Skeletal fluorosis is caused by excessive fluoride intake over long periods of time. The main sources of fluoride are drinking water, tea, and indoor air pollution from burning coal. Fluoride is deposited in bones and teeth. At low levels it strengthens teeth and bones, but at high levels it leads to skeletal and dental fluorosis. Skeletal fluorosis causes bone and joint pain and stiffness, and if severe, bone deformities and crippling. It is a major public health problem affecting millions in India, China, and other parts of Asia and Africa. Reducing fluoride intake and ensuring adequate calcium and vitamin D can help prevent and treat skeletal fluorosis.
Systemic Diseases Manifested in the Jawsvahid199212
Systemic Diseases Manifestation the Jaws based on chapter25
Oral Radiology
P R I N C I P L E S
a n d I N T E R P R E T A T I O N Sixth Edition
White and pharoah
Systemic Diseases Manifested in the Jawsvahid199212
Systemic Diseases Manifestation the Jaws based on chapter25
Oral Radiology
P R I N C I P L E S
a n d I N T E R P R E T A T I O N Sixth Edition
White and pharoah
Indices de deán
Indices de deán:Normal
Indices de deán:cuestionable
Indices de deán:Muy leve
Indices de deán:Leve
Indices de deán:Moderado
Indices de deán:Severo
índices de fluorosis por superficie dentales
índices de fluorosis por superficie dentales0
índices de fluorosis por superficie dentales1
índices de fluorosis por superficie dentales2
índices de fluorosis por superficie dentales3
índices de fluorosis por superficie dentales4
índices de fluorosis por superficie dentales5
índices de fluorosis por superficie dentales6
índices de fluorosis por superficie dentales7
índices de fluorosis por superficie dentales8
índices de fluorosis por superficie dentales9
Fluorosis is a disease caused by the consumption
of excessive amounts of mineral fluorine for long
periods. Fluorine is essential for the development
and maintenance of normal bones and teeth.
However, if it is consumed in excessive amounts
it leads to fluorosis
In India, approximately 25 million people are
presently affected by fluorosis and 66 million
are at risk of developing fluorosis, including
children of age 14 years. India is situated in
the geographical fluoride belt and in areas
where fluoride content is high in rocks or soil,
leaching of fluoride occurs, causing excess
fluoride level in groundwater.
Endemic fluorosis is an important health
problem in some districts in the states of
Andhra Pradesh, Punjab, Karnataka, Tamil
Nadu, Jharkhand and Rajasthan
Fluorosis in India - Prevention and ControlAkash Dass
Fluorosis is a disease caused by the consumption of excessive amounts of mineral fluorine for long periods.
In India, approximately 25 million people are presently affected by fluorosis and 66 million are at risk of developing fluorosis, including children of age 14 years. India is situated in the geographical fluoride belt and in areas where fluoride content is high in rocks or soil, leaching of fluoride occurs, causing excess fluoride levels in groundwater.
History
Natural Sources Of Fluoride
Physiology and metabolism of fluoride
Fluoride in Dentistry
Control of dental caries
Fluoride toxicity
Dental fluorosis
Fluorosis indices
Water defluoridation
Conclusion
Effect of Magnesium on Fluoride RemovalIJRES Journal
Fluorides in drinking water are known for both beneficial and detrimental effects on health. The fact that the problems associated with the excess fluorides in drinking water is highly endemic and widespread in countries like India prompted many researchers to explore quite a good number of both organic and inorganic materials adopting various processes from coagulation, precipitation through adsorption, Ion exchange etc. for fluoride removal. Some are good under certain conditions while others are good in other conditions. Leaching of Fluoride from the earth crust is the chief source of fluoride content in ground water; however the other sources like food items also add to increase the overall ingestion of fluoride into the human body. The soil at foot of the mountains is particularly likely to be high in fluoride from the weather and leaching of bed rock with a fluoride. The present paper aims to encompass the work carried out by various researchers in various fluoride affected areas and to access the effectiveness of using magnesium for fluoride removal.\
Similar to Skeletal Fluorosis - a case report (20)
Chronic Recurrent Multifocal Osteomyelitis - a care report.pptxvinod naneria
Autoimmune chronic multifocal recurrent osteomyelitis , case report, Auto-inflammatory osteomyelitis in children, non-pyogenic osteomyelitis in both Tibia,
Conservative management of Lumbar disc prolapse.pptxvinod naneria
conservative management, non-surgical treatment of lumbar PID,
current concepts on Lumbar disc management, MRI correlation with neurological deficit in PID
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Fluorine
• Fluorine is the most abundant element in nature, and
about 96% of fluoride in the human body is found in
bones and teeth.
