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PubMed2002

Caries reductions related to the use of fluorides: a retrospective cohort study.

AIM: To test whether topical fluoride regimes provided additional caries protection to the first molar teeth of children exposed to fluoridated toothpaste and optimally fluoridated water supplies. PARTICIPANTS AND METHODS: This two-year retrospective cohort study included 660, 8-year-old-children. A cluster sampling technique was used to select three groups of 220 children. Group 1 was selected from schools using fluoride mouthrinses (Programme 1). Group 2 was selected from schools applying fluoride gel (APF 1.23%) in addition to the weekly fluoride mouthrinse (Programme 2). Oral health education and oral hygiene instruction were provided to both groups. The control group was selected from schools in the same area that had not adopted any oral health preventive programme. All children were exposed to optimally fluoridated water and fluoridated toothpaste for the last two years or more. Participants were examined for DMFS scores of their first molars using WHO criteria by one examiner (MLRS). RESULTS: The percentage caries free children in Control, Programme 1 and Programme 2 were 55%, 65% and 65.5%, respectively. The differences between Programme 1 and 2 in relation to the Control Group were statistically significant (P < 0.05). There was no difference between Programme 1 and 2 (P = 0.92). CONCLUSIONS: Weekly fluoride rinsing combined whether or not with fluoride gel applications once every three months, provided additional caries-preventive benefits to children with high levels of caries and exposed to optimally fluoridated drinking water and toothpaste. There was no difference in caries levels between children having fluoride rinses and those having fluoride rinses and fluoride gel.

Acidulated Phosphate Fluoride↗
PubMed2004

Fluoride metabolism and fluorosis.

OBJECTIVES: This paper is primarily concerned with the only proven risk associated with water fluoridation: enamel fluorosis. Its purpose is to review current methods of measuring enamel fluorosis, its aetiology and metabolism. A further objective is to identify risk factors to reduce the prevalence of enamel fluorosis and employ methods to manage such risk factors. DATA: The prevalence of enamel fluorosis is increasing in Ireland and internationally. A critical period has been identified at which teeth are most at risk of developing enamel fluorosis: 15-24 months of age for males and 21-30 months of age for females. The data included took these two factors into account. SOURCE: A thorough narrative review of published literature was conducted to identify studies concerning the aetiology and metabolism of enamel fluorosis. Risk factors for fluorosis were identified from these studies. STUDY SELECTION: As it is the pre-eruptive phase of enamel development which represents the greatest risk to developing enamel fluorosis, studies examining sources of fluoride ingestion for young children were selected. These included studies on ingestion of fluoride toothpaste by young children, fluoride supplementation and infant formula reconstituted with fluoridated water. CONCLUSIONS: There is evidence that the age at which tooth brushing with fluoride toothpastes is commenced and the amount of fluoride placed on the brush are important risk factors in the incidence of dental fluorosis. It is recommended that brushing should not commence until the age of 2 and that a pea-sized amount (0.25 g) of toothpaste should be placed on the brush.

Adolescent↗
PubMed1983

Dental preservation in patients irradiated for head and neck tumours: A 10-year experience with topical fluoride and a randomized trial between two fluoridation methods.

Since 1972, the dentures of 935 patients irradiated for head and neck carcinoma have been preserved after careful selection and according to well-defined criteria, using a prospective programme of daily applications of topical sodium fluoride gel. The results of 1-10 years follow-up are given. Four percent of the patients developed a diffuse dental decay and 1% a bone necrosis which can be related to the dental preservation. None of these complications occurred with careful patient selections nor when programme compliance was maintained. Post-irradiation dental extractions were performed in 29 cases with subsequent healing in all cases but one. The surgical technique of such extractions is described. In March 1980, a randomized protocol was activated to compare the use of the sodium fluoride gel to high content fluoride toothpaste (1350 ppm F-). Two hundred and twenty patients were entered. At 12-36 months follow-up, dental caries were observed in 3% of the patients receiving the fluoride gel as compared to 11% receiving the toothpaste (p = 0.1). However, none of the patients adhering to the programme instructions failed in either arm. Currently, it seems reasonable to state that preservation of teeth in irradiated patients should be the rule and not the exception, given good dental condition prior to treatment and patient cooperation. The 5 min daily application of fluoride gel is the most reliable method for prevention of post-irradiation dental caries. The twice daily use of high content fluoride toothpaste is a good alternative provided its limitations are well understood by the clinician and patient.

