CASE STUDIES

Case Study 1: A male patient aged 45, Lawyer by Profession, from an endemic area for Fluorosis from the State of Bihar was admitted to the All India Institute of Medical Sciences Hospital, New Delhi with complaints of aches & pain in the joints and severe non-ulcer dyspepsia. The patient on examination was found using denture and was taking a daily dose of milk of megnesia for 12 years to have comfortable bowel movement.

Radiographs revealed increase in bone mass, bone density and interosseous membrane calcification. Investigations of fluoride levels in body fluids (urine & blood) and drinking water samples revealed excessive intake of fluoride confirming the diagnosis that the patient is suffering from Skeletal Fluorosis. The patient was kept in the hospital ward on hospital diet and drinking water, which had fluoride, content below 0.5 mg/1.

Within a fortnight, of admission to the hospital, the patient experienced considerable relief from non-ulcer dyspepsia and aches and pains in the joints. Also, the patient himself revealed that he did not require milk of magnesia after having spent two weeks in the hospital, which he was habitu­ated to take for 12 long years. The patient when discharged after 3 weeks of hospitalization was relieved of non-ulcer dyspepsia and aches & pains in the joints to a large extent, by mere consumption of safe drinking water.

 

Case Study 2:  A female patient aged 24, a Nurse by Profession consulted a Physician at the All India Institute of Medical Sciences Hospital with a complaint of severe pain in the stomach, gas formation and having a feeling of a bloated stomach. The patient was highly anemic with 7 gm/dl of Hemoglobin. The investigations carried out were (1) radiograph for bone changes, if any (2) upper GI endoscopy (3) scanning electron microscopy of punch biopsy obtained at endoscopy (4) testing of Fluoride in drinking water, blood & urine, besides other routine tests.

The radiograph appeared normal and testing of drinking water quality re­vealed fluoride content within permissible limits. Urine and blood samples revealed raised fluoride levels compared to normal healthy controls. Endos­copy revealed diffused erythema (redness of the mucosa) with petechiae (minute red spots). Scanning electron microscopy revealed scanty microvilli and cracked appearance of the mucosa.

Further enquiry revealed that the patient had visited a Dentist, with com­plaints of having discoloured teeth and the condition was diagnosed as Den­tal Fluorosis. The Dentist carried out Laminated Veneering (spraying a plas­tic emulsion and light curing) for masking the discoloured teeth.

However, he advised the patient to rinse her mouth thrice a day using fluo­ride mouth rinse to have strong teeth!!! The patient has been using the mouth rinse (containing 900 ppm of fluoride) after diluting it with water. After use of the mouth rinse for a duration of 3 months, the patient developed severe non-ulcer dyspepsia, anemia and weakness.

When it was discovered that she is using a fluoridated mouth rinse, the only advice given by the Physician at the All India Institute of Medical Sciences, New Delhi was that she stop the use of the mouth rinse as it was the primary cause for non-ulcer dyspepsia which was confirmed by Endoscopy and Scan­ning Electron Microscopy of the gastric mucosa.

The patient, improved in a matter of 2-3 weeks from all the complaints that she had and presently leading a healthy life.

The effect of fluoride on teeth is ill understood even by Dentists and there­fore they propagate the use of fluoride, which has disastrous consequences.