PFPC Daily - February 10, 2005

Eichmiller FC, Eidelman N, Carey CM - "Controlling the fluoride
dosage in a patient with compromised salivary function" J Am Dent
Assoc 136(1):67-70 (2005)

BACKGROUND: High-concentration topical fluorides are used
commonly to with compromised salivary function due to irradiation and
chemotherapy.

CASE DESCRIPTION: The authors describe a 50-year-old man with
previously treated cancer who was using tray-applied topical fluoride
gel. He complained of gastric symptoms, difficulty in swallowing, leg
muscle soreness and knee joint soreness. A computed tomographic scan
revealed thickening of the esophageal walls. An upper endoscopy
revealed abnormal motility. The motility test indicated
high-amplitude peristalsis and hypertensive lower esophageal
sphincter, and urine testing indicated high levels of systemic
fluoride. The patient's fluoride regimen was altered, and within a
short period his urinary fluoride levels returned to normal and his
symptoms resolved.

CLINICAL IMPLICATIONS: Clinicians prescribing home-applied
high-concentration fluorides need to be cognizant of
the symptoms of fluoride toxicity, carefully monitor the patient's
compliance with the treatment regimen, and adjust the dosage or mode
of application to control the total ingested dose of fluoride.