Fluoride Osteosclerosis from Drinking Water

Although the medical and dental professions are well acquainted with the effects of fluoride-containing drinking water on the teeth, with resulting dental fluorosis (mottled enamel) (1), the condition of osteosclerosis in the bones of human beings who have incurred mottled enamel from this source is not well known. As a matter of fact, no case of this kind has been reported in this country. The condition may have potential public health importance. Such a case is the basis for this paper. Erratum in: https://doi.org/10.1148/41.5.497b Report of a Case M. W. D., white soldier, aged 22, entered William Beaumont General Hospital on June 18, 1942, because of a chalazion of the upper right eyelid. The lid infection promptly subsided under treatment but, because of a rather severe anemia noted on the routine examination, the patient was detained in the hospital for further study. On questioning, it was found that he tired easily but had no other complaints. His family history was negative for anemia. Two brothers, aged 28 and 30, were in the Army and in good health. They had spent their childhood in areas in which mottled enamel was non-endemic. One sister, aged 20, was in good health but did have moderately severe mottled enamel. She had spent her entire life in the same areas in which the patient was born and raised, in which mottled enamel was endemic. Roentgenographic study of these members of the family was negative for osteosclerosis. The patient gave a history of measles and mumps in childhood. He had an appendectomy at the age of four and a tonsillectomy at the age of ten. At fifteen he sustained an injury to the right kidney, followed by hematuria for one week. There was no history of bleeding tendencies. There had been no contact with chemicals except for a period of three months before the patient entered the hospital, when he used kerosene and high octane gasoline in cleaning airplanes. For the past three months he had noticed some “trembling” of the hands. Since coming into the Army he had gained 23 lb. In the review of systems, no positive findings were elicited. There was no history of hematemesis, melena, or hemorrhoids. The patient was born in Spur, Texas, where the fluorine content of the drinking water ranges up to 12 parts per million, and lived there until the age of seven years. He then moved to Post, Texas (fluorine content of drinking water 5.7 parts per million), where he lived for two years. At the age of nine he moved to Lubbock, Texas (fluorine content of the water 4.4 parts per million), where he remained for seven years. In all of these communities, he used the city water supply for drinking and cooking purposes. He then moved to Washington, D.C., where he lived for two years. At the age of eighteen he returned to Lubbock, Texas, and was there until entering the Army at twenty-one. About five years ago the patient was troubled with easy fatigability and was seen by his local physician, who prescribed bed rest for a few days but no medication. After this he felt better. In January 1942, following an upper respiratory infection, he noticed that he began to tire easily on exertion.