ABSTRACT
Objective To understand common X-ray signs of bone and joint of forearm and shank,in order to provide a basis for diagnosis of skeletal fluorosis.Methods A total of 15 villages which were built for more than 50 years in Nongan and Qianan counties of Jilin province were selected and surveyed by quantitative epidemiological methods.These villages had no industrial and coal-burning-borne fluorine pollution; no other high fluoride sources; had not yet changed to low-fluoride drinking water,and had complete and stable historic data of fluoride content in drinking water.Drinking water fluoride content was determined.Inhabitants lived in the local for more than 10 years,between the age of 16-60 were chosen from the villages based on the 11 levels of fluoride content of drinking water from 0.5-7.0 mg/L and these people were divided into 5 age groups:16-,21-,31-,41-,51 to 60.In each age group,10-15 individuals were taken by stratified random sampling to do the forearm and shank joint X-ray examination.Drinking water fluoride content between 0.5-1.0 mg/L acted as the low fluoride group(control group),1.5-7.0 mg/L as the high fluoride group and various X-ray findings and the detection rate were observed.Results Three X-ray signs of skeletal fluorosis,joint degenerative change and osteoporosis were observed.Thereinto,joint degenerative change was the most common.In the high fluoride group(31.55％,153/485),the detection rate of joint degenerative change was higher than that of the low fluoride group (21.58％,41/190) and the difference was statistically significant (x2 =6.62,P ＜ 0.05).Seventy two of 675 peoples used by X-ray were detected with skeletal fluorosis,which occurred mainly in the higher intake of high fluoride group (x2 =25.65,P ＜ 0.01).When water fluoride was up to 6.0-7.0 mg/L,the detection rate of endemic skeletal fluorosis was increased to 44.92％(53/118).Regardless of higher or lower of water fluoride and mild or more serious of the state of fluorosis,changes of X-ray signs of bone surroundings happened first; on average with a detection rate of 95.83％ (69/72),the joint change followed by 79.17％ (57/72) and bone substance change the least at 56.94％(41/72),and the difference was statistically significant (x2=9.64,P ＜ 0.01).Regardless of water fluoride high and low,joint of elbow knee and wrist underwent degenerative change.Degenerative change of elbow joint happened first with a detection rate of 17.78％ (120/675),knee joint followed by 15.41％ (104/675),and wrist joint was the least at 7.85％ (53/675).The difference was statistically significant (x2 =30.74,P ＜ 0.01).Elbow degeneration detection rate(21.03％,102/485) in high fluoride group was significantly higher than that of the low fluoride group(9.47％,18/190; x2=12.47,P ＜ 0.01).X-ray examination showed 35 kinds of signs; most signs could be seen in the high fluoride and the low fluoride groups.But the changes of bone around were seen more often in higher fluoride content group than in lower fluoride content group.Conclusions X-ray signs of endemic skeletal fluorosis are complex and diverse.Only after comprehensive analysis,the diagnostic results are accurate and reliable.
ABSTRACT
Objective To unveil the changes of endemic fluorosis in order to provide the scientific basis for making countermeasure. Methods Seven villages was selected as monitoring points in Qianan County of Jilin Province where drinking water was improved or was going tobe improved. Dental fluorosis was surveyed with Dean method and for urine fluoride content was tested using fluoride ion-selective electrode analysis in 8 - 12 years old children. Clinical skeletal fluorosis was detected in all residents of aged 16 and over in the beginning of the monitor and every 3 years. X-ray films were taken in those over 16 years old at the beginning of the monitor and every 5 years. Results Detectable rate of dental fluorosis was decreased compared with before(Weizi: 11.3% to 2.2%, Danzi: 16.3% to 12.1%, Houqi: 53.7% to 37.5%, Houju: 38.6% to 33.3%), and severity was declining, for example, in Dongnanjing, rate of being moderate was dropping from 11.3% to 7.8%, severe rate from 2.8% to 0;in Houqi: moderate rate from 16.7% to 0, severe rate from 1.9% to 0;in Houju, moderate rate from 1.4% to 0,severe rate from 1.4% to 0. However, detectable rate of dental fluorosis rose in Dabin from 61.7% to 70.0% and in Dongbin-donju from 52.7% to 71.1% due to increased fluorides in drinking water. Urine fluorides content in 8 - 12 years old children was decreased to normal level(1.5 mg/L) in most of monitoring spots, but in Dabin it still remained at a high level, being 4.03 and 4.57 mg/L before and after respectively. Detectable rate clinical skeletal fluorosis was between 11.1% - 25.7% among those aged 16 and over in 7 monitoring point in 1991 - 2006, however it increased year after year in Dabin (15.9%, 21.6% and 25.7% in 1991, 1993 and 1995). Positive X-ray rate for skeletal fluorosis was decreased from 54.9% to 24.0% in Dabin, from 40.7% to 23.5% in Dongbin-donju and from 28.6% to 20.4% in Dangnanjing. Conclusions Endemic fluorosis has been controlled attributed to improved drinking water and decreased fluorides content in drinking water. Combined methods are needed to decrease to the intake of fluorides to control the diseases.
ABSTRACT
Objective To compare the diagnosis results of endemic skeletal fluorosis from clinical and X-rays examinations, in order to provide the foundation for revising clinical diagnostic standard of endemic skeletal fluorosis. Methods The 675 inhabitants aged 16 to 60 years old were retrospectively chosen as subjects in 15 villages drinking un-improved water, where they lived for 10 years or more. Drinking water fluoride were rated as 0.5,1.0, 1.5,2.0,2.2,2.4,3.0,3.5,4.0,6.0,7.0 mg/L levels in Qianan and Nongan County of Jilin Province. The clinical and X-rays results of endemic skeletal fluorosis were analyzed and compared at different drinking water fluoride levels. Results The clinically detectable rates of endemic skeletal fluorosis(21.43%,22.45% ,21.28%, 19.05%, 38.89%) were higher than that of X-rays(0,2.04%,0,4.76%, 12.96%, X2=7.96,9.49,11.19,4.08,9.45, P<0.05) when fluoride content of drinking water was 2.0,2.2,2.4,3.0,4.0 mg/L. X-rays detective rates were 0 at water fluorides levels of 2.0,2.4 mg/L and still low at water fluoride levels of 3.0,4.0 mg,/L. The difference of detective rates of endemic skeletal fluorosis between the clinical (1.00%,4.44%, 7.23%, 18.00%, 54.39%, 49.18%) and X-rays (0,2.22%, 3.61%, 8.00%, 36.84%, 52.46%) were not statistically significant at water fluorides levels of 0.5,1.0,1.5,3.5,6.0,7.0 mg/L(X2=1.00,0.17,0.47,2.21,3.54,0.13, P>0.05). Conclusions The detectable rates of skeletal fluorosis increase with the increased concentration of water fluoride, which is more reliable for clinical examination than for X-rays method.