What is Fluorosis?

Fluoride is an important mineral required for bone and teeth development. Normal acceptable levels of fluoride range from 1.5 to 4 mg/day. Lower levels can cause fluoride deficiency, while higher levels can cause a condition called fluorosis. Fluoride deficiency results in Tooth decay.

On the other hand, fluorosis associated with changes in the enamel of the tooth are referred to as dental fluorosis, and changes in the bones are referred to as skeletal fluorosis.

What are the Causes of Fluorosis?

Fluorosis is usually caused by a high level of fluoride in drinking water. High fluoride levels in water are usually found in certain places; these places are endemic for fluorosis. The earth’s crust has a high content of fluoride and so does the bore well water in endemic areas which is often used as a source of water. Several states in India are endemic for fluorosis.

Regular intake of products manufactured with high-fluoride containing water may also cause fluorosis. Vegetables and foods grown in endemic areas may also be high in fluoride content. Seafood and tea are normally rich in fluoride. Black Rock salt contains high amounts of fluoride and is used in several food products. Regular intake of these products may also cause fluorosis

Fluoride is also found in toothpaste and other dental products. Certain supplements may also contain fluoride. These may be harmful to people already exposed to high fluoride levels.

What are the Symptoms and Signs of Fluorosis?

Fluorosis is of two main types – dental fluorosis and skeletal fluorosis.

Dental fluorosis occurs in children less than 8 years of age during their teeth development stages. The changes become apparent once the teeth erupt. Changes noted in the teeth in dental fluorosis include the following:

  • The appearance of whitish spots or chalk-like lines
  • Brownish stains on teeth
  • In severe cases, pitting of teeth

The extent of the damage depends on the amount of fluoride consumed and the duration period. It should be noted, that fluoride deficiency also affects teeth, making them more prone to tooth decay.

Symptoms of skeletal fluorosis appear later than dental fluorosis. Structural changes take place in the bones, which make them weak. Ligaments may also calcify and harden and bony spurs may appear in skeletal fluorosis. Symptoms of skeletal fluorosis include:

  • Pain in small joints
  • Pain and stiffness in the back
  • Deformity of the hips, knees and other joints. Knock knees may be present. Gait may be affected
  • Deformity of the spine. Spinal deformity can cause compression on the spinal cord and the exiting nerves, resulting in pain, muscle weakness, tingling and numbness and other symptoms along the distribution of the nerves

Other symptoms like digestive tract symptoms like pain in abdomen, diarrhea, constipation, neurological symptoms like tingling and numbness, increased tendency to urinate and increased thirst, and muscle pain, stiffness and weakness may also be present. These symptoms may appear before the onset of skeletal fluorosis and therefore may be useful in early diagnosis.

How to Diagnose Fluorosis?

Fluorosis can be diagnosed based on:

  • Measurement of urinary and serum fluoride levels, as people with fluorosis tend to have increased levels of fluoride
  • Bone biopsy with bone fluoride estimation to detect skeletal fluorosis
  • CT scan to detect changes in bone associated with fluorosis
  • MRI scan to detect changes associated with compression of tissues and nerves

Measurement of fluoride levels in the residential area of the individual can confirm the diagnosis.

How do you Treat Fluorosis?

Fluorosis is difficult to treat especially once permanent changes occur.

Nutritional supplements containing vitamins C, D, antioxidants, and calcium are advised to reduce the deleterious effects of excessive fluoride.

Surgical treatment may be necessary to treat bony deformities due to fluorosis and subsequent compression of nerves. Rehabilitation of patients is also necessary.

It is of utmost importance to address the issue that causes fluorosis. In endemic areas, de-fluoridation plants should be set up for water supply. The World Health Organization (WHO) recommends that fluoride content of water should not exceed 1.5 mg/L, while the Bureau of Indian Standards recommends a maximum level of 1 mg/L.

Prevention of Fluorosis

Steps to prevent fluorosis especially in endemic areas include the following:

  • Find out the fluoride content in your drinking water, through local agencies
  • Do not give your child dietary supplements containing fluoride if your water contains the required amount
  • Health education is extremely important to tackle fluorosis. People should be made aware of the ill effects of fluoride. A balanced diet with plenty of fruit and vegetables should be advised. A deficient nutrition only worsens the problem
  • Breastfeeding for babies is advised
  • Make sure that your child does not swallow fluoride containing toothpaste. Use very little toothpaste for smaller children. Mouth rinses containing fluoride should be avoided in children

In India National Program for Prevention and Control of Fluorosis (NPPCF) issues guidelines to address the problem of fluorosis.


  1. Centers for Disease Control and Prevention - (http://www.cdc.gov/)
  2. Kodali Rama Krishna and NOA. Sasi Kiran. Fluorosis – An Update. International Journal of Research in Pharmaceutical and Biomedical Sciences. 2013; 4: 1084-8.

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