Article

Dental Caries and Dental Fluorosis at Varying Water Fluoride Concentrations

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Abstract

Objectives: The purpose of this study was to investigate the relationships between caries experience and dental fluorosis at different fluoride concentrations in drinking water. The impact of other fluoride products also was assessed. Methods: This study used data from the 1986-87 National Survey of US School-children. Fluoride levels of school water were used as an indicator of the children's water fluoride exposure. The use of fluoride drops, tablets, professional fluoride treatments, and school fluoride rinses were ascertained from caregiver questionnaires. Only children with a single continuous residence (n = 18,755) were included in this analysis. Results: The sharpest declines in dfs and DMFS were associated with increases in water fluoride levels between 0 and 0.7 ppm F, with little additional decline between 0.7 and 1.2 ppm F. Fluorosis prevalence was 13.5 percent, 21.7 percent, 29.9 percent, and 41.4 percent for children who consumed < 0.3, 0.3 to < 0.7, 0.7 to 1.2, and > 1.2 ppm F water. In addition to fluoridated water, the use of fluoride supplements was associated with both lower caries and increased fluorosis. Conclusions: A suitable trade-off between caries and fluorosis appears to occur around 0.7 ppm F. Data from this study suggest that a reconsideration of the policies concerning the most appropriate concentrations for water fluoridation might be appropriate for the United States.

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... Although standards or guidelines for F in drinking water vary somewhat, the World Health Organization (WHO) recommends a limit of 1.5 mg/L. The U.S. Public Health Service (USPHS) recommends 0.7 mg/L as the upper limit for human health (Heller et al., 2007;USPHS, 2015). A limit close to 1 mg/L helps children minimize dental caries while not exposing them to dental fluorosis. ...
... 5.6. The Aquia aquifer, Maryland, USA Both sedimentary and silicic igneous aquifers are notable for elevated F concentrations, too high to be healthy for drinking water purposes (>1 mg/L, U.S. Public Health Service recommends 0.7 mg/L as the upper limit for safety; Heller et al., 2007;USPHS, 2015). By the 1930s, sedimentary aquifers in the Atlantic Coastal Plain of the U.S.A. were recognized as 19. ...
Article
High fluoride (F) groundwaters (>1 mg/L) have been recognized as a water quality problem for nearly a century and occur in many countries worldwide. The affected aquifers can be sedimentary, metamorphic or igneous rocks, but the process giving rise to high-F concentrations has been studied with geochemical modeling and an examination of the rock sources. The association of high-F with silicic igneous rocks such as granites and rhyolites results from magmatic differentiation (fractional crystallization, fractional melting, and assimilation) wherein F is enriched in the liquid phase because of its incompatibility in the mafic minerals that crystallize early during cooling. Further development of F-rich groundwaters occurs during the evolution of Na-HCO3 waters because of removal of Ca through ion-exchange and calcite precipitation, thereby raising the F concentration from minerals like fluorite and fluorapatite to maintain solubility equilibrium. Increasing temperatures enhance this effect because of the retrograde solubility of calcite. From geochemical modeling using the PhreeqcI code, the primary variables controlling F concentrations are DIC (dissolved inorganic carbon), salinity (ionic strength), PCO2, and temperature. Complexing is also important but plays a more secondary role. Considering these variables, an improved set of plotting parameters, F/Cl vs. HCO3/Cl, are shown to be effective in interpreting groundwater analyses. This approach is demonstrated by examining case studies from the Black Creek aquifer, South Carolina, USA, the Madison regional aquifer, midwestern USA, the Mizunami Underground Research Laboratory, Japan, New Zealand thermal waters, the San Luis Valley groundwaters, Colorado, USA, and the Aquia aquifer, Maryland, USA.
... Although standards or guidelines for F in drinking water vary somewhat, the World Health Organization (WHO) recommends a limit of 1.5 mg/L. The U.S. Public Health Service (USPHS) recommends 0.7 mg/L as the upper limit for human health (Heller et al., 2007;USPHS, 2015). A limit close to 1 mg/L helps children minimize dental caries while not exposing them to dental fluorosis. ...
... 5.6. The Aquia aquifer, Maryland, USA Both sedimentary and silicic igneous aquifers are notable for elevated F concentrations, too high to be healthy for drinking water purposes (>1 mg/L, U.S. Public Health Service recommends 0.7 mg/L as the upper limit for safety; Heller et al., 2007;USPHS, 2015). By the 1930s, sedimentary aquifers in the Atlantic Coastal Plain of the U.S.A. were recognized as 19. ...
... F). Porém, no estudo de Heller et al. 16 , se estabeleceu o nível mais seguro de 0.7 p.p.m. F. Para todos os efeitos, se considera altos níveis de fluoreto os valores maiores que 1 p.p.m. ...
... F. Para todos os efeitos, se considera altos níveis de fluoreto os valores maiores que 1 p.p.m. F (mais que 1 mg de F por 1 litro de água) 16 Vale mencionar a dificuldade de encontrar um padrão da quantidade de p. p. m. F nas águas naturais brasileiras, fato que pode ser atribuído às dimensões continentais do Brasil. ...
Article
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Introdução: Na odontologia, o íon flúor, também conhecido como fluoreto, apresenta efeitos profiláticos e terapêuticos, porém pode trazer riscos. A sua utilização em águas de abastecimento público e em outros produtos deve ser entendida e controlada para minimizar efeitos indesejados às dentições, como a fluorose dentária. O monitoramento da fluorose em um país tem sua importância para comprovar se as cifras estão estabilizadas, uma vez que se conhece um crescente potencial imigratório mundial. Objetivo: Revisão da literatura dos últimos anos, buscando informações sobre a relação entre a concentração de fluoreto em água natural potável e a prevalência de fluorose em variadas populações de diferentes países. Materiais e Métodos: Buscaram-se publicações nas principais bases de dados: Scopus, Portal Periódicos Capes, Scielo, Biblioteca Virtual em Saúde, PubMed e Google Acadêmico, através das palavras-chave: Fluorose dentária, Flúor, Fluoreto, Epidemiologia e Água potável, nos idiomas português, espanhol e inglês. Dos 38 artigos selecionados, 29 foram utilizados no presente trabalho. Resultados: Dos países estudados, a Etiópia (com 12 partes por milhão de Flúor na água potável) obteve maior índice de fluorose dentária (100% da amostra), e o menor índice de fluorose foi encontrado na Síria (1.39 partes por milhão de Flúor na agua potável), equivalente a 15%. Conclusão: Pôde-se concluir que a prevalência e a severidade da fluorose dentária geralmente são maiores nas populações que vivem em regiões com altas concentrações de fluoreto na água natural potável.
... Both developed countries and nondeveloped countries are now facing the repercussion of excess fluoride in drinking water. In developed countries, fluoride is deliberately added into drinking water systems to prevent dental carries and dental fluorosis; an issue which has been debatable for a long time since some authors have reported an opposite trend [1][2][3][4][5]. Furthermore, the origin of these artificial fluoridation sources has been found and reported as phosphate industrial waste products rather than of pharmaceutical grade [6]. ...
... Upon treatment with a standard acid, fluoride salts form hydrogen fluoride which can be doubly protonated to form H 2 F + followed by formation of HF 2− , which is a form of homoconjugation and thus increases the acidity of the compound [20]. Fluorine can replace hydrogen whenever it encounters; thus, there are so many organic compounds in many industries [1]. However, in groundwater, fluoride ions appear to stay intact or as aqua complexes due to the lower percentage of other cations as aluminum and iron. ...
Article
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Arising awareness of health hazards due to long-term exposure of fluoride has led researchers to seek for more innovative strategies to eliminate excess fluoride in drinking water. Fluoride-bearing chemicals in both natural and anthropogenic sources contaminate drinking water, which mainly cause for human fluoride ingestion. Hence, developing sustainable approaches toward alleviation is essential. Among many emerging techniques of defluoridation, nanotechnological approaches stand out owing to its high efficiency, and hence, as in many areas, nanotechnology for excess fluoride removal in water is gaining ground compared to other conventional adsorbents and process. The present review focuses on some of the advanced and recent nanoadsorbents including their strengths and shortcomings (e.g., CNT, LDH, graphene-based nanomaterials, and magnetic nanomaterials) and other processes involving nanotechnology while discussing basic aspects of hydrochemistry of fluoride and geological conditions leading for water fluoride contamination. Considering all the findings in survey, it is evident that developing more sustainable techniques is essential rather than conducting batch-type experiments solely.
... A high fluoride concentration in the body causes the bone to become hardened and less elastic, a condition referred to as skeletal fluorosis, producing increased risk of bone fractures [206,[223][224][225][226]. The U.S. Environmental Protection Agency (EPA) limits the fluoride that can be present in public drinking-water supplies to 4 mg/L (maximum contaminant level, or MCL) as appropriate for guarding against crippling skeletal fluorosis, with a secondary maximum contaminant level (SMCL) of 2 mg/L aiming to protect against objectionable enamel fluorosis [227]. Heller et al. (1997), found that dental fluorosis had increased nearly threefold by 1987, such that 29.9% of children in fluoridated communities had dental fluorosis on at least two teeth, and not all of it in the very mild category [228]. There is also evidence of disproportionate harm to minorities, as a 2005 study from the CDC determined that 1.92% of White (Caucasian) children have moderate/severe dental fluorosis, a number that rises to 3.43% for Black children and 4.82% for Mexicans and Hispanics [222]. ...
... A high fluoride concentration in the body causes the bone to become hardened and less elastic, a condition referred to as skeletal fluorosis, producing increased risk of bone fractures [206,[223][224][225][226]. The U.S. Environmental Protection Agency (EPA) limits the fluoride that can be present in public drinking-water supplies to 4 mg/L (maximum contaminant level, or MCL) as appropriate for guarding against crippling skeletal fluorosis, with a secondary maximum contaminant level (SMCL) of 2 mg/L aiming to protect against objectionable enamel fluorosis [227]. Heller et al. (1997), found that dental fluorosis had increased nearly threefold by 1987, such that 29.9% of children in fluoridated communities had dental fluorosis on at least two teeth, and not all of it in the very mild category [228]. There is also evidence of disproportionate harm to minorities, as a 2005 study from the CDC determined that 1.92% of White (Caucasian) children have moderate/severe dental fluorosis, a number that rises to 3.43% for Black children and 4.82% for Mexicans and Hispanics [222]. ...
Article
Full-text available
Despite enjoying a high standard of living, the United States ranks 46th among nations reporting infant survival rates to the World Health Organization. Among factors that increase infant mortality are environmental toxicants. Toxic metals such as mercury, aluminum, and lead interact synergistically with uoride compounds to produce metal fuoride complexes (e.g., AlF3 and AlF4−). Such toxicants act as biophosphate mimetics disrupting biological signaling processes governing development, immune defenses, and ordinary maintenance systems. Sources for the metals include mother’s mercury amalgams, mercury and aluminum in injected medicines, and lead contaminated drinking water. All of them are made even more toxic by fuorides as evidenced recently by water contamination in Flint, Michigan. Fluorides interact with other toxins increasing their harmful impact. Among the interactants are glyphosate and phosphate containing fertilizers that end up in the food and water because of their widespread use in agriculture. The negative synergy for neonates in the U.S. is increased by the hepatitis B injection containing both mercury and aluminum, and infant formula contaminated with aluminum and the glyphosate in genetically modified soy milk reconstituted with water containing fluoride, aluminum, lead, and other toxic substances. The harmful interactions of such chemicals are associated with rising infant mortality in the U.S. We propose, therefore, a modest but urgent policy change: under TSCA §5, silicofluoride addition to public water supplies should be suspended.
... A high fluoride concentration in the body causes the bone to become hardened and less elastic, a condition referred to as skeletal fluorosis, producing increased risk of bone fractures [206,[223][224][225][226]. The U.S. Environmental Protection Agency (EPA) limits the fluoride that can be present in public drinking-water supplies to 4 mg/L (maximum contaminant level, or MCL) as appropriate for guarding against crippling skeletal fluorosis, with a secondary maximum contaminant level (SMCL) of 2 mg/L aiming to protect against objectionable enamel fluorosis [227]. Heller et al. (1997), found that dental fluorosis had increased nearly threefold by 1987, such that 29.9% of children in fluoridated communities had dental fluorosis on at least two teeth, and not all of it in the very mild category [228]. There is also evidence of disproportionate harm to minorities, as a 2005 study from the CDC determined that 1.92% of White (Caucasian) children have moderate/severe dental fluorosis, a number that rises to 3.43% for Black children and 4.82% for Mexicans and Hispanics [222]. ...
