CASE STUDY FOR THE 4TH YEAR COURSE IN ECOSYSTEM HEALTH DENTAL FLUOROSIS (under development)

MEDICAL - BACKGROUND The following questions highlight specific areas of knowledge, with which you may already be familiar; however, you may want to review the material under each question to ensure you have an accurate and complete understanding. A clear understanding of this material is necessary in order to discuss and comprehend this case study. What is Fluorosis? What about Fluoride Deficiency? What is the natural history of Fluorosis? What are common sources of Fluoride? How does Fluoride enter the human body? What is the epidemiology of Fluorosis?

What is Fluorosis? In the broadest sense, the term "Fluorosis" describes a state of toxicity of the trace element, Fluorine (commonly referred to in its ionic state as Fluoride) within an organism. Fluorosis is not limited to humans, and can affect any aspect of the ecosystem. Click here for a brief review of Fluorine chemistry. Humans appear to vary considerably with respect to their susceptibility to Fluorosis. As a general guideline, prolonged total Fluoride intake exceeding 1.0 mg/day can produce clinical signs of Fluorosis in adults. Fluoride status in humans is governed by a variety of factors that cover a wide range of Medical, Environmental, Economic and Socio-political issues. It is not possible to effectively deal with Fluorosis within your patient community without understanding all aspects of this problem. Generally speaking, human Fluoride toxicity will manifest as any combination of; Dental Fluorosis: (link to pictures) the most obvious and easily diagnosed form of Fluorosis by a characteristic bilateral white mottling of the dentition. Dental Fluorosis is usually caused by over-exposure to Fluoride when the dental enamel is actively mineralizing during early childhood. Skeletal Fluorosis: (link to pictures) involves abnormal mineralization of bone and soft tissues and/or the distruption of normal activity of the osteocytes. For this reason, Skeletal Fluorosis often mimics "generic" osteoarthritis and/or osteoporosis in relatively young adults. Systemic Fluorosis: due to the chemical nature of Fluoride and its action(s) within mammalian systems which are not limited to teeth and bone, Fluoride toxicity may potentially be linked to every major multiple cause ailment of the 20th century from cancer to Attention Deficit Disorder.

Fluoride toxicity may be acute or chronic, with affects ranging from cosmetic damage, to disability and even death. With the exception of Dental Fluorosis, Fluoride-related illness is often attributed to other diseases or syndromes (i.e. osteoarthritis for Skeletal Fluorosis, cardiovascular failure for death by acute Fluoride poisoning) making Fluorosis in itself very difficult to track epidemiologically in the absence of an ecosystem health framework.

What about Fluoride Deficiency? You will not find Hypofluoremia in Taber's Cyclopedic Medical Dictionary simply because, strictly speaking, there is no such thing as human Fluoride Deficiency. Fluoride is ubiquitous in food, water, air, and most tissues of the human body, and no physiological dysfunction results from having a "theoretically impossible" Fluoride intake of zero. The aim of artificial fluoridation of drinking water in some Western World countries as a public health measure is the prevention of