Fluoride toxicity can occur from both acute and chronic fluoride exposure. Acute toxicity results from rapid ingestion of high amounts of fluoride and causes abdominal cramps, diarrhea, vomiting and increased salivation. Chronic exposure during tooth development can lead to dental fluorosis characterized by white opaque patches on teeth. Prolonged ingestion of very high amounts over many years can cause skeletal fluorosis with severe joint and bone pain. Treatment for acute toxicity involves inducing vomiting, giving calcium supplements, and fluid replacement. Reducing fluoride intake and defluoridation of water sources are important to prevent chronic toxicity.

1. FLUORIDE TOXICITY
NOBELMEDICAL COLLEGE TEACHING
HOSPITALAND RESEARCH CENTER
SUBMITTED BY SUBMITTED TO,
MAHESH SHRESTHA,ROLL NO:52 DEPARTMENT OF COMMUNITY
DENTISTRY
3
RD
YEAR BDS
PREVENTIVE AND COMMUNITY DENTISTRY

2. Warnings
keep out of the reach of children under 6 years of age
If more than used for brushing is accidentally swallowed,
Get medicalhelp or contacta poison controlcenter rightaway.
SUBMITTED BY
MAHESH SHRES
52

3. CONTENTS
1. Introductionto fluoride
toxicity
2. Objectives
3. Fluorosis
4. Historicalperspective
5. Current incidence
6. Doses
7. Symptoms
8. Treatment
9. Defluoridation
10.conclusion

4. FLUORIDE TOXICITY
Fluoride is often calledas doubleedged sword.
Less ingestion of fluoride and excessive intake of
Fluoride can lead to dentaland skeletal fluorosis which is calledas
fluoride toxicity
TYPES
1.ACUTE FLUORIDE TOXICITY
2.CHRONIC FLUORIDE TOXICITY
3.SKELETAL FLUORIDE TOXICITY

5. OBJECTIVES:
• Acute and chronic fluoride toxicity
• Appropriateuse of fluoride products
• Optimaland toxic level of fluoride intake
• Recommendationandtreatment of fluoride toxicity

6. • Acute fluoride toxicity resultfromrapid excessive ingestionof
fluoride at one time
• Symptoms
• Abdominal cramps
• diarrhoea
• Vomiting
• Increased salivation
• Dehydrationand thirst
1.ACUTE FLUORIDE TOXICITY

7. 2.CHRONIC FLUORIDE TOXICITY
• Dental fluorosis
• Fluorosis is caused by excessive intake of fluoride during tooth
development
• An intake above 2 ppm (particularly >5ppm)in children causes
mottling of enamel and discoloration of teeth
• Clinical features
• Lustreless,opaque white patches in the enamel which may become
mottled,striatedor pitted
• Mottled areas may become stained yellow or brown
• Hypoplastic area also present

8. CHRONIC TOXICITY

9. Dosage of Fluoride Ingestion and Effects
Acute5 mg/kgProbable Toxic (PTD)
10-20 years0.15-0.33 mg/kg/daySkeletal Fluorosis
Until age 6> 0.10 mg/kg/dayDental Fluorosis
-0.05-0.07 mg/kg/dayOptimal
DurationDosageEffect

10. 3.SKELETAL FLUOROSIS
• Occurs from ingestion of very high amounts of fluoride
for long period of time
• 20-80 milligram fluoride/day for 10 to 20 years of period
causes skeletal fluorosis
• Severe pain in back bone,joints,hips,stiffnessin joints
and spine
• Outward bending of legs and hands is seen in advanced
stages
• can cause damage to foetus
• Leads to blood vessel obstruction causing cardiac
problems
• In its severe form crippling fluorosis,the spine become
rigid and joint stiffens,virtually immobilizing the patient

11. • CURRENT INCIDENCE
• Sources of fluoride
• Vitamins, dietary supplements, dental products (fluoridated
toothpastes or mouthwashes)
• More than 20,000 people are toxicated due to over ingestion of
fluoride
• 90% are young children
• 5% had minor symptom
• 2% were treated in healthcare facility
• a few cases with life-threatening symptoms and DEATH

