FLUORIDE TOXICITY

NOBEL MEDICAL COLLEGE TEACHINGHOSPITAL AND RESEARCH CENTER

SUBMITTED BY SUBMITTED TO,MAHESH SHRESTHA, ROLL NO:52 DEPARTMENT OF COMMUNITY DENTISTRY

3RD YEAR BDS

PREVENTIVE AND COMMUNITY DENTISTRY

FLUORIDE TOXICITY

NOBEL MEDICAL COLLEGE TEACHINGHOSPITAL AND RESEARCH CENTER

SUBMITTED BY SUBMITTED TO,MAHESH SHRESTHA, ROLL NO:52 DEPARTMENT OF COMMUNITY DENTISTRY

3RD YEAR BDS

Fluoride Toxicity

Warnings keep out of the reach of children under 6 years of ageIf more than used for brushing is accidentally swallowed,Get medical help or contact a poison control center right away.

SUBMITTED BY MAHESH SHRESTHA 52

CONTENTS

1. Introduction to fluoride toxicity

2. Objectives3. Fluorosis4. Historical perspective5. Current incidence 6. Doses7. Symptoms8. Treatment 9. Defluoridation 10. conclusion

FLUORIDE TOXICITY

Fluoride is often called as double edged sword.Less ingestion of fluoride and excessive intake of Fluoride can lead to dental and skeletal fluorosis which is called as fluoride toxicity

TYPES

1.ACUTE FLUORIDE TOXICITY

2.CHRONIC FLUORIDE TOXICITY

3.SKELETAL FLUORIDE TOXICITY

OBJECTIVES:

• Acute and chronic fluoride toxicity

• Appropriate use of fluoride products

• Optimal and toxic level of fluoride intake

• Recommendation and treatment of fluoride toxicity

• Acute fluoride toxicity result from rapid excessive ingestion of fluoride at one time

• Symptoms• Abdominal cramps • diarrhoea• Vomiting • Increased salivation• Dehydration and thirst

1.ACUTE FLUORIDE TOXICITY

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,striated or pitted• Mottled areas may become stained yellow or brown• Hypoplastic area also present

CHRONIC TOXICITY

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

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,stiffness in 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

• 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

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

Threshold dose that could cause toxic signs and symptoms, including death

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)

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.

Convulsion

Spasm of the

extremities

Generalized

weakness

Blood pressure drop

Cardiac arrhythmias

Respiratory acidosis

Extreme

Symptoms of fluoride toxicity

= low dosage symptom PLUS

May occur within the first few hours

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

Hypocalcemia &

Hyperkalemia

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

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

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

DEFLUORIDATION

• Defluoridation means to improve the quality of water with high fluoride

concentration by adjusting the optimal level in drinking water

– Absorption and ion exchange method:-

exchange negative ions such OH- group for fluoride ions depends up on

PH, temperature, flow rate, grain size of the material

common used materials: activated alumina, activated bauxite, Zeolite,

Tricalcium phosphate, activated bone char, magnesite, magnesite etc

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

Reference

- Essentials of Public Health Dentistry ,5th edition

- Textbook of Preventive and Community Dentistry ,2nd edition

THANK YOU !!!