Ancient and recent evidence of endemic fluorosis in the Naples area

Endemic fluorosis induced by high concentrations of natural fluoride in groundwater and soils is a major health problem in several countries, particularly in volcanic areas. The early stages of skeletal fluorosis, a chronic metabolic bone and joint disease rarely considered in palaeopathological diagnoses, are often misdiagnosed in endemic areas. In this paper, morphological, radiological, histological and chemical skeletal and dental features of the 79 AD Herculaneum population show that in this area fluorosis has been endemic since Roman times. Long-term exposure to high levels of environmental fluoride is revealed by intense calcification of the ligaments, tendons and cartilage, diffuse axial and appendicular osteosclerosis, spine osteophytosis and spondyloarthritis, bone histopathological alterations and bone fractures. High levels of fluoride found in the skeleton, as well as dental features such as mottling and hypomineralization, confirm the endemicity of fluorosis, which still occurs today. When merged with the results of a recent clinical–epidemiological investigation in schoolchildren from the Vesuvian towns, our findings reveal for the resident population a permanent fluoride hazard whose health and socio-economic impact is currently underestimated.

Graphical abstractFigure optionsDownload full-size imageDownload as PowerPoint slideHighlights► We study the pathological features of the Herculaneum victims of 79 AD eruption of Vesuvius ► The morphological and chemical skeletal features show that fluorosis is endemic since Roman times ► A parallel clinical investigation in Vesuvian schoolchildren reveals a permanent fluoride hazard ► We advise authorities to better evaluate the public health and socio-economic impact of this hazard