Talk:Dental fluorosis

Vandalism
I just deleted the following sentence in the introduction: " and it is linked to bone & thyroid cancer, osteoporosis, bone fractures, dental fluorosis, it dumbs you down, causes mental disorders, sterilisation, organ failure.

The nazis used it in their water supply to keep the public docile and more easily controlled!"

While the first part lacks any citations, everything after "it dumbs you down" cannot be meant serious. See the second sentence.

I almost deleted the following from the external links section: "Fluoride does not reduce cavities and does causes(sic!) brittle bones and a soft brain http://harmonyhealth.wordpress.com/2008/02/29/floride-does-not-reduce-cavitie"

I'm not familiar with the criteria for deleting external links so I left it in. I'm not here to take a stance on the debate as well, but even if you are of the opinion described in that article, I suggest taking it down because it makes the whole thing (and wikipedia) look highly dubious. John M. Snow (talk) 22:48, 27 January 2014 (UTC)

Bartlett et al 2005
I just saw this article:

Fluorosis: A New Model and New Insights J.D. Bartlett, S.E. Dwyer, E. Beniash, Z. Skobe, and T.L. Payne-Ferreira J Dent Res 2005;84 832-836 http://jdr.iadrjournals.org/cgi/content/abstract/84/9/832?etoc

that probably has bearing on this issue. Bedrupsbaneman 09:07, 19 August 2005 (UTC)

dental caries
I found a few sources that say flouridation *reduces* dental caries, which leads me to suspect that fluorosis does *not* come hand in hand with dental caries. The sources: this one says "fluoridation and fluoride toothpastes both substantially reduce the prevalence and incidence of dental caries." this other one says that fluorosis has a "mild association with lower caries". this last one says "Exposure to fluoride throughout life is effective in preventing dental caries."

Given that all the sources (including others) that i've seen say that caries are negatively associated with fluorosis, i'm going to delete the comment about carries. Fresheneesz 03:11, 7 March 2006 (UTC)

How is fluorsis contracted? Is it using too much fluoride products for too long? Or drinking too much water with fluoride and swallowing too much toothpaste?

POV
The article as written is blatantly biased. It only cites the same anti-fluoridation group over and over again, with a single stat from the CDC, accompanied by unsupported editorialization. I guess some people have no shame. 129.116.50.14 04:00, 7 September 2006 (UTC)

Agreed. The first trial of water fluoridation was in 1945; of course the rate of dental fluorosis is going to be higher. And as long as we're talking about water fluoridation, we might as well mention that this is has always been a recognized trade-off for overall dental health. MrWallet 16:16, 10 September 2006 (UTC)

Disagree. Article as it appears today is pretty NPOV. Removing the stopsign. Mike Ely 22:50, 12 December 2006 (UTC)

Edit
Noticed some really sloppy sentences in this entry. For example: "If the food was watered with fluoridated water or the water mixed in pop has been it is easy for children and adults to consume large amount of fluoride leading to fluorosis." I think im just going to cut the offending sentences. PGRandom 17:38, 26 September 2006 (UTC)

Hey, about a wierd bug
Despite the claim that flourosis occurs only in children 2 "The prevalence of fluorosis in permanent teeth in areas with fluoridated water has increased from about 10-15% in the 1940s to as high as 70% in recent studies..."

What's the 2 for? - Slash
 * I'm not sure if it is trying to refer to the second reference on the list, but thanks for pointing out another error because it is misleading to say that anyone claims fluorosis occurs only in children. You can see effects of fluorosis in adults, but the overexposure to fluoride would have had to occur during tooth development. - Dozenist  talk  13:23, 1 October 2006 (UTC)

bias pov
"If the water supply is fluoridated at the rate of 1ppm, it is necessary to consume one litre of water in order to take in 1mg of fluoride. It is highly improbable a person will receive more than the tolerable upper limit from consuming optimally fluoridated water alone.";

That sentence assumes that water fluoridation is optimal. A cause that is still up for debate.

What about: "… controllen fluoridated water alone."?

I could not find the adverb of 'control', but I think that works.

