 hello everyone welcome back to dentistry and more so today we have a new topic that is fluoride toxicity so far we have covered under fluorides the history of fluorides the system mechanical fluorides the various mechanisms to prevent dental caries by fluorides and do defluration techniques and today we have fluoride toxicity so let's see what is fluoride toxicity in detail so fluoride is commonly known as doubly sword okay we know how a sword look like it has a handle and it has a blade most commonly the blade has only one cutting edge it serves its purpose whatever it is it has commonly one cutting edge but there are swords which has two cutting edge this it is a phrase commonly used in English literature doubly sword because if it goes to the both extremes it create problems if it's become very good this problem if it is becoming very bad that is also problem so in that sense we can say that fluoride is a doubly sword because if it goes very low creates problem if it goes very high if it creates problem fluoride should be at optimal level for to get an ultimate caries production that is one parts per million if it is going very down it gives a chance for creation of dental caries as the protective effect is lost and if it is goes very high around 4 to 5 ppm or 8 ppm it creates fluorosis in either dental or skeletal fluorosis so that's how it is becoming a doubly sword so to keep an optimal level at around one ppm will give us the maximum benefit so it should shouldn't be going very high going very low so that's why it's known as doubly sword so the so the toxicity is broadly classified as acute acute and chronic so don't forget the doubly sword concept of fluoride when it is low and when it is high it causes problem okay so the acute and chronic as we all know acute is sudden chronic is slow slow action acute is very past just like a single ingestion of very large amount of fluoride so that becomes acute you know acute pain and chronic pain acute is sudden pain and chronic is slow throbbing type it's so similarly the fluoride if we consume very large amount in very short of period in a single shot it's known as acute and chronic very slow amounts over a longer period of time so let's see what is acute toxicity so acute toxicity as we mentioned a large amount ingestion in a very short of period or a single shot so the speed and severity of response dependent on the amount of fluoride ingested and the weight and age of the individual so it depends the prognosis or the outcome of the patient dependent on how much fluoride we consumed and weight and age of the individual so most common adverse effect is nausea and the patient may have abdominal cramps in diarrhea and salivation dehydration and thirst so after two to four hours better it is possible if first aid is not administered so the golden hour is first two to four hours so we should do the treatment you improper treatment or the emergency treatment at the first two to four hours so usually death happens if the treatment is not given by cardiac failure or respiratory analysis so that is acute toxicity the symptoms and the golden hour two to four hours so if the death is not happening after 24 hours then the prognosis will be good so we need to learn the two doses here one is certainly lethal dose also known as cld and safely tolerated dose that is std so cld is 32 to 64 milligram per kilogram body weight and safely tolerable tolerated dose is 8 to 16 gram so that is almost one fourth of the cld so that is the easy way to study the cld and std cld is equal to four stds can just see multiply 8 32 with 4 16 64 so certainly the dose is per kilogram body weight if you multiply with 100 you get 3 grams 3.226.4 grams so on average if you consume 5 gram of fluoride that might cause your death so that is certainly the dose so this is one kilogram body weight so safely tolerated dose is 8 to 6 milligrams so on average if patient has 100 kg on average if patient has 70 kg or just take 100 kg so 100 kg body weight needs a 3.226.4 grams because we are converting milligram to gram okay so it becomes 3.226.4 gram of 100 kg body weight person so if a person consumes 3.226.4 gram of fluoride it might leads to death of the person so on an average you can take 5 gram as your lethal dose so if you consume 5 grams of fluorides you might die so that is certainly the dose and safely tolerated dose is one fourth of cld so we can say that if person has 100 kg safely tolerated dose of the body is 0.8 to 1.6 gram so this is milligram and I am talking about gram because I am talking about a person with body weight 100 kg for your easy comparison so we calculated 5 grams here and we can say it is one fourth the safely tolerated dose will be around 1.25 gram can be tolerated by the body so that is cld and std okay so this will be if we calculate we get 5 grams and this will be around 1.25 gram up to 1.25 gram we can tolerate it we can tolerate body can tolerate that amount and if it goes 4 times and it becomes 5 grams around 5 grams patient the person might die so what we do if we face a situation of fluoride toxicity in in our house house or in a clinic or anywhere anywhere around us where a person consumes a large amount of fluoride by mistake or any suicide attempt what we are supposed to do so first try to understand the difference that is we have three types of treatment that is if the amount consumed is less than 5 milligram for body weight and 5 to 15 and more than 15 okay so it is like if person has 100 kg weight okay so this is 