Cases Of Fluorosis Research Articles

The Global Challenge of Fluoride Contamination: A Comprehensive Review of Removal Processes and Implications for Human Health and Ecosystems

Water resources are vital for humanity, but their quality has degraded in recent years due to increasing industrial activities. One significant issue is fluoride contamination, prevalent worldwide. Fluorides exist in combined states such as calcium fluoride, fluorapatite, and cryolite, originating from industrial processes like aluminum and fertilizer manufacturing. The World Health Organization warns against fluoride levels above 1.5 mg/L in drinking water due to health risks, including dental and skeletal fluorosis. Industrial activities also release fluoride-containing wastes into the environment, endangering ecosystems and human health. Overexposure to fluoride leads to disorders affecting organs including the kidneys, liver, and nervous system. Despite fluoride’s benefits in controlled doses, excessive intake causes health problems, as evidenced by rising dental fluorosis cases in Brazil. Thus, effective and affordable fluoride removal strategies are crucial. Various methods exist, including adsorption, membrane technology, ion exchange process, electrodialysis, and electrocoagulation. Regulation of fluoride levels in drinking water is imperative to safeguard public health from its detrimental long-term effects.

Comparison of case-based and lecture-based learning in dental fluorosis diagnostic ability with visual analog scale assessment

ObjectiveThis study aimed to compare the impact of case-based learning (CBL) versus lecture-based learning (LBL) on dental students' clinical decision-making regarding DF severity using Visual Analog Scale (VAS) scoring.MethodsEighty first-year graduate dental students were randomly assigned to either the CBL (n = 38) or LBL (n = 42) groups. Both groups received instruction on DF diagnosis, with CBL involving small group sessions analyzing real cases and LBL involving traditional lectures. Effectiveness was assessed by presenting 32 dental fluorosis cases with Thylstrup-Fejerskov Index (TSIF) scores ranging from 0 to 7 through slide presentations to both groups for VAS assessment. Five evaluators of each group randomly selected were asked to repeat the rating 2 weeks later. Statistical analysis included two-way ANOVA for group and gender differences, intra-class correlation coefficient (ICC) for reliability, and Spearman correlation coefficients for validity.ResultsVariations in VAS scores were observed between CBL and LBL groups, with no significant gender impact. Excellent inter- and intra-evaluator agreement was found for VAS scoring in both groups, indicating its reliability. Validation against established indices (such as DI and TSIF) demonstrated strong correlations, with CBL students exhibiting higher correlations.ConclusionsCBL enhances students' clinical decision-making and proficiency in DF diagnosis, as evidenced by more consistent and accurate VAS scoring compared to LBL. These findings highlight the importance of innovative educational strategies in dental curricula, with implications for improving training quality and clinical outcomes.Trial registration: The study was registered at the Clinical Research Center, Hospital of Stomatology, Wuhan University (Registration code: HGGC-036).

Prevalence of Skeletal Fluorosis in Northern Tanzania: A Follow-Up Study.

Skeletal fluorosis is a metabolic bone disease caused by excessive exposure to fluoride, predominantly through contamination of drinking water. This study aimed to identify all cases of skeletal fluorosis in Tindigani village situated in Northern Tanzania. This was done following changes in drinking water sources after a previous prevalence study in 2009 in this population. In a door-to-door cross-sectional study of Tindigani village, a sample of residents was assessed for skeletal fluorosis and dental fluorosis. Diagnosis of skeletal fluorosis was based on pre-defined angles of deformity of the lower limbs. Dental fluorosis was diagnosed and graded using the Thylstrup and Fejerskov Index. Samples from current drinking water sources underwent fluoride analysis. Tindigani village had a population of 1,944 individuals. Of the 1,532 individuals who were screened, 45 had skeletal fluorosis, giving a prevalence of 3.3% (95% CI=2.4, 4.3). Dental fluorosis was present in 82.5% of those examined (95% CI=79.8, 85.3). Dental fluorosis was present in all individuals with skeletal fluorosis and at higher grades than in the rest of the population. Drinking water samples were collected from 28 sources. These included piped, surface, well, and borehole water sources. Fluoride concentrations ranged from 0.45-38.59 mg/L of fluoride. Skeletal fluorosis is an ongoing but preventable health problem in the current population. The delivery of sustainable low fluoride piped water to this community would be of clear health benefit. This has been addressed at a local level.