... A high fluoride concentration in the body causes the bone to become hardened and less elastic, a condition referred to as skeletal fluorosis, producing increased risk of bone fractures [206,[223][224][225][226]. The U.S. Environmental Protection Agency (EPA) limits the fluoride that can be present in public drinking-water supplies to 4 mg/L (maximum contaminant level, or MCL) as appropriate for guarding against crippling skeletal fluorosis, with a secondary maximum contaminant level (SMCL) of 2 mg/L aiming to protect against objectionable enamel fluorosis [227]. Heller et al. (1997), found that dental fluorosis had increased nearly threefold by 1987, such that 29.9% of children in fluoridated communities had dental fluorosis on at least two teeth, and not all of it in the very mild category [228]. There is also evidence of disproportionate harm to minorities, as a 2005 study from the CDC determined that 1.92% of White (Caucasian) children have moderate/severe dental fluorosis, a number that rises to 3.43% for Black children and 4.82% for Mexicans and Hispanics [222]. ...
Article
Full-text available
p>Despite enjoying a high standard of living, the United States ranks 46th among nations reporting infant survival rates to the World Health Organization. Among factors that increase infant mortality are environmental toxicants. Toxic metals such as mercury, aluminum, and lead interact synergistically with fluoride compounds to produce metal fluoride complexes (e.g., AlF3 and AlF4−). Such toxicants act as biophosphate mimetics disrupting biological signaling processes governing development, immune defenses, and ordinary maintenance systems. Sources for the metals include mother’s mercury amalgams, mercury and aluminum in injected medicines, and lead contaminated drinking water. All of them are made even more toxic by fluorides as evidenced recently by water contamination in Flint, Michigan. Fluorides interact with other toxins increasing their harmful impact. Among the interactants are glyphosate and phosphate containing fertilizers that end up in the food and water because of their widespread use in agriculture. The negative synergy for neonates in the U.S. is increased by the hepatitis B injection containing both mercury and aluminum, and infant formula contaminated with aluminum and the glyphosate in genetically modified soy milk reconstituted with water containing fluoride, aluminum, lead, and other toxic substances. The harmful interactions of such chemicals are associated with rising infant mortality in the U.S. We propose, therefore, a modest but urgent policy change: under TSCA §5, silicofluoride addition to public water supplies should be suspended. </p
... bones[18,[59][60][61][62][63][64]. Hydroxyapatite (Ca10(PO4)6(OH)2) is the mineral deposited in and around the collagen fibrils of skeletal tissues to form bone. ...
... This optimal level is obviously dependent upon the amount of water consumed on a daily basis and any additional sources of fluoride in the diet. In the U.S., most studies have shown that the sharpest decline in dental caries occurs as fluoride concentrations are increased from 0 to somewhere between 0.7 and 1.2 mg/l, with little additional benefit as fluoride is increased beyond that range[60,64,66]. Consequently, the U.S. Centers for Disease Control andPrevention (CDC), with support from the American Dental Association (ADA) and American Dental Hygienist's Association (ADHA), recommends that communities with public water supplies adjust the fluoride content of their drinking water to a value between 0.7 and 1.2 mg/l, depending on the average maximum daily temperature. ...
Technical Report
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Groundwater is one of a common source for drinking. In recent times, there is a dramatically concerned about the quality of drinking water in coastal area. The purpose of the research is to investigate the quality of drinking groundwater and potential of fluoride contamination in groundwater, coastal regions of Cambodia. The determination of fluoride concentration was used spectrophotometric method, whilst other parameters such as temperature, pH, oxidation reduction potential, electrical conductivity, total dissolve solids, salinity, followed standard methods. Analytically, the results indicate that pH 22.73% of tube and dug wells was impermissible to the Cambodia drinking water quality standard. The significant difference between pH of tube and dug wells was not detected in coastal groundwater. Turbidity 31.82% of tube and dug wells does not follow the Cambodia drinking water quality standard and was also not significantly different between tube and dug well. The tube and dug wells TDS 13.64% was not met the Cambodia drinking water quality standard and not significantly different among them. The Fluoride concentration was determined in between 0.00 mg. L- and 1.33 mg. L-. The fluoride concentration is under the permissible standard of the Cambodia drinking water quality standard. However, its concentration seems to promote the dental caries for the consumers. As a consequence, the suggestions from this research is to study further the exact source of fluoride in coastal area. Even though the research was brought into being minor harmfulness to people to this coastal area; however, the local authority should get involved in this issue to keep tracking the change of this area. Furthermore, they should have any solution to those people who live near the shoreline to approach the fresh water appropriately.
... The promotion of continuous investigation is endorsed, and proficient interpretation of the foremost scientific insights into fluoridation practice is undertaken by specialists for the implementation of public health strategies. The U.S. Public Health Service advocates for a concentration of 0.7 mg/L for optimal water fluoridation [12,13]. This suggested concentration delivers the utmost advantage for oral health while safeguarding other bodily aspects from potential risks [13]. ...
... [1] Studies on children, in areas with high concentrations of fluoride in drinking water (>1 p.p.m), have revealed a higher prevalence and severity of dental fluorosis and lower caries prevalence. [11][12][13][14][15] While studies have also shown the opposite results, an increase in the severity of dental fluorosis revealed higher occurrence of dental caries. [16] Hence, with these contradicting results, this study was undertaken to identify the relationship between different grades of dental fluorosis, dental caries and the most common cariogenic bacteria S. mutans in saliva. ...
Article
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Background and Objective Worldwide, dental caries is an endemic infection and a significant public health problem. Fluoride reduces caries by helping to prevent demineralisation, by remineralising early carious lesions, and by decreasing the activity and growth of Streptococcus mutans (S. mutans). Fluoride intake above the optimal levels leads to a condition known as dental fluorosis, which causes hypo-mineralisation of the tooth. Some studies have revealed that the severity of fluorosis is directly proportional to caries, but some showed opposite results. Hence, with these contradicting results, this study was undertaken to identify the relationship between different grades of dental fluorosis, dental caries and the most common cariogenic bacteria S. mutans in saliva. Materials and Methods A total of 90 subjects within 14- to 16-year age range were selected and categorised depending on the severity of fluorosis into three groups: group I (mild), group II (moderate) and group III (severe) based on modified Dean’s fluorosis index criteria (1942). Unstimulated whole saliva samples were collected using the oral rinse technique and processed for quantification of S. mutans using Mitis Salivarius Bacitracin Agar medium. The number of colony-forming units (CFUs) was determined using a colony counter and expressed as ≥10², ≥10³, ≥10⁴ and ≥10⁵ CFUs per ml of the sample, in accordance with the scale recommended by the manufacturer (HiMedia Laboratories). The severity of the caries was measured using decayed, missing or filled teeth (DMFT). Results Observations revealed that the overall DMFT was directly proportional to the level of S. mutans titres. It was observed that 67 to 73% of participants showed fewer colony counts (10² and 10³) with minimal DMFT scores and 27 to 33% showed higher counts (10⁴ and 10⁵) with higher DMFT scores in all the groups. 10⁵ CFUs of group III showed the highest mean DMFT scores (2.9) with an increased number of involved subjects than group II (2.3) and group I (1.5). In all, male participants had higher bacterial titres and DMFT scores than females. Conclusion Fluoride in the drinking water served as anticariogenic agent regardless of the severity of fluorosis. Severe fluorosis with a higher incidence of caries and increased CFUs of S. mutans clearly indicates the importance of preventive measures and early treatment to reduce the severity of fluorosis and prevalence of dental caries.
... For this reason, researchers are trying to determine the optimal fluoride concentration that should be taken to reduce dental caries. It has been reported that the sharpest reduction in dental caries occurs when the fluoride concentration in drinking water is between 0.7 to 1.2 mg/l, with little additional benefit when fluoride goes beyond this range and is also associated with increased fluorosis (Heller et al. 1997). It is also notified that fluoride intake cannot be predicted considering the individual differences in food consumption habits of consumers, as well as food processing and preparation (Waldbott 1963). ...
Article
Sulfuryl fluoride is a colorless, odorless gas used as a fumigant against pests during the storage of agricultural products. It is also one of the alternatives to Methyl bromide, which is banned by the Montreal Protocol. During a fumigation, the decomposition product of sulfuryl fluoride residue can also be formed in addition to the sulfuryl fluoride residue. Fluoride is actually a natural constituent of the tea plant. However, within the growing process of the tea plant fluoride is concentrated in the old leaves when compared with the young shoots. Investigating the variation of the fluoride content in black tea before and after sulfuryl fluoride fumigation is the subject of this study. Three different brands black teas with different fluoride concentrations purchased from local supermarkets in 2022 were fumigated with approximately 60 g/m3 of sulfuryl fluoride for 24 hours in a 1 m3 fumigation chamber. The AOAC’s recommended method for extraction of fluoride in plants (Method 975.04) was applied in this study. It was compared with the fluoride contents after fumigation in teas (41.4; 165.1 and 329.5 mg/kg, respectively). It is concluded that there is no statistically [t(7)=0,284; t(7)=0,769 and t(7)=1,419 p>0,05] significant difference in fluoride content in teas after fumigation.
... Consumption of elevated levels (>1.5 mg/L) of F may cause dental fluorosis [8], whereas severe exposure can lead to the development of skeletal fluorosis [9], decreased birth rates [10], and kidney and liver damage [11]. However, F at optimal levels (~0.7 mg/L) is linked with lower incidences of dental caries and a reduced risk of fluorosis [12,13]. India has set a threshold of 1.0 mg/L drinking water guidelines taking into account the hot climate in certain parts [14]. ...
Article
Full-text available
Groundwater fluoride (F) occurrence and mobilization are controlled by geotectonic, climate, and anthropogenic activities, such as land use and pumping. This study delineates the occurrence and mobilization of F in groundwater in a semi-arid environment using groundwater, and an artificial intelligence model. The model predicts climate, soil type, and geotectonic as major predictors of F occurrence. We also present unsaturated zone F inventory, elemental compositions, and mineralogy from 25 boreholes in agricultural, forest, and grasslands from three different land use terrains in the study area to establish linkages with the occurrence of groundwater F. Normalized unsaturated zone F inventory was the highest in the area underlain by the granitic–gneissic complex (261 kg/ha/m), followed by residual soils (216 kg/ha/m), and Pleistocene alluvial deposits (78 kg/ha/m). The results indicate that the unsaturated zone mineralogy has greater control over F mobilization into the groundwater than unsaturated zone F inventory and land-use patterns. The presence of clay minerals, calcite, and Fe, Al hydroxides beneath the residual soils strongly retain unsaturated zone F compared with the subsurface beneath Pleistocene alluvial deposits, where the absence of these minerals results in enhanced leaching of unsaturated zone F.
... With the increasing use of groundwater resources for water supplies, there has been a growing awareness of natural, or geogenic, contaminants that are injurious to human and environmental health. One of the most widespread geogenic contaminants is the fluoride ion which can be deleterious to teeth and bones when concentrations are consistently higher than 1.5 mg/L (Fawell et al., 2006) and recent research indicates that ∼0.7 mg/L is optimal (Heller et al., 2007). Fluoride concentrations in groundwater are associated commonly with the presence of fluoride minerals such as fluorite and/or fluorapatite. ...
Article
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Thermodynamic data are constrained by the interrelated thermodynamic equations in addition to the observational measurements and their uncertainties. The consequence is a network of thermodynamic properties that can be evaluated for their internal consistency. In this study, three fluoride minerals that can cause high fluoride concentrations in groundwaters are evaluated for their solubilities and their internal thermodynamic consistency with calorimetric, isopiestic and electrochemical measurements: fluorite, CaF 2 , cryolite, Na 3 AlF 6 , and villiaumite, NaF. This evaluation involves the three solids and 13 aqueous species, the free ions of Ca ²⁺ , Na ⁺ , Al ³⁺ and F – , and the hydroxido and fluorido complexes of Al ³⁺ , and the CaF ⁺ ion pair. For the fluorite–cryolite–villiaumite–aqueous species network, the number of components is minimal, and the solubility studies are mostly of high quality. Re-evaluations of original data using PHREEQC helps to broaden the quantitative evaluation of thermodynamic properties and to resolve apparent discrepancies. A check on this thermodynamic network shows that through a careful appraisal of the literature, a highly consistent set of values can be derived. The resultant infinite-dilution solubility-product constants at 25°C and 1 bar are: for fluorite solubility, log K sp = –10.57 ± 0.08; for cryolite solubility, log K sp = –33.9 ± 0.2; and for villiaumite solubility, log K sp = –0.4981 ± 0.003.
... An in vitro pH-cycling study reported that teeth with moderate fluorosis had an increased caries susceptibility when compared to teeth with very mild or no fluorosis, which may mainly due to dissimilarities in porosity of the enamel (Marin, Cury, Tenuta, Castellanos, & Martignon, 2016). Some epidemiological investigations of dental fluorosis and dental caries in an area with endemic fluorosis were also conducted, attempting to find the connections between these two diseases by data analysis (Budipramana, Hapsoro, Irmawati, & Kuntari, 2002;Heller, Eklund, & Burt, 1997;Wondwossen, Astrøm, Bjorvatn, & Bårdsen, 2004). However, there was still no conclusion whether dental fluorosis will increase the susceptibility of dental caries or not. ...
