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Fluorosis

WHAT IS SKELETAL FLUOROSIS?

Skeletal Fluorosis (SF) is defined as the skeletal changes as a result of long term ingestion of excessive fluoride, including hyperostosis (excessive bone growth), osteopetrosis (increased bone density), and osteoporosis (increase brittleness in bone). [Miller-Keane Encyclopaedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition.]

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One of the greatest challenges in diagnosing and managing Skeletal Fluorosis is the varying degrees of presentation.

In its most extreme case, SF is marked by radiographic findings, limitation of joint movement, calcification of ligaments of neck vertebral column, crippling deformities of the spine and major joints, muscle wasting, and neurological defects/compression of spinal cord.

There are also more moderate presentations:

Pre-clinical: Asymptomatic, slight radiographically-detectable increases in bone mass

Phase I: Sporadic pain, stiffness of joints, osteosclerosis of pelvis and vertebral spine

Phase II: Chronic joint pain, arthritic symptoms, slight calcification of ligaments, increased osteosclerosis and cancellous bones, with/without osteoporosis of long bones

While it is clear that excessive fluoride intake either by way of ingestion or dermal absorption can lead to Phase III or crippling SF, what is less clear is what levels are responsible for the 1st 3 stages of SF.

HOW RARE IS SF?

Crippling SF is extremely rare.