Introduction
Skeletal fluorosis is a condition that occurs due to the accumulation of fluorides in the body's hard and soft tissues. Fluoride poisoning is a public health issue due to long-term, excessive intake of food, water, and industrial pollutants. The teeth and bones are impacted when excessive fluoride is ingested, most commonly in drinking water. Dental fluorosis, skeletal fluorosis, and non-skeletal fluorosis are major health issues that can arise. Dental effects appear much earlier than skeletal effects in people who are exposed to a lot of fluorides. Children are affected by dental fluorosis, which stains and disfigures the teeth. The bones and major joints of the body, such as the neck, backbone, shoulder, hip, and knee joints, are affected by skeletal fluorosis, which causes severe joint pain, rigidity, or stiffness. Severe forms of skeletal fluorosis are associated with significant impairment. Early manifestations known as non-skeletal forms of fluorosis are seen as gastrointestinal symptoms and may overlap with other diseases, resulting in a misdiagnosis. Non-skeletal forms of fluorosis begin long before typical changes in teeth and skeletal bones occur. It affects men, women, and children of all ages.
Fluorosis is widespread throughout the world and endemic in at least 25 nations. Fluoride belts have been found to contain this: one that extends from Syria through Jordan, Egypt, Libya, Algeria, Sudan, Kenya, and northern Thailand, and another that extends from Turkey through Iraq, Iran, Afghanistan, India, and China. The Americas and Japan both have comparable belts.
What Are the Symptoms of Skeletal Fluorosis?
Symptoms must be present one by one. For example, a person's age, nutritional status, environment, kidney function, fluoride intake, genetic background, susceptibility to allergies, and other factors like the hardness of the water due to the presence of calcium and magnesium influence the severity and duration, which are frequently episodic. Several symptoms include:
- Fluoride in the Teeth (Dental Fluorosis): Staining and pitting are signs of clinical dental fluorosis. In more severe cases, all of the enamel may be damaged (although dental enamel defects may not be solely caused by fluoride; Other conditions, such as a low-protein, low-energy diet or a vitamin A and vitamin D deficiency, are associated with enamel opacities similar to dental fluorosis. Dental fluorosis will not occur if fluoride is consumed after the age of six. On the enamel surface, the teeth may have streaks or spots that are white, yellow, brown, or black. They may also be chalky white. The discoloration is bilaterally symmetrical and absent from the gums.
- Skeletal Fluorosis: Stiffness and joint pain are the first signs of skeletal fluorosis. In severe cases, the structure of the bones may change, and the ligaments may calcify, affecting the muscles and causing pain. In addition, nerves and blood vessels are put under pressure when the vertebral canal and intervertebral foramen are narrowed, resulting in paralysis and pain.
How to Manage and Prevent Fluorosis?
In severe cases of skeletal fluorosis, no treatment is available. Instead, efforts can be made to reduce the disability. However, the disease can be easily avoided with early diagnosis and the provision of safe drinking water, promoting nutrition, and avoiding foods with high fluoride content. The only treatment for dental and skeletal fluorosis is prevention by limiting fluoride intake to safe levels. There is no treatment for this condition.
Treatment for Dental Fluorosis:
Tooth whitening for mild cases of fluorosis composite bonding porcelain veneers.
Prevention of Fluorosis-
Individuals and communities can avoid fluorosis by limiting their intake of fluoride. The following measures are helpful in excess fluoride intake. Their negative effects can be minimized or avoided by using alternative water sources, lowering the amount of fluoride in drinking water, and improving the nutritional status of populations and individuals at risk.
(a) Using Groundwater With Low Fluoride and Surface Water as Alternative Sources of Water:
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Water in the Air: Because surface water is frequently tainted with biological and chemical pollutants, special care must be taken when using it for drinking. After proper disinfection using simple, inexpensive methods like sand filtration and ultraviolet disinfection, surface water should be used; chlorination (may be sufficient in some locations, but not all).
