Dr. Dwijesh Kumar Panda, M.D. Ph.D
(Medicine)
Fluorosis
The disease and how it affects people
Ingestion of excess
fluoride, most commonly in drinking-water, can cause fluorosis which affects
the teeth and bones. Moderate amounts lead to dental effects, but long-term
ingestion of large amounts can lead to potentially severe skeletal problems.
Paradoxically, low levels of fluoride intake help to prevent dental caries. The
control of drinking-water quality is therefore critical in preventing
fluorosis. The condition and its effect on people Fluorosis is caused by
excessive intake of fluoride. The dental effects of fluorosis develop much
earlier than the skeletal effects in people exposed to large amounts of
fluoride. Clinical dental fluorosis is characterized by staining and pitting of
the teeth. In more severe cases all the enamel may be damaged. However,
fluoride may not be the only cause of dental enamel defects. Enamel opacities
similar to dental fluorosis are associated with other conditions, such as
malnutrition with deficiency of vitamins D and A or a low protein-energy diet.
Ingestion of fluoride after six years of age will not cause dental fluorosis.
Chronic high-level
exposure to fluoride can lead to skeletal fluorosis. In skeletal fluorosis,
fluoride accumulates in the bone progressively over many years. The early
symptoms of skeletal fluorosis, include stiffness and pain in the joints. In
severe cases, the bone structure may change and ligaments may calcify, with
resulting impairment of muscles and pain.
Acute high-level
exposure to fluoride causes immediate effects of abdominal pain, excessive
saliva, nausea and vomiting. Seizures and muscle spasms may also occur.
The cause
Acute high-level exposure to fluoride is rare and
usually due to accidental contamination of drinking-water or due to fires or
explosions. Moderate-level chronic exposure (above 1.5 mg/litre of water - the
WHO guideline value for fluoride in water) is more common. People affected by
fluorosis are often exposed to multiple sources of fluoride, such as in food,
water, air (due to gaseous industrial waste), and excessive use of toothpaste.
However, drinking water is typically the most significant source. A person's
diet, general state of health as well as the body's ability to dispose of
fluoride all affect how the exposure to fluoride manifests itself.
Distribution
Fluoride in water is
mostly of geological origin. Waters with high levels of fluoride content are
mostly found at the foot of high mountains and in areas where the sea has made
geological deposits. Known fluoride belts on land include: one that stretches
from Syria through Jordan, Egypt, Libya, Algeria, Sudan and Kenya, and another
that stretches from Turkey through Iraq, Iran, Afghanistan, India, northern Thailand
and China. There are similar belts in the Americas and Japan. In these areas
fluorosis has been reported.
Scope of the Problem
The prevalence of
dental and skeletal fluorosis is not entirely clear. It is believed that
fluorosis affects millions of people around the world, but as regards dental
fluorosis the very mild or mild forms are the most frequent.
Fluorosis can refer to:
Dental fluorosis
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Dental fluorosis
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Classification and external resources
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 A mild case of dental fluorosis (the white streaks on the subject's upper right central incisor) observed in dental practice |
Dental
fluorosis
is a health condition caused by a person receiving too much fluoride during tooth development. The critical period of exposure is
between 1 and 4 years old; although fluorosis can affect people of any age
despite claims that it only affects children.[1][2] In its mild form, which is the most common, fluorosis
appears as tiny white streaks or specks that are often unnoticeable.The spots
and stains left by fluorosis are permanent. They may darken over time.
