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A 79-year-old lady presented with a history of diffuse sero-negative arthritis dating from early adulthood. Numerous investigations and therapies had failed to provide any significant benefit and both knees and a hip had been replaced when initially seen a year ago. On questioning at that time, she admitted to daily drinking at least six cups of black tea since childhood. She lives in a retirement village where there has not been water fluoridation since 1994. However, her fasting fluoride results (Medlab) were elevated:
* Serum fluoride 2.5pmol/L (Ref. range 0.3-2.2)
* Urine fluoride 58pmol (Ref. range 0-31)
* Fluoride: creatinine ratio 13.5pmol (Ref. range 0-3.1)
She used a standard fluoridated toothpaste but was otherwise not on any fluoridated medications. However, given the fact that her preferred tea exceeded 3mg fluoride/ L1 it is possible that she has been unwittingly overdosing for many years. Skeletal fluorosis from tea has been identified.2 Furthermore, excessive use of fluoridated toothpaste caused severe arthritis initially diagnosed as ankylosing spondylitis with full recovery after stopping exposure.3 A year after stopping black tea drinking and changing to a herbal non-fluoridated toothpaste, this elderly woman's joint pain levels had markedly decreased with considerably improved mobility enabling her to have a long-awaited trip overseas.
Discussion
Fluoride exposures are pervasive. Traditionally,...