Diagnosis Of Fluorosis Research Articles

Fluorosis Masquerading as Compressive Myelopathy

A 60-year-old woman from Cuddalore presented with restricted neck movements, progressive difficulty in walking, and lower limb weakness, leading to bed confinement. Clinical examination revealed spastic paraparesis, brisk reflexes, and sensory deficits below the hips. Laboratory investigations indicated renal insufficiency and elevated urine fluoride levels. Imaging demonstrated calcifications of sacroiliac, sacrospinous ligaments, interosseous membrane, and posterior longitudinal ligament, with osteosclerosis and osteoporosis. Differential diagnoses included Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis. However, the unique pattern of ligament calcification and elevated fluoride levels supported a diagnosis of fluorosis. This case underscores the importance of considering fluorosis in patients from endemic areas with spastic paraparesis and characteristic radiological findings. Posterior decompression via laminectomy was performed, emphasizing the need for awareness of fluorosis as a potential cause of cervical compressive myelopathy.

Treatment of dental fluorosis Level: microabrasion with 6% hydrochloric acid. Case report

Dental fluorosis is a malformation of the dental enamel, which is characterized by an increase in its porosity and permeability, and variations in the clinical presentation in relation to the time and amount of fluoride consumed by the patient. The case of a male patient, 22 years old, with no pathological history or allergy to medications or chemical substances, goes to the dental office reporting dissatisfaction with his dental appearance. After clinical radiographic study, the diagnosis of mild fluorosis was established according to the Dean Index, and microabrasion with 6% hydrochloric acid was chosen as treatment. The procedure followed is described and the different management options for dental fluorosis are discussed. Dental fluorosis is widely present both worldwide and in Ecuador. However, many patients are unaware of their condition and do not receive adequate treatment. Microabrasion was the technique of choice for this case, due to the effectiveness and stability of its results already reported. The management of the patient with dental fluorosis must be individualized, the use of a minimally invasive technique, such as microabrasion with 6% hydrochloric acid, turned out to be a safe and effective method of treatment, which provides the patient with adequate dental aesthetics, and improves your quality of life

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.

Radiological Findings More Important and Reliable in the Diagnosis of Skeletal Fluorosis

Skeletal fluorosis is the resultant of prolonged chronic fluoride exposure through fluoride containing water and food and /or industrial fluoride emission. In this disease, due to pathological changes in various bones of the body, many types of physical deformities develop which are more painful and unbearable. These bony deformities remain in man throughout his life. There is no cure available for these fluoride-induced disorders yet. Among these deformities, the most common bone deformities in humans are bending at the waist (kyphosis) and curvature of the lower extremities (genu-varum and genu-valgum). In severe state of skeletal fluorosis, neurological complications such as paraplegia and quadriplegia are also prevalent in human population. In fact, these are the crippling deformities and can be easily recognised by necked eyes. But many times mistakes are made in identifying skeletal fluorosis in its early stages. However, radiological study makes the diagnosis of skeletal fluorosis easier, which is also more important and reliable. Because even mild fluorideborne effects, such as periosteal exostosis, osteosclerosis, osteoporosis, and osteophytosis can be easily detected in X-rays of diverse bones of skeletal. However, the presence of fluoride-induced calcification of the interosseous membrane between radius and ulna bones of upper limbs or forearms is the most ideal or correct diagnostic feature or sign of skeletal fluorosis. In present editorial, besides the different forms of crippling deformities, various fluorideinduced radiological changes in diverse bones of subjects afflicted with mild to severe skeletal fluorosis have also been focussed which are more important, useful, and reliable in the diagnosis of skeletal fluorosis in humans.

How Can Fluorosis in Animals be Diagnosed and Prevented?

Prolonged fluoride (F) exposure in domestic and wild mammalian animals either through fluoridated drinking water or/and industrial F pollution or airborne F emission causes a serious F poisoning in the form of fluorosis disease. This dreaded disease is a worldwide health problem in both man and animals and endemic in several countries. Thousands of domesticated animals (bovines, flocks, equines, camels, etc.) in the world are suffering with fluorosis due to drinking of water having F >1.0 or 1.5 mg/L and chronic exposure to industrial F emission. In this disease, mainly in the teeth and bones, many types of permanent and irreversible deformities develop one after the other, which are very painful and dangerous for the animal health. But this disease also affects other parts or soft organs of the animal body. F-induced toxic effects or anomalies in teeth, bones, and soft organs are generally referred as dental, skeletal, and non-skeletal fluorosis, respectively. Nevertheless, skeletal fluorosis is most dangerous in animals, due to which animals become victims of lameness at an early age. Fluorosis can be easily diagnosed when it is an advanced stage, but it is a bit difficult to diagnose when it is in its early stages. Nevertheless, on the basis of appearance of its main clinical or pathognomonic signs and careful physical examination, the presence of this disease in the animal can be confirmed or diagnosed. In present editorial, for researchers and investigators, some helpful and important parameters for the diagnosis of fluorosis in domesticated animals such as history, diverse clinical or pathognomonic signs, and the testing of biological samples, blood serum and urine for evidence of F have been highlighted. Simultaneously, different possible or feasible ways for the mitigation or prevention of chronic F poisoning in domestic animals have also been discussed. Along with this, those simple measures how to save animals from getting fluorosis have also been described well in this editorial.