Article
Objectives The aim of this in vitro study was to evaluate the surface properties of moderately to severely fluorotic enamel and the adhesion of Streptococcus mutans and Streptococcus sanguinis to enamel, exploring the relationship between dental fluorosis and dental caries from a microbiology perspective. Methods We examined the basic surface properties of moderately to severely fluorotic enamel by surface microhardness test, scanning electron microscopy (SEM) and atomic force microscopy. Then S. mutans single-species biofilms and S. mutans - S. sanguinis dual-species biofilms were cultured on fluorotic enamel surface. The morphology of biofilms, the volume of bacteria and expolysaccharides (EPS) and the number of bacteria were respectively tested by SEM, confocal laser scanning microscopy and colony-forming units (CFU) counting. Results Fluorotic enamel displayed lower average microhardness and greater surface roughness than sound enamel, and it also showed structure defects like pores or pits. The biofilm thickness, volume of bacteria and EPS, and CFU counts of bacteria in both single-species and dual-species biofilms on fluorotic enamel were all significantly higher than those on sound enamel. The volume of bacteria and EPS in dual-species biofilms are both less than those of single-species biofilms. Conclusions The higher surface roughness and the structure defects of teeth with moderate to severe dental fluorosis contributed to the adhesion of S. mutans and S. sanguinis, and the increased adhesion of S. mutans may increase the susceptibility of dental caries. However, S. sanguinis would play a role as a “designer bacteria” which reduce the cariogenicity of the biofilms on fluorotic enamel surface.
... However, many reports from different parts of the world indicated that people are affected with dental fluorosis, when drinking water fluoride level less than 1.0 mg/L (Sah et al., 2020;Viswanathan et al., 2009;Mabelya et al., 1992;Heller et al., 1997). This might be due to various factors such as local climatic conditions (Khan et al., 2004;Warnakulasuriya et al., 1992;Galagan and Vermillion, 1957); specific food processing and cooking methods (Viswanathan et al., 2010;Kaseva, 2006;Anasuya and Paranjape, 1996;Grimaldo et al., 1995); consumption of food items processed with fluoride-rich water (Malde et al., 2011;Viswanathan et al., 2010;Kahama et al., 1997); consumption of fluoride contaminated diets with nutritional deficiency, especially calcium (Mohamed, 2016;Ekambaram and Paul, 2001); drinking fluoride-rich brick-tea (Zhang et al., 2019;Fan et al., 2016;Cao et al., 1996) and feeding fluoride contaminated infant formula (Viswanathan, 2018;Levy et al., 2010;Hujoel et al., 2009); regular intake of fluoride-rich food stuffs such as fish bones, canned meat and other staples (Dhanu et al., 2017;Malde et al., 1997Malde et al., , 2011Cao et al., 1996); usage of fluoridated dentifrice and toothpastes (Sah et al., 2020;Rojas-Sanchez et al., 1999) as well as few dietary habits of the communities (Kaseva, 2006;Awadia et al., 1999). ...
Article
Many scientific reports emphasized that the extent of prevalence and severity of dental fluorosis is higher among the people residing at high altitude regions than lower altitudes, even though they are exposed to drinking water with similar or less fluoride levels. This review reports various factors which enhance the risk of prevalence and severity of dental fluorosis at high altitude regions through different pathways. Especially, this review focused on ecological, physiological, biochemical and dietary factors as well as to identify potential key areas to implement further research on control of dental fluorosis risk at high altitude regions. In addition, by considering the pathways of risks, suitable remedial measures are also recommended in this review to manage the dental fluorosis risk at higher altitude regions.
... When water fluoridation was first introduced in the middle of the twentieth century, U.S. health authorities estimated that less than 10% of children in fluoridated communities (at 1 mg/L water) would develop dental fluorosis, and only in its mildest forms [43]. Subsequent epidemiological studies have demonstrated prevalence and severity of fluorosis much higher than predicted [9,44,45]. Increased occurrence of dental fluorosis has also been recorded in fluoridated areas in the United Kingdom [46]. This increase may be related to the widened use of fluoridated water for beverages and food products for general consumption and for formula preparation for infants [19,21], as well as increased usage (and ingestion) of fluoride-containing toothpastes among preschoolers [47]. ...
Article
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Background: After the discovery of fluoride as a caries-preventing agent in the mid-twentieth century, fluoridation of community water has become a widespread intervention, sometimes hailed as a mainstay of modern public health. However, this practice results in elevated fluoride intake and has become controversial for two reasons. First, topical fluoride application in the oral cavity appears to be a more direct and appropriate means of preventing caries. Second, systemic fluoride uptake is suspected of causing adverse effects, in particular neurotoxicity during early development. The latter is supported by experimental neurotoxicity findings and toxicokinetic evidence of fluoride passing into the brain. Method: An integrated literature review was conducted on fluoride exposure and intellectual disability, with a main focus on studies on children published subsequent to a meta-analysis from 2012. Results: Fourteen recent cross-sectional studies from endemic areas with naturally high fluoride concentrations in groundwater supported the previous findings of cognitive deficits in children with elevated fluoride exposures. Three recent prospective studies from Mexico and Canada with individual exposure data showed that early-life exposures were negatively associated with children's performance on cognitive tests. Neurotoxicity appeared to be dose-dependent, and tentative benchmark dose calculations suggest that safe exposures are likely to be below currently accepted or recommended fluoride concentrations in drinking water. Conclusion: The recent epidemiological results support the notion that elevated fluoride intake during early development can result in IQ deficits that may be considerable. Recognition of neurotoxic risks is necessary when determining the safety of fluoride-contaminated drinking water and fluoride uses for preventive dentistry purposes.
... The main source of the fluoride in water is fluorite and apatite, released due to the weathering of pegmatites. Leaching of chemical fertilizers also releases fluoride in water (Handa, 1988;Heller et al., 1997;Raju et al., 2012). ...
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Seventeen water samples were collected from various streams in parts of Gadag, Koppal and Ballery districts of Karnataka and analyzed for major ions and heavy metals to determine the processes controlling surface water chemistry and suitability of water for drinking, livestock uses and irrigation purposes. The water samples are moderately alkaline to alkaline in nature and soft to moderately hard. The order of cations is Na>Ca>Mg>K, of anions is HCO3>Cl>SO4>CO3>NO3 and heavy metals Sr>Fe>V>Ba>Zn>Ni>Mn>As>Cu>Cr>Pb>Co. According to Gibbs diagram, the water samples fall in the dominant rock–water interaction area, suggesting chemical weathering of the rock forming minerals as the main process contributing ions to the surface water. Scatter plots of Ca + Mg vs. HCO3 + SO4 and Ca/Na vs. HCO3/Na clearly indicate the silicate weathering playing a dominant role on water chemistry. The evolution of surface water into Ca-Na-HCO3 and Ca-HCO3 water types is due to easy dissolution of silicate minerals and less time for water-rock interaction. Surface water samples are characterized by Na-Ca-HCO3-Cl the principal water type of schoeller’s plot, which can be related to the weathering of the silicate rocks along with some anthropogenic input. The physical parameters, major ions and heavy metals are within the permissible limits of WHO and BIS standards except for two samples, suggesting the water as suitable for domestic and livestock uses. The stream water is suitable for irrigation as per the quality parameters and plots including EC, sodium percent, sodium adsorption ratio, Wilcox and USDA classification diagrams.
... Health Canada's chief dental officer has reviewed the available science and sought external expert advice from the scientific dental community and has determined the optimal concentration of fluoride in drinking water for dental health to be 0,7 mg/L [18]. The technical foundation for this number is delivered by a study from Heller et al. which resulted that under modern circumstances of exposure 0,7 mg/L of fluoride in drinking water affords a suitable trade-off between the risk of dental fluorosis and the protective effect against dental caries [19]. In other words, this attentiveness offers optimal dental health benefits with the tiniest risk of dental fluorosis (The maximum reduction in tooth decay occurs with the minimum risk of dental fluorosis.). ...
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Dental Fluorosis is a developmental defect in enamel formation. It is caused by excessive fluoride intake while teeth are developing; during this period (before teeth erupt) dental tissue is very sensitive to fluoride, typically during a child's first eight years. The aim of this study is to provide the community with sufficient knowledge about the problem and suggest solutions for prevention from it in future. This study was conducted from November 2014 to January 2015 in Ghail Bawazeer district, Yemen. Subjects (N = 1739) from both sexes (967 male and 772 female) aged 9-16 years old were selected randomly from ten public and private primary schools. Oral questionnaire and clinical examination was conducted for each study sample; dental fluorosis assessment was performed according to Modified Dean Index. 10 water samples from different places were examined in YLNG lab by Metrohm 861 Advanced compact IC analyzer (Ion Chromatography) using EPA 300 method. Results showed that the water fluoride level of tap water in study area was above the optimal level, ranging from 2.34 to 2.46 mg/L and 52.4% of study sample used tap water for drinking. The overall prevalence of dental fluorosis in Ghail Bawazeer was 87.1%, where 13.3% were very mild, 34.6% mild, 18.9% moderate and 20.4% severe. Dental fluorosis is a major public health problem in Ghail Bawazeer district and quality of water seems to be the most important factor for its presence. So, it requires the attention of authorities at various levels of government and the community.
... Discolorations due to fluorosis are caused by excessive use of fluoride during development of enamel [19]. High levels of fluoride in drinking water, toothpastes, nutritional supplements and dental materials are risk factors for fluorosis, particularly in children under 8 years of age [20]. ...
... Guerrero et al. (1993) correlated severity of dental caries to the fluoride concentration in drinking water from three different cities of Chile, one with 0.19 ppm of fluoride had a dmft of 4.7, another with 0.88 ppm had a dmft of 3.4 and the last with 1.2 ppm had 1.2. In two studies in the United States, this association is also seen, rating DMFT 1.8 and 3.6 for communities with <0.3mg/L and 1.0mg/L of fluoride respectively and they also reported differences of 17.7 % in DMFT (Heller et al., 1997;Gillcrist et al.). Our results show that the presence of a higher concentration of fluoride in tap water produces a decrease in severity and dental caries experience. ...
Article
One of the most effective and studied measures in the prevention of caries is the use of fluoride, which has the property to reduce their incidence and severity. In Chile, 75 % of the population receives it the drinking water. In 1984, WHO recommended the use of milk as an alternative vehicle. In Chile, the Fluoridated School Feeding Program (FSFP) was introduced in 1994, using this alternative in rural areas without fluoride in water. The objective of the study was to compare prevalence and severity of dental caries and dental fluorosis in 8-year-old children of four state schools: two with fluoride supplementation in drinking water or milk and two without any fluoride program. Epidemiological, descriptive, comparative, observational and cross-sectional study with a sample of 140 8-year-old children, with no systemic diseases and who had lived in the same place since birth: 50 schoolchildren from an area with fluoridated water; 40 from an area with fluoridated milk and 50 from a zone without supplementation of F. The percentage of caries-free children was obtained with the methodology described by the WHO, for severity the dmft and DMFT indexes were used. To quantify the prevalence and severity of dental fluorosis, Dean Index was used. 38 % of the children were caries-free in the community with fluoridated water (CFW); 0 % in the community with fluoridated milk (FSFP) and 10 % in the community with no fluoride program established (CNF). The difference between CFW with CNF is statistically significant (p<0.05). The prevalence of fluorosis is significantly higher for CFW (48.8 %) than FSFP (35 %) and CNF (16 %). Conclusion: The contribution of fluoride in drinking water causes a decrease in the prevalence and severity of dental caries in children of 8 years of age, and an increase in the prevalence of dental fluorosis.
... Fluoride is an essential element for any living being because of its effects on strengthening bones, prevention of tooth decay and regulating growth rate etc. The excess amount of fluoride ions can cause dental fluorosis in children (>1 mg/L), skeletal fluorosis in adults (>4 mg/L) and crippling fluorosis (>10 mg/L) (Heller et al., 1997;Yu et al., 2015). Even though, the acceptable value of fluoride ions in drinking water is 1.5 mg/L, for tropical countries such as Sri Lanka upper limit values for fluoride ions in drinking water must be less than 1.0 mg/L (Mohapatra et al., 2009). ...
Article
Excessive amounts of fluoride ions and other heavy metals in drinking water instigate a solemn threat to human health. Even though materials with specific binding ability towards these ions have been developed, it is yet a challenge to meet the practical utility of developing an efficient remedy as such. With this regard, a novel tri-metal composite incorporated polyacrylamide (TCIP) has developed. TCIP has shown a significant binding efficiency towards arsenate, chromate and fluoride ions in the presence of the other competing anions. The maximum adsorption capacities (q max ) of 43.85, 42.25 and 107.52 mg/g were achieved for arsenate, chromate and fluoride respectively at 300 K and in pH 7.00. Arsenate, chromate and fluoride adsorption is highly pH dependent. Monolayer adsorption of arsenate, chromate and fluoride ions was observed and adsorption data were found well behaved with the Langmuir adsorption isotherm. Arsenate, chromate and fluoride adsorption to TCIP has shown pseudo-second order adsorption kinetics, and no leaching of metal ions was observed from the metal composite into the aqueous medium.
