Fluoride Action Network

Dental Fluorosis & Enamel Hypoplasia in Children with Kidney Disease

Fluoride Action Network | March 2012 | By Michael Connett

Children with kidney disease are known to have high levels of fluoride in their blood and to be at risk for disfiguring tooth defects. Research suggests that high levels of fluoride in blood, which can cause the tooth defect known as dental fluorosis, can contribute to the defects that occur as a result of kidney disease during childhood. On one hand, some studies have found that children with kidney disease can suffer severe dental fluorosis from relatively low levels of exposure, while other studies suggest that fluoride might worsen the condition known as “enamel hypoplasia,” a tooth defect that frequently occurs as a result of childhood kidney disease.

Excerpts from the Scientific Literature:

“[C]hildren who present with renal insufficiency before the age of 8 years are at risk for tooth defects. These effects will be more severe in the presence of F, and ingestion of F by young children with renal failure (i.e. F supplements or swallowing F-containing toothpaste) is contraindicated, as suggested previously.”
SOURCE: Lyaruu DM, et al. (2008). The effect of fluoride on enamel and dentin formation in the uremic rat incisor. Pediatr Nephrol. 23(11):1973-9.

“[T]he patients with renal disease presented more severe dental fluorosis than children without renal disease.”
SOURCE: Ibarra-Santana C, et al. (2007). Enamel hypoplasia in children with renal disease in a fluoridated area. J Clin Pediatr Dent. 31(4):274-8.

“An elevated serum fluoride level, causing fluorosis, may be an aetiological factor in the development of enamel defects in children with [chronic renal failure], since the kidneys have an important function in the removal of inorganic fluoride from the body.”
SOURCE: Lucas VS, Roberts GJ. (2005). Oro-dental health in children with chronic renal failure and after renal transplantation: a clinical review. Pediatr Nephrol. 20(10):1388-94.

“Children with polydipsia as in nephrogenic diabetes insipidus consume excessive quantities of water. We are reporting two children with nephrogenic diabetes insipidus and fluorosis, and suggest looking for evidence of fluoride toxicity in individuals with polydipsia. . . . Our patients’ daily fluid consumption while hospitalized and at home ranged from 2 1/2 to 6 times normal daily intake. They have lived in communities where the fluoride concentration is 1 ppm, the recommended amount to control caries and prevent fluorosis in children with average daily water intake. However, the patients’ excessive ingestion of water has increased the total amount of fluoride consumed to the point where they have clinical tooth mottling and laboratory evidence of fluorosis. . . . There are other pathological entities which give rise to polydipsia and polyuria. These would include central diabetes insipidus, pyschogenic water ingestion, renal medullary disease, including hypercalcemic nephropathy, hypokalemic nephropathy and anatomic and vascular disturbances and those diseases causing solute diuresis. Consumption of water in any of these disorders is excessive and could lead to fluoride toxicity in a community with acceptable fluoride concentration. Therefore, a portion of the ingested water that these children consume should be supplied from a nonfluoridated source.”
SOURCE: Greenberg LW, et al. (1974). Nephrogenic diabetes insipidus with fluorosis. Pediatrics. 54(3):320-2.