A case report of skeletal fluorosis leading to cervical compressive myelopathy and a review of literature

Fluorosis is a public health problem that is caused by excess intake of fluoride through ground/deep bore water. It gets deposited in the bones, teeth, and soft tissues. Fluoride in the human body acts as a “double-edged sword.” Fluoride is beneficial in small amounts but toxic in large amounts. People who have consumed 10–20 mg of fluoride per day for more than 10–20 years may develop crippling skeletal fluorosis. Stiffness and pain in the major joints, including the neck, back, hips, and knees, reduce mobility. The bone structure may change and ligaments may calcify in extreme cases, resulting in muscular weakness and pain. Here, we have reported a case of chronic quadriparesis due to compressive cervical myelopathy. After extensive workup, diagnosis of skeletal fluorosis was made.

The Diagnosis and Prevention of Fluorosis in Humans

Chronic fluoride intoxication in the form of fluorosis is a worldwide health problem and endemic at least in 25 countries. The principal cause of fluorosis in humans is the prolonged exposure of fluoride through drinking of fluoridated water. However, industrial fluoride emission and fluoride containing foods are also potential sources of fluoride exposures for the genesis of fluorosis. As per guidelines of the World Health Organization (WHO) fluoride content in the drinking water should not be higher than 1.5 mg/L (ppm). Above this limit of fluoride in drinking water, it becomes toxic and injurious for human health and causes diverse deformities in teeth and bones. In humans, basically three forms of fluorosis namely dental, skeletal and non-skeletal fluorosis have been recognised. The diagnosis of fluoride intoxication (fluorosis) in humans is made on the basis of history, clinical or pathognomonic signs and testing of biological samples. The current status of endemic fluorosis could be assessed by estimation of fluoride in the blood serum and urine. The presence of dental mottling and calcification of interosseous membrane on a forearm radiograph may be helpful in the diagnosis of dental and skeletal fluorosis, respectively. For the prevention of fluorosis, fluoride free drinking water and food items, diet having ample amount of nutrients, general awakening in people and collective efforts are important and highly needed. This editorial will be useful for researchers and health workers in the diagnosis and prevention of fluorosis in humans, respectively.

A novel ICT-based chemosensor for F- and its application in real samples and bioimaging

A novel colorimetric and fluorescent chemosensor MQS-Si with intramolecular charge transfer character has been designed and synthesized. The chemosensor shows exclusively “off-on” fluorescence response toward F- at 620 nm in HEPES (pH 7.4): DMSO solution (7:3, v/v), which is attributed to the specific cleavage of Si-O bond. The ultrasensitive detection limit for F- in the fluorescence measurement is down to 30 nM. Application of the chemosensor has been demonstrated by selective detection of F- in drinking water, urine and serum samples and fluorescence imaging of F- in living cells and zebrafish, which proves that MQS-Si has a promising application in vitro and in vivo detection of F- and may be utilized for the diagnosis of fluorosis and esteofluorosis.

Integrated Learning Approach Based on Fused Segmentation Information for Skeletal Fluorosis Diagnosis and Severity Grading

Skeletal fluorosis is a form of endemic disease caused by the excessive intake of fluoride. Bone deformation and periosteal calcification are the typical manifestations that can be observed in the images and are usually served as a basis of pathological grading. In the current medical systems, the diagnosis of skeletal fluorosis fully relies on doctors' knowledge and experience, and no research effort has been made in automatic image information diagnostic systems. According to the image information, the shape of the lesion is irregular, the boundary is unclear and the lesion related pixels only occupy a small part of the image. We take the lead in proposing a two-stage scheme that can achieve automated X-ray image diagnosis and severity grading. In the first stage, a Dense U-Net is proposed for reliable lesion determination, and a multitype feature fusion approach passes effective and comprehensive features to the subsequent stage. In the second stage, a novel classifier is designed with the integration of ensemble learning and multiple instance learning, which can ensure classification accuracy in case that the feature for diagnosis only takes up a small proportion of the whole image. Through plenty of experiments on the actual data collected from the hospitals, it is verified that the proposed strategy can achieve satisfactory results on skeletal fluorosis image diagnosis and severity grading.

