Availability Of Fluoride Research Articles

Concentration and Stability of Fluoride Chemically Available in Charcoal-Containing Toothpastes.

Among the wide variety of commercially oral hygiene products, activated-charcoal-based toothpastes have irrupted the market, claiming multiple benefits. Although most are fluoride-free, others incorporate fluoride into their formulations, yet the chemical availability and stability of fluoride in these products remain unclear. Our study aimed to assess the chemical availability and stability of fluoride in commercially fluoridated toothpastes formulated with activated charcoal. We purchased duplicate samples with different lot numbers of different brands containing fluoride (F) and activated charcoal (n=20) in the US and Chile. Three toothpastes, one non-fluoridated, one containing sodium fluoride (NaF) and another with sodium monofluorophosphate (Na2FPO3), were used as controls. All toothpastes were evaluated at the time of purchase (fresh) and after their expiration date (aged). We determined total-F and available total soluble-F (TSF), using a F specific ion electrode. Values were expressed in mg F/kg (ppm F, w/w). Most evaluated toothpaste contained NaF (70%) or Na2FPO3 (30%) as the F salt, and all declared to contain silica. The TSF concentration ranged from 952.6 to 1438.1 and from 925.7 to 1493.7 ppm F for fresh and aged toothpaste, respectively. TSF remained close to total-F and in agreement with the F concentration reported by the manufacturer. After expiring, the commercial toothpastes did not form insoluble F, except the Na2FPO3/CaCO3-based control. The silica-based toothpastes formulated with activated charcoal present fluoride potentially bioavailable and chemically stable to control caries. However, concerns regarding abrasiveness, as raised by other researchers, cast doubt on the suitability of these toothpastes for widespread use.

Bonding to Fluorosed Teeth: A Review of the Literature.

Excessive fluoride availability during tooth formation can cause structural alterations in enamel and dentin. These alterations may negatively impact the adhesion of various dental materials to teeth with dental fluorosis. The aim of this review of literature is to identify updates in bonding to fluorosed teeth and summarize relevant recommendations. Findings from the available literature suggest that bonding procedures may be carried out reliably on most fluorosed teeth with consideration to the severity of fluorosis and the employment of additional bond-enhancing measures for the severely involved teeth.

Nickel sulfate solution fluoride separation with hydrous zirconium oxide

AbstractFluoride is an impurity in nickel sulfate production, which is required for electric vehicle batteries. Hydrous zirconium oxide (HZO) was evaluated for removing fluoride from nickel sulfate solution. Maximum fluoride removal occurred at pH value 4 and optimal pH value is 4–5, considering Zr solubility. Fluoride availability decreases with pH due to hydrogen fluoride and zirconium fluoride aqueous species. Fluoride removal is initially rapid, with 50 wt.% removal in 7 min, followed by slow removal up to 68 wt.% after 72 h and follows second order rate kinetics. Fluoride removal was dominated by an ion exchange mechanism and resulting Zr–F bonds were observed using Fourier-transform infrared spectroscopy. The presence of nickel sulfate decreased loading capacity compared to a salt-free solution. HZO maintained adsorption capacity through five cycles of loading and regeneration.

Fluoride Concentration, Antibacterial Effect, and Cytotoxicity in Children's Toothpaste: In Vitro Study

Abstract Objectives The aim of this study is to evaluate the effect on cell viability, antibacterial activity against cariogenic bacteria, and total fluoride availability of commercially available children's toothpastes in Thailand. Materials and Methods Seven toothpaste slurries were prepared from seven commercial toothpastes for children. Total fluoride concentration was determined. The agar diffusion method was used to examine the antibacterial effect of toothpaste against Streptococcus mutans. The viability of L929 mouse fibroblasts exposed with different concentrations of each toothpaste slurry was tested by MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay. Statistical Analysis One way analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) tests were used for zone inhibition analysis. Cell viability data were analyzed using Student's t-test. Results Fluoride concentration in fluoride-containing toothpastes ranged from 521.36 to 1,377.83 ppm. Two toothpastes exhibited a similar level of fluoride concentration compared between the product labels. Other toothpastes showed a difference or slight difference in fluoride concentration between the companies' information and our data. The zone of inhibition ranged from 0 to 2.08 cm. A significantly higher zone of inhibition was observed in toothpastes with sodium lauryl sulfate. The concentration of toothpaste that reduced cell viability to less than 50% of the control was 0.8, 3.1, 6.3, 6.3, 25, and 100% for Fluocaril Deli Fruity, Oral-B Junior 6 + , Kodomo Kids, CUdent Stevia, SunStar GUM, and Kindee Organic, respectively. Conclusion The examined children's toothpastes can inhibit the growth of S. mutans, which did not correlate with fluoride concentration. The antibacterial effects could be the results of other ingredients, for example, sodium lauryl sulfate.