• Fluorine is essential for the normal mineralisation of
bones and formation of dental enamel?????
• The NRC estimates, for instance, that the biological
half-life of fluoride in bone (the time for half of it to be
removed) is as long as 20 years.
• The principal sources of fluorine was drinking water
and food such as sea fish, cheese and tea.
• The recommended level of fluoride in drinking water in
India is 0.5 to 0.8 mg/l
3. Common causes of fluorosis
• Consumption of fluoride from drinking water in
India.
• Ingestion of contaminated food grains by burning
coal as an indoor fuel source, a common practice
in China.
• Consumption of fluoride from the drinking of
poor-quality pu-erh tea (brick tea) is reported to
cause fluorosis in Tibet and China.
• Inhalation of fluoride dusts/fumes by workers in
Aluminium industry.
4. Fluorosis in China
• In China -burning coal with a non-chimney
stove → fluoride released in large quantity →
polluting indoor air → polluting stored crop
(mainly corn and chili) → ingestion into body
→ fluorosis.
5. Fluorosis - World
• Fluorosis is a public health problem in 24
countries, including India, which lies in the
geographical fluoride belt that extends from
Turkey to China and Japan through Iraq, Iran
and Afghanistan.
• Estimated total population consuming
drinking water containing elevated levels of
fluoride is over 66 million in India.
6. Five Global Belts
• Belt 1: Turkey, Syria, Jordan, Egypt, Sudan, Somali,
Ethiopia Kenya, Tanzania, Mozambique + South
Africa.
• Belt 2: Egypt , Libya , Algeria , Morocco , Western
Sahara, Mauritania.
• Belt 3: Turkey, Iraq, Iran, Afghanistan, Pakistan,
India, North Thailand, (parts of) China.
• Belt 4: Sierra Nevada, USA Rocky Mountain, Central
America, Colombia, Peru, Bolivia, Andes Mountains.
• Belt 5: Japan, Philippines, Volcanic Indonesia.
7.
8. Fluoride levels
• The safe level of fluoride is standardized to 0.5
mg/L and 1.0 mg/L, respectively as the
desirable and maximum allowable
concentrations in drinking water.
• The literature contains a wide range (0.008–
0.045 ppm) of reported normal plasma
fluoride concentrations.
9. Fluoride
• More than 90 % of the ingested fluoride is
absorbed from the gut.
• Approximately 50 % of the fluoride absorbed
is deposited in the bones and teeth. The
remaining is excreted in urine.
10. Fluoride
• About 99 % of the fluoride retained in the
body is stored in the
• mineralized bones and teeth on account of its
affinity for calcium phosphate. Its effects on
bones and teeth only are of clinical
importance influencing their mineralisation,
structure, functions and development.
• Fluoride ions are taken up rapidly by bone by
replacing hydroxyl ion in bone.
11. Fluoride
• Fluoride is a bone seeker and its incorporation
into hydroxyapatite, i.e. the spot wise
production of fluoroapatite, alters the size and
the structure of the bone crystals.
12. Fluoride
• The fluoroapatite crystals are larger in size; offer
less surface exchange, less soluble, more stable
and less reactive to the actions of parathyroid
hormone.
• The toxic effects are more severe in children with
growing bones, women with children with their
depleted bone and mineral reserves and in
labourers with excessive drinking of water that
can be up to 6 to 8 litres in summer.