Development of indole-based fluorescent probe for detection of fluoride and cell imaging of HepG2

A fluorescent probe IDS based on indole ring was designed and synthesized. It has been successfully developed for highly selective detection of fluoride ions with a low detection of 1.3 ppb. Besides, the probe IDS was used for fluorescence imaging of F− in HepG2 cells and detected the concentration of fluoride ions in the environmental water samples and urine sample. These applications suggested that IDS was a sensitive probe in research and potential for the diagnosis of endemic fluorosis.

Diagnosis and management of skeletal fluorosis in current scenario: a case report

<p>Skeletal fluorosis is a rare form of toxic metabolic disease of bone characterised by increased incorporation of fluoride in bone. Skeletal fluorosis generally occurs in endemic regions where there is increased ingestion of fluorine in water and or food over a long period of time. Fluorosis is a spectrum of disease ranging from dental, non-skeletal fluorosis to skeletal fluorosis<em>.</em> The disease is characterised by typical clinical and radiological features that raise the suspicion towards diagnosis of the disease. Radiographic features are characterized by generalised osteosclerosis and later ossification of ligaments, tendons and interosseous membranes. Skeletal fluorosis can be easily confused with other rheumatologic disorders. People exposed to large amounts of fluoride show dental changes much earlier than the skeletal effects. Management of fluorosis generally focuses on symptomatic treatment.</p>

Dental Fluorosis: the Risk of Misdiagnosis-a Review.

Fluoride has been considered as the single factor most frequently responsible for causing enamel mottling. However, in humans, either endogenous and/or exogenous factors not related to fluoride exposure may also cause enamel mottling. In this sense, various studies in the international literature have reported severe mottling of the teeth that could not be attributed to fluoride exposure. Thus, misdiagnosis of non-fluoride-induced enamel defects may occur frequently. Reports of unexpectedly high population prevalence and individual cases of fluorosis, where such diagnoses are irreconcilable with the identified fluoride history, highlight the necessity for a more precise definition and diagnosis of dental fluorosis. Also, a more discriminating diagnostic procedure is suggested. Particularly, positive identification of environmental fluoride levels to which the communities and individuals are exposed shall be developed before the confirmation of a diagnosis of fluorosis. It is considered that a more critical methodology for the diagnosis of fluorosis will be helpful in the rational use and control of fluorides for dental health, and in the identification of factors that may induce enamel defects.

Skeletal fluorosis after prolonged voriconazole therapy.

A 6-year-old girl underwent allogeneic hematopoietic stem cell transplantation for a relapsing acute myelogenous leukemia. She developed severe chronic graft-versus-host disease which required immunosuppressive therapies, including a prolonged course of high-dose steroids. She also presented a thrombotic microangiopathy complicated by renal failure requiring dialysis. Eleven months after transplantation, she was diagnosed with pulmonary and cerebral aspergillosis, prompting initiation of intravenous voriconazole. Unusually high doses were needed (11 mg/kg/dose every 8 hours) in order to achieve therapeutic plasmatic trough concentrations above 1 to 2 mg/L. After 2 months, she was transitioned to oral voriconazole at equivalent dosing. Six months after being on oral voriconazole, she complained of fatigue and diffuse musculoskeletal pain, initially attributed to her steroid treatment. Radiographs (Figure 1) of her femurs showed diffuse osteopenia and pronounced bilateral periosteal reactions with exostosis (arrows). ... The diagnosis of osseous fluorosis induced by prolonged voriconazole therapy was suspected and confirmed by a very high fluoride plasma concentration of 27.0 µmol/L (0.25 to 1.0 µmol/L). Her alkaline phosphatase level was also increased at 627 U/L (134 to 518 U/L), with a known normal baseline level preceding therapy. Voriconazole was discontinued and oral posaconazole was substituted in its place. Five months after voriconazole discontinuation, her musculoskeletal symptoms resolved and her fluoride plasma concentration decreased to 1.30 µg/mL.