Fluoride contamination in ground-drinking water and urine from rural population of Uttar Pradesh, India

This study was carried out to assess the fluoride concentration in ground-drinking water, vegetable juice and urine samples of the five villages in Lakhimpur (Kheri) of Uttar Pradesh, India. The experimental site retains a few agro-based industries like sugarcane processing units due to it enriched cultivation by the local farmers. Hence, the availability of fluoride in ground-drinking water is natural, and its excess intake through drinking water over a period caused irreversible serious illness affecting the nervous system and osteo-dental fluorosis. The fluoride level in ground-drinking water found from 0.5 to 4.3 mg L−1 with average of 3.42 mg L−1. Total number of residents involved in the study for analyzing their urine samples were 548 (277 males and 271 females). The absorption of fluoride was high among the youngsters (13–44 yrs). The positive correlation observed between fluoride content in ground drinking water intake and urine.

Biochar related treatments improved physiological performance, growth and productivity of Mentha crispa L. plants under fluoride and cadmium toxicities

Modification of biochar with chemical reagents is an effort to increase the efficiency of this organic material to adsorb environmental pollutants. Typically, these chemically modified materials have special structural specifications that allow the adsorption and stabilization of high levels of environmental pollutants. Therefore, this research was carried out to assess the possible effects of solid and chemically engineered biochars (non-biochar, solid biochar, modified biochar with H2O2, KOH, and H3PO4) on reducing fluoride and cadmium toxicities (non-toxic, 600 mg NaF kg−1 soil, 60 mg Cd kg−1 soil and 600 mg NaF kg−1 soil + 60 mg Cd kg−1) in mint plants (Mentha crispa L.). The application rate of biochar and modified biochars was 25 g kg−1 soil. The addition of biochar and especially engineered biochars to the soil reduced the availability of fluoride and cadmium to the plants. Biochar and chemically modified biochars increased soil cation exchange capacity (CEC) (up to 31%), pH (up to 11%), leaf area (up to 22%), chlorophyll content index (up to 19%), maximum efficiency of photosystem II (up to 32%), biomass (up to 21%) and essential oil production (up to 28%) in mint plants. On the other hand, biochar-related treatments reduced the reactive oxygen species generation, antioxidant enzymes activities, and lipid peroxidation in the root (up to 41%) and leaf tissues (up to 40%). In general, modified biochars showed a better effect than solid biochar in reducing fluoride and cadmium toxicities. The H3PO4-modified biochar was a bit more successful than other biochar-related treatments in increasing mint performance under fluoride and cadmium toxicities. Therefore, the chemically engineered biochars are the superior treatments to improve mint growth and productivity under fluoride and cadmium toxicities, because of their excellent physicochemical specifications such as high level of CEC, functional groups, and specific surface area.

Predicting and modelling availability of fluoride in soil from sorption properties

AbstractUsage of alkaline and saline groundwater with elevated concentrations of fluoride (F−) for irrigation of pastures requires an assessment of the mobility of F− within the plant‐water‐soil continuum. Factors influencing F− sorption and desorption in 95 Australian soils were examined. Pronounced differences in F− sorption were observed across the soils, but these differences could not be explained by differences in soil pH, electrical conductivity or organic carbon. Rather, sorption was correlated with the content of Fe/Al hydrous oxides and kaolinite in soil. Sorption of F− onto soils increased the solution pH and the ratio of (F− adsorbed) to (OH− desorbed) was consistently below 1, thereby indicating that adsorption of F− results in the release of water and hydroxyl groups from, or co‐adsorption of protons to, the sorbent surface. Maximum sorption occurred at pH values of approximately 5–6, whilst sulphate slightly increased (<5%) F− sorption. Desorption was slightly decreased (~3%–7%) in presence of sulphate anions. Hence, it is unlikely that irrigation of soil with alkaline and saline groundwater, in combination with soil applications of gypsum and sulphur to limit pH fluctuations, would increase mobility of F− in soil. Finally, the irrigation of soil columns with 1200–1500 mm of alkaline and saline groundwater containing 0.18 mM F−, as would commonly occur in irrigation systems using coal seam gas associated water in Australia, resulted in a F− concentration of 0.05 mM at 10 cm depth and the measured values were in excellent agreement with modelled F− movement based on sorption parameters. Thus, sorption parameters can be used to identify soils which minimize movement of F− because of their strong F− sorption. Based on these results, safe limits for irrigation of soil can be established which avoid F− toxicity risks to plants, animals and contamination of water resources.

