Development of skeletal fluorosis is associated with consumption of well water containing
fluoride concentrations in excess of 4 parts per million (ppm).
1
,
2
,
3
,
U.S. Environmental Protection Agency: Ground water and drinking water— current drinking water standards. Available at: http://www.epa.gov/safewater/mcl.html. Accessed January 20, 2004
4
Unprocessed foods contain insufficient fluoride to cause disease.
1
Tea, however, is fluoride rich,
5
,
6
,
7
and skeletal fluorosis occurs in Asia where inferior quality “brick” tea comprising
mature leaves, twigs, and berries of the tea plant Camellia sinensis is drunk.
8
Other causes of fluorosis are rare (Table 1).
1
,
9
,
10
,
11
Table 1Sources of fluoride toxicity
| Fluoride therapy for osteoporosis |
| Pediatric supplements |
| Certain wines |
| Teflon-coated pots |
| “Brick” tea |
| Betel nuts and leaves |
| Chewing tobacco and snuff |
| Pesticides |
| Hydrofluoric acid |
| Industrial exposure during arc welding, cryolite mining, or manufacture of aluminum, steel, or glass |
| Laundry powder containing silicofluoride |
| Niflumic acid (nonsteroidal anti-inflammatory) |
| Fluorine vapors in laboratories, coal fumes |
| Certain sparkling mineral waters |
| Dentifrices, mouthwashes, toothpastes, topical dental gels |
From references.
1
,
9
,
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References
- Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. National Academic Press, Washington, D.C1997: 288-313
- Guidelines For Drinking Water Quality: Volume 1. Recommendations. 2nd ed. World Health Organization, Geneva, Switzerland1993: 47
U.S. Environmental Protection Agency: Ground water and drinking water— current drinking water standards. Available at: http://www.epa.gov/safewater/mcl.html. Accessed January 20, 2004
- National Research Council Subcommittee on Health Effects of Ingested Fluoride. National Academy Press, Washington, D.C1993
- Fluoride concentrations in three types of commercially packed tea drinks in Taiwan.J Expo Anal Environ Epidemiol. 2003; 13: 66-73
- Concentration of fluoride and selected other elements in teas.Nutrition. 1989; 5: 237-240
- Fluoride content in caffeinated, decaffeinated and herbal teas.Caries Res. 1996; 30: 88-92
- Brick tea fluoride as a main source of adult fluorosis.Food Chem Toxicol. 2003; 41: 535-542
- Skeletal fluorosis in humans.Prog Food Nutr Sci. 1986; 10: 279-314
- Acute and chronic fluoride toxicity.J Dent Res. 1992; 71: 1249-1254
- Fluoride therapy in osteoporosis.Rev Rheum Engl Ed. 1999; 66: 67-69
United States Department of Agriculture Economic Research Service. Food Consumption (Per Capita) Data System. Available at: http://ers.usda.gov/Data/FoodConsumption/DataSystem.asp?ERSTab=3. Accessed September 16, 2004.
- It’s tea time.Food Technol. 2002; 56: 16
- The Green Tea Book. Avery Publishing Group, Garden City Park, New York1998
- Cresceri L.S. Greenberg A.E. Eaton A.D. Standard Methods for the Examination of Water and Wastewater. 20th ed. American Public Health Association, the American Water Works Association and the Water Environment Federation, Washington, D.C1998
- Bottled Water. 2003; (codified at 21 CFR §165.110).
- Compressive myelopathy in fluorosis.Neuroradiology. 1996; 38: 338-342
- Bone fragility of the peripheral skeleton during fluoride therapy for osteoporosis.Clin Orthop. 1990; 261: 268-275
- Calcium deficiency in fluoride-treated osteoporotic patients despite calcium supplementation.J Clin Endocrinol Metab. 1996; 81: 269-275
- Effect of calcium and phosphorus on fluoride metabolism in man.J Nutr. 1975; 105: 733-740
- Public Health Service Committee to Coordinate Environmental Health and Related Programs.Review of Fluoride. U.S. Department of Health and Human Services, Public Health Service, Washington, D.C1991
- A report of fluorosis in the United States secondary to drinking well water.JAMA. 1991; 265: 486-488
- Drinking water fluoridation and bone.Exp Clin Endocrinol Diabetes. 1999; 107: 12-20
- Epidemiological evidence of increased bone mineral density in habitual tea drinkers.Arch Intern Med. 2002; 162: 1001-1006
- Effect of long-term exposure to fluoride in drinking water on risks of bone fractures.J Bone Miner Res. 2001; 16: 932-939
- The relation between single/double or repeated tea catechin ingestions and plasma antioxidant activity in humans.Eur J Clin Nutr. 2002; 56: 1186-1193
- The role of tea in human health.J Am Coll Nutr. 2002; 21: 1-13
Article Info
Publication History
Accepted:
July 21,
2004
Received:
April 19,
2004
Footnotes
Supported in part by The Clark and Mildred Cox Inherited Metabolic Bone Disease Research Fund.
Identification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