Forecasting the course of occupational chronic fl uorine intoxication by means of univariate analysis

Relevance. In contemporary occupational pathology, diagnosis of occupational fluorosis is based on locomotory apparatus disorder such as fluorine osteopathy. Other significant consequences of negative effects of fluorine compounds are deactivation of enzymatic systems, metabolic disorders — that results in pathologic involvement of many organs and systems (hepato-biliary, cardiovascular, respiratory, nervous, endocrine, gastrointestinal). Topical issue is search of a complex of factors influencing development of the occupational disease, to optimize management of occupational fluorine intoxication risk.Objective. To determine spectrum of factors that promote development of occupational fl uorine intoxication in workers exposed to inorganic fl uorine compounds, for forecasting the disease outcome and selecting main trends of preventive measures.Materials and methods.Single-factor analysis methods helped to carry retrospective cohort study of occupational fl uorine intoxication development in 201 workers of aluminum production in Ural region. Th e study covered infl uence of main occupational factors and somatic health parameter s on occupational fl uorosis development.Results.Findings are reliable infl uence of age (k=0.532, p<0.001), length of service in hazardous work conditions (p<0.001), hydrofl uoride level (p<0.001) and constant magnetic fi eld (p=0.005). Besides that, analysis of immune and metabolic state of the workers revealed signifi cant infl uence of disordered lipid, carbohydrate, purine metabolism, altered immune parameters on occupational fl uorosis development. Other evidence was reliable dependence between concomitant cardiovascular diseases and period of occupational chronic fl uorine intoxication development.Conclusion.Using single-factor analysis helped to determine wide spectrum of factors associated with the workers’ health state and work conditions, that signifi cantly infl uence development of fl uorine intoxication. Th e authors proved that period of occupational chronic fl uorine intoxication is notably infl uenced by occupational factors (length of service, hydrofl uoride level, fl uorine load degree, magnetic fi eld) and somatic state characteristics as age, parameters of carbohydrate, lipid, purine metabolism, status of cardiovascular, excretory systems, kidneys and gastrointestinal tract functions.

Relationship between fluoride exposure, orthopedic injuries and bone formation markers in patients with coal-burning fluorosis

Chronic exposure to fluoride is a public health problem worldwide. We explored the relationship between fluoride exposure, orthopedic injuries and bone formation markers alkaline phosphatase (ALP), bone Gla protein (BGP) in participants with coal-burning fluorosis in Hehua Village (coal-burning fluorosis endemic area) in Zhijin County of Guizhou Province and Zhangguan Village (non-fluoride contaminated area) in Anshun City of Guizhou Province. Environmental samples were collected and fluoride contents were examined using a fluoride ion-selective electrode. Dental fluorosis and skeletal fluorosis of 295 participants from Hehua Village and 85 participants from Zhangguan Village were diagnosed with informed consent. Urinary samples and peripheral blood samples were collected from the participants to determine urinary fluoride (UF), ALP acti-vity, and BGP content. The results showed that fluoride contents in rice, pepper, corn, drinking water, clay, vegetable-grown soil, coal and indoor and outdoor air were significantly higher than those in the control area, but lower than the previously reported values. With the increases of UF concentration, the ALP activity and BGP content significantly increased, the severity of skeletal fluorosis was greater, but with no significant changes in dental fluorosis. There was positive correlation between the severity of skeletal fluorosis and ALP activity, BGP content. These results indicated that low fluoride exposure could cause orthopedic injuries. ALP and BGP could be used to eva-luate the bone turnover in patients with skeletal fluorosis, which would be useful in the auxiliary diagnosis and therapeutic evaluation of skeletal fluorosis.

Differential diagnosis of dental enamel focal demineralization and fluorosis by means of spectrophotometry

The article presents the results of spectrophotometric tooth enamel scanning for differential diagnosis of focal enamel demineralization and fluorosis. Research was conducted in vivo on teeth affected by these diseases. VITA EasyShade spectrophotometer measurements were made on the affected area and on the visually healthy part of enamel. The lightness appeared as the only one differential significant optical characteristics of tooth enamel. Lightness metrics were higher in the case of initial caries than on the healthy part of enamel when these metrics were lower in the case of fluorosis than on the healthy part of enamel.

In vitro Validation of Quantitative Light-Induced Fluorescence for the Diagnosis of Enamel Fluorosis in Permanent Teeth

