SN6 SHORT NOTE 5M

Describe fluorosis with its types, features and prevention.

Biochemistry · 1st Professional — Pre-Clinical

Fluorosis = the toxic effects of chronic excessive fluoride ingestion, affecting chiefly teeth and bone.

Optimum fluoride in drinking water is 0.5–1.0 ppm
Above 1.5 ppm dental fluorosis appears; above 3–4 ppm skeletal fluorosis follows

Fluoride replaces the hydroxyl group of hydroxyapatite → fluoroapatite formed → More resistant to acid dissolution → Prevents dental caries

Occurs when excess fluoride is taken during tooth development, before the age of 8; once teeth have erupted they are unaffected
Earliest — chalky white opaque patches on the enamel
Then yellow to brown mottling and staining
Severe — pitting, chipping and loss of enamel
Cosmetic rather than functional in mild forms, but socially distressing

Stage	Features
Early	Vague joint and back pain, stiffness, easily mistaken for arthritis
Established	Osteosclerosis, calcification of ligaments and interosseous membranes, exostoses
Crippling	Kyphosis, rigid spine ("poker back"), genu valgum or varum, restricted movement
Neurological	Cord compression from vertebral changes → paraplegia
Non-skeletal	Gastrointestinal upset, muscle weakness, fatigue; may precede bone changes

X-ray shows increased bone density with a ground-glass appearance and calcified ligaments
Fluoride also chelates calcium, causing secondary hyperparathyroidism, and inhibits several enzymes including enolase and cholinesterase

Endemic in Rajasthan, Andhra Pradesh, Telangana, Gujarat, Punjab, Haryana, Tamil Nadu and Karnataka
Source is groundwater from deep bore wells in fluoride-rich rock
Aggravated by poor nutrition, low calcium and vitamin C intake, and high water consumption in hot climates
Other sources — fluoride-rich foods, black rock salt, some toothpastes, industrial exposure, and rarely long-term drug use

Provide an alternative safe water source — the only fully effective measure
Defluoridation — the Nalgonda technique using alum and lime, activated alumina, or reverse osmosis
Improve nutrition — adequate calcium, vitamin C and vitamin D reduce fluoride absorption and its effects
The changes are largely irreversible once established, so prevention is everything; early skeletal disease may improve after removal of the source
National Programme for Prevention and Control of Fluorosis operates in endemic districts
Children under 6 should use only a smear of toothpaste and be supervised, since swallowing it adds substantially to intake

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