Musculoskeletal Imaging

Fluorosis

chronic fluorine intoxication as a result of excess of fluorine or its compounds in the body. Fluorosis may have various causes, including the drinking of water containing concentrations of fluorine greater than 4 parts per million; industrial exposure to fluorine-containing compounds over a long period of time or inhalation of fluorine vapours; treatment of osteoporosis with sodium fluoride; and the drinking of fluorine-containing wine.

Among the manifestations of fluorosis are nausea, vomiting, constipation, loss of appetite, toxic nephritis, joint pain and restriction of motion, back stiffness, restriction of respiratory movements, functional dyspnoea, and paraplegia. Mottled enamel is an early dental sign of fluoride intoxication. Chronic fluorosis leads to depressions of variable size in the teeth and discolouration. Radiographs reveal hypoplasia, irregular dental roots and periapical sclerosis.

In the skeleton, radiographic abnormalities include hypoplasia and irregularity of dental structures, osteosclerosis, vertebral osteophytosis, calcification of ligaments and periostitis (Fig.1). Increasing trabecular condensation leads to the eventual appearance of radiodense or chalky areas throughout the thorax, vertebral column and pelvis. Hyperostosis and bone excrescences develop at sites of ligamentous attachment, especially in the iliac crests, ischial tuberosities and inferior margins of the ribs. In advanced stages, fluorosis can lead to contractures and deformities of extraspinal joints, kyphosis, restricted spinal and chest motion, and neurologic complications (paresthesias, muscular weakening and wasting, sensory disturbances and paralysis). Normally the abnormalities are reversible after cessation of exposure, but a coarsened trabecular pattern without increased radiodensity may remain.

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Fig.1

AP radiograph demonstrates diffuse osteosclerosis and coarsening of the trabeculae owing to long-term oral intake of sodium flouride.
Fluorosis, Fig.1