... In the first case, the presence of fluoride in drinking water within acceptable limits is beneficial like for example in the calcification of dental surface. In the latter case, high fluoride concentrations pose a health threat to millions of people around the world with the occurrence of fluorosis, dental discoloration, bony lesions and so on [7,8]. According to the World Health Organization (WHO), the maximum acceptable concentration of fluoride is 1.5 mg/L [9]. ...
Article
The fluoride removal efficiency of the commercial product Actifluo (Brenntag) has been evaluated on both real industrial wastewater samples as well as on synthetic wastewaters. This study demonstrates that the treatment with the Aluminum polychloride (PAC) containing Actifluo, after a preliminary precipitation step with Ca(OH)2, improved the efficiency in the fluoride removal. This has been proved on wastewaters coming from four different companies of the south of Italy. In all the cases, the Actifluo treatment led to residual fluorides falling within the Italian law limits (fixed at 12 mg/L for sewage and 6 mg/L for surface waters). As a matter of fact, independently of the initial fluoride concentration, final values lower than 3 mg/L were obtained by treating wastewaters coming either from glass or dye factories. To determine whether pH and particle surface influenced the decontamination efficiency in surface water, synthetic wastewaters were analyzed by means of ζ-potential and Dynamic light scattering. The close relationship between pH and surface charge of the coagulant polymer present in the Actifluo was established and their effects on the fluoride removal efficiency assessed.
... Anthropogenic activities such as, application of fertilisers and industrial activities like brick kilning also add to fluoride levels in the aquifers Datta et al. 1996;Hem 1986;Pickering 1985). Consumption of fluoride rich water causes dental fluorosis (Heller et al. 1997;Viswanathan et al. 2009) and aids weakening ...
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Quality assessment of groundwater for drinking and irrigation was evaluated in parts of Nalgonda district of Telangana state, India. The overall groundwater quality and the suitability to drinking and irrigation were evaluated by hydrochemical analysis of 78 groundwater samples. The water quality parameters were compared with that of the limits set by World Health Organisation (WHO) and Bureau of Indian Standards (BIS). Groundwater is found to be contaminated by fluoride and nitrate ions. The water quality indices (WQI) suggest that during pre-monsoon, 72.5% samples are suitable for drinking while 86.8% are suitable during post-monsoon. Indicators like sodium absorption ratio (SAR), electrical conductivity (EC), percent of sodium (Na %), residual sodium carbonate (RSC), permeability index (PI), magnesium ratio (MR), residual sodium bicarbonate (RSBC), salinity hazard (SH), potential salinity (PS), soluble sodium percentage (SSP), and magnesium ratio (MR) were estimated for assessing the irrigation suitability of the groundwater samples. Wilcox, United States Salinity Laboratory diagrams (USSL diagram) and Doneen’s chart infer that most of the samples are suitable for irrigation purpose and the suitability improves during post-monsoon. The geochemical evolution of the groundwater was also studied using Piper’s and Chadha’s diagrams. The major facies found in groundwater are Na–Mg–HCO3–Cl, Na–Mg–HCO3, Na–HCO3, Mg–Ca–HCO3, Mg–Na–HCO3 and Na–Cl. Rock-water interaction, ion exchange and evaporite dissolution were found to be the major geochemical processes governing the groundwater chemistry.
... Further research followed on from Dean's original study on dental caries and water fluoridation. Important reports include Galagan and Vermillian (1957), Eklund and Striffler (1980), Heller et al. (1997) and several systematic reviews -the York Review (McDonagh et al. 2000, Griffin et al. 2007, Rugg-Gunn and Do 2012and Iheozor-Ejiofor et al. 2015. A number of more recent scientific articles on dental caries and water fluoridation in Australia were also available . ...
... In 2015, the USPHS released updated recommendations for those community water systems that add fluoride to achieve the optimal concentration of fluoride in drinking water for the prevention of dental caries. As mentioned earlier, the optimal fluoride concentration in drinking water is now set at 0.7 mg/L to provide the best balance for protection against tooth decay while limiting the chance of dental fluorosis [4,28]. For the USPHS review and update, a federal panel of scientists, including epidemiologists, accepted the conclusion of the extensive 2006 NRC review that severe dental fluorosis is the only adverse health effect of exposure to naturally-occurring fluoride at 2e4 mg/L in drinking water during childhood. ...
Article
Community water fluoridation (CWF) and its effect in reducing the burden of dental caries (tooth decay) is considered one of ten public health achievements in the 20th century. In the U.S., three-quarters (74.4%) of people on community water supplies have optimally fluoridated water, and each year approximately 90 communities actively consider starting or discontinuing CWF. CWF exists within the policy environment and includes actions taken by local community councils, health and water boards, and groups; state legislatures and health departments; national regulatory and science agencies; independent science entities; and professional and non-profit organizations. Epidemiologists have been in the forefront of CWF. Experience with the past 70 years reveals that the coming decades will bring additional questions, recommendations and challenges for CWF. The continued involvement of epidemiologists as part of multi-disciplinary teams is needed in research, surveillance, peer-review of studies, assessment of systematic review findings, and in the translation and communication of science findings to audiences with limited science/health literacy. This paper’s purpose is to: 1) examine how epidemiologic evidence regarding CWF has been translated into practice and policy, 2) examine how recommendations for and challenges to CWF have affected epidemiologic research and community-decision-making; and 3) identify lessons learned for epidemiologists.
Article
In 2015, the United States Public Health Service (USPHS) set a target fluoride level for drinking water at 0.7 mg/L to maximize oral health benefits while minimizing any potential harms. Using water fluoridation operational data reported by water systems to the Centers for Disease Control and Prevention (CDC) Water Fluoridation Reporting System (WFRS) during 2016–2021, this study assesses how water systems performed around this target. The authors summarize completeness of data reporting, assess the distribution of monthly average fluoride readings (MAFR) values, and evaluate precision in maintaining fluoride levels. About 69% of adjusting systems provided data, with an average completeness of 63.8% among them. MAFR mean was 0.71 mg/L (SD: 0.20 mg/L), indicating that water systems have primarily adopted the USPHS target. About 76% of MAFRs fell ± 0.1 mg/L around the reporting system point's mean, indicating feasibility in maintaining precision around a target. State programs and water systems could work together to improve data quality and educate operators on best practices.
Article
Background: Dental caries is a major public health problem in most industrialised countries, affecting 60% to 90% of school children. Community water fluoridation (CWF) is currently practised in about 25 countries; health authorities consider it to be a key strategy for preventing dental caries. CWF is of interest to health professionals, policymakers and the public. This is an update of a Cochrane review first published in 2015, focusing on contemporary evidence about the effects of CWF on dental caries. Objectives: To evaluate the effects of initiation or cessation of CWF programmes for the prevention of dental caries. To evaluate the association of water fluoridation (artificial or natural) with dental fluorosis. Search methods: We searched CENTRAL, MEDLINE, Embase and four other databases up to 16 August 2023. We also searched two clinical trials registers and conducted backward citation searches. Selection criteria: We included populations of all ages. For our first objective (effects of initiation or cessation of CWF programmes on dental caries), we included prospective controlled studies comparing populations receiving fluoridated water with those receiving non-fluoridated or naturally low-fluoridated water. To evaluate change in caries status, studies measured caries both within three years of a change in fluoridation status and at the end of study follow-up. For our second objective (association of water fluoridation with dental fluorosis), we included any study design, with concurrent control, comparing populations exposed to different water fluoride concentrations. In this update, we did not search for or include new evidence for this objective. Data collection and analysis: We used standard methodological procedures expected by Cochrane. For our first objective, we included the following outcomes as change from baseline: decayed, missing or filled teeth ('dmft' for primary and 'DMFT' for permanent teeth); decayed, missing or filled tooth surfaces ('dmfs' for primary and 'DMFS' for permanent teeth); proportion of caries-free participants for both primary and permanent dentition; adverse events. We stratified the results of the meta-analyses according to whether data were collected before or after the widespread use of fluoride toothpaste in 1975. For our second objective, we included dental fluorosis (of aesthetic concern, or any level of fluorosis), and any other adverse events reported by the included studies. Main results: We included 157 studies. All used non-randomised designs. Given the inherent risks of bias in these designs, particularly related to management of confounding factors and blinding of outcome assessors, we downgraded the certainty of all evidence for these risks. We downgraded some evidence for imprecision, inconsistency or both. Evidence from older studies may not be applicable to contemporary societies, and we downgraded older evidence for indirectness. Water fluoridation initiation (21 studies) Based on contemporary evidence (after 1975), the initiation of CWF may lead to a slightly greater change in dmft over time (mean difference (MD) 0.24, 95% confidence interval (CI) -0.03 to 0.52; P = 0.09; 2 studies, 2908 children; low-certainty evidence). This equates to a difference in dmft of approximately one-quarter of a tooth in favour of CWF; this effect estimate includes the possibility of benefit and no benefit. Contemporary evidence (after 1975) was also available for change in DMFT (4 studies, 2856 children) and change in DMFS (1 study, 343 children); we were very uncertain of these findings. CWF may lead to a slightly greater change over time in the proportion of caries-free children with primary dentition (MD -0.04, 95% CI -0.09 to 0.01; P = 0.12; 2 studies, 2908 children), and permanent dentition (MD -0.03, 95% CI -0.07 to 0.01; P = 0.14; 2 studies, 2348 children). These low-certainty findings (a 4 percentage point difference and 3 percentage point difference for primary and permanent dentition, respectively) favoured CWF. These effect estimates include the possibility of benefit and no benefit. No contemporary data were available for adverse effects. Because of very low-certainty evidence, we were unsure of the size of effects of CWF when using older evidence (from 1975 or earlier) on all outcomes: change in dmft (5 studies, 5709 children), change in DMFT (3 studies, 5623 children), change in proportion of caries-free children with primary dentition (5 studies, 6278 children) or permanent dentition (4 studies, 6219 children), or adverse effects (2 studies, 7800 children). Only one study, conducted after 1975, reported disparities according to socioeconomic status, with no evidence that deprivation influenced the relationship between water exposure and caries status. Water fluoridation cessation (1 study) Because of very low-certainty evidence, we could not determine if the cessation of CWF affected DMFS (1 study conducted after 1975; 2994 children). Data were not available for other review outcomes for this comparison. Association of water fluoridation with dental fluorosis (135 studies) The previous version of this review found low-certainty evidence that fluoridated water may be associated with dental fluorosis. With a fluoride level of 0.7 parts per million (ppm), approximately 12% of participants had fluorosis of aesthetic concern (95% CI 8% to 17%; 40 studies, 59,630 participants), and approximately 40% had fluorosis of any level (95% CI 35% to 44%; 90 studies, 180,530 participants). Because of very low-certainty evidence, we were unsure of other adverse effects (including skeletal fluorosis, bone fractures and skeletal maturity; 5 studies, incomplete participant numbers). Authors' conclusions: Contemporary studies indicate that initiation of CWF may lead to a slightly greater reduction in dmft and may lead to a slightly greater increase in the proportion of caries-free children, but with smaller effect sizes than pre-1975 studies. There is insufficient evidence to determine the effect of cessation of CWF on caries and whether water fluoridation results in a change in disparities in caries according to socioeconomic status. We found no eligible studies that report caries outcomes in adults. The implementation or cessation of CWF requires careful consideration of this current evidence, in the broader context of a population's oral health, diet and consumption of tap water, movement or migration, and the availability and uptake of other caries-prevention strategies. Acceptability, cost-effectiveness and feasibility of the implementation and monitoring of a CWF programme should also be taken into account.
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Drinking water fluoridated at the level recommended by the U.S. Public Health Service (USPHS) reduces dental caries (cavities) by approximately 25% in children and adults (1). USPHS recommends fluoride levels to achieve oral health benefits and minimize risks associated with excess fluoride exposure. To provide the benefits of community water fluoridation, water systems should target a level of 0.7 mg/L and maintain levels ≥0.6 mg/L (2). The Environmental Protection Agency (EPA) sets a safety standard at 2.0 mg/L to prevent mild or moderate dental fluorosis, a condition that causes changes in the appearance of tooth enamel caused by hypermineralization resulting from excess fluoride intake during tooth-forming years (i.e., before age 8 years). During 2016-2021, fluoride measurements for 16.3% of population-weighted monthly fluoride measurements (person-months) reported by community water systems to CDC's Water Fluoridation Reporting System (WFRS) were <0.6 mg/L; only 0.01% of person-months exceeded 2.0 mg/L. More than 80% of population-weighted fluoride measurements from community water systems reporting to WFRS were above 0.6 mg/L. Although 0.7 mg/L is the recommended optimal level, ≥0.6 mg/L is still effective for the prevention of caries. A total of 4,080 community water systems safely fluoridated water 99.99% of the time with levels below the secondary safety standard of 2.0 mg/L. Water systems are encouraged to work with their state programs to report their fluoride data into WFRS and meet USPHS recommendations to provide the full benefit of fluoridation for caries prevention.