13. Fluoride
• Continuous daily intake of 2.5 mg of fluoride
for more than 6 months deposits 4000-6000
mg/kg of fluoride and causes detectable
radiological changes of fluorosis. About 100
million people in India are affected and more
than 200 million are exposed to the risk of
developing endemic fluorosis.
14. mechanism of fluorosis
• The fluoride incorporation into the bone hydroxyapatite,
altering the size and structure of its crystals.
• The fluoroapatite formed decreases the mechanical
competence of the bone, resulting in abnormal structure
and poor quality of bone, with increased risks for fractures.
• Rickets, osteomalacia, secondary hyperparathyrodism and
regional osteoporosis are often associated with skeletal
fluorosis.
• The bone diseases and deformities are more severe and
complex in patients with dietary calcium and vitamin-D
deficiencies.
15. Fluorosis – Indian States
• 15 States in India are endemic for fluorosis
(fluoride level in drinking water >1.5 mg/l).
• Worst affected – Rajasthan, Gujarat, &
Andhra.
• Moderately affected - Punjab, Haryana,
Madhya Pradesh and Maharashtra.
• Mildly affected - Tamil Nadu, West Bengal,
Uttar Pradesh, Bihar and Assam.
16. Fluorosis is endemic in 20
states out of the 35 states.
70-100% districts are
affected in Andhra Pradesh,
Gujarat and Rajasthan.
40-70% districts are
affected in Bihar, New
Delhi, Haryana, Jharkhand,
Karnataka, Maharashtra,
Madhya Pradesh, Orissa,
Tamil Nadu and Uttar
Pradesh
10-40% districts are
affected in Assam, Jammu
& Kashmir, Kerala,
Chhattisgarh and West
Bengal.
17. Radiological features:
• The earliest radiological findings appear within six
mouths of continuous exposure to high intakes of
fluoride and include periosteal and endosteal
reactions, coarse axial trabcculations and osteopenia in
the metaphyseal regions, sclerosis, and modelling
abnormalities of the epiphyses, carpal and other bones
of the hand, more particularly observed in growing
children.
• The incidence of spinal osteoporosis is significantly low
and of osteomalacia and secondary hyperparathyroid
bone disease significantly higher in women residing in
endemic fluorosis villages.
18. Biochemical Markers:
• Plasma calcium, magnesium and phosphorus
remain normal,
• Alkaline phosphatase and fluoride levels are
elevated.
• Serum parathyroid hormone levels are always
raised as a compensatory mechanism to maintain
extracellular ionised calcium equilibrium
consequent to decreased solubility and reactivity
of fluoroapatite crystals, fluoride induced
osteomalacia and dietary calcium deficiency.
19. Biochemical Markers:
• Osteocalcin, Calcitonin and (1,25 (OH)2D3)
concentrations are increased or high normal.
• Pituitary, thyroid, adrenal and gonadal functions
remain unaltered and serum growth hormone
levels are variably increased.
• Twenty-four hour urinary excretions of fluoride
and of hydroxyproline are increased and of
calcium and magnesium are decreased or low
normal. Renal functions remain unaltered.
20. Bone scanning and densitometry
• 99mTC dl-phosphonate bone scanning revealed
nonspecific appearance of generalized increased tracer
uptake throughout the skeleton.
• Greater uptake is observed in axial skeleton with tie
sternum sign, patella sign and faint kidney images,
diagnostic of compensatory secondary
hyperparathyrodism with high bone turnover.
• The DXA bone densitometric measurements of lumber
spine (L1-L4) showed increased BMD 1.12 ± 0.04 g/cm2
in patients of endemic skeletal fluorosis as compared
to matched normal controls 0.78 ± 0.03 g/cm2.
21. Bone histopathology and
histomorphometry:
• Histopathological studies of undecalcified iliac
crest biopsies revealed poorly formed haversian
systems, disordered lamellar orientation of the
bone and the new bone formed is immature,
woven, amorphous and hypomineralized.
