Lindsey Smith

03/08/09
Fluoride: Friend or Foe?
Introduction:
Fluoride is an element added to municipal drinking water for the protection of teeth from dental
carries (1). Fluoride, calcium, and phosphate bind together to form fluorohydroxyapatite, which hardens
tooth enamel and stabilizes bone mineral (2). Dental fluorosis is caused by excessive consumption of
fluoride during tooth development over an extended period of time, which results in over-mineralization
of the teeth (1). Skeletal fluorosis is a condition of excessive fluoride consumption which results in joint
pain, extremity tingling and numbness, back pain, kyphosis, gastrointestinal disturbances, and in severe
cases knock-knees (3). Fluoride appears to stimulate new bone formation as well as hardening bones so
many of these ailments are due to osteosclerosis (dense bone) (2).

Objective:
To study the relationship between dental caries, degree of dental fluorosis and skeletal fluorosis,
and the effect of concentration levels on all.

Materials and Methods:

One hundred and three patients with skeletal fluorosis ages 20-80 who lived in three different
parts of India (with differing concentrations of fluoride) and were exposed to fluoride in drinking water
over a 15 year period were examined in a study (3). In another study, two hundred eighty two children
who lived in three different areas of Africa with differing concentrations of fluoride, ages 10-15 were
examined for dental disorders. These children lived continuously in the same area since birth and received
no dental care or additional fluoride therapy (1).

Results:
Skeletal fluorosis is higher in ages 30-60 and lower in ages 70-80 and is also higher in men than
in women (3). Skeletal fluorosis is correlated with income, with the low income class having the highest
rate of skeletal fluorosis and vice versa (3). The prevalence of dental fluorosis was ~50 % in the low and
midrange fluoride areas and 95% in the high fluoride area. Severe fluorosis was only observed in the high
fluoride area (~30% of sample) except for one individual in the midrange fluoride area (1). A high
incidence of dental caries was observed in the high fluoride area compared with the lower fluoride areas
(1).

Summary and Discussion:

The research on fluoride intake proves that in excess, fluoride intake results in dental fluorosis
and dental caries regardless of gender (1). It also results in skeletal fluorosis (3). Skeletal fluorosis and
symptom appearance is significantly higher among males and those with a lower socioeconomic status.
The African climate has a high average daily temperature which leads to higher intake of fluoridated
water (3). Frequency of dental caries increased in teeth with moderate and severe fluorosis and also with
age (1). It is evident that too much fluoride consumption negatively affects normal teeth and bone
development.

References
1. Grobler, S. R., Louw, A. J., van W. Kotze, T.J. (2001) Dental Fluorosis and Caries Experience
in Relation to Three Different Drinking Water Fluoride Levels in South Africa: International
Journal of Paediatric Dentistry. 11:5. 372-379.

2. Gropper, Sareen S., Smith, Jack, L., Groff, James L.. Advanced Nutrition and Nutrient
Metabolism. (529-532). Wadsworth-Cengage Learning. 2009.

3. Shashi, A., Kumar M., Bhardwaj M. (2008) Incidence of Skeletal Deformities in Endemic
Fluorosis: Tropical Doctor. 38: 231-233.