This study aimed to validate quantitative light-induced fluorescence (QLF) as a diagnostic tool for mild and moderate enamel fluorosis in permanent teeth, comparing it to visual diagnosis and histological assessment completed using polarized light microscopy (PLM). The buccal surfaces of 139 teeth were visually classified using the Thylstrup and Fejerskov Index (TFI) into sound (TFI 0; n = 17), mild (TFI 1-2; n = 69), and moderate (TFI 3-4; n = 43) fluorosis. Fluorosis was then assessed with QLF (variables ΔF, A, and ΔQ at 5-, 15-, and 30-radiance thresholds) using as reference areas the entire surface and a region of interest (ROI), identified as the most representative region of a fluorosis lesion. PLM images of longitudinal thin sections including the ROI were assessed for histological changes. Correlations among TFI, PLM, and QLF were determined. A receiver-operating characteristic curve was conducted to determine QLF's diagnostic accuracy when compared to the TFI and PLM assessments. This was used to assess the probability that the images were correctly ranked according to severity as determined by PLM and TFI. A positive correlation was found between QLF and PLM, and between QLF and TFI. QLF showed the highest sensitivity and specificity for the diagnosis of mild fluorosis. There was also a strong agreement between TFI and PLM. The selection of a ROI resulted in a stronger correlation with TFI and PLM than when the entire surface was used. The study results indicate that defining an ROI for QLF assessments is a valid method for the diagnosis of mild and moderate enamel fluorosis.

Industrial Fluorosis and Its Effects on Serum Biochemistry and Haemogram in Cattle of Kerala, India

Industrial fluorosis and its effects on serum biochemistry and haemogram were investigated in cattle inhabiting fluoride (F) contaminated areas due to aluminium and fertilizer units situated at Eloor industrial belt of Ernakulam district of Kerala, India. A total of 119 cattle above 3-year-old examined clinically for evidence of osteo-dental and non-skeletal fluorosis. Out of these 55 (46.22 %) animals showed clinical signs of lameness, dental lesions, bony exostoses, reproductive problems and gastro-intestinal disorders. The F level in the biological samples including plasma, urine, milk and bone of the industrial fluorosed cattle were significantly higher (P < 0.01) than the control animals. F content (ppm) in the environmental samples, forage, sludge and drinking water was also high (1.328 ± 0.294 to 251.700 ± 23.113) in the study areas. Biochemical analysis of serum revealed significant decrease (P < 0.01) of serum calcium, albumin, total protein content but increased value of serum alkaline phosphatase and inorganic phosphorus was seen in the affected animals. Total erythrocyte count, haemoglobin and packed cell volume were significantly (P < 0.01) decreased in such animals. Differential leucocyte count showed neutrophilia, lymphocytopenia, monocytophenia and eosinophilia. No significant changes were noticed in the total erythrocyte count, mean corpuscular volume, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration. Changes in the serum biochemistry and haemogram could be used for diagnosis of fluorosis in bovines where clinical signs of osteo-dental fluorosis are not evident or poorly discernible.

Impact of dental fluorosis on the quality of life of children and adolescents

INTRODUCTION: Dental fluorosis is a disturbance of high prevalence caused by the ingestion of fluoride ions present mainly in toothpaste. Preventive measures to avoid it are still controversial. Thus, knowing the impact that fluorosis can cause on the population's quality of life it is important for planning public health policies.OBJECTIVE: To evaluate the impact of dental fluorosis on the quality of life of children and adolescents.MATERIAL AND METHOD: We studied 300 subjects aged 8 to 12 years divided into 4 groups: children (8-10 years) and adolescents (10 to 12 years) with and without fluorosis. The diagnosis of fluorosis was performed according to the index Thylstrup and Fejerskov and quality of life was evaluated using Child Perceptions Questionnaire 8-10 and 11-14. The socio-demographic characteristics of the patients were also evaluated. For inclusion in the sample, selected patients should present eight permanent incisors with crowns fully erupted. Patients who had extensive restorations, fractured teeth, other dental enamel defects and who wore braces were excluded.RESULT: Fluorosis was present in 64.7% of the patients analyzed and in most cases (80.3%) was mild or very mild. In children, the average overall score of the questionnaire was 15.9 for the group without fluorosis and 18.3 for the group with fluorosis (p = 0.255). The teenagers' score in the group without fluorosis was 26.1, while the group with fluorosis was 22.7 (p = 0.104).CONCLUSION: Dental fluorosis caused impact on the quality of life of the population analyzed only in the functional domain.

Dental fluorosis in the paediatric patient

Exposure to excessive fluoride intake during the early childhood years can disrupt the normal development of enamel, resulting in dental fluorosis. This varies in severity, ranging from white opacities in mild cases to more severe black and brown discoloration or enamel pitting. This article aims to give the reader a better understanding of the aetiology, diagnosis and subsequent treatment of dental fluorosis in the paediatric patient. Fluorosis can have a marked effect on dental aesthetics. The prevalence of fluorosis in the United Kingdom may increase following the publication of Delivering Better Oral Health, published by the Department of Health in 2007, which suggested changes to fluoride levels in children's toothpastes. This article highlights the importance of accurate diagnosis of fluorosis and also explains the treatment options available to paediatric patients.