November 1st, 2021
More than 80% of fluoride toxicity is seen in children before the age of 6 years, due to ingestion of fluoride-containing toothpaste or mouthwashes (29); it is rare in adults in the developed world. Acute toxicity is characterized by nonspecific gastrointestinal disturbances such as pain, nausea, vomiting, and diarrhea (30,31). In severe cases, this may progress to renal and cardiac dysfunction, coma, and ultimately death (32). In children, as little as 8.4 mg/kg may produce symptoms (30). Chronic fluoride toxicity is usually caused by high fluoride concentrations in drinking water or the use of fluoride supplements.
Chronic ingestion of high doses leads to dental fluorosis, a cosmetic disorder where the teeth become mottled (1). In more severe cases, it leads to skeletal fluorosis, in which bone is radiologically dense, but fragile. Fractures can occur, and there may be calcification of ligaments and tendons, leading to reduced joint mobility (1). The syndrome also may include extensive calcification of ligaments and cartilage, as well as the bony outgrowths of osteophytes and exostoses