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Fluoride Toxicity

Fluoride toxicity can occur acutely or chronically. Acute toxicity results from rapid excessive ingestion and can cause gastrointestinal issues, cardiac or respiratory failure, and even death at high doses. Chronic toxicity occurs from long term ingestion of small amounts and can cause dental or skeletal fluorosis. Dental fluorosis causes enamel discoloration or pitting while skeletal fluorosis causes joint and bone pain and stiffness over many years of high fluoride intake. Management involves gastric emptying and calcium supplementation for acute cases or preventing excessive intake chronically.

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126 views

Fluoride Toxicity

Fluoride toxicity can occur acutely or chronically. Acute toxicity results from rapid excessive ingestion and can cause gastrointestinal issues, cardiac or respiratory failure, and even death at high doses. Chronic toxicity occurs from long term ingestion of small amounts and can cause dental or skeletal fluorosis. Dental fluorosis causes enamel discoloration or pitting while skeletal fluorosis causes joint and bone pain and stiffness over many years of high fluoride intake. Management involves gastric emptying and calcium supplementation for acute cases or preventing excessive intake chronically.

Uploaded by

Lilly Paul
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Fluoride Toxicity

• Fluoride is often called as a double edged sword as an expression


for anything that can simultaneously help and hinder

• There are 2 types of Fluoride toxicity


1. Acute toxicity
2. Chronic toxicity
Acute toxicity

• Acute Fluoride toxicity result from rapid excessive ingestion of


fluoride at one time.
• Fluoride + hydrogen-> hydrofluoric acid.
• Most frequently encounter adverse effect of topical fluoride
therapy is nausea.
• Other symptoms may be Abdominal cramps, Vomiting,
Diarrhea, Increased salivation, Dehydration and Thirst.
• Causes death by blocking normal cellular metabolism
• Death occurs as a result of cardiac failure or respiratory paralysis
• If first aid not administered fatality is possible
• If death has not occurred after 24hrs- Good prognosis

• Certainly lethal dose- 32- 64 mg/ kg body wt


• Safely tolerated dose- 8-16 mg/kg body wt
Management of fluoride toxicity
• Less than 5mg/kg
 Give calcium orally (milk) to relieve gastro-intestinal symptoms.
 Observe for few hours
 Induce vomiting (not necessary).
• More than 5mg/kg but less than 15mg/kg body weight
 Empty the stomach by inducing vomiting with emetic or gastric lavage is
performed after an endotracheal intubation
 Give orally soluble calcium in any form (milk, 5% calcium gluconate, or
calcium lactate solution)
 Admit to hospital and observe for a few hours.
• More than 15mg/kg
 Admit to hospital immediately
 Induce vomiting
 Begin cardiac monitoring.
 Slowly administer intravenously 10 ml of 10% calcium gluconate
solution. Additional doses may be given if clinical signs of tetany
develops. Electrolytes, especially calcium and potassium, should be
monitored.
 Adequate urine output should be maintained diuretics if necessary.
 General supportive measures for shock.
Chronic fluoride toxicity
• Results from long term ingestion of small amounts of fluoride.
• This may be scene as
 Dental fluorosis- When it affects teeth
Intake > 2 times the optimal
For a duration of 5yrs
 Skeletal fluorosis- When it affects our Skeletal frame
10- 25 mg/day
For a duration of 10-20 years
Dental fluorosis
• Caused due to intake of fluoride during tooth development.
• Fluorosis occurs symmetrically.
• Premolars are first affected followed by second molars maxillary
incisors.
• Though the these teeth may present with aesthetic issues they
are highly resistant to carious attack.
• Enamel fluorosis- developmental phenomenon
• Clinically may be seen as

Chalky lusterless opaque white patches in the enamel which may


become mottled striated or pitted.
Mottled areas may become stained yellow or brown.
Hypoplastic areas may also be present to such an extent in severe
cases that normal tooth form is lost.
Skeletal fluorosis

• Occurs due to ingestion of very high amounts of fluoride for a


long period.
• It may develop when water fluoride levels go beyond 8ppm or an
intake of 20 to 80 mg fluoride/ day for 10 – 20 years.
• Neurological manifestation are seen in very advanced cases.
• Clinical features may include,

Severe pain in the back bones, joints, hips, stiffness in joints and spine.
Knock knee syndrome - Outward bending of legs and hands is seen in
advanced stages and these parts loose their shape and contours.
 Pregnant lactating mothers and children- most vulnerable group.
Fluoride can also damage a foetus if the mother consumes excess
fluoride during pregnancy. Calcium fluoride seemed to be more toxic to
the foetus than sodium fluoride.
Fluoride may lead to blocking and calcification of blood vessels
causing cardiac problems.
 In its severest form, 'crippling fluorosis', the spine becomes rigid and
the joints stiffen, virtually immobilizing the .patient.
REFERENCE
• Soben Peter- ESSENTIALS OF PUBLIC HEALTHDENTISTRY-6th edition
• TOPIC – Toxicity of fluorides
• CHAPTER-Fluoride
• Published by Sudhir Kumar Arya
Thank you!

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