"[F]luorides
easily pass through the mouth’s mucous membrane but do not
cross the skin barrier. This would explain the lack of response
of ordinary p-tests. Anyway, in cases of benign
aphthosis, replacing toothpaste with normal soap is not such
a difficult test. Of course, not all benign recurrent aphthoses
respond favorably to this test, but because of its simplicity, it
would be unwise not to try it. In cases of fluoride intolerance
it would also be important to eliminate, among other items, salts
and beverages enriched with fluoride compounds from the family diet..."
SOURCE: Brun R. (2004). Recurrent Benign
Aphthous Stomatitis and Fluoride Allergy. Dermatology
208: 181
"It is my understanding that dermatologists
frequently recommend that their patients with perioral dermatitis
discontinue use of toothpastes with pyrophosphates and/or fluorides,
citing that these are the most frequent causes."
SOURCE: McCaffery K. (2003). Fluoride and dermatitis. Journal
of the American Dental Association
134: 1166.
"Discontinuing use of strong topical steroid
lotions, or toothpastes containing fluoride or pyrophosphates,
seems to reduce the symptoms of perioral dermatitis...
[I]f this is the case, these patients need to be educated about
other preventive measures to prevent tooth decay."
SOURCE: Fuchs SS. (2003). Fluoride and dermatitis. Journal
of the American Dental Association
134: 1167.
"This preliminary study demonstrates that tacrolimus 0.075%
ointment may be effective for patients with steroid-induced rosacea,
when combined with avoidance of topical steroid use, as well as
avoidance of other agents known to aggravate
rosacea (caffeine, spicy foods, alcohol, hot fluids, and fluoride)."
SOURCE: Goldman D. (2001). Tacrolimus ointment for the treatment
of steroid-induced rosacea: a preliminary report. Journal
of the American Academy of Dermatology
44: 995-8.
"7 hours after the 3rd application, a very severe disseminated
acute urticaria and facial angioedema
appeared, requiring hospital admission... The clinical features
and patch tests do not allow a distinction to be made between
immunological and non-immunological contact urticaria. Nevertheless,
the case confirms that, in some atopic patients, painting the
teeth with sodium fluoride can lead to severe and potentially
dangerous reactions."
SOURCE: Camarasa JG, et al. (1993). Contact
urticaria from sodium fluoride. Contact
Dermatitis 28: 294
"A patient is reported who had a suggestive
but not proved exacerbation of dermatitis
herpetiformis from a dental fluoride
treatment, presumably through both local and systemic absorption.
It seems reasonable that fluorides can produce
a reaction similar to the one well established for their close
relatives, the iodides. Physicians caring for persons with dermatitis
herpetiformis should be aware of this possibility."
SOURCE: Bovenmyer D. (1985). Aggravation of dermatitis herpetiformis
by dental fluoride treatments. Journal
of American Academy of Dermatology
12: 719-720.
"We decided to conduct a study of the possible role of fluoride
toothpaste in the development of PD (perioral
dermatitis) when one of our patients noted dramatic
improvement after switching from a fluoride to a nonfluoride toothpaste...
She remained free of lesions for approximately three months, at
which point we asked her to resume use of fluoride toothpaste.
Within a few days she experienced an exacerbation of PD (perioral
dermatitis) that resolved completely when she stopped using the
fluoride toothpaste. Table 2 presents the results of the double-blind
crossover phase of the study... [T]he data seem
to support our hypothesis that fluoride-containing dentrifices
play a role in the development of PD (perioral dermatitis).
Six of the fourteen patients who completed the study experienced
exacerbations of PD while using the fluoride-containing toothpaste
but not while using the nonfluoride. Two patients reported
mild reactions with both the fluoride and nonfluoride toothpastes,
and six patients experienced no reaction with either toothpaste.
SOURCE: Mellette JR, et al. (1983). Perioral dermatitis.
Journal of the Association of Military
Dermatologists 9: 3-8. **Click
here to read the full paper**
"In two patients receiving [topical fluoride]
therapy a papulonodular eruption developed, similar to
the recognized halogenodermas. These cases may help to increase
awareness of this entity."
SOURCE: Blasik LG, Spencer SK. (1979). Fluoroderma. Archives
of Dermatology 115:1334-5.
"Since its description in 1957... perioral
dermmatitis (PD) has continued to be a perplexing entity.
Many causes have been postulated, including sunlight sensitivity,
birth control pills, emotional stress, fluorinated steroid creams,
Candida albicans, and rosacea. We have gathered
clinical and historical data implicating fluoride dentrifices
as an important etiologic factor in this dermatosis... For
the past eighteen months, we have been
conducting a clinical study with the assumption that in some patients,
fluoride dentrifices cause or aggravate perioral dermatitis. The
clinical and historical evidence gathered has been impressive
in support of this hypothesis."
