FLUOROSIS (Latin Fluorum fluorine + - osis) — the chronic disease (intoxication) developing at long excess receipt in an organism of fluorine and its connections.
Distinguish professional and local F. Professionalny F. comes to light at the workers who are affected by various compounds of fluorine (see) in high concentration, napr, in the aluminum industry; in the USSR it is observed seldom. Local F. occurs among the population using drinking water with the increased content of fluorine — St. 1,0 — 1,5 mg/l.
Professional fluorosis. At the heart of a pathogeny professional F. oppression of activity of many enzymes owing to formation of chemical bonds of an ion of fluorine with active centers of enzymes, and also change of permeability of cellular membranes lies that leads to disturbance of bio-energetics and development patol. changes in different bodies and systems.
At inhalation receipt in an organism of gaseous compounds of fluorine there are atrophic changes of a mucous membrane of upper respiratory tracts and bronchial tubes, development of rhinitis (see), pharyngitis (see), laryngitis is possible (see). High concentration of gaseous compounds of fluorine can cause nasal bleedings (see) and perforation of a nasal partition; quite often dystrophic changes in parenchymatous bodies develop.
Ability of fluorine to cumulation in highly mineralized fabrics leads to development patol. changes in bone system, and also in some cases to emergence pretty and a nevus pigmentosus on enamel of teeth, to increase in their fragility and erasability.
Specific damages of a bone tissue were the basis for the first classifications of intoxication by fluorine and its connections. On these classifications stages professional F were allocated. depending on degree radiological the revealed signs of damage of a bone tissue. For I (dokost-ache) stages professional F. functional changes of the major systems of an organism are characteristic. Patients show complaints to ostealgias and joints, separate muscular groups, and also in epigastric area and the right hypochondrium. Degree of manifestation of symptoms and patol. changes depends on amount of the fluorine which came to an organism. In the II stage changes of a bone tissue in the form of symmetric periosteal stratifications on tubular bones come to light (usually shins). Muscular weakness increases. Muscular contractures are possible. Disturbances of main types of exchange, function of a liver also went. - kish. a path become resistant, gaining the nature of organic changes. At a fluorosis of the III stage allocate substages And yes B (IIIA and ShB). At a fluorosis of IIIA of a stage, in addition to changes of the bones observed in the II stage of a disease narrowing of marrowy channels, calcification of the copular device and increase in density of a bone tissue come to light. The generalized system osteosclerosis is characteristic of a fluorosis of IIIB of a stage (see).
At a fluorosis of the II—III stage defeats of pelvic bones, vertebrae, long tubular bones, edges, clavicles, shovels are observed.
Fig. Roentgenogram (direct projection) of the right half of a basin of the patient with a professional fluorosis:
the gene osteosclerosis of pelvic bones expressed Goma, trabecular structure of a bone is not differentiated.
In pelvic bones and vertebrae the drawing of spongy network amplifies, trabeculas are thickened, the bone loses the drawing, its structure becomes undifferentiated, homogeneous (fig.). Also changes of outlines of bones belong to typical symptoms. Contours of bodies of vertebrae and their shoots become greased, rough, periosteal growths are formed. At edges of vertebras secondary labelloid and coronoid bone outgrowths tower, the next bodies of vertebrae are connected by bone bridges and brackets. Calcifications of sheaves, in particular at front edges of bodies of vertebrae are visible.
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V initial stages of defeat ^трубчатых bones is noted by places a nek-swarm narrowing of the marrowy channel due to endosteal growths. Changes of a cortical layer and a periosteum in the form of small thickenings come to light. In the beginning the specified changes appear in the field of combs and in places of an attachment of muscles. Restructuring of bones is characterized by the grubopetlisty drawing of a spongy bone tissue. Further these changes amplify. The spongy bone drawing becomes more dense, trabeculas are thickened and condensed. Periosteal growths develop, the drawing of a bone becomes undifferentiated. The marrowy channel is completely closed by places owing to * endosteal growths,
the bast layer is unevenly condensed.
Interosseous ligaments of a shin and a forearm can be exposed to calcification or ossification. In hard cases process extends to all skeleton.