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This study reviewed groundwater fluoride and the associated human health risks in Ghana. The physical and chemical properties of fluorine that make it soluble in the soil and aquifer materials were carefully reviewed. The pathways through which fluoride gets into groundwater were also reviewed. Fluoride concentrations in groundwater can be as high as 67 mg/L. Its natural concentration in water depends largely on the nature of the geologic formations; fluoride-bearing minerals, anion exchange capacity of aquifer materials (OH⁻ for F⁻), pH, temperature and residence time of waters within a particular formation. High F⁻ concentrations in groundwater are due to geogenic and anthropogenic sources. The fluorosis endemic parts of Ghana are only restricted to northern Ghana, where elevated groundwater fluoride concentrations (0.05–13.29 mg/L) in the North East Region, Northern Region, Upper East Region, and surrounding communities have been reported. The elevated groundwater fluoride concentrations are as a result of intense water-rock interaction, ion exchange reactions, and mineral dissolution from the Bongo Granitoids and Voltaian sediments. Children in the fluorosis endemic parts of Ghana are exposed to the intake of more fluoridated water than the other age groups and thus, children have higher non-carcinogenic risks. Although, almost all the age groups show evidence of dental fluorosis, children are the hypersensitive population. It is recommended that sustainable defluoridation methods such as adsorption, precipitation, membrane separation and ion exchange techniques be employed to curtail the menace of dental fluorosis.
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The Comet Assay, also called single cell gel electrophoresis (SCGE), is a sensitive and rapid technique for quantifying and analyzing DNA damage in individual cells. This is one of the techniques used in the area of cancer research for the evaluation of genotoxicity and effectiveness of chemoprevention. Ostling & Johansson developed this technique in 1984. The Comet Assay can be used to detect DNA damage caused by double strand breaks, single strand breaks, alkali labile sites, oxidative base damage, and DNA cross-linking with DNA or protein. The Comet Assay is also used to monitor DNA repair by living cells. It has been reported that smokers have higher level of DNA damage in nasal epithelial cells and buccal cells. Comet assay is an excellent screening test for exposures that may be DNA damaging even in the oral cavity. Keywords: Comet assay, DNA, genotoxicity, carcinogenesis, single cell gel electrophoresis.
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Introduction Les besoins hydriques du nourrisson sont apportés par l’eau lorsque l’allaitement n’est pas exclusif. La grande variété des sources d’eaux embouteillées en Algérie rend le choix difficile aux parents. L’objectif de ce travail était d’étudier les caractéristiques chimiques des eaux embouteillées disponibles en Algérie, selon les critères de qualité requis pour les eaux destinées aux nourrissons. Matériels et méthodes La composition chimique de 47 eaux embouteillées disponibles en Algérie a été étudiée à partir des étiquetages. L’étude a été complétée par le dosage du fluor (par une méthode potentiométrique) en raison de l’absence de sa teneur sur l’étiquetage. Résultats Les résultats ont montré que 46 eaux sur les 47 échantillons étudiés présentaient une faible à moyenne minéralisation, soit inférieure à 1000 mg/L. La teneur en nitrates était supérieure à la limite recommandée pour les nourrissons dans 38,3 % des échantillons. L’analyse du fluor sur les eaux embouteillées a révélé que la moyenne de sa teneur était de 0,35 ± 0,22 mg/L, avec un minimum de 0,15 mg/L et un maximum de 1,05 mg/L. Conclusion Les données obtenues sont essentielles pour les professionnels de santé afin d’orienter sur le choix de l’eau à utiliser pour les nourrissons.
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Springs and hot spas have been used worldwide since ancient times as sources of potable, medicinal and bathing water, as well as for industrial purposes. They also sustain spring-dependent ecosystems and provide water flow to downstream ecosystems. We investigated the major element hydrogeochemistry of traditional springs, CO2-rich waters, and hot spas in South Korea and their relationships with features of bedrock geology and structural settings at the national scale to classify water types and identify the major factors controlling the occurrence of each water type. Three criteria—mineral content, CO2(aq), and water temperature—defined six major water types. Alkaline mineral water in carbonate rocks and sedimentary rocks result from readily weatherable lithology. The majority of mineralized waters are CO2-rich or thermal waters with a wide range of mineral contents. Their occurrence was found to be mainly concentrated near faults and boundaries between Early to Middle Jurassic granitic rocks and other rocks of much older ages, and this pattern was quantitatively identified through proximity analysis. This finding indicates that younger granitic rocks provide sources of heat and deep-seated CO2, and faults link these deep sources to groundwater flow. Hydrolysis of primary silicate minerals, including feldspar and biotite, is likely to supply major and minor solutes including Mg²⁺, F⁻, and Fe to CO2-rich and thermal waters. F⁻ concentration appears to be regulated by the saturation states of calcite and fluorite, and Mg²⁺ concentration in alkaline thermal water is driven by the formation of Mg-bearing secondary silicates. We demonstrated that natural mineral water in tectonically stable regions has diverse thermal and hydrogeochemical properties that are mainly controlled by their lithological and structural settings at the regional scale. These results may help elucidate the generation processes of natural mineral waters with high cultural and ecological values, leading to their sustainable use and protection.
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Chronic pancreatitis is considered a common gastrointestinal disorder, with significant morbidity and mortality. Fluoride is an important agent for the development of our body systems, especially for bone and teeth, however on its excess consumption, it deposits in different body tissues, especially the pancreas, causing its chronic inflammation and destruction. Fraxetin proved to possess versatile activities including; antioxidant, anti-inflammatory, antifibrotic, and anti-apoptotic activities. In the present study, we have evaluated the fraxetin potentiality to prevent fluoride-induced chronic pancreatitis in rats, by evaluating animal body weights and body weight gain rate, serum amylase, and lipase activities, pancreatic oxidative stress markers, cytokines, apoptotic markers, myeloperoxidase, and hydroxyproline levels, and histopathological changes. Nine-weeks-old male Wistar rats drank distilled water containing 500 ppm sodium fluoride (NaF) for 60 days to induce chronic pancreatitis. Oral fraxetin (20, 40, and 80 mg/kg/day) received simultaneously to prevent chronic pancreatitis development. Fraxetin in a dose-dependent manner alleviated chronic pancreatitis induced by NaF, as it restored the decreased body weight and weight gain rate, decreased the elevated serum amylase and lipase activities, pancreatic IL-6, TNF-α, MDA, caspase-3, MPO and hydroxyproline levels, and Bax/Bcl-2 ratio, enhanced pancreatic CAT and SOD activities, and GSH levels, besides it augmented the elevated IL-10 level, with the restoration of normal pancreatic architecture. Therefore, fraxetin could be a promising agent recommended for the prevention of fluoride-induced chronic pancreatitis in endemic areas.
Chapter
The use of fluoride for promoting oral health has always involved a balance between the protection against caries and the risk of fluorosis. Dental fluorosis, a developmental condition of enamel, results from excessive intake of fluoride during the tooth development period. Dental fluorosis is the most common adverse effect of fluoride use in prevention of dental caries. The public health importance of dental fluorosis lies in its role as the canary in the coalmine, that is, a population indicator of excessive fluoride exposure. Dental fluorosis is an important aspect of oral health because (a) scientific evidence has recently elevated dental fluorosis to prominence as the adverse outcome associated with fluoride use; (b) public opinion on the safety of fluoride use now routinely includes dental fluorosis as a concern; and (c) recommendations about the use of fluoride should be based on evidence of a risk-benefit trade-off between a preventive benefit against dental caries and a risk of having fluorosis. Research on various aspects of dental fluorosis is important to inform oral health policies.
Chapter
This chapter examines the methods of oral epidemiology applied to research on the effectiveness of water fluoridation. The path from a dose-response association to initial community fluoridation trials to replication of these in other settings and finally to the monitoring of water fluoridation as a public health measure is described. A benefit of water fluoridation in the prevention of caries was a consistent finding in these stages along the path. However, there is a good deal of heterogeneity in the effect size across individual studies. Study design and confounding, measurement of exposure, and measurement of outcomes are examined as potential sources of bias. The modes of action of fluoride and their induction period are considered as a background to an examination of how exposure to fluoridated water is measured. Caries outcomes are frequently expressed as prevalence or caries experience measures. The relationship between prevalence and experience is examined and the sensitivity of different experience measures at the tooth or tooth surface level considered. Finally, alternative outcome measures are presented that might better reflect true reductions in caries associated with water fluoridation.
Article
Objective This study aims to incorporate 2:1 MgAl and 2:1 CaAl layered double hydroxides (LDHs) in experimental dental-composites to render them fluoride rechargeable. The effect of LDH on fluoride absorption and release, and their physico-mechanical properties are investigated. Methods 2:1 CaAl and 2:1 MgAl LDH-composite discs prepared with 0, 10 and 30 wt% LDH were charged with fluoride (48 h) and transferred to deionized water (DW)/artificial saliva (AS). Fluoride release/re-release was measured every 24 h (ion-selective electrodes) with DW/AS replaced daily, and samples re-charged (5 min) with fluoride every 2 days. Five absorption-release cycles were conducted over 10 days. CaAl and MgAl LDH rod-shaped specimens (dry and hydrated; 0, 10 and 30 wt%) were studied for flexural strength and modulus. CaAl and MgAl LDH-composite discs (0, 10, 30 and 45 wt% LDH) were prepared to study water uptake (over 7 weeks), water desorption (3 weeks), diffusion coefficients, solubility and cation release (ICP-OES). Results CaAl LDH and MgAl LDH-composites significantly increased the amount of fluoride released in both media (P < 0.05). In AS, the mean release after every recharge was greater for MgAl LDH-composites compared to CaAl LDH-composites (P < 0.05). After every recharge, the fluoride release was greater than the previous release cycle (P < 0.05) for all LDH-composites. Physico-mechanical properties of the LDH-composites demonstrated similar values to those reported in literature. The solubility and cation release showed a linear increase with LDH loading. Significance LDH-composites repeatedly absorbed/released fluoride and maintained desired physico-mechanical properties. A sustained low-level fluoride release with LDH-composites could lead to a potential breakthrough in preventing early stage carious-lesions.
Chapter
Dental fluorosis is a hypomineralization of enamel associated with elevated fluoride intake during the process of enamel formation. Dental fluorosis appearance ranges from barely discernable fine flecks or lines of opaque white enamel in its mildest form to discrete pits, which can be accompanied by areas that are stained orange to dark brown in its severe form. In this chapter the description, etiology, measurement, distribution, risk factors and indicators, and public health significance of dental fluorosis are presented.
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Fluoride related to caries prevention is at the center of a scientific controversy. Studies show that fluoride causes damage to health and the environment, as well as reducing IQ in children. The fluoridation of drinking water, mandatory in Brazil, has repercussions over the whole society. One of our objectives was to know the concentrations of fluoride (F) and toxic metals of Sinos River, treated water and final consumers of the cities of Campo Bom (CB), Novo Hamburgo (NH) and São Leopoldo (SL), as well as the groundwater from Ivoti, located in southern Brazil. We also evaluated in rats the effects of F and, in association with lead (Pb), on thyroid hormones and the Total Antioxidant Capacity (TAC). Three groups of rats were exposed to different waters: G1-Control with distilled water (DW); G2-DW with 25ppm (F); G3-DW with 25ppm (F) + 30 ppm (Pb). The Sinos River has an average concentration of 0.0735 mg.L-1 of F. But the F of both the water treated by the ETA of SL as well as in the final consumers of SL had concentrations above 0.9 mg.L-1 (State Ordinance No. 10/1999). In addition, we verified the presence of Pb and Cr (VI) in all types of water. The results with the animals showed a significant difference in T3 (p=0.032) and in T4 (p=0.043) from G3 to G1. In TAC, the difference was significant from G2 to G1 and G3 (p=0.007), showing that F and F with Pb interfere with the endocrine and antioxidant functions of rats. In addition, the fact that there are water fluoridation failures shows that the population is exposed to health risks. We confirm that drinking water fluoridation needs to be demystified and reconsidered as a public health intervention.
