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PubMed1990

Feasibility of the combined use of fluorides.

An increase in the number of methods of fluoride administration over and above traditional modes, while offering new caries-preventive possibilities, has also created problems. These cannot be solved by the purely scientific, objective approach, since emotional resistance to fluoride has increased in some countries in parallel to environmental pollution. In most of the highly developed countries, the decrease of caries prevalence has dramatically lowered the number of children in need of concentrated preventive programs. On the other hand, dental awareness and multiple sources of fluoride have increased the risk of chronic fluoride overdosage. Means to avoid the latter problem are discussed. In addition to community-delivered fluoridation programs, individual counseling and "tailor-made" preventive measures are of increasing importance.

Attitude to Health↗
PubMed1992

The pathology of chronic bovine fluorosis: a review.

Clinical, pathologic, and analytical records from 200 cattle were reviewed to determine if long-term exposures to elevated fluorides resulted in previously unrecognized or unreported pathologic changes, especially skeletal neoplasia. Animals were part of comprehensive field and laboratory investigations of bovine fluorosis conducted by the Utah State University Agricultural Experiment Station over a 25-year period. Records indicated that over 170 cattle included in this review were exposed to dietary fluorides levels in excess of 25 ppm (dry wt), for most of their life span, and these animals exhibited bone fluoride concentrations ranging between 2,000 and 12,500 ppm (dry wt). Although dental and/or skeletal changes were present in most animals, significant soft tissue damage or neoplasia was not observed in any organ system. Renal degeneration and mineralization were slightly more prevalent in range cattle ingesting high fluoride levels, but these changes were not recognized in animals that received high experimental fluoride doses. The absence of significant soft tissue damage or neoplasia in these cattle combined with results of an extensive literature review suggests that environmental fluorides are not significant factors in mammalian carcinogenesis.

Animals↗
PubMed2007

Recovery from skeletal fluorosis (an enigmatic, American case).

UNLABELLED: A 52-year-old man presented with severe neck immobility and radiographic osteosclerosis. Elevated fluoride levels in serum, urine, and iliac crest bone revealed skeletal fluorosis. Nearly a decade of detailed follow-up documented considerable correction of the disorder after removal of the putative source of fluoride (toothpaste). INTRODUCTION: Skeletal fluorosis, a crippling bone disorder, is rare in the United States, but affects millions worldwide. There are no data regarding its reversibility. MATERIALS AND METHODS: A white man presented in 1996 with neck immobility and worsening joint pains of 7-year duration. Radiographs revealed axial osteosclerosis. Bone markers were distinctly elevated. DXA of lumbar spine (LS), femoral neck (FN), and distal one-third radius showed Z scores of +14.3, +6.6, and -0.6, respectively. Transiliac crest biopsy revealed cancellous volume 4.5 times the reference mean, cortical width 3.2 times the reference mean, osteoid thickness 25 times the reference mean, and wide and diffuse tetracycline uptake documenting osteomalacia. Fluoride (F) was elevated in serum (0.34 and 0.29 mg/liter [reference range: <0.20]), urine (26 mg/liter [reference range: 0.2-1.1 mg/liter]), and iliac crest (1.8% [reference range: <0.1%]). Tap and bottled water were negative for F. Surreptitious ingestion of toothpaste was the most plausible F source. RESULTS: Monitoring for a decade showed that within 3 months of removal of F toothpaste, urine F dropped from 26 to 16 mg/liter (reference range: 0.2-1.1 mg/liter), to 3.9 at 14 months, and was normal (1.2 mg/liter) after 9 years. Serum F normalized within 8 months. Markers corrected by 14 months. Serum creatinine increased gradually from 1.0 (1997) to 1.3 mg/dl (2006; reference range: 0.5-1.4 mg/dl). Radiographs, after 9 years, showed decreased sclerosis of trabeculae and some decrease of sacrospinous ligament ossification. DXA, after 9 years, revealed 23.6% and 15.1% reduction in LS and FN BMD with Z scores of +9.3 and +4.8, respectively. Iliac crest, after 8.5 years, had normal osteoid surface and thickness with distinct double labels. Bone F, after 8.5 years, was 1.15% (reference range, <0.1), which was a 36% reduction (still 10 times the reference value). All arthralgias resolved within 2 years, and he never fractured, but new-onset nephrolithiasis occurred within 9 months and became a chronic problem. CONCLUSIONS: With removal of F exposure, skeletal fluorosis is reversible, but likely impacts for decades. Patients should be monitored for impending nephrolithiasis.

Biopsy↗
PubMed1985

Diagnosis and treatment of acute fluoride toxicity.