12. DOSES
‘Fatal dose’ or ‘Minimum lethal dose’ is not established for fluoride
Exact doses were not precisely documented
Hodges and Smith (1965): ‘Certainly Lethal Dose’ (CLD)
Equivalent to LD100
Ingested dose that would be lethal to everyone if not treated
promptly
Based on case reports
Note: NaF has 45% fluoride by weight
CLD = 5-10 g of NaF for adult 70 kg bodyweight
= 32-64 mg F/kg

13. Threshold dose that could cause toxic signs and symptoms, including de
Not include chronic effect like fluorosis
‘Probable Toxic Dose’ (PTD):
PTD = 5 mg F/kg
PTD for 1-2 year old child = 50 mg F
PTD for 5-6 year old child = 100 mg F
PTD for adult, = 3000 mg F (3 g)

14. Amount of fluoride ingested less than PTD
Chronic effect (fluorosis)
PTD Acute toxicity
Recommendations for parents:
Child-proof containers
Keep products out of reach of young children
Supervise children when brushing / rinsing
Do not swallow toothpaste / mouthrinse
RECOMMENDATIONS
2 out of 3 deaths of children caused by fluoride in dental products
were from the ingestion of fluoride tablets.

15. Convulsion
Spasm of the
extremities
Generalized
weakness
Blood pressure drop
Cardiac arrhythmias
Respiratory acidosis
Extreme
disorientation
Coma
Death
Symptoms of fluoride toxicity
Low Dosage
Nausea
Vomiting
Abdominal pain
Diarrhea
Hypersalivation
Tears
Discharge from nose and mouth
Headache
High Dosage
Symptoms develop very fast, a few minutes after
ingestion
= low dosage symptom PLUS
Hypocalcemia
&
Hyperkalemia
May occur within
the first few hours

16. Can ingestion of fluoridated water
cause acute toxicity?
PTD (Probably Toxic Dose) = 5 mg/kg
Optimal fluoridation 1 ppm = 1 mg/LAcute toxicity from water fluoridation
Accidental over-fluoridation of school or community water supplies
Most were relatively minor
Alaska, 1992
150 ppm F in water supply
Almost 300 people had nausea, vomiting, abdominal pain, diarrhea
One death

17. Long term ingestion of low levels of fluoride
(e.g., 5 ppm in water for years)
1. Not detectable risks of cancer in humans
2. No indication that organ systems are affected
3. No association with birth defects, including Down’s
syndrome
4. Skeletal fluorosis: relatively high F intake > 10 years
5. Osteoporosis & bone fracture: Benefit or Harmful or None ?
6. Dental fluorosis increase: Cosmetic or Toxic ?
Critical reviews on risk of chronic fluoride
exposure

18. Reduce absorption
Treatment of Fluoride Toxicity
Need immediate treatment
Additional washing of stomach with lime water
IV fluid replacement
+ calcium gluconate : blood calcium level
+ sodium bicarbonate : urine flow rate & urinary pH
Other monitoring and supportive therapies
Generally, if death has not occurred in 1-2 days the prognosis is good.
Transfer to hospital (as soon as possible)
Induce vomiting immediately (providing no risk of aspiration)
Reduce bioavailability : 1% CaCl2
or calcium gluconate, milk
defluoridation

19. DEFLUORIDATION
• Defluoridation meansto improvethe quality of water with high fluoride
concentrationby adjustingthe optimallevel in drinking water
– Absorption and ion exchange method:-
exchange negativeions such OH
-
group for fluoride ionsdepends up on
P
H
, temperature, flow rate, grain size of the material
common used materials: activatedalumina,activatedbauxite,Zeolite,
Tricalciumphosphate,activatedbone char, magnesite, magnesite etc

20. CONCLUSION
• Fluoride can help prevent caries but at high intakes it can
harm tooth development (dental fluorosis) and bones
(skeletal fluorosis) there is a narrow range between intakes
which are detrimental.population consuming artificially
fluoridated drinking water or other products,such as
fluoridated paste develop fewer caries

21. Reference
- Essentials of Public Health
Dentistry ,5th
edition
- Textbook of Preventive and
Community Dentistry ,2nd
edition
THANK YOU !!!