Salivary Fluoride Bioavailability after Brushing with Brazilian Red Propolis Dentifrice: A Clinical Study.

Introduction Fluoride plays an important role in the control of dental caries, and currently new dentifrices are being associated with natural products. Objective This study aimed to evaluate the availability of fluoride in saliva samples after using a dentifrice incorporated with Brazilian red propolis (BRP, INPI Patent no. BR1020170110974) and to compare it to a conventional fluoridated dentifrice in healthy participants. Methods This study was conducted implementing a double-blind, randomized, controlled, and crossover design. Saliva samples of participants were collected at the following time points: 0 at baseline and 5, 15, 30, 45, and 60 minutes after brushing with each dentifrice. Salivary fluoride concentrations showed no statistically significant difference when comparing the two treatments (p > 0.05). All available fluoride concentrations in saliva decreased after one hour, with no significant difference between BRP and conventional fluoridated dentifrice treatment samples (p > 0.05). Results The results showed that there was no difference between the analyzed fluoride concentrations 1 hour after brushing with the different dentifrices. Conclusions The results of this study suggest that the propolis incorporated in the dentifrice did not interfere with the kinetics and bioavailability of the fluoride ion in saliva samples, enabling its integration with the pharmaceutical formula and thereby promoting its anti-inflammatory and antimicrobial benefits without compromising the anticaries activity of the formulation.

The Biocompatibility of a New Erythritol-and Xyltol-Containing Fluoride Toothpaste.

The basic function of toothpastes is biofilm removal in order to prevent caries and gingivitis. Toothpastes should provide maximal fluoride availability, optimal abrasivity, and ingredients that do not interfere with fluoride release but should have additional beneficial effects. Further, the effect on cells of the oral cavity is of the utmost importance. We investigated several biological parameters of a new toothpaste (AirFlow-AF) that contains fluoride, xylitol and erythritol but no sodium lauryl sulfate and compared them to commercially available toothpastes (Zendium-Ze, Sensodyne-Se, OdolMed-OM, OralB-OB). The half lethal concentration (LC50) as well as the proliferation behavior on gingival (GF), periodontal ligament (PDL), and mouse fibroblast cells (L929) were was tested. The mean LC50 values of AF on GF, PDL, and L929 were 16.2, 10.9, and 9.3, respectively. In comparison, the four other toothpastes showed mean LC50 values of 1.5 (OB), 1.2 (OM), 1.4 (Se), and 27.7 (Ze) on GF. Mean LC50 values on PDL and L929 were 1.0 and 0.2 (OB), 3.7 and 0.9 (OM), 1.2 and 0.6 (Se), and 25.4 and 5.6 (Ze), respectively. Proliferation behavior mainly confirmed the LC50 values. While cells after stimulation with AF returned to almost unimpaired proliferation behavior at 6%, cells were still strongly impaired after stimulation with all tested commercially toothpastes. AF showed high biocompatibility with different cell types.