I've left the article as it is, for the time being.
 * I have edited thearticle, now, accordiy.Rob Del Monte 12:49, 3 February 2007 (UTC)
 * I have reverted it back. "Controllen" is not a word, and "optimal" refers to the amount necessary to reduce caries while also lowering the incidence of dental fluorosis.  The term is used by many health organizations.  Thus, it should stay as is. - Dozenist  talk  13:27, 3 February 2007 (UTC)

FLUOROSIS A BIT CONFUSING ISSUE!
What realy causes severe dental fluorosis, many articles I read talks about fluorosis caused by too much consumption of fluoridated foods/water.........Others says too much consumption of the 'F' element reduces the risk of getting severe dental fluorosis............... whats the real thing ? I think this is subjected to more research.. MABHENA MB, UNIVERSITY OF VENDA —Preceding unsigned comment added by 196.13.185.253 (talk) 15:40, 17 March 2008 (UTC)

clarification
First, I'm not convinced the images in this article are being used properly: the source website does not specifically mention that the images can be freely reused.

Question: in the first image (mild fluorosis where the white-speckled teeth are shown), is the effect of fluorosis the white speckles or the yellowish background? That is, does fluorosis cause darker-colored teeth except in a few spots where it "missed" the teeth which are a normal white color, or does it cause bright white speckles on normally darker teeth. The article does not make this clear (though it is sort of addressed in the section on Dean's index--or Deans index?). 128.197.81.41 (talk) 20:19, 31 August 2008 (UTC)
 * To your second question, the white speckles are the resulting effect of the mild fluorosis. The yellowish background is the normal tooth color. To the first question, I am uncertain whether the pictures should be freely used here. It looks suspicious to me. - Dozenist  talk  12:47, 1 September 2008 (UTC)

Photos
This article used to have much better and accurate photos of more typical cases. Or would you say that the current pic looks much like this? The current pic in the article is very old and b/w, so ancient it makes it look as if a side-effect of fluorosis would be one's gum turning totally black. Just a misleading, bad pic of an untypical case, while the pic at the link I gave looks much more like a typical case. What happened to those modern digital photos that used to be in this article anyway? --79.193.123.99 (talk) 21:42, 1 May 2009 (UTC)


 * File:Fluorosis-mild.jpg and File:Fluorosis-severe.jpg were removed because they were copyright violations; please see commons:Commons:Deletion requests/Image:Fluorosis-mild.jpg and commons:Commons:Deletion requests/Image:Fluorosis-severe.jpg, respectively. I agree that http://www.fluoride-history.de/fluorosis3.jpg would be a much better image of severe fluorosis; however, it's also copyrighted so we can't use it. I also agree that File:FluorosisFromNIH.jpg is so horribly misleading that it's worse than having no image at all, so I just now removed the image from the article. Eubulides (talk) 22:05, 1 May 2009 (UTC)

"Most-typical"?
I'd like to note that Eubulides has moved the severe picture further down by calling the other one "more typical". Just why do you think that the colloquial term for the common form of dental fluorosis is "mottled teeth" and "Colorado brown stain"? You can see a much more typical case here (where you also find describtions of common dental fluorosis such as "'black stains on their teeth", "similar to the polished areas in caries nigra'", "black teeth [...] or teeth with black markings", "yellow or brown spots or areas", "usually darkly discolored", "brown stain", "copper teeth", "a blackish or brownish color", "the Brown Stain problem", "These teeth were also observed to grow into abnormal positions") than what is called "mild" here (which latter I'd rather consider a questionable case, if anything). You can find more about the "severe case" being closer to the common form here. --79.193.38.159 (talk) 02:06, 3 March 2010 (UTC)


 * Most dental fluorosis cases are mild, so the mild case is more typical. Cases such as the one shown in the severe image are quite rare. There's nothing questionable about the mild case; many cases are milder than that. The Colorado brown stain came from water naturally fluoridated to levels well above recommended levels, and it was more severe than what is typically experienced nowadays. Today, most dental fluorosis (in western countries anyway) comes from too much toothpaste-swallowing by young children. Eubulides (talk) 02:30, 3 March 2010 (UTC)


 * More pictures and websites on the common modern form being yellow to brown from even just 5 minutes of googling for fluorosis:, , , , , , , , , , , , . --79.193.38.159 (talk) 03:19, 3 March 2010 (UTC)


