Dental Digest

1956; 62: 353-357

Prenatal and postnatal ingestion of fluorides - A progress report.

Reuben Feltman, D.D.S., Passaic, New Jersey


Undesirable Effects

Out of the 601 cases in the adult group, six have shown undesirable side effects from the fluoride supplement. Five out of the 495 children have presented evidence of undesirable reactions. This is 1 per cent incidence of side effects.

Reactions in Adults - Included in the adult cases are three cases previously reported. (9) Because the three patients were within two weeks of their expected date of confinement, it was not possible to investigate thoroughly the causes and relationship of the fluoride therapy and the symptoms: two cases of vomiting and one of urticaria. At the time the cases were reported, it was concluded that these symptoms were not the result of the fluoride ingestion, but a reaction to the binder used in the tablets.

Fluoride Possible Source of Side Effects - More recent cases which are reported here seem to indicate, however, that the fluoride itself was the source of the reactions.

Case 1

The patient was a seven-year old white child with an itchy skin rash, headache, epigastric distress, generalized weakness, and listlessness. Her discomfort was such that most of her time in school was spent in the nurse's room. When the tablets were withdrawn, symptoms disappeared but returned again when therapy was reinstituted. Again withdrawal resulted in disappearance of symptoms. The patient has been symptom free since. The parents of this child refused to allow further experimentation.

Case 2

A report from a physician concerning an experience with a white male child, two and a half years of age when treatment was instituted, states: "Beginning in his first year of life, after an episode of measles, the child developed an atopic dermatitis, at first, involving the entire skin of the body and with usual treatment receding to a controllable state. He was placed on fluoride, 1 milligram, every day. Approximately three days after ingestion of the daily dose, he developed a generalized vesicular type of rash associated with marked pruritus. Upon cessation of the drug, the rash markedly improved in ten days when he was again placed on the fluoride which again resulted with a rash of the same general appearance. After this second episode the use of fluoride was terminated"

Case 3

A 23-year-old well-oriented primipara in the fourth month of pregnancy was admitted to the prenatal clinic on January 7, 1955. She was placed on fluoride tablets, one daily, slowly dissolved in the mouth. After one week the drug was stopped because she developed a rash on her face. The rash looked like chapped blotches of various sizes and shapes, it was scaly and itchy, and covered the entire forehead, right cheek, and chin. The rash did not occur on the left cheek or chin.

Fluoride discontinued - The patient's face cleared up in three days on discontinuing the fluoride. Upon resuming the tablets the rash recurred in two days, this time accompanied by nausea. Tablets were again withdrawn and symptoms disappeared. Two weeks later the patient returned to the clinic and was directed to take the tablets again.

Development of Serious Symptoms - The patient took the tablets for three days, the rash reappeared and she developed serious symptoms including vomiting with blood showing in the vomitus. The fluoride description was discontinued. The patient then continued an uneventful pregnancy and delivered a healthy baby.

General Conclusions from Case Histories

The cases described indicate that certain patients react unfavorably to fluoride therapy. Whether the fluorine acts as an allergen after short term use or whether the fluorine acts as an intoxicant after many months of use, is unknown and should be determined.

Possible Association with Allergy - It has been reported that cases of fluorine intoxication occur in persons with a history of allergy. It is emphasized that a lower threshold in tolerance to drugs in allergic patients must be reckoned with. (10)

Termination of Undesirable Effects Simple - Whatever the mechanism involved it is simple to terminate the undesirable reaction of fluoride dosage by discontinuing the ingestion of the tablets. If the source of the fluoride is the public water supply, the problem is more complicated.

Additional Investigation Needed - Much has yet to be learned and understood regarding the metabolism and physiologic actions of this element and its salts.

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