Empowering Beautiful Smiles - a Case of Digital Smile Designing with Resin Infiltration

Dental fluorosis, especially if present in moderate to severe grades, can render an unaesthetic appearance to the dentition. An esthetic makeover creates a smile where the stomatognathic structures function with no hindrance to each other, a perfectly balancing orofacial structure reciprocates each other. With the advent of Digital Smile Designing, the outcome and predictability of the treatment is significantly enhanced. The present case report describes one such case of dental fluorosis treated with a multidisciplinary approach using Digital Smile Designing and resin infiltration.

Two cases of skeletal fluorosis from the historic cemetery at Zhangwan, Henan Province, China

AbstractSkeletal fluorosis is a systemic chronic disease caused by long‐term intake of excessive fluoride, which accumulates in bone tissue and causes changes to the bone and periosteal tissue. Skeletal fluorosis is rarely considered in paleopathological analyses, but in areas with relatively high fluoride in the environment, it may be an important cause of bone hyperplasia. In this study, we observed pathological lesions consistent with fluorosis on two human skeletons from the Ming Dynasty (1368–1644 CE) excavated from a cemetery in western Henan Province. By using an electron microprobe to measure the fluoride content in the teeth, and by considering the living conditions in the area during the Ming Dynasty, we conclude that the remains show evidence of skeletal fluorosis. We also consider the content of fluoride in the local groundwater, the local way of life, and other factors, to identify potential causes of skeletal fluorosis in this population and demonstrate that environmental factors were the main cause. This offers insight into the relationship between humans and their environments in China, especially western Henan Province, in the historical past. It also demonstrates the unique contributions bioarchaeology can make to environmental health studies and studies of the history of health.

Fluoride in groundwater of industrial town of Sonbhadra district, Uttar Pradesh, India: probable release mechanism and potential health risk assessment.

In the selected study region of Sonbhadra district, coal burning and mining activities are dominant. Previous studies reported F contamination in very few groundwater samples of this region. A detailed study is required to estimate the fluoride in groundwater of this area. Hence, a total of 128 groundwater samples were collected during post- and pre-monsoon seasons in the year 2017 to estimate the F-, its geochemistry, and health risk assessment from Renukoot and Anpara industrial clusters of Sonbhadra district, Uttar Pradesh, India. The pH of groundwater samples varied from slightly acidic to alkaline during both seasons. Almost all the major cations (Ca2+, Mg2+, Na+, and K+) and major anions (HCO3-, Cl-, SO42-, and F-) values in groundwater samples of both clusters were found within the permissible limit of World Health Organization (WHO) and Beauro of Indian standards except F- in both seasons. The scatter plots of F- with Ca2+, Na+, HCO3-, and pH are used to explain the release mechanism of fluoride in groundwater. Saturation indices (SI) calcite versus SI fluorite and SI dolomite versus SI fluorite plots of both clusters used to check the involvement of these minerals in fluoride enrichment of aquifers. F- contamination in groundwater due to coal burning in coal mining and thermal power plant dominated region is discussed globally and locally both. The non-carcinogenic health risk due to consumption of fluoride-contaminated water is estimated by using target hazard quotient (THQ). THQ values of F- showed that children are at high risk than adults in both clusters of the study area during both seasons. Pictorial representation is used to show the dental fluorosis cases in children of the study region.

Managing dental fluorosis: A guide to improving appearance of the teeth

Too much consumption of fluoride during tooth formation causes the disorder known as dental fluorosis, leading to changes in their appearance and structure. The severity of dental fluorosis is typically classified into different stages based on the visual appearance of the teeth. Mild cases of dental fluorosis may not require any treatment, and the condition may improve over time as the enamel continues to mineralize. In more severe cases, treatment options include teeth whitening, dental bonding, veneers, and crowns. While treatment can improve the appearance of the teeth, it cannot reverse the damage that has already occurred to the enamel surface. Therefore, it is important to take steps to prevent further damage by monitoring fluoride intake and practicing good oral hygiene. Regular dental checkups and cleanings can also help to identify and manage any issues related to dental fluorosis. Overall, dental fluorosis is a cosmetic issue which has got nothing to do with functional changes related to a tooth and appropriate treatment can help to improve the appearance of the affected teeth. In this article we will see various aspects of dealing with dental fluorosis right from its etiology to management.