In
its most severe form, which is also called mottling of dental enamel, it is
characterized by black and brown stains, as well as cracking and pitting of the
teeth.[3]
The
severity of dental fluorosis depends on the amount of fluoride exposure, the
age of the child, individual response, as well as other factors including
nutrition.[1] Although water fluoridation can cause fluorosis, most of this
is mild and not usually of aesthetic concern.[4] Severe cases can be caused by exposure to water that is
naturally fluoridated to levels well above the recommended levels, or by
exposure to other fluoride sources such as brick tea or pollution from high fluoride coal.[5]
Physiology
Dental
fluorosis occurs because of the excessive intake of fluoride, either through fluoride in the water supply, naturally
occurring or added to it; or through other sources. The damage in tooth development occurs between the ages of 3 months
to 8 years, from the overexposure to fluoride. Teeth are generally composed of hydroxyapatite and carbonated hydroxyapatite; when fluoride is present, some fluorapatite is generated. Excessive fluoride can cause white spots, and
in severe cases, brown stains or pitting or mottling of enamel. Fluorosis cannot occur once the tooth has erupted into the
oral cavity. At this point, fluorapatite is beneficial because it is
more resistant to dissolution by acids (demineralization). Although it is
usually the permanent teeth which are affected, occasionally
the primary teeth may be involved.
The
differential
diagnosis
for this condition may include Turner's hypoplasia (although this is usually more
localized), some mild forms of amelogenesis
imperfecta,
and other environmental enamel defects of diffuse and demarcated opacities.
Dean's Index
A
severe case of dental fluorosis, or "mottled dental enamel."
H.T.
Dean's fluorosis index was developed in 1942 and is currently the most
universally accepted classification system. An individual's fluorosis score is
based on the most severe form of fluorosis found on two or more teeth.[6]
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Dean's Index
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Classification
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Criteria – description of enamel
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Normal
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Smooth,
glossy, pale creamy-white translucent surface
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Questionable
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A few
white flecks or white spots
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Very
Mild
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Small
opaque, paper white areas covering less than 25% of the tooth surface
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Mild
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Opaque
white areas covering less than 50% of the tooth surface
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Moderate
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All
tooth surfaces affected; marked wear on biting surfaces; brown stain may be
present
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Severe
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All
tooth surfaces affected; discrete or confluent pitting; brown stain present
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Prevalence
As
of 2005 surveys conducted by the National
Institute of Dental Research in the USA between 1986 and 1987[7] and by the Center of Disease
Control
between 1999 and 2002[8] are the only national sources of data concerning the
prevalence of dental fluorosis.
Treatment
Before and after porcelain laminate veneers
Dental fluorosis
can be cosmetically treated by a dentist. The cost and success can
vary significantly depending on the treatment. Tooth bleaching, microabrasion, and conservative composite restorations or porcelain veneers are commonly used treatments. Generally speaking, bleaching and
microabrasion are used for superficial staining, whereas the conservative
restorations are used for more unaesthetic situations.
Fluoride/Arthritis:
Skeletal
fluorosis, especially in its early stages, is a difficult disease to diagnose, and can be readily confused with
various forms of arthritis including osteoarthritis and rheumatoid arthritis.
The
arthritic symptoms of fluorosis can occur before the onset of bone changes detectable by x-ray, thereby making the early stages of
fluorosis difficult to differentiate from arthritis.
In
the advanced stages of skeletal fluorosis, the spine may closely resemble the
appearance of spondylosis/spondylitis and DISH (Diffuse Idiopathic Skeletal Hyperostosis).
General
Info - Arthritis:
"The word arthritis literally
means joint inflammation, but it is often used to refer to a group of more than
100 rheumatic diseases that can cause pain, stiffness, and swelling in the
joints."
SOURCE: National Institutes of Health
SOURCE: National Institutes of Health
"Arthritis
and chronic joint symptoms affect nearly 70 million Americans, or about one of
every three
adults, making it one of the most prevalent diseases
in the United States. As the population ages, this number will increase
dramatically."
References
World Health Organization. Guidelines for drinking-water quality. Vol. 1. Geneva, 1993 (Second edition)World Health Organization. Guidelines for drinking-water quality. Vol. 2. Geneva, 1999 (Second edition)
Dr. Dwijesh Kumar Panda, M.D. Ph.D
(Medicine)
Filariologist, Pathlogist &
Micro-biologist
M-5, 12, Acharya Vihar,
Bhubaneswar.
Contact:+919438470777
Submitted
to The Secretary, Odisha Bigyan Academy, for favor of publication in Science
Horizon for the International Year of Chemistry (IYC)-2011.