Abstract
A survey was done of the prevalence of dental fluorosis among children aged 7-16 years and the occurrence of skeletal fluorosis among adults aged 40-60 years living in regions in Senegal where fluoride concentrations in the drinking water ranged from less than 0.1 to 7.4 mg/l. In the area where the fluoride concentration in the drinking water was 1.1 mg/l milder forms of dental fluorosis were found, the prevalence being 68.5%. In areas where fluoride concentrations exceeded 4 mg/l the prevalence of dental fluorosis reached 100%. Kyphosis was very prevalent among a community whose drinking water contained 7.4 mg/l fluoride. Radiographs of the vertebral column, hand, and wrist of 3 adults with kyphosis confirmed the diagnosis of skeletal fluorosis. High sweat loss and a high intake of water because of the hot weather may account for the finding. The present World Health Organisation guideline for the upper limit of fluoride concentration in drinking water may be unsuitable for countries with a hot, dry climate.
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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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Effects of smoking, use of aluminum utensils, and tamarind consumption on fluorosis in a fluorotic village of Andhra Pradesh, India
A field study was undertaken to determine effects of tamarind, the use of aluminium (Al) cooking utensils, and smoking on dental and skeletal fluorosis in the randomly selected fluoride (F) endemic village of Buttlapally in the Nalgonda District, Andhra Pradesh, India, where the F level in the drinking water is
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Association of dental and skeletal fluorosis with calcium intake and vitamin D concentrations in adolescents from a region endemic for fluorosis
Objective: Patan, is a semi urban area in Gujarat, India where fluorosis is endemic (Fluoride concentration in ground water 1.96–10.85 ppm, Patel et al., 2008). Exposure to fluoride is likely to be higher in lower socio-economic class (SEC) due to lack of access to bottled water. Calcium intake and vitamin
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Association of Dietary Calcium Intake with Dental, Skeletal and Non-Skeletal Fluorosis among Women in the Ethiopian Rift Valley.
Fluorosis is a major public health problem in the Rift Valley of Ethiopia. Low calcium (Ca) intake may worsen fluorosis symptoms. We assessed the occurrence of fluorosis symptoms among women living in high-fluoride (F) communities in South Ethiopia and their associations with dietary Ca intake. Women (n = 270) from
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Age-sex specific disability-adjusted life years (DALYs) attributable to elevated levels of fluoride in drinking water: A national and subnational study in Iran, 2017.
Highlights DALYs attributable to elevated water fluoride levels in Statistical Center of Iran, 2017 were estimated. The attributable DALYs and DALY rate in Statistical Center of Iran, 2017 were respectively 3443 and 4.31. About 94% of the attributable DALYs were concentrated in 4 out of 31 provinces. Over 66%
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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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Skeletal Fluorosis & Individual Variability
One of the common fallacies in the research on skeletal fluorosis is the notion that there is a uniform level of fluoride that is safe for everyone in the population. These "safety thresholds" have been expressed in terms of (a) bone fluoride content, (b) daily dose, (c) water fluoride level, (d) urinary fluoride level, and (e) blood fluoride level. The central fallacy with each of these alleged safety thresholds, however, is that they ignore the wide range of individual susceptibility in how people respond to toxic substances, including fluoride.
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Racial Disparities in Dental Fluorosis
In 2005, the Centers for Disease Control published the results of a national survey of dental fluorosis conducted between 1999 and 2002. According to the CDC, black children in the United States have significantly higher rates of dental fluorosis than either white or Hispanic children. This was not the first time that black children were found to suffer higher rates of dental fluorosis. At least five other studies -- dating as far back as the 1960s -- have found black children in the United States are disproportionately impacted by dental fluorosis.
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Fluoridation, Dialysis & Osteomalacia
In the 1960s and 1970s, doctors discovered that patients receiving kidney dialysis were accumulating very high levels of fluoride in their bones and blood, and that this exposure was associated with severe forms of osteomalacia, a bone-softening disease that leads to weak bones and often excruciating bone pain. Based on
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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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