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Summary
Chronic fluorosis alters bone structure, leads to odd exostosis, to osseous appositions, to ossification of ligaments and tendons and their insertions. This can cause pain and discomfort. Radiological examination usually leads to the correct diagnosis; the most constant changes were found in films of elbows and forearms. Such films may be useful in the diagnosis of industrial fluorosis and perhaps for detecting undesirable effects of prolonged fluoride therapy. It seems clear that manifestations of fluorosis in adults appear only after prolonged exposure at high dosage. If signs of fluorosis are present, they may lead to symptoms of the osteoarticular system. Therapy with high dosage fluoride should be monitored carefully.
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Back pain in chronic renal failure.
Article w/o Photos (see pdf attached) Patient SK, a 40-yr-old female, resident of Bhagalpur village in Bihar, India, was operated for gallstones 3 years previously. On pre-operative checkup, mild renal dysfunction was detected. She was asymptomatic for renal disease with serum creatinine of 159 mmol/l (1.8mg/dl), bland urinary sediment and small echo-genic kidneys on ultrasound. She was
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[Two cases of skeletal fluorosis in the hand].
Skeletal fluorosis is well known, particularly in the spine, pelvis and forearm. However, the hand may also be involved. The authors report two cases of this site in endemic areas in Senegal, after ingestion of large amounts of fluoride in the water. Fluorosis consisted of deforming metacarpal and phalangeal osteoperiotitis in one case
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Skeletal fluorosis mimicking seronegative spondyloarthropathy: a deceptive presentation
Skeletal fluorosis is rarely recognized early and is amajor cause of morbidity.We report on a 40-year-old man with skeletal fluorosis mimicking seronegative spondyloarthropathy.
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Skeletal fluorosis and instant tea
Tea drinking remains popular in the United States and increasingly is suggested to promote health. We caution that skeletal fluorosis can result from consumption of excessive amounts of instant tea because of substantial fluoride levels in some commercial preparations. Case report A 52-year-old white woman consulted in 1998 for dense lumbar vertebras
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Bone mineral structure after six years fluoride treatment investigated by backscattered electron imaging (BSEI) and small angle x-ray scattering (SAXS): a case report
NaF, a bone formation stimulating agent, is used for the treatment of osteoporosis. Controversy exists concerning the quality of the newly formed bone and the antifracture effectiveness. We report about a 70 years old woman, who had received 50 mg NaF/d for about 6 years. Calcium or Vit D supplements
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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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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 & 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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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 in India & China
In India and China, scientists have repeatedly found that skeletal fluorosis occurs in populations drinking water with just 0.7 to 1.5 ppm fluoride. Although nutritional deficiencies and hot climates make populations in India and China more susceptible to fluoride toxicity than is generally the case in western countries, this fact does not remove the relevance of the Indian and Chinese experience to the situation in fluoridating countries. This is because (a) nutritional deficiencies also exist in the western world, particularly in low-income communities, and (b) some individuals, including those with kidney disease, can be just as -- if not more -- susceptible to fluoride toxicity.
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