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  1. Fluorosis in very low concentration - 1 part per million (ppm) or less is used to reduce the incidence of dental caries. At slightly higher levels (2 - 4 ppm) it may produce mottling of teeth. In some parts of India & Africa, where fluorine concentration in the drinking water may be above 10 ppm - chronic fluorine intoxication (fluorosis) is endemic and results in skeletal anomalies.

Dental mottling


Interosseous membrane calcification

Spine ligament calcification
  1. Fluorine stimulates osteoblastic activity; fluoroapatite crystals are laid down in bone and these are usually resistant to osteoclastic resorption. This causes calcium retention implied mineralization and secondary hyperparathyroidism.
  2. Characteristic pathological feature is subperiosteal new bone accretion and osteosclerosis (increased bone density). most marked in vertebrae, ribs, pelvis, forearm and leg bones, together with hyperostosis at the bony attachments of ligaments, tendons and fascia.
  3. Despite the apparent thickening & density of skeleton, tensile strength is reduced and the bones fracture more easily. First clinical manifestation is usually a stress fracture, back pain, bone pain, joint stiffness and neurological defects (hyperostosis encroaching vertebral canal).
  4. Characteristic x-ray features are osteosclerosis, osteophytosis and ossification of ligamentous and fascial attachments.
  5. Radiologically can be mistaken for other osteosclerotic conditions as Paget’s disease, osteopetrosis, renal osteodystrophy, idiopathic skeletal hyperostosis etc.

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