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To evaluate the physicochemical characteristics, water samples were collected from thirty-three villages at Dindigul district. From the analysis, pH of the all samples were varying from 6.64 to 8.17. The pH values are within the permissible limit. In Natham taluk, bore wells samples showed extreme (991, 963 and 951 mg L-1) total dissolved solids (TDS) values when compared to maximum permissible TDS is 600 mg L-1. The taste of water comes under poor TDS rating. The highest total hardness (TH) 725 mg L-1 was tested at Silukuvarpatti bore well in Nilakottai taluk. Residual free Chlorine and Iron were not detected in any of the samples. All samples showed Nitrate (NO3-) concentrations were ranged from 0 to 25 mg L-1. The values are less than NO3- desirable limit, that is 45 mg L-1 respectively. Maximum number of samples showed chloride (Cl-) values were higher than Cl- permissible limit (1000 mg L-1) as referenced by BIS. The highest Cl- values were obtained at 2950 and 2000 mg L-1 in Pudukkottai well and Sengulam bore well taken from Reddiyarchatiram and Natham taluks. In regards to fluoride (F-) contamination, thirty-four samples showed < 0.5 ppm F- and rest of fourteen samples viewed <1ppm F-. According to BIS and WHO standard, low concentration of F- below 0.5 ppm may increase the risk of tooth decay.
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Background: Excessive ingestion of fluoride during tooth development, particularly at the maturation stage, may result in dental fluorosis, with clinical implications. Literature is scarce on dental fluorosis in Enugu, Nigeria. Purpose: The aim of this study was to assess the prevalence of dental fluorosis in Enugu, a major city in South East Nigeria. Materials and methods: A multistage sampling technique was used to select a calculated sample of 400 students. A pretested interviewer-administered questionnaire was used to ascertain student's sociodemographic and related variables. The student participants were examined for dental fluorosis using Dean's index criteria according to the World Health Organization guidelines. Data were analyzed using SPSS version 16, and Chi-square test of association was used to compare proportions and ratios with significant level set at P < 0.05 and 95% confidence level. Results: Among the 400 students analyzed, 231 (57.8%) and 169 (42.2%) were male and female, respectively. Mean age was 13.43 ± 1.021 years. The prevalence of dental fluorosis was 11.3%, with the preponderance of very mild score (82.2%), and no observed severe dental fluorosis. The difference in the distribution of the scores of fluorosis among the children was highly statistically significant (χ2 = 72.80, P = 0.000). Dental fluorosis was found present in 39 (10.3%) of 378 users of fluoridated toothpaste and in 6 (27.7%) of the 22 users of nonfluoridated toothpaste. The differences in the presence and absence of dental fluorosis were statistically significant among users of fluoridated toothpaste. Conclusion: This study shows the prevalence of dental fluorosis to be low among secondary school students of Enugu metropolis.
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The citation count is one of the indications of a manuscript's impact. The objective of the current study was to identify and analyze the top cited articles published on fluoride in the context of oral health. The articles published from January 1997 to December 2017 on fluoride in the context of oral health were identified using the Scopus database. The 100 top cited articles were ranked based on the number of citations received. The manuscripts were also analyzed for the type of study, the name of the journal, the impact factor, the publication year, the author names, the institutional affiliation and the country of origin. The data analysis was performed using SPSS (version 20) statistical software (IBM, NY, USA). Among the top 100 most cited articles, the citation count ranged from 419 to 63. The two most prominent journals were Caries research (n=22) and Journal of Dental Research (n=16). The four year period with the greatest number of manuscripts published was 2001-2004 (n=37) and most of the papers originated from USA (n=25). The most frequent institutions were the University of Oslo, the University of California, San Francisco, the Justus Liebig University, and the Academic Centre for Dentistry Amsterdam (n=5 for each institution). The most frequent first author was Ganss C (n=7), and the most frequent coauthor was Klimek J (n=8). The majority of the studies were in vitro studies (n=40) and narrative reviews (n=23). This article reveals the progress of research on fluoride in oral health by identifying the topics, the institutions, and the authors contributing to fluoride research. There was a predominance of in vitro studies and narrative reviews among the highly cited manuscripts.
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p>La fluorosis dental es una alteración en el desarrollo del esmalte dental causada por la exposición a altas concentraciones de flúor durante el desarrollo del diente, lo que causa un esmalte hipomineralizado y con la presencia de porosidades. El objetivo de este estudio es determinar la prevalencia de fluorosis y su grado de severidad en los niños de 6-15 años de edad hijos de los trabajadores de la florícola Valleflor. Para esto se examinaron 104 niños a los cuales se les observó sus piezas dentarias y se determinó si poseían o no fluorosis por medio del índice de Dean. Se realizó el análisis estadístico y se determinó que la prevalencia de fluorosis en el grupo estudiado fue del 76%. Los sectores que predominaron con presencia de fluorosis fueron Pifo (24%), Yaruquí (21,3%), Puembo (18,70%), Collaquí (14,7%) y El Arenal (12%). Los grados que se observaron con mayor prevalencia es el grado 2 (32%), seguido por el grado 1 (22%), grado 3 (20%), grado 0 (18%), grado 4 (9%) y finalmente el grado 5 con ausencia total. Además se encontró una relación entre la presencia de fluorosis y el tiempo de vivencia en un sector determinado. Con estos resultados se pudo concluir que en el sector de Valle de Tumbaco existe una alta prevalencia de esta alteración, la cual puede deberse a varios factores, entre ellos el agua pública de consumo. Se prevé que esta prevalencia irá en aumento si no se toman medidas de salud pública y si no se alerta a la comunidad.</p
Article
Objectives: There are reports showing higher prevalence of enamel fluorosis among African-American children. This study was conducted to assess whether the effect of water fluoride level on enamel fluorosis is different among different race/ethnicity groups among US school children. Methods: Data from the National Survey of Oral Health of US School Children 1986-1987 were analyzed to determine the prevalence of enamel fluorosis among 7-17 year-old children. The association between race/ethnicity and enamel fluorosis was examined using logistic regression modeling after controlling for potential confounders age, gender, water fluoridation, other sources of fluoride, and region of residence. Results: The prevalence of very mild to severe enamel fluorosis was 20.8 (95% CI, 15.4, 26.3) and 25.7 (95% CI, 15.0, 36.5) percent among non-Hispanic White and non-Hispanic Black children, respectively. Neither the adjusted odds ratio of 1.3 (0.8, 2.0) for the non-Hispanic Black group nor the interaction effect between non-Hispanic Black and water fluoridation were statistically significant. Conclusions: Enamel fluorosis was not associated with race/ethnicity. Our analysis suggests that exposure to similar levels of fluoride in the water does not appear to place certain race/ethnic groups at a higher risk for developing enamel fluorosis, and lowering the optimal range of drinking water fluoride to a single value of 0.7 ppm will provide a level of protection against enamel fluorosis that will benefit all race/ethnicity groups.
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The Concept of a Maximum Acceptable Daily Dose Fluoride Intake in Our Diet Do Not Swallow Contesting Conventional Wisdom Too Much of a Good Thing? References
Article
A negative correlation between the fluoride (F) concentration of the public water supply and the dental caries experience of children continuously exposed to such waters is reported. A study of eight suburban Chicago communities discloses marked differences in the amount of dental caries. The dental caries experience rates in Elmhurst, Maywood, Aurora, and Joliet, whose public water supplies contain 1.8, 1.2, 1.2, and 1.3 parts per million of fluoride (F), respectively, were 252, 258, 281, and 323, respectively. At Evanston, Oak Park, and Waukegan, using fluoride free water, the dental caries experience rates were 673, 722, and 810, respectively. Using the proximal surfaces of the four superior permanent incisors as a basis of measurement, there was 14.3 times as much of this type of dental caries in the 1,008 children from Evanston, Oak Park, and Waukegan as in the 1,421 children from Elmhurst, Maywood, Aurora, and Joliet. The differences in the counts of L. acidophilus in the saliva corresponded to the differences in the dental caries experience in the groups of communities studied. Considering the relative homogeneity of these urban populations and the sampling method followed, it is difficult from an epidemiological standpoint to ascribe these observed differences to any cause other than the common water supply. The dental caries inhibitory factor, presumably fluoride, was operative at such low concentrations (e.g., 1.2 p. p. m. of F in Aurora) that mottled enamel as an esthetic problem was not encountered.
Article
The purpose of this case-control investigation was to investigate the possible association between mild-to-moderate enamel fluorosis and exposure during early childhood to Infant formula, fluoride toothpaste, and/or fluoride supplements. Analysis was performed on 401 residents of fluoridated communities in Connecticut, who wore 12–16 years old and born prior to 1980. The case and control subjects for this study were selected on the basis of a clinical examination given in 1991. Subject fluorosis status was determined using the Fluorosis Risk Index. Risk factor exposure was ascertained via a mailed questionnaire with a response rate of 89% and a question naire reliability of 87%. Logistic regression analyses, which adjusted for confounding variables, revealed that mild-to-moderate enamel fluorosis on early forming (Fluorosis Risk Index (FRI) classification I) enamel surfaces was strongly associated with both milk-based (odds ratio (OR)=3.34, 95% confidence interval (Cl) 1.38–8.07) and soy-based (OR = 7.16, 95% Cl 1.35–37.89) infant formula use, as well as with frequent brushing (OR = 2.80,95% Cl 1.15–6.81). A very strong association was observed with inappropriate fluoride supplement use (OR = 23.74, 95% Cl 3.43–164.30). Respectively similar associations were observed between mild-to-moderate enamel fluorosis on later forming (FRI classification II) enamel surfaces and frequent brushing and fluoride supplement use, but not with infant formula use.
Article
Fluoride supplements have contributed significantly to caries prevention; however, better information about the dynamic nature of fluoride's effect on caries has made a reappraisal desirable. It seems, from a review of the literature, that the benefit from supplement use that can be expected today in populations in low-fluoride areas is small. Possible reasons include the low caries incidence in children of recent years. Few people are willing to use supplements with sufficient regularity to achieve an effect. The principal mode of action of fluoride in supplements, topical exposure of teeth to fluoride, can be achieved with toothpastes and other means. Supplement use has been associated with dental fluorosis in children. This is displeasing to look at and may put at risk the undoubted benefits of water fluoridation if the public associates fluoride with negative cosmetic effects. This reason alone should be sufficient to compel a reconsideration of existing recommendations. An appropriate new dosage schedule for fluoride supplements should be aimed only at identifiable high caries-risk individuals, not at groups defined by age or residence and should result in much lower fluoride intake in the age span birth-eight years than many current recommendations. It should start at six months or later, expressly recommend lozenges rather than tablets for swallowing to maximize the topical effect, stipulate that the maximum fluoride ion content of a tablet be 0.50 mg to reduce the chances of fluorosis and over consumption, and have no upper age limit, as caries risk may occur at any age. A dosage schedule meeting these requirements is proposed.
Article
This paper assesses, by comparing recent published evidence with Dean's pioneering work, whether an increase in the milder forms of dental fluorosis may have occurred since Dean's time. To the extent that the crude comparisons of recent research with historic studies are valid, the data indicate a slight trend toward more fluorosis today than would be expected based upon findings in the late 1930s and early 1940s. This suggested increase in fluorosis is not as clear-cut nor as widely accepted as the recent decline in the prevalence of dental caries. Thus, further study of the prevalence of fluorosis and caries in relation to fluoride ingestion will be required to help validate the trend, and to allow dental researchers and decision makers to plan for the future.
Article
Article
A study was executed to investigate the relation between the use of fluoride tablets by children in the age period 1.5-6 yr on the one hand and the caries experience at the age of 6 and 15 yr and the prevalence of fluorosis at the age of 15 yr on the other hand. The year of birth of the child, the motivation of the mother to engage in preventive dental behavior, the level of her school education and her place of birth were taken into account as possible confounding factors. A significant relation was found between the use of fluoride tablets and the prevalence of fluorosis. The most important predicting factor for the caries experience of the child was the mother's motivation to engage in preventive dental behavior. An effect of fluoride tablets on the caries experience could not be demonstrated.
Article
Fluorosis prevalence has increased in North America since the 1930's-1940's. It may also have increased since 1970, though the evidence for that is less clear. Continued monitoring will help determine whether increased fluorosis prevalence in children in the United States is a cohort effect from the 1970's. This review considers the evidence for an increase in fluoride ingestion from all sources since the 1970's. If an increase has occurred, the most likely sources are fluoride dietary supplements, inadvertent swallowing of fluoride toothpastes, and increased fluoride in food and beverages. For adults, there is no evidence from dietary surveys to show that fluoride intake has increased over the last generation. Dietary surveys for children aged six months to two years are similarly inconclusive, though the great variation in fluoride content of various infant foods might be obscuring real effects. The data on fluoride intake by children from food and beverages, infant foods included, are not strong enough to conclude that an increase in fluoride ingestion has occurred since the 1970's. However, the suggested upper limit of fluoride intake is substantially being reached in many children by ingestion of fluoride from food and drink (0.2-0.3 mg per day) and from fluoride toothpaste (0.2-0.3 mg per day). Two public health issues that arise from this review are: (a) the need for a downward revision in the schedule for fluoride supplementation, and (b) education on the potential for high fluoride concentration of soft drinks and processed fruit juices.
