Possible Fluoride Toxicity in North America: a paleopathological assessment and discussion of modern occurrence

When toxic levels of fluoride are consumed, the pathological condition of fluorosis ensues. Skeletal fluorosis is an endemic problem in populations at risk of ingesting excess fluoride. Whether ingestion takes place as result of toxic levels of natural mineral content in water of from anthropogenic factors such as tea drinking or smoking, the results can be detrimental to an individual’s health. Fluorosis has been identified in archaeological skeletons from Bahrain, Naples, and the United Arab Emirates. While a very serious concern in some parts of the world today, the United States continues to fluoridate municipal water supplies. Although the natural geologic environment in many regions of the United States (US) is conducive to fluorosis, this condition is largely ignored in the US. This may suggest an absence of the condition in this region of the world; however, the etiology and history of this metabolic bone disease is poorly understood therefore, it may often be misdiagnosed or overlooked clinically and perhaps archaeologically. In this paper, I review clinical and epidemiological literature discussing the prevalence of fluorosis. From this review, I conclude that fluorosis may in fact be a current public health issue in the United States. This is demonstrated by the frequency of fluorosis reported in both National Research Council and Center for Disease Control documents. Furthermore, although this condition is not yet described in archaeological collections from North America, I hypothesize it may be present in the Illinois River Valley, due to the natural geologic conditions conducive to fluorosis. Skeletal signs of fluorosis, including ossification of tendinous and ligamentous attachments, an increased presence of fractures, and periosteal and sclerotic deposition, are documented in 8 individuals from the Ray Site.