• There is an increase in bone surfaces lined with
wide osteoid seams associated with increased
bone re-sorption. These findings suggest
occurrence of osteomalacia with secondary
Hyperparathyroidism in patients with endemic
skeletal fluorosis.
22. Bone quality
• Bone quantity in skeletal fluorosis is increased at the
cost of bone quality, which increases the risk for
fracture.
• True fractures are extremely rare and occurred in less
1.5 percent of our cases.
• Pseudo-fractures appeared in more than 35% of the
patients with endemic skeletal fluorosis, more
particularly in women of child bearing age.
• The rare occurrence of true fractures and of spinal
osteoporosis may be due to associated osteomalacia
consequent to chronic exposure to fluoride.
23. Fluorosis, Goiter, & Renal Stones
• In the community with endemic fluorosis,
goiter and stone disease were practically non-
existent. In the community with endemic
goiter, fluorosis was non-existent and the
stone disease was sporadic. In the community
with endemic renal stone disease, the
prevalence of goiter was sporadic and
fluorosis was practically non-existent.
24. Fluorosis, Goiter, & Renal Stones
• A positive correlation existed between the
occurrence of stone disease, water hardness
and its calcium content. In endemic fluorosis
villages water analysis showed higher the
fluoride, higher the iodine, higher the
alkalinity and softer the water. In the areas
endemic for goitre lower the iodine and lower
was the fluoride in the drinking water.
25. Clinical recovery
• Clinical recovery occurred in more than 85%
with mild to moderate severity within 1-5
years after the exposure to fluoride is ceased
and treated with calcium and vitamin D.
• In severe cases clinical recovery was slow and
took 5-15 years for satisfactory clinical and
occupational recovery after the exposure to
fluoride is ceased and treated with calcium,
vitamin D and appropriate physiotherapy.
26. Clinical recovery
• The radiological reversibility in radiographs of the
pelvis, spine, chest and hands showed that the
trabecular sclerosis in all the films was slowly
reduced.
• The urine showed persistent increase in the
excretion of calcium. The cortical thickness and
sclerosis, calcifications of ligaments, muscular
attachments, tendons, capsules and of
interosseous membrane essentially remained
unchanged.
27. Reversibility
of ESF in 15
years old
girl 9
months
after
exposure to
fluoride is
ceased and
treated
with vit-D
and
calcium.
29. Reversibility of ESF in 18 years old boy 8 years after exposure
to fluoride is ceased and treated with vit-D and calcium.
(A) Before Treatment (B) After Treatment
30. Prevention
• The most illustrious and practical example is of Sri
Sathya Sai Project for the safe drinking water
supply, which has controlled fluorosis from more
than 1,000 villages in district Ananthpur of the
state of Andhra Pradesh, using deep bore water
technology.
• The use of more than 100 m deep bore water
supply is able to provide water with fluoride less
than 1mg/L, low alkalinity and normal or high
normal calcium contents and this could play a
master role in the control of endemic fluorosis.
31. Calcium and vitamin D supplements:
• Calcium is the strongest antagonist of fluoride toxicity. The
toxic effects of fluoride on bones and teeth are more
severe and complex in dietary calcium deficiency states.
• Calcium deficiency and fluoride interaction syndrome of
bone disease and deformities are more severe and complex
in growing children, adolescents, pregnant and lactating
mothers, because of the greater demands for calcium in
these groups.
• Adequate intakes of calcium to maintain the positive
calcium balance to counteract the toxic effects of fluoride is
therefore essential for the population residing in endemic
fluorosis villages.
32. Dental Fluorosis
• There is no conclusive evidence proving that
fluoride is an essential nutrient for human
health.
• The widely propagated dental caries
protection effect of fluoride is erroneous and
has not been supported by long-term control
double blind scientific investigations on a large
cross-section of population.