Differential diagnosis carry out with a marble disease (see), osteomiyelofshbrozy (see), a disease to Gosha (see Gosha a disease) and other diseases having similar with F. rentgenol. picture. At differential diagnosis F. the anamnesis, working conditions and life for the purpose of establishment of the fact of impact of fluorine on an organism is considered.
Treatment is carried out by vitamins A,
With, P, groups B, compounds of calcium, magnesium, salts milk and piece-rovinogradnoy to - the t influencing pathogenetic mechanisms F. Pine, hydrosulphuric and radonic needle baths give positive effect. Are shown klimato-and a balneoterapiya.
At patients with a professional fluorosis of I and II stages perhaps partial recovery of the broken functions of internals.
Stuck, with an initial stage of intoxication fluorine recommends to transfer to other work temporarily. Permanent disturbances of health (hepatitis, defeat of a musculoskeletal system, resistant pain syndrome etc.) are the indication to discharge from contact with fluorine and to rational employment.
Prevention F. it has to be directed, first of all, to the maximum elimination of contact working with compounds of fluorine that is provided with mechanization and the industrial automation, sealing of the equipment, implementation of effective ventilation (see), use of individual protection equipment (see Respirators), observance of rules of personal hygiene. Treatment-and-prophylactic food (see clinical nutrition) in the form of hot breakfasts before work (a diet 2) with addition of vitamins A (2 mg) and With (100 — 150 mg), dairy products, juice, fresh vegetables is shown. Preliminary and periodic medical examinations are important (see. Medical examination).
Local fluorosis. The biogeochemical provinces differing in the increased content of fluorine in water sources that is the reason local F. among local population, are described in many countries of the world. In the USSR the centers local F. are more often connected with the sources of the decentralized water supply containing fluorine in rather low concentration — to 2 — 4 mg/l owing to what an endemia have limited and slight character. Usually at local
F. not all local population, but its part is surprised — the concentration of fluorine in water is higher, the bigger percent of indigenous people has signs F. If the person comes in local on F. the area is aged more senior
than 10 — 12 years, the expressed forms F. at it do not develop. Manifestations local F. are more often limited to damage of teeth (ShM.), however at the content of fluorine in drinking water above mg/l would come to light changes of a bone tissue as osteoporosis (see) or an osteosclerosis.
Damage of teeth at local F. begins with emergence of single pretty specks on the separate symmetrically located teeth, is more often on cutters, the first painters and premolar tooths. Then yellow-brown pigmentation of teeth develops, their increased erasability is noted.
At further development of process, in addition to yellow-brown pigmentation and pretty regeneration, morphological defects of enamel in the form of erosion are observed that leads to considerable deformation of crowns of teeth.
Treatment local F. it is sent to hl. obr. on elimination of cosmetic defects of teeth.
Prevention local F. provides replacement of the sources of drinking water supply containing high concentration of fluorine, or carrying out on water constructions of defluorination of water (see) . See also Teeth, a fluorosis of teeth.
Bibliography: And in c y A. P. N and A. A. Patologiya's Larks of a fluorosis, Novosibirsk, 1981, bibliogr.; Bogdanov N. A. and e m and c to and y E. V. Production fluorosis, JI., 1975, bibliogr.; Questions of hygiene and professional pathology in nonferrous and ferrous metallurgy, under the editorship of S. V. Miller and M. S. Sadilova, page 49, Sverdlovsk, 1971; Occupational health and professional pathology in the aluminum industry, under the editorship of S. G. Domnin, page 122, 126, M., 1976; Clinic, diagnosis, treatment and prevention of a professional fluorosis, sost. D. M. Zislin, etc., Sverdlovsk, 1980; Scribes V. A. Flyuoroz in Kazakhstan and value of fluorine of drinking water for health of the population, Works Kazakh in-that epidemiol., mikrobiol. and gigabyte., t. 3, page 331, Alma-Ata, 1958; K. P. Rentgenologiya's Prickly lettuces of occupational diseases and intoxications, M., 1961; Ovrutsky G. D.
Fluorosis, Kazan, 1962; Fly N -
e r of S. A. Radiodiagnosis of diseases of bones and joints, book 2, page 95, M., 1964; Fluorides and zdo
to a rovya of the person, Chronicle of WHO, t. 24, No. 6, page 286, 1970.
T. K. Semennikova; O. A. Grigoryan (rents.); V. A. Knizhnikov (local fluorosis).