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Fluorosis is a chronic metabolic bone disease caused by excessive ingestion of fluoride, leading to skeletal and dental changes.
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- Endemic in regions with high fluoride content in drinking water (>1.5–2 ppm).
- Common in India (Andhra Pradesh, Rajasthan, Assam, Odisha), China, parts of Africa.
Etiopathology
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- Normal fluoride intake: 0.5–1 mg/day is beneficial for teeth and bones.
- Excess intake: >3–5 mg/day → deposition of fluoride in bone and teeth.
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Sources:
- Drinking water (most important).
- Groundwater contamination.
- Tea, brick kilns, fertilizers, industrial exposure.
Pathogenesis:
- Fluoride replaces hydroxyl groups in hydroxyapatite → fluorapatite.
- Leads to increased bone density, osteosclerosis, ligament calcification, and joint stiffness.
(a) Fluorosis thoracic cage, (b) Fluorosis specimen - Interosseous muscular attachments.
Kakarla S. Musculoskeletal fluorosis – imaging spectrum. J Med Sci Res 2013; 1(3): 117-123. http://dx.doi.org/10.17727/JMSR.2013/1-021
Clinical features
- Dental fluorosis (earliest, in children exposed during tooth formation):
- Chalky white patches → brown discoloration, pitting, enamel hypoplasia.
- Skeletal fluorosis:
- Chronic joint pain, stiffness, restricted movement.
- Deformities: kyphosis, genu valgum.
- Neurological complications (spinal cord compression due to ligamentous calcification).
- Usually affects adults after long-term exposure.
Radiology