33. Dental Fluorosis
• The decline in the incidence of dental caries in
fluoridated areas, in fact has resulted due to
simultaneously increased dental health
facilities, increasing number of dental clinics
and hospitals, besides education and rising
community awareness on 1) oral health and
hygiene, 2) calcium and vitamin D nutrition,
and 3) the deleterious effects of excess
consumption of the sugary and starchy foods
on dental health.
34. Dental Fluorosis
• Tooth enamel is principally made up of
hydroxyapatite (87%) which is crystalline calcium
phosphate.
• Fluoride which is more stable than
hydroxyapatite displaces the hydroxide ions from
hydroxyapatite to form fluoroapatite.
• Fluorosis of dental enamel occurs when excess
Fluoride is ingested during the years of tooth
calcification-essentially during the first 7 years of
life.
35. Dental Fluorosis
• 1890 - "Tanagra", first Calcium Fluoride
containing toothpaste, sold by Karl F. Toellner
Company, of Bremen, Germany.
• Fluoride toothpastes developed in the 1950s
received the ADA's approval.
• In 1955, Procter & Gamble's Crest launched its
first clinically proven fluoride-containing
toothpaste.
36. Children under 6 years of age should have adult supervision.
Use only a pea sized amount.
Do not swallow.
Directions for use in children
37. Dental Fluorosis
• It is characterised by mottling of dental enamel, which
has been reported at levels above 1.5 mg/L intake.
• On prolonged continuation of this process the teeth
become hard and brittle.
• Dental fluorosis in the initial stages results in the tooth
becoming coloured from yellow to brown to black.
• Depending upon the severity, it may be only
discolouration of the teeth or formation of pits in the
teeth. The colouration on the teeth may be in the form
of spots or as streaks.
40. Skeletal Fluorosis
• Exposure to very high fluoride over a
prolonged period of time results in acute to
chronic skeletal fluorosis.
• Crippling skeletal fluorosis might occur in
people who have ingested 10 to 20 mg of
fluoride per day for over 10 to 20 years.
41. Skeletal Fluorosis
• Early stages of skeletal fluorosis start with pain
in bones and joints, muscle weakness,
sporadic pain, stiffness of joints and chronic
fatigue.
• During later stages, calcification of the bones
takes place, osteoporosis in long bones, and
symptoms of osteosclerosis where the bones
become denser and develop abnormal
crystalline structure.
42. Skeletal Fluorosis
• In the advanced stage the bones and joints
become completely weak and moving them is
difficult.
• The vertebrae in the spine fuse together and the
patient is left crippled which is the final stage.
• Neurological symptoms developed in the form of
radiculopathy or myelopathy due to mechanical
compression of the spinal card any multiple level.
43. Severity classification of skeletal fluorosis by Teotia et al:
Mild:
Clinical: Generalised bone and joint pains. Radiology: Only osteosclerosis.
Moderate:
Clinical: As above + Stiffness, rigidity and restricted movements at spine and
joints. Radiology: As above + Periosteal bone formation, dense cortex, loss of
trabecular pattern, calcifications of interosseous membrane and ligaments.
Severe:
Clinical: As above + Flexion deformities at spine and joints (hips, knees, elbows,
hands), features of metabolic bone disease. Radilogy: As above +
Osteophytosis, exostoses, Calcification of muscular attachments, tenons and
capsules.
Very Severe:
Clinical: As above + Crippling deformities, neurological complications (radicular
pains, muscle wasting, compression rediculo-myelopathy at cervical and
lumbar regions, paraplegia, quadriplegia) and bed-ridden state.
Radiology: As above + Metabolic bone disease (osteomalacia, pseudofractures,
osteoporosis, hyperparathyroid bone disease), Calcification of neural arch and
narrowing of spinal canal and intervertebral foramina.
44. Drinking water - fluorination
• More than 150 million people in the U.S. drink
fluoridated water.
• 50 cities or towns in USA have withdrawn
fluoride from supplies since 1990.
• Their legal limit, of four parts per million - is
four times our legal limit.