Administration, Topical↗
PubMed2001

Abrasion and stain removal by different manual toothbrushes and brush actions: studies in vitro.

BACKGROUND AND AIMS: A limited amount of data using flat trim multitufted toothbrushes shows that abrasion of substrate surfaces by a standard toothpaste varies dependent on filament stiffness and configuration; soft brushes producing the most abrasion. The aims of these studies in vitro were to assess toothpaste abrasion of acrylic and stain removal by 5 proprietary medium toothbrushes with different head filament arrangements, and a prototype brush with rectangular filaments. The prototype brush had a medium texture in the long axis and soft texture at right angles to the long axis. MATERIAL AND METHOD: Optically clear acrylic was used as the substrate for abrasion by a standard toothpaste. Loss of substrate was determined by profilometry after 5000, 10000, 15000 and 20000 linear or rotary brushing actions. Stain removal was determined spectrophotometrically from optically clear acrylic specimens stained by chlorhexidine tea soaking sequences. Stained specimens were brushed with water using linear or rotary actions and measurements taken every 10 s to 60 s. RESULTS: Abrasion was progressive with increasing strokes and the pattern for each brush and brush action was to a first approximation linear. Overall, abrasion was significantly greater with linear compared to rotary action. Also overall brushes differed in the abrasion produced with both actions and particularly at greater exposure times. Within brush differences for the two motions were all significant by 20000 strokes except for the prototype brush. Stain removal was progressive over time with each brush but the pattern was non-linear. For the proprietary brushes the rotary motion removed less stain. For the prototype brush more stain was removed with the rotary action. Overall brushes differed significantly in stain removal within each motion and for each motion most differences between the proprietary and prototype brushes reached significance. CONCLUSIONS: The differences between brushes for both abrasion and stain removal must in large part relate to the filament contact area with the substrate surface. Whilst the model may not be predictive of clinical differences, it could find use to establish minimum criteria for toothbrush action.

Acrylic Resins↗
PubMed2000

Epidemiology of eczematous cheilitis at a tertiary dermatological referral centre in Singapore.

In a retrospective epidemiologic study of 202 patients with eczematous cheilitis attending a patch test clinic, females (182 (90%)) predominated over males (20 (10%)). The mean age of our patients was 30.9 years. There was no significant difference between the mean age of females (31 years) presenting with cheilitis compared to males (29 years). Endogenous cheilitis (53%) was the commonest diagnosis, followed by allergic contact dermatitis (34%) and irritant contact dermatitis (5.4%). A personal history of atopy was recorded in 33%. There was no significant difference in the prevalence of atopy between the sexes or among the diagnoses. The mean duration of cheilitis was 16.4 months. The duration was significantly longer in males (29 months) than in females (15 months) (p=0.004). The mean number of positive patch test reaction in patients with allergic contact cheilitis (2.8) was significantly higher than in those with irritant contact cheilitis (0.2) (p = 0.012) or endogenous cheilitis (0.5) (p = 0.00). The commonest cause of allergic contact cheilitis were lip cosmetics, including lipsticks and lipbalms, followed by toothpastes. The commonest cause of irritant contact cheilitis was lip-licking, lipsticks and medication. In 81/202 (40%) patients, 1 or more causes of contact cheilitis could be ascertained. In females, lip cosmetics were the commonest cause, accounting for 54% (44/81) of cases. Toothpastes accounted for 21% (17/81), followed by topical medication 7% (6/81). For males, toothpastes were the commonest cause of allergic contact cheilitis. Ricinoleic acid and the patient's own lip preparations were the commonest relevant contact allergens.

Adult↗
PubMed2003

Uptake of vitamin A in buccal mucosal cells after topical application of retinyl palmitate: a randomised, placebo-controlled and double-blind trial.

