Fluoride safety and toxicity.

i am preparing an article about fluoride role in tooth decay prevention and methods of application you can come back after two days (isa) to read it.

safety:

Fluoride safety is one of the most health subjects that has been investigated for the last 60 years i don’t want to list the performed researches with all the results because it is very very much and only the scientists should have that headache. I will jumb to the some conclusions here that is collected from my readings as a professional dentist:

1-Water fluoridation is proved to be one of the best  way to reduce decay in modern world with no doubt.

2-Fluoride  occur naturally in  water in many water sources in the world in a ratio that is close or even exceed the ratio present in the fluoridated water.

3-Also we have to say that fluoride is toxic and harmful in the large doses like many other chemical materials but usually the harmful doses is far away from the amount that present in the house  products(if you are 80 kg weight then you have to swallow 400 ml from fluoridated tooth paste to be hospitalized for fluoride toxicity  ).

4-The products that containing a high conc of fluoride like fluoride tablets, varnishes, salt and drops should not be used unless described by a dentist or a physician and also the fluoride conc in the drinking water of the patient should be measured before he start to use this products(if the drinking water is already containing enough fluoride and you started to take fluoride treatment you are exposing yourself to chronic fluoride toxicity )

5-fluoridated water is proved to completely   safe and very effective in caries prevention so use it and stop this phobia.

6-last thing you may find some researchers saying that fluoridation is bad and harmful but they are really really rare and usually in science we believe the majority.

Toxicity:

fluoride present naturally in water but like any other chemical material if the ratio exceeded the limit it will cause some side effects that start from simple white patches on tooth surface to the dangerous toxicity cases that we rarely see.Naturally flouride ratio in drinking water which is the main fluoride source  should not exceed 1 ppm (part per million) any excess fuoride is not healthy and can cause side effects.   We will explain now the different side effects of fluoride excess.

1-Teeth mottling (flourosis) : mottling happen when the child exposed to high level of fluoride in drinking water for a long time during tooth formation. The symptoms start from simple small white patches on the surface of the tooth to extreme pitting and porosity. In the cases with high fluoride ratio the tooth usually become discolored and bad looking. Flourosis usually happen in areas or countries with naturally excess flouride in the drinking water as we mentioned before flouride ratio in water should not exceed 1 ppm (part per million)  if the ratio reached 2 ppm this will result very severe mottling.

2- General Toxicity :

Toxicity is presented in three stages according to the amount of digested:(we will estimate later the fluoride ratio in some products to evaluate the case in real life matter )

1-Safe tolerated dose: if the intake is less than 1mg/kg.Usually this dose IS too small to produce symptoms and the patient should only be checked by the doctor.

2-Potential  lethal dose: It is not so pad as its name.The name is coming from that it is the least dose with reported mortality but vast majority of the patient pass this with no problems but sure the patient have to be hospitalized.The dose digested here is about 5 mg/kg.

now we will roughly estimate the fluoride concentration in some of the fluoride containing products :

Adult normal tooth paste: Usually the  ratio is about 1000 ppm f this means that the 50 ml tooth paste tube contains about 50mg fluoride.

fluoride rinse: The fluoride conc. here is 0.23 mg f/ml.

so to reach the the 5mg/kg ratio that require hospitalization for a  5 yr-old child with approximate 20 kg white he have to eat 85 ml from adult fluoridated tooth paste .

Management of toxicity and antidote:

if the ingested dose less than 5 mg /kg give a large volume of milk  and it is better to call your doctor immediately.

If the ingested dose is more than 5mg /kg run to the hospital for gastric lavage if there is any delay give iv calcium gluconate and emetic.