0.5 gram becomes 0.5 gram and this is 0.5 to 1.5 gram and this is more than 1.5 gram so we need to understand the amount consumed this is just kilogram per body weight so I am explaining explaining about a person who is having 100 kg okay so you can you can calculate if the person has around 80 70 kg it will be somewhere here 0.4 grams or something like that so if it is very less just 0.5 gram we need to give calcium because calcium binds to this fluoride fluoride is highly electronegative the ion exist in highly electronegative state that is f minus so it will immediately react and bind to the calcium okay so calcium fluoride will be formed because it's very difficult fluoride to stay as an ion so it always exists compound so if we give calcium this fluoride will join with calcium and becomes calcium fluoride so it relieves GA symptoms and there is no need for induced vomiting if the person is consuming around 0.5 gram less than 5 milligram per body weight so what if the consumption is between 5 milligram to 15 milligram per body weight or 0.5 to 1.5 gram okay all calculation I am referring with a person of 100 kg so what we have to do is we have to induce vomiting using any ametic and we have to give the same oral calcium just like milk 5 person calcium gluconide or calcium lactate solution and we should rush him to the hospital for observing for few hours so vomiting oral calcium and taking him to hospital will be the treatment scenario if it is a moderate amount that is 0.5 to 1.5 gram so what if it is very high dose like 1.5 gram so we know lethal dose is 5 gram so we have to take him to the hospital very immediately induce vomiting and we should monitor the cardiac and we should keep IV not orally IV calcium gluconide because absorption absorption should be very fast and supporting measures and sometimes diuretics also should keep so if we don't know the amount consumed it's better to take him to hospital and can assess the symptoms if patient is very okay if person seems to be okay can assume that the amount consumed is mild or moderate person is not properly oriented and person has this um vomiting tendency and dizziness so all the symptoms you can rush him to hospital so these are the various protocols for emergency treatment of fluoride exposure so next is a chronic fluoride toxicity it is commonly there are two types that is one is dental and skater for for so chronic we know it is a chronic consumption or a very longer period of time not immediate consumption and it doesn't need immediate treatment because it happens for a very longer period so dental process we know the tooth optimal amount of fluoride in drinking water is 1 ppm if we are consuming water with more than 1 ppm for a very longer period especially during the tooth development that is the highlight point tooth development that is less than six years old because the second monar will be finishing its mineralization around six years so if person consumes water with fluoride more than 1 ppm after six years there are very less chances of fluorosis because most of the teeth completes its mineralization cycle so if person consumes water more than 1 ppm during the mineralization cycle there are chances of dental fluorosis so most commonly the fluorosis appears as white flecks and choque opaque areas on the enamel okay so most commonly it should be at 1 ppm and if it is going higher and higher the appearance will be changed if it is 2 ppm or 3 ppm that is two or three times greater it will be white flecks or choque opaque areas where if it is going high that is 4 to 5 ppm it become brown and pitted corroded appearance that is severe fluorosis that is about dental fluorosis that is in range 1 to 5 ppm we can say if it is going very high more than 6, 7, 8 ppm our bones also will be affected usually all mineralized structure will be affected but mostly it is visible on the teeth if it is a very milder or the up to 3 to 4 ppm the skeletal structures also will be affected but we cannot make it very obvious because it is bonds we can't see the bonds so the only calcified tissue we can see is our teeth so it is very visible on the teeth so the visible changes that what we can see in our bonds is crippling stage it is very very bad situation because the bonds will be crippled and its shape will be changed so that is the only state where we can see the bone or skeletal fluorosis not like dental fluorosis so it happens only when the fluoride amount is more than 8 ppm so symptoms will be severe pain in the back bones, joints, hips and stiffness and there will be a special syndrome known as knock knee syndrome because usually we can bend our legs and hands only in one side or backward but we can do outward bending of legs and hands that is knock knee syndrome it is very advanced stage of skeletal fluorosis so that's all about dental fluorosis and skeletal fluorosis which is seen in chronic fluoride toxicity and acute fluoride toxicity it requires treatment, imni treatment, various stages I mentioned and the chronic toxicity so fluoride is a double edged sword if it is used at a proper optimal level that is around 1 ppm it gives proper and a good protection against dental caries and if it is moves to the other side if it is very low and if it is very high it becomes a sword like double edged sword like function so fluoride is safe and effective if it is used with that's all about fluoride toxicity so we have completed the fluoride topics so I'll come up with a new topic on my next video thank you for watching