The Protective Effect of Breastfeeding on Dental Fluorosis Among Children in Rural Fluoride-Endemic Areas.

Background: Living in fluoride-endemic areas and the inevitable use of groundwater for consumption have imposed children at high risk of dental fluorosis. To mitigate exposure to excessive fluoride at age of developing dentition, breastfeeding might serve as a natural public health intervention against dental fluorosis in that socially disadvantaged context. Objective: This study aimed to evaluate the preventive effect of breastfeeding against dental fluorosis in children living in fluoride-endemic areas in Nakhon Pathom Province, Thailand. Evaluation of the association through several epidemiological models depicted by a directed acyclic graph (DAG) was undertaken. Methods: A case-control study of 127 cases of dental fluorosis and 85 controls was conducted. Independent factor of breastfeeding, along with other past exposure variables, were traced backwardly since infancy by caregiver history taking. Fluoride concentrations in groundwater utilized for household supply matching to residence and number of years by age of each child were collected from 2008 to 2015. Multivariable Poisson regression with robust standard errors was sequentially executed to estimate prevalence ratio (PR) according to models in DAG. Results: Breastfeeding was significantly higher (95.3%) among controls compared to cases (84.2%), p = 0.014. Contrastingly, prevalence of using toothpaste larger than pea-sized and having fluoride ≥1.5 ppm in household water supply was higher among cases. Univariable and subsequent five multivariable regression models according to DAG consistently unveiled significant protective effect of breastfeeding on dental fluorosis with PR ranging from 0.66 to 0.75. Conclusions: Breastfeeding for at least 6 months had preventive effect against dental fluorosis among children living in fluoride-endemic areas.

Association between polymorphism and haplotype of ATP2B1 gene and skeletal fluorosis in Han population

ABSTRACT To evaluate the association between ATP2B1 gene polymorphisms and skeletal fluorosis, a cross-sectional study was conducted. In China, 962 individuals were recruited, including 342 cases of skeletal fluorosis. Four TP2BA1 polymorphisms (rs2070759, rs12817819, rs17249754, and rs7136259) were analysed. The results suggested that rs17249754 and rs7136259 were associated with skeletal fluorosis. After controlling confounders, the protective effect of GG genotype in rs17249754 was apparent in individuals over 45 years old, female, with urine fluoride concentration below 1.6 mg/L, serum calcium above 2.25 mmol/L or serum phosphorus between 1.1 and 1.3. Heterozygote TC in rs7136259 increased the risk of skeletal fluorosis in subjects who are elderly, female, with urinary fluoride more than 1.6 mg/L, serum calcium more than 2.25 mmol/L and blood phosphorus between 1.1 and 1.3 mmol/L. Four loci were found to be tightly related by linkage disequilibrium analysis, and the frequency of distribution of haplotype GCGT was lower in the skeletal fluorosis group.

Aesthetic Conservative Management of Fluorosis Affected Teeth with Resin Infiltration: Case Report

Aims: The scientific case report aims to show recent technique of minimally invasive procedure for aesthetic resolution in moderate to severe fluorosis affected teeth.
 Presentation of Case: A clinical case of severe fluorosis was treated with microabrasion followed by resin infiltration. A commercial resin was applied on the facial surfaces of the anterior teeth resulting in masking of spots and re-establishing color uniformity.
 Discussion: The procedure proved to be a good option to mask spots associated with moderate to severe fluorosis. Moreover, it is a relatively quick, inexpensive and minimally invasive treatment.
 Conclusion: This case report demonstrates that the microabrasion and resin infiltration technique is an effective conservative aesthetic treatment. It minimizes an individual’s tooth discoloration when diagnosed with moderate to severe levels of dental fluorosis and has shown a good outcome even after twelve months.