Retinoids have been reported to produce regressions in metaplastic changes of the mucosal epithelium. In order to define the role of these micronutrients in the prevention of squamous metaplasia of the oral cavity, it is necessary to measure their uptake in target tissues such as the buccal mucosal epithelium. We demonstrated in a trial that retinyl palmitate applied topically via a toothpaste is taken up by buccal mucosal cells in young healthy volunteers. In the randomised, parallel-designed, placebo-controlled and double-blind trial, forty volunteers divided in two groups cleaned their teeth either with a placebo toothpaste or a retinyl palmitate-containing toothpaste (1 mg/g) for 56 d. Buccal mucosal cells samples were taken from the healthy volunteers during the retinyl palmitate application and the following wash-out phase to determine the concentration of retinyl palmitate and retinol by HPLC. Supplementary blood samples were taken from the volunteers on days 0 and 56 to investigate changes in plasma retinyl palmitate and retinol concentrations. Results from only thirty participants (sixteen placebo and fourteen treated subjects) were used in the statistical evaluation as the remaining sample results were spoiled by a technical defect during the HPLC analysis. A significant (P<0.05) uptake of retinyl palmitate in buccal mucosal cells after 7 d and a significant (P<0.05) increase of plasma retinol after 17 d was demonstrated in our present study. The uptake of retinyl palmitate and the following hydrolysis to retinol led to an enrichment of vitamin A in buccal mucosal cells.

Absorption↗
PubMed1987

The oral retention and antiplaque efficacy of triclosan in human volunteers.

An antiplaque toothpaste containing 0.2% (w/w) triclosan significantly inhibited overnight plaque growth in 12 human volunteers. After use of a 1 g quantity of the toothpaste containing 0.2% (w/w) [3H]-triclosan, 36.3 +/- 1.4% of the triclosan was retained. The mean concentration (+/- s.d.) achieved in saliva 5 min after toothpaste use was 8.16 +/- 2.50 micrograms g-1. The saliva decay curve for triclosan was consistent with a two phase model with t1/2 values of 0.45 h and 2.42 h, respectively. Triclosan was present in bacterial plaque for at least 8 h after dosage and in the oral mucosa for at least 3 h.

Adult↗
PubMed1999

Effect of toothbrushing on elemental release from dental casting alloys.

PURPOSE: This study assessed the effect of toothbrushing on the elemental release from common dental casting alloys. MATERIALS AND METHODS: A Au-Pt high-noble alloy, a Au-Pd high-noble alloy, a Pd-Cu-Ga noble alloy, and a Ni-Cr base-metal alloy were placed into a biological medium for 1 week to allow equilibration of elemental release, then brushed for 30 minutes at 90 strokes/min under 200 g of force with a soft toothbrush. The brushing was performed in neutral saline or lactic acid at pH 4 with or without toothpaste. The alloys were then transferred back into a biological medium for 1 week. Atomic absorption spectroscopy was used to measure the mass lost from each alloy during and in the week after brushing. Mass loss was expressed as micrograms per square centimeter of alloy surface, and the various brushing conditions were compared by analysis of variance and Tukey multiple comparison intervals (alpha = 0.05). RESULTS: During brushing, element release increased significantly over nonbrushed controls for all alloys except the Ni-Cr. Toothpastes, acidic solutions, or combinations of these conditions with toothbrushing further enhanced elemental release, but Ni release from the Ni-Cr alloy increased the most (30-fold). In the week after brushing, brushing alone increased elemental release only from the Ni-Cr alloy. However, toothpastes and acidic solutions increased elemental release for all alloys significantly, except for the Au-Pd alloy. In general, elemental release during brushing was far greater than in the week after brushing. CONCLUSIONS: Under the conditions of this study, toothbrushing increased the elemental release from dental casting alloys.

Analysis of Variance↗
PubMed1990

The effect of triclosan, stannous fluoride and chlorhexidine products on: (II) Salivary bacterial counts.