SOURCE: Mellette JR, et al. (1976). Fluoride
tooth paste: A cause of perioral dermatitis. Archives of Dermatology
112: 730-731. **Click here to read
the full paper**
"I recently received a note from Emery Kocsard, MD, of Sydney,
Australia, who has had an interest in perioral dermatitis and
who has published an article on that subject. In his article,
he anticipated the possible relevance of fluorinated toothpastes
and fluoridated corticosteroids to the perioral dermatitis
problem. In his note, he reported that, since reading my letter
to the editor, he had treated approximately
50 patients with fluoride-related perioral dermatitis;
in all cases, the condition responded favorably after the discontinuance
of the use of fluorinated toothpastes."
SOURCE: Saunders MA. (1976). Fluoride toothpaste as a cause of
acne-like eruptions. Archives of
Dermatology 112: 1033-1034.
“Recognizing the fact that fluoride
toothpastes are the prevalent type of dentrifice and that my findings
could be a mere coincidence, I requested,
nevertheless, that these patients switch, on a trial basis, from
their fluoride toothpastes to a nonfluoride-containing toothpaste.
Within a period varying from two to four weeks, approximately
one half of the patients thus observed cleared of their previously
persistent acne-like eruption... Several of the
patients, who were concerned about the dental health factors relative
to fluoride and its exclusion, requested to resume use of a fluoride
toothpaste despite assurances that fluoride in water and dental
treatments should be sufficient for good dental health and protection.
These patients were then allowed to resume use
of a fluoride toothpaste. Without exception, each developed the
same distribution of acne-like eruption that had previously occurred.”
SOURCE: Saunders MA. (1975). Fluoride
toothpastes: A cause of acne-like eruptions. Archives
of Dermatology 111: 793. **Click
here to read the full paper**
"Mr. E. H., age 48, consulted one of us
on May 9, 1961, because of giant urticaria of one month's
duration. The lesions involved mainly hands and feet and at times
the entire body surface. At the first visit the lips and gums
showed a marked edema. The lesions usually
occurred about one hour after breakfast. The patient had been
using a fluoridated toothpaste at that time... He was asked to
discontinue the fluoride toothpaste and not to take any medication.
Three days later, be reported having had only a single hive and
slight residual pruritus. Six days later (May 18), he was completely
free of symptoms." (NOTE: This patient consented to
a double-blind test to determine if fluoride toothpaste was in
fact the cause. The double-blind test confirmed
that the patient did in fact have an allergic reaction to fluoride.)
SOURCE: Shea JJ, et al. (1967). Allergy to fluoride. Annals
of Allergy 25:388-91. **Click
here to read the full paper**
"[S]he had 3 local applications of a 2%
solution of NaF by her dentist in the manner usually employed
for caries prophylaxis. After the first and
second treatments the oral mucosa became edematous and
irritated for periods of about 4 days. Within an hour after the
third application on 3/5/56, a cheilitis developed involving
the entire anterior portion of the oral mucosa. This subsided
gradually within a week. Local application of this solution to
the oral muccous membranes for about 30 seconds produced marked
injection and edema of the test area. An
intradermal test with a 1% aqueous solution of NaF produced an
erythematous reaction of the size of a 25 cent piece;
one for horse serum and horse serum combined with NaF were negative.
On 6/18/57 the patient was given as a placebo 300 cc. of distilled
water without ill effect. The following day a test dose of 6.8
mg. of fluoride (as NaF) elicited within 20 minutes moderately
severe vomiting."
SOURCE: Waldbott GL. (1958). Allergic
Reactions from Fluorides. International
Archives of Allergy 12: 347-355.
**Click here to read the full paper**
"Mrs. L.C.H., 62-year-old white, developed
an ulcer in the mouth within three days after she started
to use stannous fluoride tooth paste. During the following 10
days, additional lesions developed throughout the oral mucosa
accompanied by severe spastic pains throughout the whole
abdomen, flatulence, diarrhea and dryness in mouth, nose and throat...
Her dentist (Dr. W.H.P.) having observed a similar case suggested
to her that the tooth paste might have induced this condition.
Upon eliminating it, the condition gradually subsided... On 12/13/56,
saline solution was applied with a cotton swab beneath her tongue
without ill effect. Thirty minutes later a cotton
swab soaked in 1% NaF was used similarly. Within 5 minutes hyperemia,
edema and pruritus developed in the test area followed
by more extensive irritation in a large portion of the oral mucosa.
A smear of the mucus from the area showed marked eosinophilia.
The patient refused further tests with the fluoride tooth paste."
SOURCE: Waldbott GL. (1958). Allergic
Reactions from Fluorides. International
Archives of Allergy 12: 347-355.
**Click here to read the full paper**
"There is nothing specific
in the appearance of the lesions (stomatitis) which would
distinguish or differentiate them from any of the other common
oral pathologic processes. I believe that if one were to
describe the lesions, it would be as shallow, superficially ulcerated
areas which tend to have a whitish exudate on the surface and
surrounding areas. The worst lesion and, indeed, the earliest
lesions, commenced on the buccal mucosa opposite the teeth - that
is, in those areas which come in contact with the teeth. The tongue,
hard palate, soft palate, floor of the mouth, gingival regions
and oral pharynx also produced similar ulcerations. Indeed, the
longer the patient had used the fluoride dentrifice, the more
chance he had of showing general involvement of the entire oral
and pharyngeal regions... Treatment of these
lesions is rather simple in the early stages - namely, changing
to a dentrifice which does not contain fluoride...
