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Fluoride Poisoning (Toxicity) Symptoms, Effects and Treatment

What is fluoride?

Fluoride is a halide and the reduced form of fluorine, a naturally occurring element. It is found in many different forms in a range of household substances like toothpaste, insecticides and certain dietary supplements. It is probably best known for playing an important role in dental health by preventing dental caries and assisting with tooth strength.

Effects of Fluoride

Fluoride in water and toothpaste works in two ways for maintaining strong and healthy teeth. In assists with the remineralization of damaged teeth and prevents the acid produced by bacteria from breaking down enamel (demineralization).

In terms of fluoride toxicity, the high levels of fluoride in the system may have a range of the effects.

  • Irritation of the mucosal lining of the gastrointestinal tract.
  • Binds to calcium ions and affects utilization.
  • Affects a number of enzymes responsible for energy production, transmission of nerve impulses and blood coagulation.
  • Increases levels of potassium in the blood.
  • Calcification of ligaments.

Types of Fluoride Products

  • Toothpaste and other oral hygiene products – sodium monofluorophosphate
  • Dietary supplements (vitamins and minerals) – sodium fluoride
  • Glass etching, chrome cleaning agents – ammonium bifluoride
  • Insecticides/pesticides – sodium fluoride

Fluoride Exposure and Toxicity

The controversy over fluoride poisoning or fluorosis revolves around high fluoride levels in drinking water. The accepted range of fluoride in water in 0.7 to 1.2 ppm. Drinking water with levels of fluoride exceeding 2ppm should not be consumed, especially by children. Levels moderately higher than this may cause mild signs and  symptoms of poisoning but levels exceeding 10 ppm can cause serious symptoms and even result in death.

Other methods of excessive fluoride exposure include accidental or intentional consumption of insecticides or exposure to fluoride dust in industrial settings.

Signs and Symptoms of Fluoride Poisoning

  • White specks or streak to yellow-brown discoloration of the teeth.
  • Pitting of the teeth.
  • Damage of tooth enamel – teeth are more prone to cavities.
  • Increased salivation (hypersalivation).
  • Nausea with or without vomiting.
  • Difficulty swallowing (dysphagia).
  • Abdominal pain.
  • Diarrhea.
  • Muscle spasms.
  • Muscle weakness.
  • Headaches.
  • Tremors.
  • Arrhythmias.
  • Joint stiffness.
  • Shortness of breath (dyspnea).
  • Low levels of calcium (hypocalcemia), magnesium (hypomagnesemia) and glucose (hypoglycemia) in the blood.
  • High levels of potassium in the blood (hyperkalemia).

In severe cases of fluoride poisoning, there may be signs of shock and cardiac arrest is possible.

Treatment for Fluoride Poisoning

The approach to treating fluoride poisoning depends on whether it is acute (sudden, large dose) or chronic (small dose over long periods). Acute toxicity (poisoning) is by far the most dangerous and requires immediate medical attention. Ideally the person or caregivers should call the National Poison Control Center as well for further advice. Milk or calcium can help with treating fluoride poisoning. Emergency medical personnel will stabilize the patient at the scene and rush them through the emergency room. Here a gastric lavage (stomach pumping) may be considered and calcium (possibly in the form of milk) will be given.

In most instances there is no permanent effects of acute fluoride poisoning. This ultimately depends on the amount of fluoride consumed and the time over which it was ingested. One of the major deciding factors is the speed at which medical treatment was received as this can drastically reduce the chances of any complications developing over the long term.