A previous study demonstrated that triclosan and stannous fluoride containing oral hygiene products reduced plaque regrowth compared to saline but were not more effective than a conventional commercial fluoride/anionic detergent toothpaste. To further understand these results, this study measured the persistance of antimicrobial activity of the same products by recording the duration of salivary bacterial count reductions following a single exposure to each product. Comparison was also made with a chlorhexidine rinse as the positive control. From a panel of 16 volunteers, in an 8-cell randomised cross-over designed study, salivary bacterial counts were recorded at baseline and to 420 min. All test and control products were significantly more effective than saline and significantly less effective than chlorhexidine at suppressing bacterial counts. Unlike chlorhexidine, evidence of bacterial recovery was apparent after the 30-min sampling time. There were essentially no significant differences between the test and control products, although the stannous fluoride toothpaste performed marginally better than other products. The findings are consistent with the plaque regrowth results previously obtained and again demonstrate to date that it is difficult to surpass the antimicrobial and plaque inhibitory properties of conventional commercially available toothpastes by the addition of antimicrobial agents such as triclosan and metal salts.

Adult↗
PubMed2004

Dentine hypersensitivity: development and evaluation ofamodel in situ to study tubulepatency.

BACKGROUND AND AIMS: Lesions of dentine hypersensitivity have numerous tubules open at the dentine surface as opposed to non-sensitive dentine where tubules are mostly covered by a smear layer. The present two studies were designed to model both states in situ and evaluate the effects of agents on the model. METHOD: Etched (sensitive) and smeared (non-sensitive) dentine specimens prepared from human third molar teeth were retained in lower buccal acrylic appliances. The results of Study 1 led to the development of a method to ensure tubules were sectioned at right angles. Study 1 was a 5-day period, seven treatment regimens randomised, part blind cross over design involving five subjects. Treatments were 2x day application of a desensitising (SA) or non-desensitising toothpastes (F) or chlorhexidine (CHX) mouthwash with or without drinking orange juice (OJ)(1 l/day). A no treatment group (P) allowed plaque to accumulate. The evaluation of effects was observational by scanning electron microscopy (SEM). Study 2 involved 1 subject, 4 treatments applied once and studied after 0, 6, and 12 h by SEM with image analysis. The 12 h groups were studied with and without imbibing water or OJ. Treatments were two desensitising (SA & SC) and one non-desensitising (F) toothpastes and an in office product (DS). RESULTS: Study 1: Treatment SA resulted in occlusion of tubules an outcome little changed by OJ. Treatment P produced a bio-film, which covered the dentine surface. CHX produced some tubule occlusion in three of the five subjects. F+/-OJ and CHX+OJ had little effect and tubules remained open. For smeared specimens toothpastes and OJ removed the smear layer but SA+/-OJ blocked tubules. P and CHX had no effect on the smear layer. Study 2: At 0 h, tubule occlusion was in order of magnitude DS>or=SA>SC>F. After 6 and 12 h with SA, SC and F some loss of occlusion occurred but not DS. Water and OJ by 12 h decreased occlusion for SA, SC and particularly F. Water and OJ removed virtually all of DS. CONCLUSIONS: The aims of Study 1 were achieved and effect of treatments was not inconsistent with data in vitro. The need for more standardisation of specimens was appreciated and applied in Study 2 to allow image analysis to quantitatively record data. Further use of the model in randomised controlled clinical trials is envisaged.

Acid Etching, Dental↗
PubMed2005

Reducing variability and choosing ideal subjects for experimental gingivitis studies.

