Neurology India, Vol. 58, No. 2, March-April, 2010, pp. 338
Endemic skeletal fluorosis
Umakant K Misra
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow - 226 014, India
Correspondence Address:Umakant K Misra, Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareilly Road, Lucknow - 226 014, India
Code Number: ni10093
D Raja Reddy, Srikanth R, Deme Ramaiah Vidyapeetham, Hyderabad.
This book addresses a common environmental problem, endemic fluorosis, in a simple clear manner. The book has 10 chapters. After a brief introduction, the second chapter deals with the metabolism of fluoride. Details of epidemiological data are provided highlighting the magnitude of endemic fluorosis in India and comparing it with the other regions. This chapter highlights that there may be several general or environmental factors contributing to the more severe manifestations of fluorosis in India. The chapters on clinical features describe in details the dental, skeletal and neurological aspects of fluorosis. The neurological manifestations of fluorosis include myelopathy, radiuculopathy and radiculomyelopathy and rarely entrapment neuropathy. The authors emphasize that the neurological manifestations are much more common in India and could be due to renal impairment and also suggest the role of other chemicals such as cadmium and strontium. The chapter on laboratory diagnosis deals with water, serum and urinary fluoride estimation and the authors highlight the variation in urinary fluoride estimation on a day-to-day basis. The gross and microscopic changes in bone, muscle and nerve are presented clearly and supported by photographs. The authors emphasize the large fiber involvement in fluorosis. The authors also discuss the controversy about optimal water fluoride level and the conflict with the Western recommendations and suggest that in India a conservative level of 0.05 ppm is more desirable. The treatment of fluorosis and prevention has been separately dealt with. The authors have discussed why the defluoridation of the patients has not succeeded. The work is well supported by photographs, radiographs, histological pictures, diagrams and tables. The references are appropriate.
Though the authors have not mentioned a work highlighting the coexistence of frank osteomalacia or rickets with osteoslcerosis, ligament calcification  , they however have discussed the probable effects of nutritional deficiency on the severity of endemic fluorosis in India.
This book presents in a simple, succinct manner an overview of endemic fluorosis and is addressed to a wide range of readers. I would recommend this book to those interested in or wanting to know about fluorosis.
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