Those patients who had repeated courses of fluoride testing
proved to be very grave problems indeed. In fact, some of them
became so resistant to clearing of the oral lesions that I began
to wonder if the lesions had not become irreversible. Duration
from the time we actually commenced trying to rid the patients
of their lesions until actual improvement was noted, was, indeed,
very prolonged in those who had three, four or more courses of
fluoride testing. The period from partial clearing to complete
clearing of the lesions was even more prolonged and uncertain."
SOURCE: Douglas TE. (1957).
Fluoride dentifrice and stomatitis. Northwest
Medicine 56: 1037-1039.
"Application of ammonium fluoride under
an occlusive patch to the abdomen of a rabbit converts a simple
scratch into a double row of sterile pustules. Sodium fluoride
produces a similar response, but ammonium chloride does not produce
pustules... It appears that tissue damage and the presence of
fluorides result in the 'sterile pustular response.' This can
be called 'enhancement of inflammation.' The
concentration of fluoride used will not induce inflammation, but
it will enhance inflammation... We are not stating that
iodide, fluoride, and nickel necessarily enhance inflammation
in identical ways, but there is no doubt that
they all enhance the inflammatory response. The fact that
each of these substances produces the pustular patch test in man
indicates that the reaction is not limited to animals."
SOURCE: Stone OJ, Willis CJ. (1967). Enhancement
of inflammation by fluorides. Texas
Reports on Biology and Medicine
25: 601-6.
"Scratches were made to the depth of the upper dermis on
the abdomen of rabbits. The scratches were covered by patch tests
for 18 hours with solutions of stannous fluoride or stannous chloride.
Both these substances produced a destructive reaction with intraepidermal
polymorphonuclear leukocyte pustules
occurring on each side of the scratch. Stannous
fluoride was destructive at lower concentrations than stannous
chloride. When these substances were patch tested over
non-traumatized tissue, no tissue damage occurred... We believe
that the metals and halogens that produce pustule along the scratch
are damaging the body's defenses against the
mediators of inflammation and are
therefore exaggerating the early cellular phase of inflammation...
Dentrifices (toothpastes) are not made
for prolonged contact with tissue; however, even brief exposure
might influence preexisting oral pathology. Further clinical observations
on the effects of fluoride dentrifices on oral inflammation are
indicated."
SOURCE: Stone OJ, Willis CJ. (1968). The effect of stannous fluoride
and stannous chloride on inflammation. Toxicology
of Applied Pharmacology 13: 332-8.
"Topical and systemic administration or
contact with fluorides has produced various forms of cutaneous
reactivity. These studies, conducted wtih 150-400 g. Sprague-Dawley
rats, investigated the effect of topical application of NaF to
a shaved, epidermal abraded region (5 cm) of dorsal skin.
After 24 hrs. NaF (1%) produced inflammation of the epithelial
keratin and the formation of intraepidermal vesicles abundant
in fluid, polymorphonuclear leukocytes, lymphocytes, and erythrocytes.
Edematous subendothelial changes were noted with cellular hypochromicity.
Electron microscopy revealed extensive mitochondrial vacuolization.
The cutaneous vesicles persisted for approximately 7 days after
NaF application. In rats treated wtih NaF (23)
skin histamine levels were significantly (p <0.01) elevated
above those for NaCl-treated, H20-treated, or shaved only rats.
In non-abraded skin NaF did not produce either chemical or histological
changes. No further increase in vesicle formation or histamine
elevation was produced by prolonging the duration of topical application.
The accumulation of histamine as a result of NaF-induced inhibition
of diamine oxidase, or enzymes of the skin glycolytic pathway
providing for increased Ca++ availability, may explain the present
data."
SOURCE: Essman EJ, Essman WB. (1979). Rat skin reaction to topical
fluoride: metabolic and histological changes. Federation
Proceedings 38: 1242.
"The topical application
of sodium fluoride to abraded rat skin produced several morphological
and biochemical effects. Related to the degranulation of
dermal mast cells, skin histamine concentration
was increased, fluorides were absorbed into the skin, and
deposited mainly kin mitochondria. Dermal histamine binding was
decreased for both H1 and H2 receptors with reduced binding sites,
but epidermal adenyl cyclase was activated by fluorides. The response
of the rat skin to fluorides involves a sequence of changes by
which the potentiation of an inflammatory response
also involves alterations in specific histamine receptors and
a histamine-specific adenyl cyclase system."
SOURCE: Essman EJ, Essman WB, Valderrama E. (1981). Histaminergic
mediation of the response of rat skin to topical fluorides. Archives
of Dermatological Research 271:
325-40.
