Fluoride recommendation depends on age, oral health, and usage of fluoridated water. Fluoridating water is a convenient and feasible way to reduce dental caries in children, where 1ppm (parts per million) or 1mg/dl is maintained in the drinking water.
Daily recommended intake for fluoride is generally defined as,
Birth to 3 years of age: 0.1 to 1.5 milligrams (mg).
4 to 6 years of age: 1 to 2.5 mg.
7 to 10 years of age: 1.5 to 2.5 mg.
Above ten years and adults: 1.5 to 4 mg.
When the water is fluoridated, it is recommended to maintain fluoride between 0.7ppm to 1.2ppm. Using fluoridated toothpaste is also an effective method, but swallowing too much of it causes side effects, especially in children. There are other methods to include fluoride like fluoridated mouthwash, topical creams, tablets, fluoridated milk, etc.
Gastrointestinal symptoms are the first to occur with excessive fluoride. Fluoride gets readily absorbed by the stomach, and its excess produces hydrochloric acid, which can lead to irritable bowel disorder (IBD) in severe cases. An excessive amount of fluoride taken can present itself as fluorosis. The two types of fluorosis are dental and skeletal fluorosis. Dental fluorosis: Surplus fluoride builds up in teeth causing dental fluorosis, which can be mild or have an aesthetic concern. But when noted, de fluoridation should be under medical guidance to avoid further complications.
Skeletal fluorosis: Exceeding the upper limit for decades can result in fluoride deposition in bones, making them weak and prone to fractures. This is more common in India and China. Fluoride poisoning in the blood can also cause dehydration, hip dislocations, kidney injuries, and in some cases, arthritis.
Excess amount of fluoride can come from,
Certain teas like the brick tea
Pollution by uncontrolled fluoride emission of companies
Freshwater fishes eaten with bones
Swallowing oral fluoride in the form of mouth wash and toothpaste by children etc.
Further, metal leaching of fluoride and arsenide in drinking water, and accidents in water treatment plants drug abuse can be causative factors for this toxicity. However, the occurrence of fluorosis is less when compared to the amount of decrease in dental cavities when water fluoridation was initiated. While dental fluorosis is a biomarker for fluoride toxicity of month-long, hair, and nail beds show recent toxic fluoride intake. Hence, it is important to follow the state guidelines and attend regular dental visits.
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