Fluorosis Damion Francis MSc. TMRI-ERU

Essential Nutrient or Health Hazard Sensitive methods can detect fluorine in every bone and teeth Sensitive methods can detect fluorine in every bone and teeth Suggested that formation of biological apatites may not be possible in the absence of fluorine Suggested that formation of biological apatites may not be possible in the absence of fluorine Fluorination of water as shown to significantly reduce carious lesions in children Fluorination of water as shown to significantly reduce carious lesions in children Claims of it being essential as not been substantiated. Claims of it being essential as not been substantiated.

Essential Nutrient or Health Hazard Fluorine is the most electronegative element and is highly reactive Fluorine is the most electronegative element and is highly reactive Abundantly found in mineral salts such as Calcium Fluoride (fluorspar) Abundantly found in mineral salts such as Calcium Fluoride (fluorspar) There is no appreciable absorption by plants in fluorine rich soil There is no appreciable absorption by plants in fluorine rich soil Although broad leave varieties such as cabbage and lettuce absorb airborne fluoride, eg fertilizers and sprays Although broad leave varieties such as cabbage and lettuce absorb airborne fluoride, eg fertilizers and sprays

Fluoride Ingestion Natural water always contain some amount of fluorine Natural water always contain some amount of fluorine Concentration depend on the fluorine containing mineral present Concentration depend on the fluorine containing mineral present Most fluorine containing mineral are soluble in water: underground sources are more heavily laden with fluorine. Most fluorine containing mineral are soluble in water: underground sources are more heavily laden with fluorine.

Fluoride Ingestion Dietary sources include mackerel, salmon, sardines, some mineral waters, wine and tea. Dietary sources include mackerel, salmon, sardines, some mineral waters, wine and tea. The latter is very important as it contains large quantities of which up to 90% is extracted during infusion The latter is very important as it contains large quantities of which up to 90% is extracted during infusion Large consumers of tea such as in India Large consumers of tea such as in India

Fluorides in the body Soluble fluorides such as sodium and tin (stannous fluoride) are completely absorbed by the GI Soluble fluorides such as sodium and tin (stannous fluoride) are completely absorbed by the GI Insoluble occur at much slower rates Insoluble occur at much slower rates Reduced by the presence of Ca and Mg Reduced by the presence of Ca and Mg Blood contains about mg F per litre; small quantity is ionic Blood contains about mg F per litre; small quantity is ionic Transient rise when fluorine is ingested Transient rise when fluorine is ingested

Fluorides in the body Fluoride levels in the body is regulated, two mechanisms Fluoride levels in the body is regulated, two mechanisms 1. Excretion – about half of F ingested is removed via urine 2. Uptake by calcified tissues- remainder removed with great avidity by calcified tissue, however a steady state is finally reached

Fluorides in the body Deposition of fluoride is slightly reversible Deposition of fluoride is slightly reversible Moving from area of high concentration to low ingestion Moving from area of high concentration to low ingestion More is excreted in urine More is excreted in urine Presumably due to loss of physicochemically exchangeable fluoride and also osteoclastic activity Presumably due to loss of physicochemically exchangeable fluoride and also osteoclastic activity

Fluoride Toxicity chronic intoxication is more common, fluoride concentrated in the hard tissue, the bones and teeth show the most obvious effects of Fluorosis. chronic intoxication is more common, fluoride concentrated in the hard tissue, the bones and teeth show the most obvious effects of Fluorosis. Intake of excessive amounts of fluoride during tooth development results in mottled enamel Intake of excessive amounts of fluoride during tooth development results in mottled enamel Characterized by scattered irregular white flecks. Characterized by scattered irregular white flecks.

Mild David Kenedy DDS Mild/Moderate Severe Hardy Limeback, DDSsevere

Grade of Description of fluorosis Dental fluorosis Fluorosis index (DFI) Normal None 0 Questionable A few white flecks or white spots 0.5 Very mild Small opaque, paper-white areas involving 1.0 Less than 25% of the surface Mild white opacities are more extensive but do not 2.0 Involve more than 50% of the surface Moderate Distinct brown stain, all enamel surfaces affected 3.0 Severe Besides brown staining, the tooth is worn and 4.0 hypoplastic. All enamel surfaces affected