Skeletal fluorosis

Skeletal fluorosis is a bone disease exclusively caused by excessive consumption of fluoride.

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Causes

Common causes of fluorosis include inhalation of fluoride dusts/fumes by workers in industry, use of coal as an indoor fuel source (a common practice in China), consumption of fluoride from drinking water, and consumption of fluoride from the drinking of tea, particularly brick tea.^[1]

In some areas, skeletal fluorosis may be endemic. In India, the most common cause of fluorosis is fluoride-laden water derived from deep bore wells.

Incidence/prevalence

While fluorosis is most severe and widespread in the two largest countries - India and China - UNICEF estimates that "fluorosis is endemic in at least 25 countries across the globe. The total number of people affected is not known, but a conservative estimate would number in the tens of millions." ^[2]

Skeletal fluorosis in China and India

The World Health Organization recently estimated that 2.7 million people in China have the crippling form of skeletal fluorosis.^{[citation needed]} In India, 17 of its 32 states have been identified as "endemic" areas, with an estimated 66 million people at risk and 6 million people seriously afflicted.^{[citation needed]}

According to scientific surveys, skeletal fluorosis in India and China occurs when the fluoride concentration in water exceeds 1 part per million (ppm), and has been found to occur in communities with only 0.7 part per million.^[3]

The Chinese government now considers any water supply containing over 1 ppm fluoride a risk for skeletal fluorosis.^[3]

Skeletal fluorosis in the United States

In the United States, an average of 1 ppm of fluoride is intentionally added to water supplies for water fluoridation. The Maximum Contaminant Level (as established by the US Environmental Protection Agency) is 4 ppm.^[4]

Skeletal fluorosis phases

References

acquired deformities of fingers and toes (Boutonniere deformity, Bunion, Hallux rigidus, Hallux varus, Hammer toe) - other acquired deformities of limbs (Valgus deformity, Varus deformity, Wrist drop, Foot drop, Flat feet, Club foot, Unequal leg length, Winged scapula)

patella (Luxating patella, Chondromalacia patellae)

synovium and tendon: Synovitis - Tenosynovitis (Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome)

bursitis (Olecranon, Prepatellar, Trochanteric)

fibroblastic (Dupuytren's contracture, Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis, Fasciitis, Fibromatosis)

enthesopathies (Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis)