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!