 * There are many web sites posting misinformation about fluoride (for more on this please see Armfield 2007, ), but this article, like all Wikipedia articles, should be based on reliable sources. Eubulides (talk) 03:23, 3 March 2010 (UTC)


 * So Oralhealtheducation.com, TheFreeDictionary's Medical dictionary (main sources The American Heritage® Stedman's Medical Dictionary, Second Edition and Dorland's Medical Dictionary for Health Care Consumers), Dr. Kamsiah Gulam Haider (also see ) are "unreliable sources"? All of those report yellow to brown teeth as primarily due to industrial water fluoridation. You might call the other links biased misinformation I guess, as no matter how many peer-reviewed studies they're quoting, they're communal public health campaigns educated by the existing professional literature in print. And could non-prescription doses of fluoride legal for and expressedly measured for daily toddler consumption in a Western country be that much higher than in water? The exposure in the pictured "severe case" was even extremely short compared to lifelong intake from water and other dietary standards. --79.193.38.159 (talk) 04:05, 3 March 2010 (UTC)


 * Oralhealtheducation.com doesn't work for me. It gives an advertisement for Hanyang Women's College, but no info about dental fluorosis. TheFreeDictionary's Medical dictionary doesn't work for me either. That page does not contain the word "fluorosis". Dr. Kamsiah Gulam Haider says "Fortunately, in most cases, fluorosis is so minor that it doesn’t warrant any treatment.", which agrees with my point that typical cases are mild. says nothing about fluorosis.
 * None of these sources (the ones that work for me, anyway) talk about "primarily due to industrial water fluoridation". In developed countries most fluorosis is due to children swallowing too much fluoride toothpaste.
 * None of the sources you've cited are particularly reliable in the sense needed for biomedical information in Wikipedia. Reliable sources would be published in peer-reviewed medical, dental, or scientific journals. And they should be reviews, so that they're secondary sources. For more on this subject, please see Reliable sources (medicine-related articles).
 * "could non-prescription doses of fluoride legal for and expressedly measured for daily toddler consumption in a Western country be that much higher than in water" Yes, of course. And the problem with fluoride drops (or whatever they were) is that it's very easy to mistakenly give a child much more fluoride than the dentist or doctor ordered.
 * "The exposure in the pictured "severe case" was even extremely short" Not particularly. Children are at risk for dental fluorosis only during a relatively short window. You can't get dental fluorosis after you're about 8 years old.
 * Eubulides (talk) 05:45, 3 March 2010 (UTC)
 * I agree with Eubulides -- the "extreme" image shown above is not at all representative of the effects of water fluoridation. Putting it into the article for water fluoridation would be misleading. -- Jrtayloriv (talk) 06:40, 3 March 2010 (UTC)
 * The reason those links "don't work for you" is that after linking the exact sub-pages above, I linked you to those sites's homepages a post further down. Oralhealtheducation.com is the homepage to, TheFreeDictionary's Medical dictionary is to and  (the text to the picture of brown teeth reads "from fluoridated drinking water", "due to ingestion of too much fluoride in drinking water over a long period", "usually from drinking water"), and Dr. Kamsiah Gulam Haider is to  ("darkened teeth", "main characteristic of fluorosis is the stains which form on the teeth when yellow and brown spots appear", "drinking an excess of fluoridated water", "fluoridated water consumption"). The first two are standard medical dictionaries (clearly secondary sources), and the third is a certified Master in Dental Science. Right now, I don't have the time to copy-paste you the amount of peer-reviewed sources, such as from medical journals, from the eight other links. Just how many scientific sources do you even need? You have but one source agreeing with your opinion on prevalence of yellow and brown fluorosis, and yet you keep re-uttering your belief in spite of a two-digit number of sources giving you the fact that the prevalent form of fluorosis is yellow and brown. --79.193.38.159 (talk) 07:54, 3 March 2010 (UTC)
 * "Oralhealtheducation.com is the homepage to " That may be an image of dental fluorosis, but that image by itself says nothing about water fluoridation, or about the frequency of mild vs severe fluorosis.
 * TheFreeDictionary's Medical dictionary is to Again, nothing to do with water fluoridation, or with the frequency of mild vs severe fluorosis.
 * " (the text to the picture of brown teeth reads "from fluoridated drinking water", "due to ingestion of too much fluoride in drinking water over a long period", "usually from drinking water")" I don't see that text in the image you gave. All I see is the image. From the quotes you gave, the text (whatever it is from) could well be talking about water naturally fluoridated to levels above recommended levels.
 * "Dr. Kamsiah Gulam Haider is to ("darkened teeth", "main characteristic of fluorosis is the stains which form on the teeth when yellow and brown spots appear", "drinking an excess of fluoridated water", "fluoridated water consumption")" First, that page agrees that "in most cases, fluorosis is so minor that it doesn’t warrant any treatment", so it supports the point that most cases of dental fluorosis are mild, not severe. Second, that page doesn't say water fluoridation caused the more-severe cases. Third, under "Preventing Fluorosis" that page talks only about toothpaste (which is appropriate, since most dental fluorosis in western countries is caused by children swallowing too much toothpaste).
 * "The first two are standard medical dictionaries (clearly secondary sources), and the third is a certified Master in Dental Science." Even if these sources agreed with you that severe dental fluorosis is a common consequence of water fluoridation (which they do not), they are weak sources compared to what's already cited in Water fluoridation and Dental fluorosis. Please cite sources that meet the standards in Reliable sources (medicine-related articles), which ask for "general or systematic reviews in reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally reputable expert bodies".
 * Eubulides (talk) 08:47, 3 March 2010 (UTC)

