Skeletal fluorosis

Overview
Skeletal fluorosis is a bone disease exclusively caused by excessive consumption of fluoride.

Causes
Common causes of fluorosis include inhalation of fluoride dusts/fumes by workers in industry, use of coal as an indoor fuel source (a common practice in China), consumption of fluoride from drinking water, and consumption of fluoride from the drinking of tea, particularly brick tea.

In some areas, skeletal fluorosis may be endemic. In India, the most common cause of fluorosis is fluoride-laden water derived from deep borewells.

Incidence/prevalence
While fluorosis is most severe and widespread in the two largest countries - India and China - UNICEF estimates that "fluorosis is endemic in at least 25 countries across the globe. The total number of people affected is not known, but a conservative estimate would number in the tens of millions."

Skeletal fluorosis in China and India
In China, the World Health Organization recently estimated that 2.7 million people have the crippling form of skeletal fluorosis, while in India, 17 of its 32 states have been identified as "endemic" areas, with an estimated 66 million people at risk and 6 million people seriously afflicted.

According to scientific surveys, skeletal fluorosis in India and China occurs when the fluoride concentration in water exceeds 1 part per million (ppm), and has been found to occur in communities with only 0.7 part per million.

The Chinese government now considers any water supply containing over 1 ppm fluoride a risk for skeletal fluorosis.

Skeletal fluorosis in the United States
In the United States, an average of 1 ppm of fluoride is intentionally added to water supplies for water fluoridation. The Maximum Contaminant Level (as established by the US Environmental Protection Agency) is 4 ppm.