikhamari village. There is no piped water supply in Joka.
“At Hatasahi, we tested the water of a hand pump within the premises of its primary school. The colour of the water sample changed to dark yellow, indicating very high levels of fluoride. All the 85 students in the school drink that water and their midday meals are also cooked in the same water,” said Chatterjee. “Dental fluorosis is rampant,” he said.
Laboratory tests have confirmed very high fluoride levels in raw water (hand pump) of the primary school — 8.2 mg/l — as against the acceptable limit of 1 mg/l.
Incidentally, the hand pump at the primary school in Hatasahi is connected to a defluoridation unit (DFU), which can remove excess fluoride from water, “but because the flow of water from the DFU is very slow, people directly collect high-fluoride water from the hand pump and the DFU unit remains idle,” said Chatterjee.
INREM Foundation tested another hand pump in Hatasahi habitation and found its water also contaminated with very high fluoride levels. No wonder, there are patients suffering from skeletal fluorosis in Hatasahi.
Harihar Nayak, a 45-year-old villager, has been immobile due to skeletal fluorosis for the past 10-12 years. Earlier, he used to farm a field, but now he is unable to work. Currently, his wife and brother work as farm labourers to support the family. Since there is no alternate source of safe water, the family continues to drink high fluoride water from the hand pump.
The third village visited by the team was Badamtalia village of 377 residents. It is located about two kilometres from Joka and has no piped water supply. At Badamtalia, five water samples were tested — one pond, one open dug well, and three hand pumps.
“Two samples were found to be safe from fluoride. These include pond water and a hand pump that is 250 metres away from the habitation. Meanwhile, a dug well and two hand pumps in the village showed high levels of fluoride. Most village residents drink that water,” said Chatterjee.
“The village anganwadi also sources its drinking water from the fluoride-contaminated hand pump. The anganwadi didi is aware of high fluoride, but there is no other source of drinking water nearby,” he said.
According to Chatterjee, the hand pump in Badamtalia village was connected to a DFU through a small pipe, but the community has removed it and the DFU is lying defunct while village residents and young children are drinking high fluoride water. Women in this village were seen walking with bent backs due to the severe, crippling effects of chronic high fluoride intake.
Jharna Jyoti Marandi, a tribal sarpanch (village chief) of Budhikumari village said there are at least three to four more villages in Budhikumari panchayat that are affected due to high fluoride water. People have low awareness and there is no clarity on safe and unsafe water sources.
According to Krishnan, INREM Foundation is now working closely with the Budhikumari gram panchayat. The first step is to undertake participatory mapping in 10-15 villages in the region to monitor and test water sources. This will be done with active participation of the village residents and will cover all kinds of water sources — open dug wells, hand pumps, borewells, ponds, and piped water supply.
“It is only after this mapping that we will know the exact situation of fluoride contamination and its health impacts on the local population. This exercise will also help identify safe and unsafe water sources,” said Krishnan. “We want to do the entire work by involving local people so that they absorb what is happening and also act on it,” he added.
Meanwhile, village residents also need to improve their dietary intake to address high fluoride ingestion. “Severely skeletal fluorosis affected people need to be having nutrition supplements for calcium, magnesium and vitamin C for six months. The approach, well researched and tested, helps detoxify fluoride from the body,” said Krishnan.
The team of INREM Foundation has informed villagers to consume local foods rich in these nutrients such as juice of moringa leaves, amla (Indian gooseberry), til (sesame seed) laddu, and green leafy vegetables. “We have also told villagers to collect water from the nearest safe source and store it and use it as much as possible,” said Chatterjee.
There is no concrete and reliable data on fluoride-affected habitations in Mayurbhanj, Odisha. For instance, a reply dated August 6, 2024, filed by the Odisha government in the National Green Tribunal claims that 26 districts in the state have localised occurrence of fluoride (more than 1.5 ppm) in groundwater and Mayurbhanj is included in the list.
But the reply notes that as of June 19, 2024, only two villages— Badamatalia (Budhikhamari panchayat) and Basantpur (Kusum Bandh panchayat) in Bangriposi block of Mayurbhanj district — are affected due to high fluoride and both are covered under community water purifications plants (CWPP) of Jal Jeevan Mission of Government of India.
Meanwhile, on December 9, 2024, in reply to an unstarred question in Rajya Sabha, the Minister of State for Jal Shakti quoted Central Ground Water Board (CGWB) data of 625 groundwater samples tested in Odisha, of which only 28 samples had fluoride concentration above 1.5 ppm. And these were from the districts of Angul, Balangir, Bargarh, Jharsuguda, Nayagarh, Nuapada, Puri, Sambalpur, Sonapur, and Sundargarh. Mayurbhanj district is not included in this list.
According to Jal Jeevan Mission’s Har Ghar Jal dashboard, 70.04 per cent households in Mayurbhanj district have functional tap water connection. In Bangriposi block, where Budhikhamari panchayat is located, the functional tap water connection is 57.22 per cent, as of November 30, 2025.