How effective and cost-effective is water fluoridation for adults? Protocol for a 10-year retrospective cohort study

BackgroundTooth decay can cause pain, sleepless nights and loss of productive workdays. Fluoridation of drinking water was identified in the 1940s as a cost-effective method of prevention. In the mid-1970s, fluoride toothpastes became widely available. Since then, in high-income countries the prevalence of tooth decay in children has reduced whilst natural tooth retention in older age groups has increased. Most water fluoridation research was carried out before these dramatic changes in fluoride availability and oral health. Furthermore, there is a paucity of evidence in adults. The aim of this study is to assess the clinical and cost-effectiveness of water fluoridation in preventing invasive dental treatment in adults and adolescents aged over 12.Methods/designRetrospective cohort study using 10 years of routinely available dental treatment data. Individuals exposed to water fluoridation will be identified by sampled water fluoride concentration linked to place of residence. Outcomes will be based on the number of invasive dental treatments received per participant (fillings, extractions, root canal treatments). A generalised linear model with clustering by local authority area will be used for analysis. The model will include area level propensity scores and individual-level covariates. The economic evaluation will focus on (1) cost-effectiveness as assessed by the water fluoridation mean cost per invasive treatment avoided and (2) a return on investment from the public sector perspective, capturing the change in cost of dental service utilisation resulting from investment in water fluoridation.DiscussionsThere is a well-recognised need for contemporary evidence regarding the effectiveness and cost-effectiveness of water fluoridation, particularly for adults. The absence of such evidence for all age groups may lead to an underestimation of the potential benefits of a population-wide, rather than targeted, fluoride delivery programme. This study will utilise a pragmatic design to address the information needs of policy makers in a timely manner.

The impact of stopping or reducing the level of fluoride in public water supplies on dental fluorosis: a systematic review.

The increased availability of fluoride and concern over the impact of fluorosis, have led to guidance suggesting a decrease or cease in the optimal concentration of fluoride in water fluoridation schemes. To date there have been no systematic reviews looking at both impact of fluoride reduction and total cessation. This review aimed to examine the impact of stopping or reducing the level of fluoride in public water supplies on dental fluorosis. Multiple databases were searched (MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Web of Science). Two reviewers independently screened sources, extracted data and assessed study quality. Results were synthesised qualitatively and quantitatively. The main outcome measure was the prevalence of dental fluorosis. Six studies of cross-sectional design were included. Two studies were scored as evidence level B (moderate) and the remaining four publications were evidence level C (poor). Meta-analysis indicated fluorosis prevalence was significantly decreased following either a reduction in the concentration of fluoride or cessation of adding fluoride to the water supply (OR:6.68; 95% CI:2.48 to 18.00). The evidence suggests a significant decrease in the prevalence of fluorosis post cessation or reduction in the concentration of fluoride added to the water supply. However, this work demonstrates that when studies are subject to current expectations of methodological and experimental rigour, there is limited evidence with low methodological quality to determine the effect of stopping or reducing the concentration of fluoride in the water supply on dental fluorosis.

Clinical Trials with Herbal Products for the Prevention of Dental Caries and Their Quality: A Scoping Study.

It is currently recognized that an injudicious strategy about caries in the last decades has been not only focusing of research mostly in children, but also the narrow focusing on fluoride, because despite sufficient availability of fluoride in water and oral healthcare products, caries levels escalate steadily as people get older and caries remain a main public health issue to be settled. In the last two decades the scientific community intensified efforts of exploring other products for caries prevention, herbal products being one of these approaches. Preliminary evidence indicated that clinical trials for caries prevention with herbal products are heterogeneous in design, quality and products evaluated, we therefore performed a scoping review intended to explore the main characteristics of such clinical trials. From an initial collection of 1986 unique papers from different literature databases, 56 articles satisfied the inclusion and exclusion criteria. The species investigated, dosage forms, study designs, duration of intervention, controls, endpoints, quality of reporting, and risk of bias are discussed. Of the trials reviewed here, 85.71% reported positive results but given the methodological flaws and biases affecting them, it is difficult to conclude on the efficacy of those products based on the studies published thus far.

S4B-01 SESSION 4B: ORTHOGNATHIC / TREACHER-COLLINS DENTAL CARIES IN A CRANIOFACIAL POPULATION: ‘UNDERSTANDING THE RISK: PREVENTING THE PREVENTABLE’ WEST MIDLANDS SUPRA REGIONAL CRANIOFACIAL UNIT, UK