Eubulides, it is irrelevant to say that "severe flurosis pictures cannot be used because they are caused by higher than recommended levels of fluoride". If for example I went to the wiki for obesity and removed all the pictures of fat people and claimed that they were "examples of people who ate more than the recommended amount of food", you would realize how ridiculous the argument is. This page is about dental fluorosis, not water fluoridation. "Colorado Brown Stain" is a notable instance of widespread dental fluorosis and therefore is justified in being represented here in full glory. Colorado Brown Stain is possibly more notable than mild cases of fluorosis. Eubulides has claimed here and elsewhere that most fluorosis is not a problem. So why is the common case of fluorosis (which is not a problem for Eubulides) pictured first? If it is notable at all, it is logically of less note than the Colorado Brown Stain. Colorado Brown Stain should be pictured first.

Eubulides also states that most fluorosis in the west is cause by swallowing toothpaste. The CDC reports that 70% of fluoride intake is through water fluoridation. I would like to know how Eubulides has come to his conclusion. Thank you.

New Data from the CDC
The CDC poll on fluorosis prevalence is outdated. Here is a newer CDC poll: http://iadr.confex.com/iadr/2007orleans/techprogram/abstract_92598.htm As of 2004, 48.42% of humans 12 to 15 have fluorosis! If no one gets around to updating the chart, I will look into how to do it myself.

That chart focuses on wee ones younger than 12 to 15 years old. You might want to hold off on modifying it. Docjay8406 (talk) 11:33, 22 November 2011 (UTC)

fluorosis impossible in adults
It is not clear from the introduction if fluorosis can also occur in adults ?

In a simple question:Is it true that as an adult you can eat 1 tube of fluoride toothpaste every day and still you will not get fluorosis ? —Preceding unsigned comment added by 174.89.72.183 (talk) 01:41, 3 February 2011 (UTC)

It's true that an adult can eat 1 tube of fluoride toothpaste every day and still not get fluorosis, though that adult would probably have a terrible case of diarrhea! The diarrhea is due to the sodium lauryl sulfate. Anyway, the adult will not get fluorosis because fluorosis occurs in developing teeth, not teeth that have already erupted from the gums. I've clarified the part of the article on adult dentition to point out that fluorosis risk occurs up to the age of 8. After that the risk of developing dental fluorosis is typically over. Dental fluorosis occurs in adults, but develops in children. So an adult with dental fluorosis will have had it since they were a child! Hope this helps. Docjay8406 (talk) 06:40, 21 November 2011 (UTC)

