Abstract
An epidemiological investigation was undertaken in the villages of Tilaipani and Hirapur located in Mandla District of Central India to determine the cause and extent of a peculiar skeletal deformity characterised by knock knee (genu valgum) occurring mainly among children. In Tilaipani, 74.4% of children and adolescents below age 20 had dental mottling, and 51.2% were afflicted with genu valgum. In Hirapur the figures were 56.9% and 6.25%, respectively. Radiological examination revealed extensive osteosclerosis with coarse trabecular pattern. In a few cases juxta-articular bone resorption, periosteal reaction, and bony exostoses were also present. Bio-chemical parameters were generally within normal limits, but dietary surveys indicated that calcium and vitamin C intakes were significantly below recommended levels. In Tilaipani the fluoride content of the drinking water ranged from 9.22 to 10.83 ppm and in Hirapur from below 1 ppm to 13.5 ppm. The mean urinary fluoride concentration in the cases of skeletal deformities was 4.42 ppm. The typical fluorotic dental mottling, the radiological findings, and the high fluoride content in the urine and drinking water all point to high fluoride, probably enhanced by deficient nutrition, as the cause of the genu valgum and other bone deformities.
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The effect of nutrition on the development of endemic osteomalacia in patients with skeletal fluorosis
The aim of the study was to study the relationship between nutrition and endemic osteomalacia, resulting in bone deformation with hump back, spinal curvature and "0" legs, in persons living in high drinking water fluoride areas with skeletal fluorosis. A dietary survey was made of 30-50 families from each of
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Vitamin D deficiency, rickets, and fluorosis in India
Data on the vitamin D status of the populations in a tropical country like India have seldom been documented. Vitamin D deficiency is presumed to be rare. Population studied by the author and others in the country has proved otherwise. Studies were carried out to document the dietary habits, serum
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Comparison of two village primary schools in northern Tanzania affected by fluorosis
High fluoride levels in drinking water sources are a problem throughout the East African Rift Valley and can lead to dental fluorosis (DF) and skeletal fluorosis (SF) in exposed local populations. Two villages in the Hai District of northern Tanzania in which fluoride has been identified as a problem were
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Epidemiological, clinical, and biochemical study of endemic dental and skeletal fluorosis in Punjab
The incidence of dental fluorosis in 46,000 children in the Punjab was assessed and compared with the fluoride content of their water supplies. Ten villages were selected for more detailed studies of skeletal as well as dental fluorosis. Factors other than the fluoride content of the drinking water which were found to influence
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Efficacy of Calcium-Containing Eggshell Powder Supplementation on Urinary Fluoride and Fluorosis Symptoms in Women in the Ethiopian Rift Valley.
Dietary calcium binds Fluoride (F), thus preventing excess F absorption. We aimed to assess the efficacy of supplementing calcium-containing Eggshell Powder (ESP) on F absorption using urine F excretion and on fluorosis symptoms. In total, 82 women (41 Intervention Group, IG; 41 Control Group, CG) were recruited; overall, 39 in
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Skeletal Fluorosis: The Misdiagnosis Problem
It is a virtual certainty that there are individuals in the general population unknowingly suffering from some form of skeletal fluorosis as a result of a doctor's failure to consider fluoride as a cause of their symptoms. Proof that this is the case can be found in the following case reports of skeletal fluorosis written by doctors in the U.S. and other western countries. As can be seen, a consistent feature of these reports is that fluorosis patients--even those with crippling skeletal fluorosis--are misdiagnosed for years by multiple teams of doctors who routinely fail to consider fluoride as a possible cause of their disease.
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Kidney Patients Are at Increased Risk of Fluoride Poisoning
It is well established that individuals with kidney disease are susceptible to suffering bone damage and other ill effects from low levels of fluoride exposure. Kidney patients are at elevated risk because when kidneys are damaged they are unable to efficiently excrete fluoride from the body. As a result, kidney patients
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"Pre-Skeletal" Fluorosis
As demonstrated by the studies below, skeletal fluorosis may produce adverse symptoms, including arthritic pains, clinical osteoarthritis, gastrointestinal disturbances, and bone fragility, before the classic bone change of fluorosis (i.e., osteosclerosis in the spine and pelvis) is detectable by x-ray. Relying on x-rays, therefore, to diagnosis skeletal fluorosis will invariably fail to protect those individuals who are suffering from the pre-skeletal phase of the disease. Moreover, some individuals with clinical skeletal fluorosis will not develop an increase in bone density, let alone osteosclerosis, of the spine. Thus, relying on unusual increases in spinal bone density will under-detect the rate of skeletal fluoride poisoning in a population.
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Factors which increase the risk for skeletal fluorosis
The risk for developing skeletal fluorosis, and the course the disease will take, is not solely dependent on the dose of fluoride ingested. Indeed, people exposed to similar doses of fluoride may experience markedly different effects. While the wide range in individual response to fluoride is not yet fully understood, the following are some of the factors that are believed to play a role.
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Nutrient Deficiencies Enhance Fluoride Toxicity
It has been known since the 1930s that poor nutrition enhances the toxicity of fluoride. As discussed below, nutrient deficiencies have been specifically linked to increased susceptibility to fluoride-induced tooth damage (dental fluorosis), bone damage (osteomalacia), neurotoxicity (reduced intelligence), and mutagenicity. The nutrients of primary importance appear to be calcium,
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