Article
Caries experience in 1374 children aged 15-16 years from three towns in the north east of England with varying concentrations of fluoride in drinking water, was determined. The mean DMFT values for 15-year-old continuous residents was 1.7 in Hartlepool (natural F 1.0-1.3 ppm), 2.5 in Newcastle (F adjusted to 1.0 ppm) and 3.3 in Middlesbrough (F = 0.2 ppm). Forty per cent of Hartlepool 15-year-olds were caries free, compared with 30% in Newcastle and 24% in Middlesbrough. Caries prevalence for both Hartlepool and Newcastle 'continuous residents' was lower than for non-continuous residents, whereas in Middlesbrough, the low fluoride area, non-continuous residents had a lower DMF value than those who had lived in Middlesbrough all their lives. There was a slight trend in both Newcastle and Middlesbrough for DMFT values to increase from social class I to social class V, but no discernable trend was observed in Hartlepool. The results for Hartlepool 15-year-olds were very similar to those reported by Weaver in 1949.
Article
Most water supplies in Western Australia (WA) have been fluoridated since about 1968, but one region has persistently resisted. Supplement use has been encouraged there, and fluoride toothpaste is widely used. Caries prevalence and caries experience in children in Perth (F- 0.8 mg/L) have declined steadily since fluoridation, but in the Bunbury region (F- less than 0.2 mg/L), caries measures remain higher than in Perth. The purpose of this study was to correlate the magnitude and timing of fluoride exposure with caries experience. Altogether, 592 randomly selected children born in 1978 (mean age, 11.8 years) in Perth and the Bunbury region provided residence and fluoride exposure information for the periods from birth to four and from four to 12 years of age. Caries experience was recorded clinically in accordance with DMFT and WHO criteria. Sixty-one percent had been continuous residents of fluoridated areas from birth to four years, and 51% between the ages of four and 12 years. Fluoride supplement use was low. By the age of 1.5 years, 42% had used toothpaste. The prevalence of caries was 0.38 in Perth and 0.61 in the Bunbury region, and mean DMFT scores were 0.89 (SD, 1.39) and 1.57 (SD, 1.60), respectively. Bivariate analysis revealed all fluoride exposure to be associated with reduced caries experience, but there were large correlations between some variables. When unconditional logistic regression analysis was used, the most important (p less than 0.05) odds ratios associated with no caries experience were for residence in a fluoridated area from four to 12 years of age and early use of toothpaste.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
The prevalences of dental caries and developmental enamel defects were assessed in 643 randomly selected children aged 11 to 13 years who were lifelong residents of three areas of Naples with high (4 ppm), optimal (1 ppm), and low (0.3 ppm) concentrations of fluoride in their drinking water. The children living in the high fluoride area had significantly lower dental caries scores (DMFT 0.59, DMFS 1.01) than those in the optimal fluoride area (DMFT 1.67, DMFS 2.87) and those in the low fluoride area (DMFT 1.97, DMFS 3.48). The FDI index of developmental defects of dental enamel (DDE) was used to record enamel defects. There was a significant increase in the number of children with at least one tooth affected by an enamel defect as the fluoride level in their drinking water increased; the prevalences were 9.8 per cent in the low fluoride area, 23 per cent in the optimal area and 53.1 per cent in the high fluoride area. The prevalences of teeth affected were 2.2 per cent in the low fluoride area, 5.7 per cent in the optimal, and 20.3 per cent in the high. Demarcated opacities were the most common defect seen. Diffuse opacities were found to be the discriminating factor between fluoride and non-fluoride areas. In the high fluoride area 64.3 per cent of children with enamel defects had at least six teeth affected. In the maxilla the central incisors were the most affected teeth followed by the second and first premolars; in the mandible the first premolars and first molars were the most affected teeth.
Article
The purpose of this study was to evaluate the difference in dental caries and fluorosis prevalence in 936 randomly selected life-long residents selected from public and private schools in Trois-Rivières (1.0 ppm F in 1987) and Sherbrooke (less than 0.1 ppm F), Que., Canada. Students, 11-17 years of age, were examined for dental caries using the National Institute for Dental Research criteria and for dental fluorosis using the Tooth Surface Index of Fluorosis. Because of an inconsistent fluoridation history in Trois-Rivières, comparisons were carried out between two age strata: students 11-14 years of age who consumed for a longer duration suboptimally fluoridated water than those in the second stratum: students 15-17 years of age. Only public school students, 15-17 years of age, from Trois-Rivières had significantly lower mean filled surface and decayed, missing, and filled tooth surface (DMFS) scores (28 and 24%, respectively) than similar students in Sherbrooke. Among private school students, differences were not found, except in the youngest age group in Sherbrooke who had significantly lower mean DMFS than similar students from Trois-Rivières. The prevalence of fluorosis was 45.6% and 58.0% in Trois-Rivières public and private schools, respectively, and 31.1% and 30.1% in Sherbrooke public and private schools, respectively. The use of fluoride tablets was significantly associated with fluorosis. This study showed that water fluoridation benefitted students from public schools and that the risk factors for dental fluorosis were the use of fluoridated water and fluoride tablets.
Article
The decline in dental caries in U.S. schoolchildren, first observed nationwide in 1979–1980, was confirmed further by a second national epidemiological survey completed in 1987. Mean DMFS scores in persons aged 5–17 years had decreased about 36% during the interval, and, in 1987, approximately 50% of children were caries-free in the permanent dentition. Children who had always been exposed to community water fluoridation had mean DMFS scores about 18% lower than those who had never lived in fluoridated communities. When some of the “background” effect of topical fluoride was controlled, this difference increased to 25%. The results suggest that water fluoridation has played a dominant role in the decline in caries and must continue to be a major prevention methodology.
Article
Eight hundred fifty 11- to 14-year-old residents of nonfluoridated communities in Massachusetts and Connecticut, who were born between 1972 and 1975, were investigated in a case-control study of the possible association between enamel fluorosis and exposure to fluoride supplements, infant formula, and/or fluoride dentifrice. The effect of median household income, an indicator of socioeconomic status, was also examined. Clinical examination, using the Fluorosis Risk Index, a fluorosis index developed for this project, allowed cases and controls to be identified based upon the specific time period of exposure to the various sources of ingested fluoride. Risk factor exposure was assessed via a mailed questionnaire with a response rate of 80%. Mild-to-moderate enamel fluorosis was strongly associated with fluoride supplementation during the first six years of life (odds ratio = 4.0) and with median household income (odds ratio = 6.6). Subjects in the middle median household income group who had used fluoride supplements through the first six years of life had a 28-fold increase in the risk of fluorosis compared with unexposed subjects in the lower median household income group. An odds ratio of 1.7 associated with infant formula use was suggestive of an increased risk of enamel fluorosis as was an odds ratio of 2.9 associated with fluoride dentifrice use.
Article
The efficacy of communal water fluoridation in reducing dental caries has been reviewed based on surveys conducted in the last decade of caries prevalence in fluoridated and nonfluoridated communities in the United States as well as in Australia, Britain, Canada, Ireland, and New Zealand. The efficacy is greatest for the deciduous dentition, with a range of 30-60 percent less caries in fluoridated communities. In the mixed dentition (ages 8 to 12), the efficacy is more variable, about 20-40 percent less caries. In adolescents (ages 14-17), it is about 15-35 percent less caries. Current data on caries prevalence in adults and seniors are extremely limited and include several populations living in communities with higher than optimal fluoride levels. For these adults and seniors, a range of 15-35 percent less caries would also apply. Viewed in toto, the current data for children, adolescents, adults and seniors show a consistently and substantially lower caries prevalence in fluoridated communities. For an accurate measurement of the efficacy of water fluoridation in reducing dental caries, it is essential that only persons with a record of continuous or long-term residency in fluoridated versus nonfluoridated areas be included in such assessments. Because of the high geographic mobility in our society and the widespread use of fluoride dentifrices, supplements, and other topical fluoride agents, such comparisons are becoming more difficult to conduct. Accordingly, the effectiveness (rather than the efficacy) of water fluoridation has decreased as the benefits of other forms of fluoride have spread to communities lacking optimal water fluoridation.
Article
Objectives: This paper presents findings for dental caries and fluorosis from an October 1990 follow-up survey in Illinois and compares results with those obtained from two similar school-based examinations conducted in 1980 and 1985 within the same communities. Methods: The seven study sites were grouped into four categories according to the approximate relation of their water fluoride concentration to the recommended optimal fluoride level for the area. Tests for differences in dental caries and dental fluorosis across the four water fluoride groupings and three examinations were conducted. Results: DMFS scores for children who resided in communities with above-optimal water fluoride levels did not change significantly from 1980 through 1990. At the optimal water fluoride concentration, caries scores did not change substantially from 1980 to 1985; however, the mean DMFS score in 1990, 1.9, was significantly lower than caries levels observed during the two previous exams. In the optimally fluoridated area, the proportion of fluorosed tooth surfaces increased significantly from 1980 to 1985, but then declined by 1990 to the level observed in 1980 for both age groups. Conclusions: The results suggest that: (1) in the optimally fluoridated community, the apparent increase in the prevalence of dental fluorosis observed from 1980 to 1985 did not continue from 1985 to 1990; and (2) at above-optimal water fluoride concentrations, dental fluorosis either remained stable or demonstrated no sustained increase over the decade.
Article
Previous studies have shown that fluoride is present in beverages prepared with fluoridated water. The purpose of this study was to determine the availability of fluoride from beverages consumed in adjacent fluoridated and non-fluoridated communities taking into account fluoride supplementation regimens. Children in grade six were invited to participate in recording of beverage intake in two cities in Alberta, Canada: Wetaskiwin, with water supplies fluoridated at 1.08 ppm F, and Camrose, non-fluoridated with water supplies at 0.23 ppm F. Three-day beverage intake records--"Drink Diaries"--were collected from 179 children in Wetaskiwin and 230 children in Camrose. Fluoride values, based on the analyses of Hargreaves, were assigned to the reported consumption of the children with the three highest and three lowest total beverage intakes in each community. A wide range of available fluoride was found. A substantial source of fluoride was shown to be available in the non-fluoridated community from beverages other than water, primarily from carbonated beverages commercially prepared with fluoridated water. Available beverages and actual consumption should be considered in the prescription of fluoride supplementation for children with minimal fluoride in their drinking water.
Article
The prevalence of dental caries and dental fluorosis was assessed in 1,123 children aged 8 to 16 years who were lifelong residents of areas with negligible, optimal, and above-optimal concentrations of natural fluoride in drinking water. Caries prevalence in the optimal fluoride area was 38.1% lower than it was in the negligible fluoride area, and, in the higher-than-optimal fluoride areas, even greater caries protection was evident. Caries protection was compromised in children with severe fluorosis. Findings do not support the contention that definite increases in the prevalence of fluorosis are occurring in communities with negligible and optimal water-fluoride concentrations because of increased total fluoride consumption from various sources.
Article
As a result of undocumented observations that the prevalence of dental fluorosis in both fluoridated and nonfluoridated communities may be higher than would be predicted on the basis of Dean's data from the 1940s, dental fluorosis assessments using a modification of Dean's Index were made in 1981 as part of routine examinations in a series of clinical trials. A total of 1,663 children in fluoridated or nonfluoridated communities, ranging in age from seven to 17 years, were examined during 1981–82. The prevalence of dental fluorosis in nonfluoridated communities ranged from 1.7 percent in 16-year-olds to 13.9 percent in 10-year-olds and, in fluoridated communities, ranged from 17.1 percent in 13-year-olds to 33.0 percent in 14-year-olds. At all age levels common to the two types of communities, the difference in prevalence of dental fluorosis was statistically significant. Compared with findings in Dean's studies in 1942, for children of comparable age in communities with essentially the same water-fluoride levels, the prevalence of dental fluorosis in the present study was 3½ times higher in nonfluoridated communities and two times higher in fluoridated communities. Mean fluorosis scores, however, were similar. If additional studies substantiate that the prevalence and intensity of dental fluorosis are increasing, the accepted norms for fluoride dosage need to be reassessed—especially in supplements, dentifrices, and water.
Article
The National Preventive Dentistry Demonstration Program assessed the cost and effectiveness of various types and combinations of school-based preventive dental care procedures. The program involved 20,052 first, second, and fifth graders from five fluoridated and five nonfluoridated communities. These children were examined at baseline and assigned to one of six treatment regimens. Four years later, 9,566 members of this group were examined again. Analyses of their dental examination data showed that dental health lessons, brushing and flossing, fluoride tablets and mouthrinsing, and professionally applied topical fluorides were not effective in reducing a substantial amount of dental decay, even when all of these procedures were used together. Occlusal sealants prevented one to two carious surfaces in four years. Children who were especially susceptible to decay did not benefit appreciably more from any of the preventive measures than did children in general. Annual direct per capita costs were 23forsealantorfluorideprophy/gelapplicationsand23 for sealant or fluoride prophy/gel applications and 3.29 for fluoride mouthrinsing. Communal water fluoridation was reaffirmed as the most cost-effective means of reducing tooth decay in children.