Put "severe" image at the top
According to the CDC, most people who have fluorosis have it "severe". According to, 30-50% of youths aged 12-19 in the years 1999-2004 were suffering of "severe" fluorosis, compared to only 2-10% with "very mild and mild" cases. Therefore, the severe photo should be at the top. Also, many images of mostly *BLACK* teeth you'll find when googling for dental fluorosis       suggest that what's presented here as a "severe" case (and upon its first introduction was immediately removed as an allegedly unrealistic, propagandistic "scare image", even) is, with its *YELLOW* and slightly brownish teeth, actually a rather moderate one. The way it is now, what we have at the top corresponds to a small minority of only 2-10% of cases at best, as it may even be considered a questionable case. Looking at it, most people would ask you what's wrong with that "mild" picture at all! --79.193.59.135 (talk) 04:57, 25 July 2012 (UTC)


 * Is there any evidence the "severe" image is even fluorosis? I'm having trouble finding anything that confirms it as legit.  Micahmedia (talk) 19:57, 31 August 2012 (UTC)


 * As said one section further below, I as the owner of the teeth in the image could scan and post my official medical records of 15 years in a row that all read fluorosis due to prior dentist malpractice when I was a toddler and preteen (where my original dentist had prescribed me adult dosages of fluoride pills for years, a prophylactic "fluoride treament" to prevent cavities in my front teeth from the start), but I think it's a bit beyond usual privacy standards on Wikipedia. Also see all the official fluorosis medical photos I have linked above that look just like my teeth did until my insurance paid for purely cosmetic enamel replacement. --2003:71:4E33:E513:6493:E9A2:DDD1:289A (talk) 23:10, 21 March 2017 (UTC)


 * The link is dead. In any event, the 1999-2004 CDC study did not say that at all. Though it did indicate an extremely high rate of fluorosis among adolescents 12-15: 41% had definite cases and an additional 20% had "questionable" cases(!).  I have added this info to the article.JustinReilly (talk) 16:20, 19 September 2016 (UTC)

Removed bogus image
Hi, I've removed the unsourced image which did NOT show dental fluorosis but rather, decay. It was clearly there to push POV. To see what severe fluorosis really looks like, see here: http://healthvermont.gov/family/dental/fluoride/formula.aspx#fluorosis — Preceding unsigned comment added by 119.224.111.128 (talk) 03:34, 21 August 2013 (UTC)
 * Images of fluorosis not found at link given. Please link to correct page. &bull; &bull; &bull; Peter (Southwood) (talk): 06:36, 23 March 2017 (UTC)
 * I'm sorry, but you've removed a picture of a case that was certified by at least five dentists to be due to a documented case of a high fluoride intake in the form of prescribed fluoride pills as a toddler and preteen, where the amount prescribed to the child for years equalled an adult dosage due to malpractice of the original dentist. Due to this very case history, the patient never suffered from cavities in his front teeth as the fluoridation treatment had been prescribed to prevent exactly that, but suffered from the case of Colorado brown stain seen in the photo that you have deliberately removed. The picture was taken when the patient was in his late 20s, when not a single case of cavities had ever been identified by a long line of dentists that had examined the condition for almost two decades, and shortly before the patient had his tooth enamel replaced simply out of cosmetic reasons (as he had suffered from severe social stigma due to Colorado brown stain, and his medical insurance paid for his artificial new enamel as just that: A COSMETIC TREATMENT simply for optical reasons!). The patient is now in his mid-30s and still has all his original teeth, only with artificial enamel in the front which had become necessary because of fluorosis. Never once has a single dentist suspected or treated any case of cavities in the patient's frontal teeth during his entire life, while many cavities were identified and treated in his molars during the same time span. What more do you want? Scans of all my official medical records of 15 years in a row where it reads fluorosis all over until I had my enamel replaced? I have them here, but I think that goes a tad beyond Wikipedia's usual modes of privacy. --2003:71:4E33:E513:6493:E9A2:DDD1:289A (talk) 21:59, 21 March 2017 (UTC)
 * And just in case anybody's wondering, we're talking about this picture here: . --2003:71:4E33:E513:6493:E9A2:DDD1:289A (talk) 22:28, 21 March 2017 (UTC)
 * Interesting. We are talking about just this kind of thing at WT:MED now. Will put a link to this, there. Jytdog (talk) 02:05, 22 March 2017 (UTC)
 * Yup just got another position from a dentist. They say this is a mix of severe dental fluorsis and dental caries. Doc James  (talk · contribs · email) 12:39, 24 March 2017 (UTC)
 * Tooth substance which shows mild fluorosis is actually more resistant to decay than "healthy" tooth surfaces. This would correspond to the "snow-capped" teeth where there are white opacities. However, more severe fluorosis can be affected by hypoplasia of enamel, e.g. pitting, which would predispose to decay. I would agree with whoever added the arrows that this seems to be a reasonable analysis of the image, however it is important to state that without more info there could be other cause of tooth discoloration at work. Matthew Ferguson (talk) 23:37, 25 March 2017 (UTC)
 * As said, being the person whose teeth are pictured, at least five dentists over a period of 15 years found no cavities in my front teeth, including at the state pictured, even though my then-dentist's photographer who made photos for my insurance as an amateur suspected cavities and expected my dentist would pull all my teeth, when in fact he only replaced my enamel. What's seen in the image is chipping combined with color change, which is why my insurance refused to pay for my enamel replacement as a medical treatment, only as cosmetic treatment. When the picture was taken, the visual state had deteriorated further than it had been for years because I'd lately begun using whitening toothpaste, which, as can be seen in the picture, only makes everything worse with fluorosis because the few spots with natural enamel became brighter, making the parts made of pure fluoride appear even darker. --2003:71:4E33:E576:D161:9B02:FBB2:87CF (talk) 15:55, 27 March 2017 (UTC)