INTRODUCTION: This study was undertaken to test the hypothesis that male, non-smokers, aged 25-50 years, with a proven track record of developing gingivitis would provide suitable subjects for experimental gingivitis studies because the inter-subject variation would be greatly reduced. MATERIALS AND METHODS: Subjects were required to be men aged between 25 and 50 years, in good general health with at least four sound teeth in one posterior quadrant of the mandible. Subjects who were smokers, taking antibiotics, anti-inflammatory drugs or had any other medical, surgical or social condition making participation in the study inadvisable, were excluded. Subjects had previously participated in a 21-day experimental gingivitis study. Subjects with the most gingivitis at the end of the previous study were invited to participate first, moving down the list until the required number of subjects had been achieved. Subjects were randomly assigned to one of three toothpastes: Crest Gum Care, Mentadent P or a placebo (UK Signal). Subjects were asked to brush their teeth twice daily for 1 min., with the tooth-shield in place and containing 1 ml of their assigned toothpaste. RESULTS: Thirty-five subjects completed the study using the placebo, 36 used Mentadent P and 39 completed the study using Crest Gum Care. Both toothpastes containing active gum health ingredients (Triclosan and Zinc Citrate in Mentadent P and Stannous Fluoride in Crest Gum Care) resulted in statistically significant reductions in gingival bleeding and inflammation. Although a directional reduction, there was no statistically significant reduction in plaque scores. No significant differences between the two active groups were established. CONCLUSION: The factors that were controlled or measured and analyzed in these studies were: gender, smoking status, age and chronic gingivitis level. The results add support to the hypothesis that male subjects show less variation, however there is limited evidence linking the female menstrual cycles to variations in gingivitis status. Further research in this area is required before definitive conclusions can be made. Selecting a subject population in order to decrease variation must be undertaken with caution. A subject population selected for particular attributes can be extremely valuable when assessing the anti-gingivitis potential of new agents, but this population would be as biased if used for large efficacy clinical trials. The data obtained will not necessarily be able to be generalized, that is, applicable to the whole population. However there is sufficient evidence to justify balancing for (or excluding) smokers from subject populations in experimental gingivitis studies.

Adult↗
PubMed1994

Oral hygiene in relation to caries development and immigrant status in infants and toddlers.

The purpose of this study was to describe oral hygiene factors in infants and toddlers living in Sweden with special reference to caries prevalence at 2 and 3 yr of age and to immigrant status. The study was designed as a prospective, longitudinal study starting with 671 children aged 1 yr. At 3 yr, all the children were invited to a further examination. A total of 298 children, randomly selected from the original group, were also examined at 2 yr. The accompanying parent was interviewed about the child's oral health habits. Children who were free of caries at 3 yr had had their teeth brushed more frequently at 1 and 2 yr of age, had used fluoride (F)-toothpaste more often at 2 yr of age, and had a lower prevalence of visible plaque at 1 and 2 yr of age than children with caries. Immigrant children had had their teeth brushed less frequently, had used less F-toothpaste, and had a higher prevalence of visible plaque at 1 yr of age than nonimmigrant children. Early establishment of good oral hygiene habits and regular use of F-toothpaste seem to be important for achieving good oral health in pre-schoolchildren.

Child, Preschool↗
PubMed1997

Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age.

OBJECTIVE: This paper analyzes reports to the American Association of Poison Control Centers (AAPCC) of suspected overingestion of fluoride by children younger than 6 years of age between 1989 and 1994, and estimates the probably toxic amounts of various home-use fluoride products in children younger than 6 years of age. METHODS: Annual incidence rates of reported fluoride exposures attributed to dietary supplements, toothpaste, and rinses were calculated. Probably toxic amounts of each product were calculated using the frequently cited dose of 5 mg/kg. RESULTS: Children younger than 6 years of age accounted for more than 80 percent of reports of suspected overingestion. While the outcomes were generally not serious, several hundred children were treated at health care facilities each year. A 10 kg child who ingests 50 mg fluoride (10.1 g 1.1% NaF gel; 32.7 g 0.63% SnF2 gel; 33.3 g 1,500 ppm F toothpaste; 50 g 1,000 ppm F toothpaste; and 221 mL 0.05% NaF rinse) will have ingested a probably toxic dose. CONCLUSIONS: Overingestion of fluoride products in the home is preventable. Dentists and other health care providers should educate parents and child care providers about the importance of keeping fluoride products out of reach of children. Manufacturers should be encouraged by the ADA and the FDA to use child-resistant packaging for all fluoride products intended for use in the home.

Acute Disease↗
PubMed1997

Effect of an amine fluoride dentifrice on dental caries used in a community-based oral health education program.