Enhanced fluoride removal from groundwater using red and white kaolinite lithomarge to develop a low cost eco-friendly defluoridation unit in rural areas of Shilabati river basin, West Bengal

Fluoride is an anionic pollutant found in high concentrations (>2 mg/l) in the Shilabati river basin of West Bengal, India, which has reported numerous serious cases of skeletal fluorosis and bone deformation in recent years. This study investigated fluoride adsorption on kaolinite lithomarge (red and white laterite) from Paschim Medinapore (West Bengal, India), exploring both kinetic and equilibrium facets with a series of batch tests and a fixed bed column study using natural water. Based on the X-ray Powder Diffraction analysis, Alpha SiO2 with trigonal structure and Alpha Al2O3 with hexagonal structure of this natural adsorbent played a critical role in fluoride absorption mechanism. Experimental results showed that based on pH values relevant to the fluoride enriched groundwater, kaolinite lithomarge of red type was the most efficient having an effective removal efficiency (98.32 %) at pH 6.58 whereas the white type demonstrated the highest removal efficacy of 95.31 % at pH 6.51. The modelled breakthrough curves were obtained, and they were in good accordance with the corresponding experimental data. Finally, water samples were collected from 11 sites from the fluoride contaminated zone within the river basin and natural groundwater was filtered using kaolinite lithomarge of red type obtaining a removal capacity of 97.13 % within 30 min, for the initial concentration of 2.37 mg/l. The prototype tested in the laboratory showed promising contaminant removal as a low-cost, time saving, natural filtration option supplying a liter of fluoride free water for 0.0015 USD.

Aesthetic Rehabilitation of Fluorosed Teeth with Indirect Laminate Veneers- A Case Report

Dental fluorosis is a condition caused by chronic ingestion of excess fluoride during tooth enamel formation. This induces subsurface porosities to varying extents depending on the severity of fluorosis. Such patients consult dentist mainly for aesthetic reasons. Selection of an appropriate treatment plan for such cases depends on the severity of the condition. Laminate veneers is a conservative method of restoring the appearance of discoloured, pitted teeth, and teeth with diastemas that provide extremely good aesthetic results. They are considered as the treatment of choice for moderate to severe cases of dental fluorosis given the optimum aesthetics, wear resistance, biocompatibility, and long-term results of these veneers.

Radiologically Identified Morphologic Changes of Maxillary and Mandibular Bones among Diagnosed Cases of Skeletal Fluorosis in Ethiopia

In 1937, the chronic toxic effect of fluoride on skeletal fluorosis was demonstrated for the first time in history in the Indian state of Madras. Exposure to fluoride concentrations greater than eight ppm in water is reported to cause skeletal fluorosis. Skeletal fluorosis is a chronic metabolic bone disease resulting from prolonged ingestion of large amounts of fluoride. Bone knee syndrome, osteosclerosis, pathological fractures, calcification of ligaments, joint stiffness, immobility, muscle atrophy, and severe forms of neurological deficits are some of the consequences of skeletal fluorosis. Skeletal fluorosis, as such, is a highly morbid disease. Yet, the condition is overlooked, and, most importantly, little is known about its effects on the facial skeleton. This unique, investigative, crosssectional study was initiated to evaluate the morphologic changes in the jawbone caused by skeletal fluorosis in adults diagnosed with skeletal fluorosis. A two-dimensional radiograph was used to evaluate the possible skeletal fluorosis-related morphological changes in the maxillary and mandibular bones. A total of 9 patients diagnosed with skeletal fluorosis underwent panoramic radiography of the maxillary bones and mandibular. Several skeletal fluorosis-related morphological changes were detected in the jaw bones of 6 study participants, including exostosis, osteosclerosis, thickened cortical bone, narrowed bone marrow, and periosteal plaques. According to studies, these morphological changes pose a serious threat to the healing process of the bone. Therefore, surgeons practicing in the Oro-craniofacial region must be alert to potential perioperative and postoperative complications when treating patients diagnosed with skeletal fluorosis.

