Fluorosis: Causes, Symptoms & Treatment

Fluorosis is a condition that can affect different parts of the body. To combat fluorosis, the first step is to stop excessive fluoride intake.

What is fluorosis?

The term fluorosis is used in medicine to describe diseases that result from an over-supply of fluorine (a mineral found in bones and teeth, among other things) to the human body. The forms of fluorosis include, for example, dental fluorosis and bone fluorosis (skeletal fluorosis). While dental fluorosis accounts for the most frequent cases of fluorosis, skeletal fluorosis occurs comparatively rarely. Depending on the severity of the disease, dental fluorosis can manifest itself as brownish-yellow or chalky-white discoloration of the teeth. The resistance of the tooth enamel to caries is reduced in the case of fluorosis affecting the teeth. In the context of fluorosis that occurs in the bones, hardening or densification of bone material may occur, among other symptoms; as a result, affected bones lose elasticity and become more brittle.

Causes

Fluorosis is caused by long-term excess fluoride intake. Possible causes of such excess fluoride intake include, for example, long-term ingestion of drinking water that has naturally high fluoride saturation. In various countries, fluorine is added to drinking water, which is why an increased incidence of fluorosis is observed in corresponding areas. Chronic overdosing of fluorine in the body can also be caused by long-term intake of fluoride preparations that are highly concentrated. Since various dental care products are also enriched with fluorine, fluorosis, especially in children, may occasionally be due to frequent swallowing of appropriate toothpaste during dental cleaning.

Symptoms, complaints, and signs

Depending on the form of fluorosis, the condition can cause a range of symptoms and complaints. In dental fluorosis, brown to white discoloration and stains appear on the teeth, which increase as the disease progresses and may eventually cause psychological symptoms. Bone fluorosis does not initially cause clear symptoms. As the disease progresses, the spine stiffens and the bones thicken, making the bones and joints more fragile. Affected individuals suffer more frequent bone fractures and are physically less able overall. Bone fluorosis can cause permanent movement restrictions as well as joint wear, poor posture and other secondary complaints. Acute fluoride poisoning leads to nausea and vomiting after a few minutes to hours. Those affected suffer from diarrhea, abdominal pain and occasionally constipation. In the course of the disease, there may be disturbances of consciousness such as dizziness and loss of consciousness. In addition, cardiovascular complaints set in, which may be manifested, for example, by sweating, palpitations and panic attacks. The symptoms of fluorosis can develop gradually or occur acutely, always depending on how intensively the affected person is exposed to the substance. With early treatment, serious complications can be reliably avoided.

Diagnosis and course

Depending on the form of fluorosis, the diagnosis is different; thus, the suspected diagnosis of dental fluorosis can often already be made by a dentist on the basis of the symptoms typically present. If fluorosis affecting the bones is suspected, so-called imaging procedures such as X-rays can provide further diagnostic indications: An existing skeletal fluorosis can be recognized on X-rays, for example, due to clear bone neoplasms that make the bone appear completely white. General indications of fluorosis can also be taken from the blood count of an affected person. If no countermeasures are taken to combat an existing fluorosis, the symptoms usually increase as the disease progresses. While dental fluorosis may be manifested in the early stages, for example, by only minimal discoloration of the teeth, in later stages the teeth often take on two-dimensional, chalky-white discoloration; the teeth become increasingly porous and can decay.Later stages of bone fluorosis can lead to joint mobility limitations, for example, due to new bone formation in some cases.

Complications

In the worst case scenario, fluorosis can lead to death. However, this case is reached only if the increased intake of fluorine is not stopped. In most cases, fluorosis causes spots to form on the teeth. These can be white or brown. The bones are also less resilient, so the risk of bone fracture is increased. Fluorosis also causes diarrhea, vomiting and nausea. The quality of life is reduced by the symptom, and heavy physical loads can no longer be performed. If fluorosis is stopped, the symptoms may recede, so there are no further complications. Since the teeth are also affected in fluorosis, treatment by the dentist is necessary to repair the damage. It is usually possible to restore the teeth or replace them with implants. This does not cause any further discomfort. If fluorosis occurs acutely due to the increased intake of fluorine, death may result. Therefore, urgent medical care is necessary in this case. Most often, the patient’s stomach is rinsed.

When should you go to the doctor?