The literature has shown overwhelmingly that fluoride used for dental prophylaxis presents minimal risks if used appropriately. However, there is an increasing potential for ingestion of toxic doses of fluoride because of the increasing use of pleasant-tasting fluoride products. The ADA has recommended that no more than 120 mg fluoride (264 mg NaF) be dispensed at any one time. As with any medication, fluoride preparations should be prescribed in child-resistant containers, and patients or parents (or both) should be instructed as to the proper daily treatment regimens and the potential for toxic overdoses. Possibly the greatest risk of fluoride intoxication relates to the concentrated fluoride preparations used for professionally applied fluoride treatment (Table 3). Therefore, patients receiving professional topical fluoride treatments should have well-fitting trays with the minimal amount of fluoride necessary to contact the teeth. These patients should be provided with a saliva ejection system, and they should never be left unobserved during the topical application. Health professionals should be aware of the potential toxic effects of fluoride in addition to the well-known caries preventive effects. It is necessary to know how to calculate the amount of fluoride ingested and the emergency treatment recommended to prevent toxic effects in suspected overdose cases.

Child↗
PubMed1997

Fluoride.

Explore the source record for details and available documents.

Cariostatic Agents↗
PubMed2005

Controlling the fluoride dosage in a patient with compromised salivary function.

BACKGROUND: High-concentration topical fluorides are used commonly to with compromised salivary function due to irradiation and chemotherapy. CASE DESCRIPTION: The authors describe a 50-year-old man with previously treated cancer who was using tray-applied topical fluoride gel. He complained of gastric symptoms, difficulty in swallowing, leg muscle soreness and knee joint soreness. A computed tomographic scan revealed thickening of the esophageal walls. An upper endoscopy revealed abnormal motility. The motility test indicated high-amplitude peristalsis and hypertensive lower esophageal sphincter, and urine testing indicated high levels of systemic fluoride. The patient's fluoride regimen was altered, and within a short period his urinary fluoride levels returned to normal and his symptoms resolved. CLINICAL IMPLICATIONS: Clinicians prescribing home-applied high-concentration fluorides need to be cognizant of the symptoms of fluoride toxicity, carefully monitor the patient's compliance with the treatment regimen, and adjust the dosage or mode of application to control the total ingested dose of fluoride.

Arthralgia↗
PubMed1982

Excessive ingestion of fluoride and the significance of sialic acid: glycosaminoglycans in the serum of rabbit and human subjects.

The levels of sialic acid and glycosaminoglycans were explored in the sera of rabbit and human subjects who ingested fluoride and had clinical manifestation of fluorosis. Changes observed in the level of these chemical constituents in sera possibly reflect changes occurring in calcified and noncalcified tissues due to fluoride intoxication. The ratio of sialic acid content vs glycosaminoglycans revealed there was a 50% reduction in rabbit and human sera. The test is recommended for evaluating the prognosis of fluoride poisoning/fluorosis.

Adolescent↗
PubMed1996

Circulating testosterone levels in skeletal fluorosis patients.

OBJECTIVE: The present study focuses on serum testosterone concentrations in patients with skeletal fluorosis, in order to assess the hormonal status in fluoride toxicity. METHODS: Serum testosterones were compared for patients afflicted with skeletal fluorosis (n = 30) and healthy males consuming water containing less than 1 ppm fluoride (Control 1, n = 26) and a second category of controls (Control 2, n = 16): individuals living in the same house as the patients and consuming same water as patients but not exhibiting clinical manifestations of skeletal fluorosis. RESULTS: Circulating serum testosterones in skeletal fluorosis patients were significantly lower than those of Control 1 at p < 0.01. Testosterone concentrations of Control 2 were also lower than those of Control 1 at p < 0.05 but were higher than those of the patient group. CONCLUSIONS: Decreased testosterone concentrations in skeletal fluorosis patients and in males drinking the same water as the patients but with no clinical manifestations of the disease compared with those of normal, healthy males living in areas nonendemic for fluorosis suggest that fluoride toxicity may cause adverse effects in the reproductive system of males living in fluorosis endemic areas.

Adolescent↗
PubMed1986

Hip fracture incidence not affected by fluoridation. Osteofluorosis studied in Finland.

Iliac crest biopsies were taken from patients with hip fracture from a low-fluoride area (less than 0.3 ppm), from an area with fluoridated drinking water (1.0-1.2 ppm), and from a high-fluoride area (greater than 1.5 ppm). Fluoride content analysis and histomorphometry of bone were performed. The hip fracture incidence during 1972-1981 was studied in the same areas. The fluoride content of the bone samples correlated with drinking water fluoride. In patients with hip fracture, both osteomalacia and osteoporosis were common. In the high-fluoride area also osteofluorosis was found in many patients. Osteofluorosis may occur if the fluoride content of trabecular bone exceeds 4,000 ppm and either the volumetric density of osteoid or the osteoid-covered trabecular bone surface is abnormally increased. There was no difference in incidence of hip fracture in the three areas.

Aged↗