A review on source, impacts and mitigation measures of groundwater fluoride contamination: a major health issue

Fluoride (F¯) in groundwater is one such ion that makes the groundwater unsuitable for drinking purposes and responsible for serious human health problems such as dental, skeletal, and non-skeletal fluorosis in more than 25 countries worldwide. Recent studies estimated that cases of fluorosis are prevalent in 67 million people in 19 out of the 32 states of India due to intake of fluoride-enriched groundwater ranging from 0.01 to 37.0 mg/l affecting 8 and 18 million people among them by skeletal and dental fluorosis, respectively. The distribution of fluoride in groundwater varies due to geogenic or anthropogenic sources or combined factors. The various geological and artificial factors that govern the F¯ prevalence in aquifers have been discussed. Different types of adverse health hazards of fluoride on humans and plants have also been enlightened. Since fluoride occurrence above 1.0 mg/l (BIS) or 1.5 mg/l (WHO) in groundwater can produce endemic health issues, there is an essential requirement to monitor groundwater fluoride levels frequently. Higher concentration in water needs treatment to bring them under the guideline value. Some available fluoride removal techniques from groundwater have been deliberated in study. Groundwater fluoride contamination is generally natural and unpreventable. However, most people unintentionally consume the untreated groundwater in developing countries leading to a widespread problem worldwide. A prominent solution is to educate and aware people about this issue. Frequent monitoring and defluoridation of the contaminated groundwa ter must be needed before consumption for a healthy world. The present review work is a step toward this fluoride hazard awareness with compact information about its various sources, status, removal technologies, and their relation with the environment.

Receiver Operating Curve (ROC) analysis for fluorosis using simple blood parameter neutrophil lymphocyte ratio

The study aims to assess the preclinical stage of fluorosis i.e. Non skeletal fluorosis in human populations using a simple blood parameter, Neutrophil Lymphocyte Ratio as a predictive tool and includes different fluorosis categories (Dental, Skeletal & Non skeletal) surveyed out in the endemic villages and compared with the control population of non endemic area. Study Populations belonging to endemic villages Kowataal, Fulsar, Mahuapaani, Korbi and Amatikra within the block Podi uproda, distt. Korba situated in Chhattisgarh state of central India were cross sectionally studied. Segregation was done on the basis of Suspect (non-symptomatic) and Confirmed (Dental and Skeletal) cases of fluorosis and neutrophil to lymphocyte ratio calculated. A total 180 individuals were included in the study, out of which 67.33 % were confirmed cases of fluorosis. A significant decline in neutrophil to lymphocyte ratio was observed upon chronic fluoride ingestion. In the Receiver Operating Characteristic curve analysis of obtained NL ratios, the overall cut off value for fluorosis was obtained as ≤ 2.379 in the selected endemic region irrespective of symptoms of fluorosis i.e. dental or skeletal. The results concluding that The NL ratio can be used as a simple parameter for preclinical identification of fluorosis in fluoride exposed populations. However, urine and blood fluoride analyses of the subjects are also needed for further confirmation.

Hydro-quality Analysis of Ground Potable Water in Relation to Fluoride at Barkagaon, Hazaribag, Jharkhand, India

Quality assessment was carried out at 36 sites of Barkagaon Block of Hazaribag district. With reference to three different sources of potable water (i.e. 108 samples) different water parameters analysis was done in view of fluoridation. It reveals that out of 108 samples were fluoride observed in only 9 samples, in % contribution, the fluoride level zero (0) was observed in 91.67% while more than zero (0) was confirmed in 8.33% of water sample ranging in between 0.4-6.5 mg/ L. Lowest fluoride sites was Napokhurd and highest was Gali in the Barkgaon Block. Dental fluorosis cases were also observed at the study area, as per Dean’s index. A correlative studies of different water parameters and fluoride indicated –ve relation with pH (r= -0.28), alkalinity (r=-0.21), total hardness (r= -0.02) and Calcium(r=-0.65), while +ve correlation was observed with temperature(r=+0.23) ,TDS (r=0.1) , chloride (r=0.25) and magnesium (r=0.62).

Assessing Fluorosis Incidence in Areas with Low Fluoride Content in the Drinking Water, Fluorotic Enamel Architecture, and Composition Alterations.