OBJECTIVES: The purpose of this study was to investigate the caries-reducing effect of an amine fluoride toothpaste when used under real-life conditions in a community preventive program. METHODS: Approximately 12,500 children 3-12 years of age were provided with toothpaste (four tubes or 360 grams annually during three years) to be used in kindergartens or schools and once a day at home. The teachers supervised daily toothbrushing sessions. Random samples of children in each of the ages 3, 6, 9, and 12 years were selected from the intervention and the reference communities at both the start of the study and after three years, and examined for dental caries experience. RESULTS: Amine fluoride dentifrice seemed to provide a reduction in dental caries prevalence compatible to the most commonly used fluoride dentifrice compounds. CONCLUSIONS: The implemented fluoride toothpaste program is a feasible and practical method of improving the oral health status of children.

Amines↗
PubMedDate not supplied

A randomised controlled trial of the efficacy of supervised toothbrushing in high-caries-risk children.

Scottish children have one of the highest levels of caries experience in Europe. Only 33% of 5-year-old children in Dundee who developed caries in their first permanent molars by 7 brushed their teeth twice a day. High-caries-risk children should benefit if they brush more often with fluoridated toothpaste. The aim of this clinical trial was to determine the reduction in 2-year caries increment that can be achieved by daily supervised toothbrushing on school-days with a toothpaste containing 1,000 ppm fluoride (as sodium monofluorophosphate) and 0.13% calcium glycerophosphate, combined with recommended daily home use, compared to a control group involving no intervention other than 6-monthly clinical examinations. Five hundred and thirty-four children, mean age 5.3, in schools in deprived areas of Tayside were recruited. Each school had two parallel classes, one randomly selected to be the brushing class and the other, the control. Local mothers were trained as toothbrushing supervisors. Children brushed on school-days and received home supplies. A single examiner undertook 6-monthly examinations recording plaque, caries (D(1) level), and used FOTI to supplement the visual caries examination. For children in the brushing classes, the 2-year mean caries increment on first permanent molars was 0.81 at D(1) and 0.21 at D(3) compared to 1.19 and 0.48 for children in the control classes (significant reductions of 32% at D(1) and 56% at D(3)). In conclusion, high-caries-risk children have been shown to have significantly less caries after participating in a supervised toothbrushing programme with a fluoridated toothpaste.

Cariostatic Agents↗
PubMed1994

Fluoride inhibits the antimicrobial peroxidase systems in human whole saliva.

Fluoride (F-) ions at concentrations present in vivo at the plaque/enamel interface (0.05-10 mM) inhibited the activities of lactoperoxidase (LP), myeloperoxidase (MP) and total salivary peroxidase (TSP) in a pH- and dose-dependent way. The inhibition was observed only at pH < or = 6.5 and with F- concentrations > or = 0.1 mM. At pH 5.5 LP activity was inhibited by 85% and MP by 34% with 10 mM F-. TSP activity was also inhibited only at low pH (5.5) by approximately 25%. Furthermore, the generation of the actual antimicrobial agent in vivo, hypothiocyanite (HOSCN/OSCN-), of the oral peroxidase systems was inhibited by F-, again at low pH (5.0-5.5) both in buffer (by 45%) and in saliva (by 15%). This inhibition was observed only with the highest F- concentrations studied (5-10 mM). Fluoridated toothpaste (with 0.10 or 0.14% F) mixed with saliva did not inhibit TSP or HOSCN/OSCN- generation. This may have been due to the 'buffering' effect of toothpaste which did not allow salivary pH to drop below 5.9. We conclude that the F- ions in acidic fluoride products, e.g. in gels or varnishes (but not in toothpastes), may have the potential to locally inhibit the generation of a nonimmune host defense factor, HOSCN/OSCN/SCN-, produced by oral peroxidase systems. The possible clinical significance of this finding remains to be shown.

Animals↗
PubMed1991

Dental caries and fluoride exposure in Western Australia.