45. Drinking Water - Fluorination Banned
• Fewer than 2 per cent of Europe's population
have fluoridated water. Last year the Belgian
government outlawed the sale of fluoride tablets
and chewing gum.
• This was based on fears that it might increase the
risk of osteoporosis.
• France, Italy, Germany, Sweden, Denmark and
Holland have also rejected mass water
fluoridation.
• There has also been mounting opposition to it in
Ireland.
46. Fluoridation Linked To:
• Dental Fluorosis: Almost half of people drinking
fluoridated water at permissible levels, one part
per million, exhibit dental fluorosis. White and
brown spots appear on the enamel of the teeth -
causing an unsightly 'mottled' effect.
• This is the first sign that fluoride has poisoned
enzymes in the body. Some dentists
understandably question the wisdom of
preventing dental disease in one in six people,
only to cause it in one in two.
47. Fluoridation Linked To:
• Skeletal Fluorosis: - symptoms include pains in the
bones and joints, muscle weakness and gastrointestinal
disorders - may occur in people who have ingested 10-
20mg of fluoride per day for 10 to 20 years (equivalent
to 2.5-5 mg per day for 40-80 years). In the most
severe cases, the spine becomes completely rigid.
• Osteoporosis: Although fluoride exposure results in
denser bones, the bone appears to be weaker than
normal bone. Scientists in America have reported that
fluoride in strengths as little as 1 part per million
decreases bone strength and elasticity.
48. Fluoridation Linked To:
• 1992, a study of elderly patients in Utah found 'a small but
significant increase' in the risk of hip fracture in both men and
women.
• 1992, a study by the New Jersey Department of Health in the U.S.
found a strong link between fluoridation and osteosarcoma in
young males. They reported that osteosarcoma rates were three to
seven times higher in fluoridated areas than non-fluoridated areas.
• This disease is routinely found to be more common in males than in
females due to it’s interfere with the testosterone.
• Kidney Stones: 4.6 times more common in an area with high
fluoride (3.5 to 4.9 ppm) than in a similar area without high
fluoride.
• Moreover, in the high fluoride area, the prevalence of kidney stones
'was almost double in subjects with fluorosis than without
fluorosis‘.
49. Case report
• A 45 female from Kota Rajasthan.
• Obese, Peri-menopausal, Hypothyroid, &
Hypertensive.
• C/o – chronic backache for last 2 years,
cramps, leg pains, parasthesia Rt > lt.
• Claudication distance about 10 meters, can
stand for 5 minutes.
• No bladder problem.
50. Case report – cont….
• On Exam – Spinal movements were limited.
• SLRT – negative.
• Hips, Knees, and Ankle movements normal.
• All deep jerks were brisk.
• Planter reflex equivocal.
• Can stand and walk on heels and toes.
• Referred to Neurologist for possible
myelopathy.
51. Case report – cont….
• X-ray of Chest.
• X- Both fore arms - AP
• MRI of Dorsal and Lumbar Spine.
• CBC, serum Creatinine, TSH, PTH, Ca, Alk Po4,
Urine routine.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62. Treatment
• Calcium.
• Vitamin D.
• Vitamin C.
• Use of tape water/ river water, deep well.
• Use of water filter.
• Physiotherapy
• Continuous follow ups.
63. DISCLAIMER
• Information contained and transmitted by this presentation is
based on personal experience and collection of cases at Choithram
Hospital & Research centre, Indore, India.
• Some representative x-rays & text have taken from an article
“Highlights of Forty Years of Research on Endemic Skeletal
Fluorosis in India - S P S Teotia *, M Teotia and K P Singh, India.
• It is intended for use only by the students of orthopaedic surgery.
Views and opinion expressed in this presentation are personal
opinion. Depending upon the x-rays and clinical presentations
viewers can make their own opinion. For any confusion please
contact the sole author for clarification. Every body is allowed to
copy or download and use the material best suited to him. I am not
responsible for any controversies arise out of this presentation. For
any correction or suggestion please contact naneria@yahoo.com