There is currently no consensus among researchers on the optimal level of fluoride for human growth and health. As drinking water is not the sole source of fluoride for humans, and fluoride can be found in many food sources, this work aimed to determine the incidence and severity of dental fluorosis in Poland, in areas where a low fluoride content characterizes the drinking water, and to assess the impact of fluoride on the enamel composition and microstructure. The dental examination involved 696 patients (aged 15–25 years) who had since birth lived in areas where the fluoride concentration in drinking water did not exceed 0.25 mg/L. The severity of the condition was evaluated using the Dean’s Index. Both healthy teeth and teeth with varying degrees of fluorosis underwent laboratory tests designed to assess the total protein and fluoride content of the enamel. Protein amount was assessed spectrophotometrically while the level of fluoride ions was measured by DX-120 ion chromatography. The clinical study revealed 89 cases (12.8%) of dental fluorosis of varying severity. The enamel of teeth with mild and moderate fluorosis contained a significantly higher protein (p-value < 0.001 and 0.002, respectively) and fluoride level (p < 0.001) than those with no clinical signs of fluorosis. SEM images showed irregularities in the structure of the fluorotic enamel. An excessive fluoride level during amelogenesis leads to adverse changes in the chemical composition of tooth enamel and its structure. Moreover, dental fluorosis present in areas where drinking water is low in fluorides indicates a need to monitor the supply of fluoride from other possible sources, regardless of its content in the water.

Household-level Fluoride reduction from drinking water using crushed fired clay – proof of concept

Residents of Bunyangabu District in Uganda have reportedly suffered from cases of dental fluorosis due to consumption of water with high levels of Fluoride from Ntabago Stream. A household-level sand filter incorporating crushed fired clay as an adsorbent was designed for a household to reduce the Fluoride concentration in their drinking water from the natural raw water levels (2-3 mgF/L) to permissible, healthy levels (0.5-1.0 mg/L). Pieces of fired clay bricks were crushed, and particles of 150 μm to 300 μm in size were selectively obtained by sieving. Stream water was filtered through replicate model layered filter columns of the prepared clay, sand (fine sand of 150 μm-2 mm; coarse sand of 2-5 mm), and gravel (6-15 mm). It was found out that fired clay layers of 2.5 and 5 cm thick reduce the concentration of Fluoride in water by up to 74%, to less than 1.0 mg/L. This was deduced by evaluating Fluoride concentration in both the clay and water before and after filtration, using the SPADNS Colorimetric method. Use of crushed fired clay for reduction in Fluoride concentration in drinking water is the focus of this paper. Additional work will optimise filter design to improve overall water quality.

Prevalence of Neurological Manifestations in Individuals Affected with Skeletal Fluorosis in Endemic Villages of Nalgonda District

Background: Fluorosis is a prevailing public health problem in many parts of the country. It is mainly caused by excessive intake of fluorides through drinking water. The effects are mainly on bones and teeth, producing skeletal and dental fluorosis respectively, which often are irrevers-ible. Nalgonda district in Telangana state was known for highest fluorosis cases. So, we aimed to study the prevalence of headache, lethargy, impaired memory and insomnia and to determine the severity of these conditions.Methodology: A community-based cross-sectional study was conducted in Marriguda and narayanapuram mandals of Nalgonda district. 85 patients were recruited for the study. The data was collected using ‘Headache Impact Test-6 version 1.1’ for headache, ‘Regensburg Insomnia Scale’ for insomnia, ‘Fatigue Assessment Scale’ for lethargy and ‘Six Item Cognitive Impairment Test (6CIT)’ for impaired memory. Results: It was found that a total of 48.2% of individuals suffered from headache, 48.2% of individuals had insomnia, 57.6% of them complained of lethargy and 43.5% of them had impaired memory. Males were more prone to these manifestations except insomnia where females were more affected. Conclusion:Our study reported that the most prevalent neurological manifestation was lethargy and impaired memory is the least prevalent manifes-tation. Males were found to be more prone to developing these manifestations than females except in the case of insomnia.

Management of fluorosed teeth using newer material – A case series

Dental fluorosis is a specific esthetic disturbance, which can be described as a chronic condition, where enamel development has been disrupted and the resulting tooth enamel is hypomineralized. It is caused by ingestion of excessive fluoride during enamel formation stage. Hence, overtime, various treatment modalities have evolved, like, microabrasion, bleaching, resin infiltration, veneers, etc. Microabrasion using Opalustre has been used extensively. However, the results may not be promising. With advancement in material science, a new product, namely, Antivet enamel cleansing kit is available, which is effective in removing brown stains due to fluorosis. Post operative sensitivity is also significantly less with this product. This paper presents two cases of fluorosis for which different agents have been used. Keywords – discolouration, fluorosis, microabrasion