4. INTRODUCTION
• Fluoride is both useful as well as fatal if not used properly.
• Inadequate ingestion of fluoride can lead to dental caries and an
excessive amount cause dental and skeletal fluorosis.
• The toxic effect of fluoride can be classified as:
acute-single ingestion of a large amount.
Chronic-long term ingestion of small amounts.
5. EFFECT OF EXTRAORDINARY FLUORIDE INTAKE IN
HUMAN
DOSE FREQUENCY EFFECT
0
1-2ppm
Daily for years
Daily for years
*increased dental caries.
*reduced dental caries
TOXIC EFFECTS
3-15 ppm
20-80 ppm
Daily for years
Daily for eight or more
*dental fluorosis of varying
severity and frequency and
reduced dental caries.
*crippling dental fluorosis .
ACUTE
EFFECTS(LETHAL
DOSE)
250-1000 mg
2.5-5 gm(for children)
5-10 gm(for adults)
One retained dose
One retained dose
One retained dose
*nausea,vomiting,abdo-
minal pain
*probable death
*probable death
6. ACUTE TOXICITY OF FLUORIDE
• Due to rapid excessive ingestion of fluoride at one time.
• The speed and severity is dependent on amount of fluoride ingested
and weight and age of the individual.
• Nausea -most common adverse effect of topical fluoride application.
• Nausea is caused when:
fluoride + hydrogen
(gastric juice)
Hydrofluoric acid
(stomach irritant)
8. CLINICAL FEATURES(cont.)
• serious symptoms arise within 1-2 hours and death can occur from 2-
4 hours.
• Death due to cardiac failure or respiratory paralysis.
• If death has not occurred the prognosis is good.
• Certainly lethal dose:32 to 64mg of fluoride/kg body wt.
• Probably toxic dose:5.0 mg of fluoride /kg body wt.
• Safely tolerated dose:8-16mg of fluoride/kg body wt.
9. Less than 5mg/kg 1)Give calcium orally(milk)-
relieves git symptoms and observe
the patient
2)Induce vomiting (if necessary)
More than 5mg/kg but less than
15mg/kg body wt.
1)Empty the stomach by induced
vomiting with emetic.
2)Give orally soluble
calcium(milk,5%calcium gluconate
or calcium lactate)
3)Admit in hospital and observe for
few hours.
MANAGEMENT OF ACUTE FLUORIDE TOXICITY
10. More than 15mg/kg 1)Admit to hospital immediately.
2)Induce vomiting.
3)Begin cardiac monitoring.
4)Slowly administer intravenously
10ml of 10% calcium gluconate
solution. Additional dose given if
tetany develops. Electrolyte levels
must be monitored
5)Adequate urine output must be
maintained using diuretics.
6)General supportive measures for
shock.
MANAGEMENT OF ACUTE FLUORIDE TOXICITY(CONT.)
11. CHRONIC FLUORIDE TOXICITY
• It is due to long term ingestion of small amount of fluorides.
• The effect on enamel –dental fluorosis
• The effect on skeleton-skeletal fluorosis
12. DENTAL FLUOROSIS
• It is caused due to excessive intake of fluoride during tooth
development especially amelogenesis
• White flecks and chalky opaque areas on tooth enamel is seen when
water with fluoride concentration 2-3 times more than recommended
amount is consumed.
13. DENTAL FLUOROSIS(cont.)
• Brown stained ,pitted surface on consumption of 4 times more
fluoride than recommended.
• Aesthetically compromised but caries resistant.
14. CLINICAL FEATURES:
• Lusterless, opaque white patches on enamel
• mottled ,striated or pitted.
• Mottled areas become stained yellow or brown.
• Hypoplastic areas are seen in severe cases where normal
structure is lost.
15. CLINICAL FEATURES(cont.)
• The hypo calcified enamel are less soluble in acids, and have greater
permeability to dyes.
• Premolar is usually affected followed by second molar ,max
incisor,canine,first molar and mandibular incisors.
16.
17. TREATMENT OF DENTAL FLUOROSIS
• Etching with hydrofluoric acid followed by bleaching with hydrogen
peroxide(30%) can be done.
• Acid etch is followed by resin labial veneer restoration.
• In severe form of fluorosis crown placement can be done.
18. SKELETAL FLUOROSIS
• Skeletal fluorosis occurs from ingestion of very high amounts of
fluoride for a long periods of time.
• Symptoms are highly varied
• Severe pain in the back bone,joints,hips,stiffness in joints and spine.
19. CLINICAL FEATURES
• Knock knee syndrome: Outward bending of legs and hands is seen in
advanced stages and these parts lose their shape and contour .
20. CLINICAL FEATURES(cont.)
• Pregnant women, lactating mothers and children - most vulnerable
group.
• Teratogenic effects seen.
• Blocking and calcification of blood vessels causing cardiac problems.
21. CLINICAL FEATURES (cont.)
• Crippling fluorosis: in severest form of fluorosis the spine become
rigid and joints stiffen which ultimately lead to immobilization the
patient.
22. CLINICAL FEATURE(cont.)
• The fluoride dosage necessary to produce pathologic skeletal fluorosis
is estimated at 20 to 80mg fluoride/day for a period of at least 20
years .
23. PREVENTION OF FLUOROSIS
• Avoid ingestion of fluoride containing water
• Identification of alternative water supply with optimal or suboptimal
levels of fluoride.
• Mixing of water with different concentration of fluoride so ultimately
there is reduced level of fluoride.
• Recommendation for defluoridation either at domestic level or at
community level.
24. DEFLUORIDATION OF WATER
• Defluoridation is the process of removing excess naturally
occurring fluoride from drinking water in order to reduce
the prevalence and severity of fluorosis.
25. • Defluoridation is divided into 3 basic types:
1)based upon ion exchange process or adsorption.
2)precipitation method.(Nalgonda technique)
3)based on membrane separation
26. CONCLUSION
• Fluoride is referred to as a double edged knife if not used properly
can cause deteriorating effect on health.
• Inadequate use can cause caries and excessive use causes fluorosis.
• It should always be consumed in the recommended levels to be on the
safe side.
• Defluoridation techniques must be employed at domestic or
community level
27. REFERENCE:
• Peter S Essentials of Public Health Dentistry 5th edition Arya Medi
Publishing House Private Limited New Delhi July 2016.
• Hiremath SS Textbook of Preventive and Community Dentistry 2nd
Edition Elsevier a Division of Reed Elsevier New Delhi 2015.