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Rainwater: It is typically a simpler, cleaner, and less expensive source; however, there is a problem with the large reservoir and storage of water in communities and homes.
In groundwater with low fluoride levels, the fluoride content of wells in the same area can vary based on the aquifer's geological structure and the depth at which water is drawn. Digging new wells and deepening existing tube wells may be beneficial. In groundwater, fluoride is unevenly distributed both vertically and horizontally.
b) Water Defluoridation (The Removal of Too Much Fluoride From Drinking Water):
Prevention of fluorosis is possible by drinking water that contains safe levels of fluoride; However, safe drinking water is hard to come by in areas where fluorosis is common.
The only option is to defluoridate; This can be accomplished in many ways:
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Electrolyte Defluoridation, Chemical Precipitation, and Alkaline Coagulation (Nalgonda Technique): A mixture of raw water and aluminum sulfate (alum: hydrate aluminum salt), lime or sodium carbonate (one-fifth of alum because the process works best in alkaline conditions), and bleaching powder (three milligrams per liter) are added to disinfect the water. This method is suitable for household and community use. One bucket of water is mixed with bleach, alum, and lime at the household level. The amounts of alum and lime are calculated based on the water's fluoride content and alkalinity, and the flocks are allowed to solidify and settle at the bottom of the bucket for at least one hour. Then, the treated water is withdrawn safely above the sludge level through a tap five centimeters above the bucket's bottom. Discard the sludge and store the drinking water in a different bucket.
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Fluorination of the Electrolytes: Active aluminum hydroxide is produced when a direct current is passed through the aluminum electrodes in water containing too much fluoride, which adsorb the fluoride ions in the water, causing sludge and treated water (used for drinking) to form.
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Adsorption: Activated alumina (AL2O3), activated charcoal, or ion exchange resins are examples of strong adsorbents that can be used in this method to filter water down through a column. Additionally, this approach is suitable for both household and community levels. As the backwashing material is high in fluoride, it should be disposed of carefully to avoid recontaminating nearby groundwater after the adsorbent has become saturated with fluoride ions. Sludge with a very high fluoride content is produced by all methods, which must be disposed of; Therefore, treated water should only be used for drinking and cooking, particularly in developing nations.
c) Electrodialysis With Reverse Osmosis and Ionic Separation: An effective complement to the technical solutions mentioned above measures to improve the nutritional status of the affected population, particularly children, by increasing their intake of calcium, and vitamin C, iron, and antioxidants. Since breast milk typically contains little fluoride, pregnant women in affected areas should be encouraged to breastfeed.
The following methods do not eliminate fluoride:
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Making Water Boil: will concentrate rather than eliminate fluoride content.
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Condensing water: does not affect fluoride concentration.
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Carbon activation: Fluorides are not removed by filters.
d) Health Training: For fluorosis control and prevention, educating the community about fluorosis, drinking clean water, and eating healthy is important. Consumption of fluoride-contaminated water exceeding one ppm is not recommended. Products with high fluoride content, such as Tobacco, black rock salt, and red rock salt (Sindhi), drugs, and cosmetics with high fluoride content, such as toothpaste and mouth rinses, should be avoided.
Milk, curd, fruits, and other foods high in calcium, iron, vitamin C, and other antioxidants should be encouraged.
e) Development of Human Resources: Cultivating sufficient human resources in the public health engineering and health sectors. The information that doctors and medical professionals need to recognize the disease is particularly important. Similarly, the public health engineering department, integrated child development services, and other departments strongly emphasize effective water management and early detection of endemic areas.
Conclusion
Skeletal fluorosis can occur due to excessive accumulation of fluoride in the bone. The dissemination of information regarding the use of preventative measures requires additional effort. Therefore, appropriate treatment and prevention strategies for skeletal fluorosis necessitate long-term efforts. Because it is difficult to treat skeletal fluorosis with treatments completely, prevention is currently considered more effective than treatment. Additional research is also required to understand the pathogenic mechanisms of skeletal fluorosis.