Article
A 20-month study was conducted in a non-fluoridated community to determine the caries-inhibitory effect of rinsing weekly during the school year for 1 min with 10 ml of a 0.2 per cent neutral sodium fluoride solution. Subjects beginning the study were 493 white and Negro children in Grade 1 and 381 in Grade 5; each grade was equally divided into comparable test and control groups. The control groups rinsed with a placebo solution. Classroom teachers dispensed the solutions and supervised rinsing. After 20 months, 133 children rinsing with fluoride in Grade 1 developed 25 per cent fewer new DMFT and 16 per cent fewer new DMFS than 123 controls; after 12 months, their reductions had been 34 and 30 per cent, respectively. In Grade 5, 98 children who used the fluoride mouthrinse had 52 per cent fewer new DMFT and 44 per cent fewer new DMFS than 110 controls after 20 months. After 12 months, the 5th Grade test group had had 34 per cent fewer new DMFT and 28 per cent fewer new DMFS than controls. Only the differences in Grade 5 after 20 months were statistically significant (p < 0.05). Occlusal and buccolingual surfaces received protection in Grade 1, but there were no benefits to mesiodistal surfaces. In Grade 5, all types of surfaces were protected.
Article
Enamel mottling is strongly associated with the water fluoride level of the community water supply. About 32% of the variation in the mottled enamel scores of subjects aged 7 to 12 was attributable to their community's water fluoride level. Objectionable mottling (moderate mottling) occurred at 2.3 times the currently accepted optimum water fluoride level. Subjects with incomes less than $10,000 have slightly more mottling (mostly moderate mottling) than subjects from higher income families. It should be emphasized that the effect of gender, ethnic group, or family income on enamel mottling is small compared with the effect of water fluoride level. Although many other personal and water supply characteristics were evaluated, virtually none of the remaining variation in mottled enamel scores could be attributed to any of these characteristics.
Article
The prevalence of dental caries and dental fluorosis was assessed among 807 schoolchildren in four areas of Illinois where the respective water supplies contained natural fluoride at concentrations of 1, 2, 3, and 4 times the recommended optimal for the geographic area. Mean caries scores in all three above-optimal fluoride areas were significantly lower than in the optimal area. The prevalence of dental fluorosis was characteristically low in the optimal fluoride area. Substantial increases in fluorosis occurred in the above-optimal fluoride areas, with the condition being most pronounced in the 4-times optimal area.
Article
The benefits to be expected from the adjustment of fluoride levels in drinking water have been studied in great depth, but for the most part only with respect to changes from negligible concentrations to approximately 1.0 ppm. This study makes use of previously gathered data on fluoride concentration in domestic water supplies, the average decayed, missing, and filled teeth (DMFT) scores of the 12- to 14-year-old children, and temperature data in conjunction with linear mathematical models to estimate the effect on DMFT of changes in fluoride concentrations from levels above 0.1 ppm to ideal levels. The results of the analyses indicate that the endemic levels of fluoride in a community water supply play a major role in determining the relative benefit of adjusting that water supply to an ideal level of fluoride. If a rational policy decision is to be made with respect to fluoridation for a given community, the endemic fluoride levels must be considered in conjunction with such factors as population size and the anticipated cost to initiate and maintain the program.
Article
The prevalence of enamel fluorosis has increased in optimally fluoridated areas in recent years. This has led to efforts to identify the cause or causes and to make recommendations that seek to maintain the caries-preventive effectiveness of fluoride use while minimizing the risk of fluorosis. In this study, the author estimated the potential direct impact that dental practitioners could have on reducing the amount of enamel fluorosis in U.S. children. The findings suggest that dental practitioners could have an important impact on reducing the prevalence of enamel fluorosis by guiding the public toward the most appropriate use of fluoride products.
Article
This study investigated the prevalence of dental fluorosis and caries in 7-14-year-old children residing in communities with negligible (NF: 0.2 ppm), optimal (OPF: 1.0 ppm), and four-times optimal (4X OPF: 4.0 ppm) naturally occurring fluoride in their water systems. Examinations were performed on 344 children who were lifetime residents of their communities. Whether using the tooth surface index of fluorosis or Dean's index, children examined in the 4X OPF community had the highest prevalence of dental fluorosis. While the severity of fluorosis seen in the OPF and NF communities was mild in appearance, the results indicate that fluorosis does occur in optimally and negligibly fluoridated communities. Compared to the NF community, DMFT and DMFS scores in the OPF community were 9.2 percent and 21.2 percent lower, respectively. The ingestion of water containing 1 ppm or less fluoride during the time of tooth development may result in dental fluorosis, albeit in its milder forms. However, in these times of numerous products containing fluoride being available, children ingesting water containing 1 ppm fluoride continue to derive caries protection compared to children ingesting water with negligible amounts of fluoride. Thus, the potential for developing a relatively minor unesthetic condition must be weighed against the potential for reducing dental disease.
Article
An increase in the prevalence of dental fluorosis among children in North America is well documented. Published reports of the relationship between the occurrence of dental fluorosis and early exposure to various fluorides and the use of different types of infant feeding practices have begun to provide insights into possible causes for this increase. This study was designed to investigate this issue for children living in a non-fluoridated and a fluoridated community in British Columbia, Canada. Parents or guardians completed a questionnaire which detailed exposure to different types of fluorides and infant feeding practices during the first 6 yr of life. Completed questionnaires were returned and examinations were performed on 1131 children. 60% of children had dental fluorosis, and only 8% presented with scores of 2 or greater. Logistic regression analyses showed that the use of infant formula and parental educational attainment were significantly associated with the occurrence of dental fluorosis in the range of scores from 2 to 6. Despite these statistically significant findings, these variables actually had little additional predictive value beyond a chance occurrence in determining which children would have dental fluorosis.
Article
The purpose of this case-control investigation was to investigate the possible association between mild-to-moderate enamel fluorosis and exposure during early childhood to infant formula, fluoride toothpaste, and/or fluoride supplements. Analysis was performed on 401 residents of fluoridated communities in Connecticut, who were 12-16 years old and born prior to 1980. The case and control subjects for this study were selected on the basis of a clinical examination given in 1991. Subject fluorosis status was determined using the Fluorosis Risk Index. Risk factor exposure was ascertained via a mailed questionnaire with a response rate of 89% and a questionnaire reliability of 87%. Logistic regression analyses, which adjusted for confounding variables, revealed that mild-to-moderate enamel fluorosis on early forming (Fluorosis Risk Index (FRI) classification I) enamel surfaces was strongly associated with both milk-based (odds ratio (OR) = 3.34, 95% confidence interval (CI) 1.38-8.07) and soy-based (OR = 7.16, 95% CI 1.35-37.89) infant formula use, as well as with frequent brushing (OR = 2.80, 95% CI 1.15-6.81). A very strong association was observed with inappropriate fluoride supplement use (OR = 23.74, 95% CI 3.43-164.30). Respectively similar associations were observed between mild-to-moderate enamel fluorosis on later forming (FRI classification II) enamel surfaces and frequent brushing and fluoride supplement use, but not with infant formula use.
Article
This review of the literature was undertaken to demonstrate the changing trends in the prevalence of dental fluorosis in North America. Using Dean's early work to establish a baseline for the prevalence of dental fluorosis, results of more recent prevalence surveys were used to establish a range for the occurrence of dental fluorosis today. These results suggest that the prevalence of dental fluorosis now ranges somewhere between 35% and 60% in fluoridated communities and between 20% and 45% in nonfluoridated areas, depending on the influence of different local conditions. While the increase has occurred primarily in the very mild and mild categories of dental fluorosis, there is also some evidence that the prevalence is increasing in the moderate and severe classifications as well.
Article
One hundred and sixty children who had lived from birth in a region with low fluoride levels in the drinking water, and who had been offered sodium fluoride supplementation in the form of drops for daily use, were examined to evaluate dental caries and dental fluorosis. Two age ranges were selected: 7-9 years and 11-14 years. In addition to the dental examinations, questionnaires were mailed to the parents, followed-up by telephone interviews, to gather information on compliance with the fluoride supplementation program. The results showed no statistically significant differences in dental caries activity between the regular and irregular users of fluoride supplementation. Considerable dental fluorosis was found in both regular and irregular user groups of the fluoride supplement (38 to 63 per cent of the children seen), however, with no statistical difference between the user groups. Most of the fluorosis detected was of a mild degree. Fluoride supplementation under the daily control of a parent or child is not recommended because of the difficulty in maintaining regular compliance and the risk of fluorosis.
Article
An epidemiological assessment of differences in caries and fluorosis prevalences between children in Truro (< 0.1 ppm) and Kentville (fluoridated at 1.1 ppm in 1991), Nova Scotia, Canada, was completed in 1991. Out of a total of 429 children, in grades 5 and 6, in the two towns in 1991, 219 (51%) were examined. Parents answered a self-administered questionnaire investigating the sources of drinking water used by the children since birth, residence history, use of fluoride supplements, dentifrices, and other fluoride products during the first 6 yr of the life. The examination criteria differentiated between non-cavitated and cavitated carious lesions. Dental fluorosis was measured using the TSIF index. Examiner agreement was excellent. Of the children examined, 80 (36.5%) drank water (fluoridated or non-fluoridated) from municipal water systems during the first 6 yr of life. The children were assigned into five groups based upon residence history and exposure to fluoridated water during the first 6 yr of life. The percentage difference in mean DMFS scores between children in the fluoridated and non-fluoridated groups is 17% (delta DMFS1 = 0.7) when non-cavitated carious lesions are included and 39% (delta DMFS2 = 1.1) when they are excluded. The differences are not statistically significant. The significant risk factors associated with the DMFS1 and DMFS2 scores identified by a stepwise multiple regression analysis are: education level of the father, gender, and number of years of reported use of toothpaste during the first 6 yr of life. Dental fluorosis (mainly TSIF score of 1) was present in 41.5% and 69.2% of the children in the non-fluoridated and fluoridated groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Mild dental fluorosis is frequently linked to fluoridated water, but discretionary fluoride sources may also be important. The aim of this study was to record age of weaning and fluoride exposure from water, toothpaste and supplements, and to relate these to the presence of caries and fluorosis in children born in 1983. In Perth (Western Australia) 14 school classes were selected. The 350 children (mean age 7.5 years) ultimately included gave fluoride exposure data for the period birth to 4 years of age. Caries (DMFT, WHO criteria, no radiographs) and dental fluorosis (TF index, dry permanent incisors) were registered clinically. Most (89%) children had lived at least 2.5 years in a fluoridated area. Supplement use was minimal and unrelated to caries or fluorosis. Mean age of weaning of those who had been breast-fed was 7.7 months; by 9 months, 74% had been weaned. Eighty-five percent liked toothpaste, 60.7% had swallowed it, and the mean age of starting to use it was 1.5 (SD 0.96) years. Caries prevalence was 0.1 and mean DMFT was 0.13. The prevalence of fluorosis was 0.48; 63% of fluorosis was TF score 1. Residence in a fluoridated area for > or = 2.5 of the first 4 years of life had an odds ratio (OR) of 4.9 for fluorosis. Weaning before 9 months of age, swallowing toothpaste and liking toothpaste were also statistically significant risk factors. Major risk factors for more severe fluorosis (TF > or = 2) were early weaning and swallowing toothpaste (ORs 2.77 and 2.64, respectively). Residence in a fluoridated area (OR 2.2) was not a statistically significant risk factor.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
The Third National Health and Nutrition Examination Survey-Phase 1, conducted from 1988 to 1991 in the United States, included an assessment of dental caries in US children and adolescents and provided the opportunity for differences in dental caries status to be viewed by a ge, sex, race, and race-ethnicity. The measurement of dental caries in children and adolescents from 2-17 years of age included the number of decayed, missing, and filled permanent tooth surfaces and teeth, and the number of decayed, and filled primary tooth surfaces and teeth. Additionally, a brief visual inspection for the presence or absence of early childhood caries in the maxillary incisors was conducted for children 12-23 months of age. The survey yielded weighted estimates for 1988-1991 for over 58 million US children and adolescents 1 to 17 years of age. For infants aged 12-23 months, 0.8% were scored positive for early childhood caries. Over 60% (62.1%) of the children aged 2-9 years were caries-free in their primary dentition. Over half (54.7%) of the children 5-17 years were caries-free in their permanent dentition. The occurrence of caries in the permanent dentition is clustered: A quarter of the children and adolescents ages 5 to 17 with at least one permanent tooth accounted for about 80% of the caries experienced in permanent teeth. Differences in caries experience were found among race and race-ethnicity subpopulations, and caries patterns for the primary and permanent dentition were dissimilar. Further analyses are needed to explore other potential determinants of caries in children.
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