Introduction: Abnormalities of oral and dental anatomy are noted in many craniofacial conditions. Children diagnosed with craniosynostosis may present with dental anomalies, skeletal abnormalities and cognitive defects. This puts them at a greater risk of developing dental caries. Dental caries is a largely preventable disease, however dental extractions are still a common reason for hospital admission in the UK. Having a healthy dentition will provide a more accurate base for later proposed orthognathic/ facial deformity surgery in the craniofacial patient. Aim: A prospective audit to assess craniofacial patients’ caries experience and associated risk factors at Birmingham Children’s Hospital. Objectives: 1.To assess the patients’ caries risk against UK guidelines; 2. To assess if the patients have access to a General Dental Practitioner (GDP) To assess the patients’ previous experience of dental treatment Methods: Questionnaires were disseminated prospectively over a 4-month period to patients who attended the craniofacial clinic at BCH. This comprised a series of questions to understand their risk of developing dental decay, access to dental professionals and any experience of dental treatment. Results: 40 patients completed the questionnaire, 16 had craniosynostosis related to a syndrome or multi-suture synostosis, the other 24 patients had single suture synostosis. Caries risk status: The caries risk for each patient was assessed based on their diet, availability of fluoride and dental caries experience. In the single suture cohort, 4 patients were regarded as being ‘low caries risk’ and the remaining 20 were ‘high caries risk’. In the syndromic/multi-suture craniosynostosis cohort, all children were regarded as being ‘high caries risk’ as a result of their medical condition and the other risk factors for caries. Access to routine dental care: In the syndromic/multi-suture synostosis cohort, 3 children did not have access to a dentist and 4 children did not have access in the single suture group. Patients’ previous dental experience: Of the study population, 10 had experienced dental fillings, 4 had previous extractions and 2 children had undergone a general anaesthetic for dental treatment. The 4 children who had undergone extractions were in the multi-suture craniosynostosis group. Conclusion: This patient reported questionnaire, demonstrated that the majority of our craniofacial patients sampled were at high risk of developing dental caries. To reduce this risk, there is a need for a preventative strategy and development of a robust pathway to support the young craniofacial patient population.

Oral health-related behaviours reported by elite and professional athletes.

Background In elite sport, the protection of an athlete's health is a priority. However, research indicates a substantial prevalence of oral disease in elite and professional athletes. The challenges to oral health from participation in sport require investigation to identify effective strategies and mitigate risk.Aim To explore athlete-reported oral health behaviours, risks and potential for behaviour change in a representative sample of elite athletes based in the UK.Method This was a cross-sectional study. We provided oral health screening for 352 elite and professional athletes from June 2015 to September 2016; 344 athletes also completed a questionnaire.Results The median age was 25 years (range 18-39) and 236 (67%) were male; 323 (94.2%) said they brush twice daily while 136 (40%) said their most recent dental attendance was within the previous six months. Ninety-seven (28%) would be assessed as high consumers of sugar in their regular diet. The use of sports nutrition products was common with 288 (80%) reporting the use of sports drinks during training or competition but were positive about behaviour changes.Conclusion Despite reporting positive oral health-related behaviours, athletes have substantial amounts of oral disease. Athletes are willing to consider behaviour change related to daily plaque removal, increased fluoride availability and regular dental visits to improve oral health.

Defeating Fluorosis in the East African Rift Valley: Transforming the Kilimanjaro into a Rainwater Harvesting Park

The high availability of fluoride in surface and groundwater in the East African Rift Valley was documented during the colonial period. Since the early 1960s, many studies have been conducted to solve the fluorosis crisis in this region. At present, no cost-effective solution to mitigate fluoride contamination is available for the large majority of the population. This situation prompted a process analysis of commonly used technologies. Results revealed that the geochemistry of fluoride is the main problem. Fluoride is very difficult to remove from the aqueous phase. Thus, eliminating the need for technical water defluoridation is an excellent way out of the fluorosis crisis. This goal can be achieved by harvesting fluoride-free rainwater. Harvested rainwater can be mixed with naturally polluted waters in calculated proportions to obtain safe drinking water (blending). This paper presents a concept to transform the Kilimanjaro Mountains into a huge rainwater harvesting park for drinking water supply for the whole East African Rift Valley. However, blended water may contain other pollutants including pathogens that are easy to treat using low-cost methods such as metallic iron based-filters (Fe0 filters). The proposed concept is transferable to other parts of the world still enduring fluoride pollution.

Groundwater fluoride contamination, probable release, and containment mechanisms: a review on Indian context.

