The effects of excessive fluoride intake.

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Abstract
A survey was undertaken in the Arusha district of Tanzania in areas where the water contains 1.1 to 45.5 ppm of fluoride. Examinations of the teeth for fluorotic mottling and caries, of the nails for certain abnormalities, and of the thyroid gland for goiter, were made on 1243 persons. The prevalence of fluorotic mottling of the teeth was high (95%) and of dental caries was low (DMF [decayed, missing, filled] index =0.58). Nail changes were found in 44%. Clubbing of the fingers, possibly related to skeletal fluorotic changes, occurred in 18 older persons; 27% of those examined had goiter. Older subjects believed to be at high risk were offered X-ray examinations. Of the 112 who had radiographs taken, 87% had fluorotic bone changes. Possible preventive measures to control this endemic focus of fluorosis are discussed. In Arusha township, the alternatives are a de-fluorination process for the muncipal water supply or the phased transfer to sources of water containing lower levels of fluoride. In rural areas, a program of health educat ion to encourage the drinking of rain water, the drawing of domestic water from places with the lowest available content of fluoride, and in the future the careful selection of sites for drawing piped water supplies are suggested.

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