Abstract
Two illustrative cases of patients with skeletal fluorosis and classic radiographic changes are presented. One patient demonstrated a progressive paraparesis, while the other was diagnosed incidentally on routine radiographs. A review of the literature, treatment, and histologic findings are presented.
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Skeletal fluorosis and its neurological complications
Of 46 cases of skeletal fluorosis in Punjab, India, 21 had compression paraplegia, All the patients lived in a small area where drinking-water and soil had an extremely high (though variable) content of fluoride. The intoxication chiefly affected the skeleton, producing typical radiological features of diagnostic value. The teeth also showed
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Chronic fluoride intoxication with fluorotic radiculomyelopathy
This case of a patient with chronic fluoride intoxication, extensive osteosclerosis, and fluorotic radiculomyelopathy is believed to be the first reported froni the United States. The development of advanced fluorosis in this patient exposed to drinking vater with less than 4 ppm of fluoride was unusual and with probably a
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An uncommon presentation of fluorosis
A 70 years old farmer from Yemen was referred as a case of osteoarthritis of both knees for preoperative rehabilitation procedures. Six years before he developed progressive skeletal stiffness. By 70 years he became dependent for ambulation and many other self-care activities. He showed quadriparesis resulting from compression of spinal cord
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Posttraumatic pseudomenigocoele of cervical spine in a patient with skeletal fluorosis. Case report
A case of fluorotic cervical compressive myelopathy precipitated by trauma is reported. The delayed neurological deterioration was due to a posttraumatic pseudomenincocele, the prompt treatment of which resulted in recovery. Posttraumatic pseudomeningocele is very rate; and certainly so in fluorosis, and thus has not been reported in the literature to date.
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Endemic fluorosis with neurological complications in a Hampshire man
We describe below a case of skeletal fluorosis occurring in a Hampshire man who presented with neurological complications, and whose condition was appreciably improved by operation. We believe that this is the first case of its kind to be reported from Britain, and also the first case of skeletal fluorosis
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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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Fluoride & Osteoarthritis
While the osteoarthritic effects that occurred from fluoride exposure were once considered to be limited to those with skeletal fluorosis, recent research shows that fluoride can cause osteoarthritis in the absence of traditionally defined fluorosis. Conventional methods used for detecting skeletal fluorosis, therefore, will fail to detect the full range of people suffering from fluoride-induced osteoarthritis.
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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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Fluoride & Spinal Stenosis
Spinal stenosis is a narrowing of the spaces in the spine that results in pressure being placed on the spinal cord and/or nerve roots. Although stenosis can develop without symptoms, it may produce numbness, tingling, pain and difficulty in walking, as well as a heavy/tired feeling in the legs. It is estimated that 250,000 to 500,000 Americans currently have symptoms of spinal stenosis. Skeletal fluorosis is one cause of stenosis.
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Fluoride & DISH (Diffuse Idiopathic Skeletal Hyperostosis)
Among individuals with skeletal fluorosis, the fluoride-induced changes to the spine, and the accompanying symptoms, can bear a close resemblance to DISH (Forestier's Disease). Some authors report that skeletal fluorosis can so closely resemble that DISH that the only way to distinguish the two would be to conduct an invasive bone biopsy. No studies have ever been conducted to determine what role, if any, fluoride plays in the development of DISH.
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