2. The disease fluorosis is caused by an element
known as fluorine, the 13th most abundant
element available in the earth crust.
3. Chemical Properties of Fluorine
Element of Halogen group with molecular weight
19 and atomic number 9.
Fluorine is the most electro negative of all
elements
This fluorine exists as a diatomic molecule with
remarkably low dissociation energy (38 K
cal/mole).
As a result it is highly reactive and has strong
affinity to combine with other elements to produce
compounds known as Fluoride.
5. What is Fluorosis
Fluorosis is a disease caused by
deposition of fluorides in the hard and
soft tissues of the body. It is not merely
caused by excess intake of fluoride but
there are many other attributes and
variables which determine the onset of
fluorosis in human population. It is
usually characterised by discoloration of
teeth and crippling disorders.
6. Worldwide in distribution
Endemic in 22 countries
Asia and in Asia,India and China are
worst affected
Mexico in North and Argentina in Latin
America
East and North Africa are also endemic
7. EXTENT OF PROBLEM
International Status
The following countries have been identified for
the problem of fluorosis:
Pakistan, Bangladesh,
Argentina, United States of America,
Morocco, Middle East countries,
Japan, South African Countries,
New Zealand, Thailand etc.
8. In India
The problem has reached alarming proportions
affecting at least 17 states of India:
50-100% districts are affected - Andhra Pradesh,
Tamil Nadu, Uttar Pradesh, Gujarat, Rajasthan
30-50% districts are affected - Bihar, Haryana,
Karnataka, Maharashtra, Madhya Pradesh,
Punjab,Orissa, West Bengal
< 30 % districts are affected - J & K, Delhi, Kerala
9.
10. SOURCES OF FLUORIDE
Sources of fluoride in environment
Usually the surface water is not contaminated
with high fluoride, whereas ground water may be
contaminated with high fluoride because the
usual source of fluoride is fluoride rich rocks.
When water percolates through rocks it leaches
out the fluoride from these rocks.
The rocks rich in fluoride are:
Flurospar- CaF2 (Sedimentary rocks, lime
stones, sand stones);
Cryolite- Na3AlFPO6 (Igneous, Granite);
Fluorapatite- Ca3 (PO)2 Ca (FCl)2
11. Sources of fluoride for human
exposure
Main sources of fluoride for human are
Water: most assimilable form of fluoride and
hence the most toxic
Food: from soil and water
Air: occupational exposurefrom industries
Medicament: Na flouride, niflumic acid, dental
products
Cosmetic etc.
12. CHEMOBIOKINETICS AND
METABOLISM
Ingested fluoride is rapidly absorbed through
gastrointestinal tract and lungs. The peaks are
reached after 30 min in blood.
The rapid excretion takes place through renal system
over a period of 4 to 6 h.
In children less than three years of age only about
50% of total absorbed amount is excreted
Adults and children over 3 years - about 90% is
excreted.
Approximately 90% of the fluoride retained in the
body is deposited in the skeleton and teeth
The biological half-life of bound fluoride is several
years.
Fluoride also passes through the placenta and also
appears in low concentrations in saliva, sweat, and
13. biochemical changes
. Fluoride is rapidly absorbed into serum. carried
to the bone, replace hydroxyl in the bone
hydroxyapatite, creating fluoroapatite. Mainly in
trabecular bone increasing it’s density.
The fluoride also stimulates the formation of new
irregular bone at the sites of tendon and ligament
insertions, resulting in gradual ossification of soft
tissues.
Sclerotic type in high calcium intake and porotic
type in low calcium intake
14. Primarily it is Fluoride which is present in drinking
water
when F in water is more than 1.5 mg per litre,it is toxic
to health
pH in terms of alkalinity of water promotes the
absorption of F
calcium in the diet reduces the absorption of F
Hard water rich in Calcium reduces the F toxxicity
Fresh Fruits and Vit.C reduces the effect of F
Trace elements like Molubdenum enhances the
effect of F
AGENT FACTORS
15. In School going children seen as dental fluorosis.
In third and fourth decade of life seen as Skeletal
Fluorosis.