Acute fluoride poisoning must be treated immediately. For example, if a child has swallowed an entire tube of toothpaste, a visit to the doctor is indicated. Warning signs that indicate poisoning include nausea and vomiting, pallor and diarrhea. In addition, blood clotting disorders and cardiac arrhythmias may occur, which should also be clarified immediately. Fluorosis does not necessarily have to be treated. In most cases, the symptoms only occur in the teeth and recede as soon as the person affected switches to a different toothpaste or reduces the intake of fluorine tablets. With strongly visible yellowish-brown discoloration, it is imperative to visit the dentist. In most cases, the affected teeth must be extracted to prevent spreading. A visit to the doctor is also necessary if the use of a fluorine-containing toothpaste causes further discomfort. For example, patients with gastrointestinal complaints or headaches should see their family doctor, who can diagnose possible fluorosis and refer the patient to a dentist. Patients with fluorosis should have regular checkups with the appropriate physician to rule out complications.

Treatment and therapy

Once fluorosis has been diagnosed, it is first important to stop excessive fluoride intake. If this is possible, disease-related changes in the bones may partially regress. The treatment steps that follow the regulation of the amount of fluoride supplied in dental fluorosis depend on the dental damage that has already been caused by the disease. As a rule, the goal in dentistry is to preserve teeth that have been attacked. However, if one or more teeth are severely damaged by the effects of fluorosis, it may be necessary to remove or artificially replace the corresponding teeth. So-called acute fluorosis (fluoride poisoning) requires emergency medical care in some cases or can be life-threatening (especially in children). Such acute fluorosis can occur as a result of a single ingestion (usually unintentional), toxic amount of fluorine. Medical measures for acute fluorosis include gastric lavage; ideally, this should occur no later than two hours after ingestion of the fluoride.

Outlook and prognosis

In fluorosis, a distinction must be made between the acute and chronic forms of progression. Acute fluorosis is unpleasant but not dangerous in an otherwise healthy adult. There is nausea, vomiting or diarrhea and there may be accompanying paresthesia. Once the excess fluoride is eliminated, the symptoms disappear and the patient soon feels better. In children, the toxic dose of fluoride is lower, so they may experience worse symptoms than adults. Chronic fluorosis has more long-term effects that can be seen in the bones or teeth. In the teeth, excessive intake of fluoride leads to white spots and bright, extensive discoloration on the teeth. Depending on the severity, the stained appearance is an aesthetic problem for the affected person.Moreover, in the affected areas, the teeth wear out more quickly because it is a change in the mineral composition of the enamel and it can no longer provide adequate protection for the teeth. If fluorosis affects the bones, certain structures of the bones thicken, making them more susceptible to fractures and breaks. In addition, joints may have limited mobility or, in the worst case, may not be able to move at all if they are affected by the thickening caused by fluorosis.

Prevention

Fluorosis can be prevented by controlling the amount of one’s fluoride intake (as much as possible). If fluoride supplements are taken for health reasons, it may be advisable (if medically justifiable in the individual case) to avoid dosages that exceed a daily fluoride amount of 2 milligrams.

Follow-up

The measures or options for aftercare in fluorosis are very much dependent on the exact cause and symptoms of fluorosis. For this reason, no general prognosis can be given here. In the first instance, however, the disease itself or its underlying disease must be treated, whereby above all the increased intake of fluoride must first be stopped. If the fluorosis is a poisoning, no further follow-up measures are usually necessary. After detoxification, the affected person should avoid the increased source of fluoride and not take in the increased amount again. Attention should also be paid to an appropriately correct diet, and a physician can also provide assistance. If the fluorosis leads to damage to the teeth, they must be treated properly. As a rule, a dentist should be consulted immediately after detoxification to prevent further complications in the oral cavity. However, if the amount of fluoride is very high, a hospital should be visited or an emergency doctor should be called immediately. It cannot be generally predicted whether there will be a decreased life expectancy as a result of the disease.

What you can do yourself

First, check all sources of fluoride in the home: Toothpaste and table salt sometimes contain very large amounts. Fluoride-free toothpaste and additive-free salt are available in stores. If children are given fluoride tablets as part of dental prophylaxis, their continued use should be discussed with the doctor treating them. Since fluorine attacks the body’s calcium reserves, attention should be paid to a diet rich in vital substances and calcium. In this way, the body’s own depots can be replenished. Dairy products and green vegetables such as broccoli and kale are particularly rich in calcium. Mineral waters can also contribute to a good calcium supply. Existing discoloration of the teeth can be counteracted with coconut oil. This has a whitening effect and is also antibacterial. The dentist will always try to preserve diseased teeth. In some cases, however, they must be replaced with artificial dentures. In case of acute fluorosis – which often affects children – emergency medical treatment is necessary. In the hospital, the stomach is first pumped out and rinsed to contain the poisoning reaction. To protect teeth from caries without adding fluoride, homeopathy offers an alternative. The remedies Calcium fluoratum (D12), Calcium phosphoricum (D6) and Silicea also have a strengthening effect on teeth, gums and oral flora. A balanced acid-base balance is also important, since an acidic oral flora attacks the tooth enamel.