Effect of Fluoride Toxicity on Some Haematological Indices in Human Population

The present study aimed to determine the toxicity of Fluoride on haematological indices in some population residing in fluoride endemic area of Dongergaon village of Chandrapur district, Maharashtra, India. The study group was selected on the basis of elevated level of serum fluoride and symptoms of skeletal fluorosis. Various haematological parameters such as Hb, TEC, TLC, HCT and PLT count were analysed. Students t-test was applied for statistical analysis and the result showed that values of haematological indices in study group were significantly declined as compared to control group. The outcomes of the present study indicated the reduction in Hb, TEC, HCT, increase in TLC and non-significant change in PLT.

Progress of Signaling Pathways, Stress Pathways and Epigenetics in the Pathogenesis of Skeletal Fluorosis

Fluorine is widely dispersed in nature and has multiple physiological functions. Although it is usually regarded as an essential trace element for humans, this view is not held universally. Moreover, chronic fluorosis, mainly characterized by skeletal fluorosis, can be induced by long-term excessive fluoride consumption. High concentrations of fluoride in the environment and drinking water are major causes, and patients with skeletal fluorosis mainly present with symptoms of osteosclerosis, osteochondrosis, osteoporosis, and degenerative changes in joint cartilage. Etiologies for skeletal fluorosis have been established, but the specific pathogenesis is inconclusive. Currently, active osteogenesis and accelerated bone turnover are considered critical processes in the progression of skeletal fluorosis. In recent years, researchers have conducted extensive studies in fields of signaling pathways (Wnt/β-catenin, Notch, PI3K/Akt/mTOR, Hedgehog, parathyroid hormone, and insulin signaling pathways), stress pathways (oxidative stress and endoplasmic reticulum stress pathways), epigenetics (DNA methylation and non-coding RNAs), and their inter-regulation involved in the pathogenesis of skeletal fluorosis. In this review, we summarised and analyzed relevant findings to provide a basis for comprehensive understandings of the pathogenesis of skeletal fluorosis and hopefully propose more effective prevention and therapeutic strategies.

A Brief Review of Ideal Bio-Indicators, Bio-Markers and Determinants of Endemic of Fluoride and Fluorosis

Fluorosis in man and animals is the resultant of chronic exposure of Fluoride (F) for prolonged period through F contaminated drinking water and foods and industrial F pollution. However, fluoridated water and industrial F emissions are the major sources of F exposure for humans and domestic animals. Chronic F exposure not only deteriorate the health of human beings and animals but also causes diverse adverse toxic effects on hard (teeth and bones) and soft (organs) tissues. Various F induced pathological changes in teeth and bones are known as dental and skeletal fluorosis, respectively. However, skeletal fluorosis is more dangerous and highly significant since it diminishes the mobility at a very early age and develops crippling or lameness bone deformity. Thousands of people and domestic animals are suffering with fluorosis worldwide. Dental fluorosis is rampant and the commonest form of chronic F toxicosis and appears in subjects of almost all age groups. However, children and bovine calves are relatively more sensitive and highly susceptible to F toxicosis and revealed the earliest clinical sign of chronic F poisoning in the form of dental fluorosis. Hence, these are ideal bio-indicators for chronic F intoxication or fluorosis. Nevertheless, the magnitude or severity of fluorosis is much more depending on the density and rate of bio-accumulation of F. Biological samples, milk, urine, blood serum, teeth, nails, etc. are better bio-markers for F intoxication. However, urine F concentration is the best bio-marker for endemic of F and fluorosis. In this communication, ideal bio-indicators and bio-markers for endemic of F and fluorosis and diverse potential determinants influencing the severity of F toxicity (fluorosis) are considered and briefly and critically reviewed. Findings of this review are useful in making and implementation of health policy and the commencement of mitigation and control of fluorosis programme in F endemic areas where it is problematic for human and animal health.

Efficacy of Calcium-Containing Eggshell Powder Supplementation on Urinary Fluoride and Fluorosis Symptoms in Women in the Ethiopian Rift Valley

Dietary calcium binds Fluoride (F), thus preventing excess F absorption. We aimed to assess the efficacy of supplementing calcium-containing Eggshell Powder (ESP) on F absorption using urine F excretion and on fluorosis symptoms. In total, 82 women (41 Intervention Group, IG; 41 Control Group, CG) were recruited; overall, 39 in each group completed the trial. Morning spot urine was collected before (baseline, BL) and after (endline, EL) the intervention that was 6-months daily supplementation with 2.4 g ESP (providing ~1000 mg of calcium). Dental, skeletal, and non-skeletal fluorosis assessments was carried out at BL and, except for dental, at EL. Relative risk (RR) and linear generalized estimating equation were used to compare outcomes between groups. At BL, urinary F excretion in the IG and CG groups was similar, ~10 mg/L. At EL, urinary F excretion in IG women was six-fold lower (β = −6.1 (95% CI: −7.1, −5.1)) compared to CG. The risk of developing skeletal and non-skeletal fluorosis were significantly (p < 0.001) reduced in the intervention group. A significant reduction in urinary F excretion and reduction in many fluorosis symptoms were observed among women supplemented with calcium-containing ESP, thus providing evidence for using this dietary calcium source for mitigation of fluorosis. Clinical trials registration: NCT03355222.

Spinal cord compression as the presenting feature of skeletal fluorosis

Skeletal fluorosis is a rare toxic osteopathy reported as an endemic disease and caused especially by prolonged ingestion of high fluoride concentration. Spinal cord compression primarly by the ossification of the posterior longitudinal ligament and ligamentum flavum, may rarely reveal the disease. Surgical decompression is the treatment of choice.