Most water supplies in Western Australia (WA) have been fluoridated since about 1968, but one region has persistently resisted. Supplement use has been encouraged there, and fluoride toothpaste is widely used. Caries prevalence and caries experience in children in Perth (F- 0.8 mg/L) have declined steadily since fluoridation, but in the Bunbury region (F- less than 0.2 mg/L), caries measures remain higher than in Perth. The purpose of this study was to correlate the magnitude and timing of fluoride exposure with caries experience. Altogether, 592 randomly selected children born in 1978 (mean age, 11.8 years) in Perth and the Bunbury region provided residence and fluoride exposure information for the periods from birth to four and from four to 12 years of age. Caries experience was recorded clinically in accordance with DMFT and WHO criteria. Sixty-one percent had been continuous residents of fluoridated areas from birth to four years, and 51% between the ages of four and 12 years. Fluoride supplement use was low. By the age of 1.5 years, 42% had used toothpaste. The prevalence of caries was 0.38 in Perth and 0.61 in the Bunbury region, and mean DMFT scores were 0.89 (SD, 1.39) and 1.57 (SD, 1.60), respectively. Bivariate analysis revealed all fluoride exposure to be associated with reduced caries experience, but there were large correlations between some variables. When unconditional logistic regression analysis was used, the most important (p less than 0.05) odds ratios associated with no caries experience were for residence in a fluoridated area from four to 12 years of age and early use of toothpaste.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed2007

Recovery from skeletal fluorosis (an enigmatic, American case).

UNLABELLED: A 52-year-old man presented with severe neck immobility and radiographic osteosclerosis. Elevated fluoride levels in serum, urine, and iliac crest bone revealed skeletal fluorosis. Nearly a decade of detailed follow-up documented considerable correction of the disorder after removal of the putative source of fluoride (toothpaste). INTRODUCTION: Skeletal fluorosis, a crippling bone disorder, is rare in the United States, but affects millions worldwide. There are no data regarding its reversibility. MATERIALS AND METHODS: A white man presented in 1996 with neck immobility and worsening joint pains of 7-year duration. Radiographs revealed axial osteosclerosis. Bone markers were distinctly elevated. DXA of lumbar spine (LS), femoral neck (FN), and distal one-third radius showed Z scores of +14.3, +6.6, and -0.6, respectively. Transiliac crest biopsy revealed cancellous volume 4.5 times the reference mean, cortical width 3.2 times the reference mean, osteoid thickness 25 times the reference mean, and wide and diffuse tetracycline uptake documenting osteomalacia. Fluoride (F) was elevated in serum (0.34 and 0.29 mg/liter [reference range: <0.20]), urine (26 mg/liter [reference range: 0.2-1.1 mg/liter]), and iliac crest (1.8% [reference range: <0.1%]). Tap and bottled water were negative for F. Surreptitious ingestion of toothpaste was the most plausible F source. RESULTS: Monitoring for a decade showed that within 3 months of removal of F toothpaste, urine F dropped from 26 to 16 mg/liter (reference range: 0.2-1.1 mg/liter), to 3.9 at 14 months, and was normal (1.2 mg/liter) after 9 years. Serum F normalized within 8 months. Markers corrected by 14 months. Serum creatinine increased gradually from 1.0 (1997) to 1.3 mg/dl (2006; reference range: 0.5-1.4 mg/dl). Radiographs, after 9 years, showed decreased sclerosis of trabeculae and some decrease of sacrospinous ligament ossification. DXA, after 9 years, revealed 23.6% and 15.1% reduction in LS and FN BMD with Z scores of +9.3 and +4.8, respectively. Iliac crest, after 8.5 years, had normal osteoid surface and thickness with distinct double labels. Bone F, after 8.5 years, was 1.15% (reference range, <0.1), which was a 36% reduction (still 10 times the reference value). All arthralgias resolved within 2 years, and he never fractured, but new-onset nephrolithiasis occurred within 9 months and became a chronic problem. CONCLUSIONS: With removal of F exposure, skeletal fluorosis is reversible, but likely impacts for decades. Patients should be monitored for impending nephrolithiasis.

Biopsy↗