Males suffer more than females.
Migration influences the occurrence depending
on which way people migrate.
Illitrates suffer more frequently in the fluorotic
belts.
Where aluminium ores are mined,it is seen as
occupational health hazard.
Host Factors
16. High Annual Mean Temperature
Low Rainfall
Low humidity
F rich Natural subsoil rocks
Vegetables from high F belts
Fluoridated tooth paste particularly when
used by children
Tropical climate
Developing Countries
Environmental Factors
17. FACTORS INFLUENCING THE
ONSET OF THE DISEASE
Concentration of fluoride in drinking water, food,
cosmetics etc
low calcium and high alkalinity of drinking water
age of the individual
duration of intake
pregnancy
lactating mother
derangement in hormonal profile
calcitonin, parathormone, vitamin D and
cortisol
18. Other factors
other trace elements in the water
dietary intake of fluoride
nutritional status
water storage methods
work patterns
tea-drinking habits
19. Endemic flourosis
Endemic skeletal flourosis is a
chronic metabolic bone disease
caused by ingestion of large
amounts of fluoride through either
water or food in geographic areas
where high levels of fluoride occur
naturally.
20. Endemic flourosis
When more than one-fifth ( 20 % ) of
the persons surveyed in a known high
fluoride area shows positivity of the
clinical tests, it indicates the
endemicity
21. Tests for Skeletal Fluorosis Affection of the joints can be ascertained through
simple tests which can be carried out at the bed-head
side and in the field:
COIN TEST: The subject is asked to lift a coin from the
floor without bending the knee. A fluorotic subject
would not be able to lift the coin without flexing the
large joints of lower extremity.
CHIN TEST: The subject is asked to touch the anterior
wall of the chest with the chin. If there is pain or
stiffness in the neck,it indicates the presence of
fluorosis.
STRETCH TEST: The individual is made to stretch the
arm sideways,fold at elbow and touch the back of the
head. When there is pain and stiffness, it would not be
possible to reach to the occiput indicating presence of
flourosis
22. Clinical Picture of Endemic Fluorosis
Dental Fluorosis in Children
Skeletal Fluorosis in Adults
Non Skeletal Fluorosis
26. Allergic manifestation
Very painful skin rashes, which are perivascular
inflammation. Prevalent in women and children.
Pinkish red or bluish red spot, round or oval
shape on the skin that fade and clear up within 7-
10 days.
28. Red Blood cells
Fluoride is ingested accumulates on the
erythrocyte membrane, Which looses calcium
content. This change causes formation of
echinocytes.
The life span of these echinocytes is less than
the normal life span of RBC, and hence early
destruction of the RBCs in form of ecchynocytes
causes anemia.
29. Ligaments and Blood Vessel
Calcification
A unique feature of the disease is soft tissues like
ligaments, blood vessels tend to harden and
calcify and the blood vessels will be blocked.
30. Fluoride and mental efficiency
Excessive fluoride intake since early childhood
would reduce mental work capacity (MWC) and
hair zinc content
Excessive fluoride intake decreased 5-hydroxy
indole acetic acid and increased norepinephrine
in rat brain
31. Clinical symptoms
The initial symptoms usually were headache and
vague pains, arthralgia, backache, rigidity weakness.
These were followed by multiple joint pains, mostly in
the feet, knees, and back.
Spinal stiffness and kyphosis developed in a few
patients.
Constipation
Limitation of joint movement. Inability to close the fist
Difficulty in walking
Flexion of spine
Neurological complications
Bones subjected to stress are more likely to be
involved
43. Osteopenia
Sparse thick
trabeculae along lines
of stress
Thinned out cortex
Growth lines
Calcification and
ossification at muscle
and tendon
attachment