Your story is interesting but the statement that no cavities (I read this as tooth decay) are present in the image is surprising. The picture strongly gives the appearance of decay, these lesions having been highlighted already by someone else with red arrows. However, the information you have is the result of a clinical examination and so must be correct, compared to only limited guesswork that can be gained from looking at the picture and without a full case history. I explain below.

"Cavities" could refer to any loss of tooth substance, not just as a hole caused by tooth decay. For example, tooth wear can cause loss of tooth substance. So there are definitely holes in the image shown, there has been loss of tooth substance here. From what you describe -- chipping -- this is likely to have been enamel which was so weakened (termed enamel hypocalcification/hypomineralization) or malformed (termed enamel hypoplasia) by fluorosis that it broke down rapidly during life and left these holes in the enamel. Also inside the holes, what appears to be dental plaque, a main requirement for decay to occur. Whether we can say there is any decay in these holes and under the plaque would require a clinical examination, importantly by pressing gently inside the holes with a small probe to see if it is softened or hard. If the surface is hard, it also does not rule out the possibility of arrested decay (once soft, now hardened again under more favourable conditions such as less sugar frequency in diet and improved oral hygiene). Arrested decay leaves a stained, but re-hardened surface inside the cavity.

Whitening toothpaste is just a more abrasive type of toothpaste, it removes surface stains (tea, coffee), it does not contain any bleach which can increase the shade of the tooth surface beyond its underlying shade. If there is intrinsic staining from e.g. fluorosis then yes whitening toothpaste will not change this.

When you say replaced the enamel, I image this as placing white filling material to restore the natural contour of the tooth surface. It seems harsh that insurance considered this cosmetic. You can see in the image holes which have plaque inside. Even if there was no decay under this plaque at the time as you say, then this situation would have been very risky to develop decay in future. Generally speaking wherever plaque is allowed to stagnate, decay rapidly follows. So such treatment could be considered preventative rather than cosmetic. Matthew Ferguson (talk) 20:00, 27 March 2017 (UTC)

NIDR and CDC findings on children
For the chart labeled "NIDR and CDC findings on children", shouldn't the 17% result for both "Questionable fluorosis" and "Very mild fluorosis" be listed twice? Bringing the 1987 total to 39.3%? Looking at the numbers side by side, it doesn't seem like that big of a difference, but the totals at the end seem extreme.

Maybe that table shouldn't be included at all, since they apparently collected different sets of data, or maybe it could be presented more clearly in another way?

While we're on the topic, shouldn't infant Amoxicillin exposure be included in this article? http://www.news-medical.net/news/2005/10/04/13528.aspx "The results show that amoxicillin use during early infancy seems to be linked to dental fluorosis on both permanent first molars and maxillary central incisors," the authors report. "Duration of amoxicillin use was related to the number of early-erupting permanent teeth with fluorosis."

Sorry if this submission doesn't follow the standard format. This is my first time ever commenting on wikipedia.

174.111.231.166 (talk) 17:07, 27 November 2013 (UTC)

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