Image Diagnosis: Dental and Skeletal Fluorosis

Abstract

A 45-year-old man presented to the Department of Medicine at our institution with 1 year of noninflammatory pain in multiple joints. The pain had begun in both knee joints, followed by low-back ache and neck, wrist, and foot pain. There was no associated fever or swelling of any joint. The patient did not report any history of addiction or illness but did report using fluoridated toothpaste. The patient also lived in a region of India where the problem of fluorosis is endemic. On examination, we found his teeth had brown strains and rough, pitted enamel ( Figure 1). There was diffuse tenderness at the cervical spine, the lumbosacral spine, and elbow, wrist, knee, and ankle joints. There was no swelling or restriction of movement in any of these areas. There were no neurologic deficits, and the rest of the physical examination was normal. X-ray scans showed osteosclerosis of the knee (Figure 2), ankle, wrist, pelvis, and vertebral column, and calcification of the sacrotuberous ligament (Figure 3) and the posterior longitudinal ligament (Figure 4). Twenty-four-hour urinary fluoride levels were elevated (18 ppm). The patient was advised to avoid fluoridated water, fluoridated toothpaste, and foods containing fluoride. He was kept under close follow-up and was educated about the potential development of neurologic symptoms and signs.Nishtha Gupta, MDS, is a Student in the

The Effects of Calcium, Magnesium, Phosphorus, Fluoride, and Lead on Bone Tissue

“…There is also a widening of and an increase in the porosity of the cortical layer, and increased periosteal activity [ 123 ]. Excessive fluoride intake may disturb bone turnover, thus affecting the differentiation of osteoblasts and osteoclasts, and induce the development of bone changes [ 124 , 125 ]. This ultimately results in an imbalance between bone formation and bone resorption [ 111 , 126 , 127 ].…”

Skeletal Fluorosis With Thoracic Myelopathy: A Report of 2 Cases

“…5,6 In the skeletal system, chronic fluoride ingestion causes skeletal fluorosis, which results in osteosclerosis, degenerative joint changes, and ligament calcification. 7,8,9 It causes a substitution of the hydroxyl group in hydroxyapatite and leads to fluorapatite formation. 10 The resultant fluorapatite is resistant to the resorptive effect of parathyroid hormone.…”

An Innovative Investigation on the Clinical, Radiological, and Biochemical Alterations in Various Degrees of Dental Fluorosis with and without Periodontitis

“…(Singh A [13] , Karakala S [14] , Gupta N [15] , Mithal A [17] , Wang [18] ). There is no consistent reporting of radiological features of skeletal uorosis due to several variables involved in causing skeletal uorosis.…”