fluoride toxicity
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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 !!!