Fluoride contamination in the groundwater has got great attention in last few decades due to their toxicity, persistent capacity and accumulation in human bodies. There are several sources of fluoride in the environment and different pathways to enter in the drinking water resources, which is responsible for potential effect on human health. Presence of high concentration of fluoride ion in groundwater is a major issue and it makes the water unsuitable for drinking purpose. Availability of fluoride in groundwater indicates various geochemical processes and subsurface contamination of a particular area. Fluoride-bearing aquifers, geological factors, rate of weathering, ion-exchange reaction, residence time and leaching of subsurface contaminants are major responsible factors for availability of fluoride in groundwater. In India, several studies have reported that the groundwater of several states are contaminated with high fluoride. The undesirable level of fluoride in groundwater is one of the most natural groundwater quality problem, which affects large portion of arid and semiarid regions of India. Rajasthan, Andhra Pradesh, Telangana, Tamil Nadu, Gujarat, and West Bengal are the relatively high-fluoride-contaminated states in India. Chronic ingestion of high doses of fluoride-rich water leads to fluorosis on human and animal. Over 66 million Indian populations are at risk due to excess fluoride-contaminated water. Therefore, groundwater contamination subject to undesirable level of fluoride needs urgent attention to understand the role of geochemistry, hydrogeology and climatic factors along with anthropogenic inputs in fluoride pollution.

Influence of anodization mode on the morphology and photocatalytic activity of TiO2-NTs array large size electrodes

Properties of nanotubular titania structures (TiO2-NTs) have been widely evaluated in small electrodes at lab scale. A novel experimental approach to overcome the limitations for the anodization of large size electrodes is presented. Several potentiostatic and galvanostatic anodization procedures have been tested, and their impact on the morphological features of the TiO2-NTs analyzed. A clear relationship between the applied voltage and current density and the NTs length and diameter is confirmed. Photocatalytic activity of the TiO2-NTs structures was evaluated in the methanol oxidation reaction. From these results, it was obtained that kinetic constant for the photocatalytic oxidation of methanol is higher when the reaction is carried out with NTs of higher length/diameter aspect ratio. This is related to a higher TiO2 active surface area available to generate photo-induced electron-hole pairs and for the adsorption of the reactants. This work confirms the viability of formation of photocatalytically active large size TiO2-NTs electrodes when high voltage or current density is applied under controlled conditions. Availability of fluoride in the electrolyte can be ensured by the use of a novel concept of continuous flow anodization reactor allowing the renovation of the electrolyte to keep under control not only the composition but also the temperature of the solution.

Caries-Preventive Effect of Salt Fluoridation in Preschool Children in The Gambia: A Prospective, Controlled, Interventional Study

The aim of this study was to investigate the anticaries effect of fluoridated salt in a communal feeding program for preschool children. In the Gambian city of Brikama, drinking water had a low fluoride content (0.1 mg F^-/L) and young children did not use toothpaste for oral hygiene. Its 2 preschools served as clusters for the trial. Random allocation of the kindergartens was performed by one person not involved in the study, and the clinical examinations were carried out using the envelope method. Meals were prepared with fluoridated salt (250 mg F^-/kg salt) in the intervention group but not in the control group. According to the inclusion criteria (complete primary dentition and informed consent from legal guardian), 441 children aged 3-5 years were enrolled. The children were examined by calibrated persons according to WHO criteria, allowing the calculation of d₃mft scores. The primary end point was the mean difference in the incidence of caries cavities (Δd_3/4mft) after 12 months. After 12 months, the mean caries incidence per person was 1.29 d_3/4mf teeth (95% CI: 0.96; 1.62) in the test group (n = 304 children) and 3.83 d_3/4mf teeth (95% CI: 2.94; 4.72) in the control group (n = 137 children). Thus, the caries-prevented fraction was 66.3%. No signs of harm due to the intervention were observed. The use of fluoridated salt in a communal feeding program and in an environment with negligible availability of fluoride from other sources yields a considerable caries-preventive effect.

Why are caries levels reducing in five-year-olds in England?

Objective To explore possible reasons for the reduction in population caries levels among 5-year-old children in England since 2008.Design An ecological study to explore possible reasons for the apparent reduction in dental caries, which included changes in survey methods, deprivation levels and ethnic mix of the population, impact of community level oral health improvement interventions, reductions in sugar intake, and increases in the availability of fluoride.Setting Data were drawn from three consecutive epidemiological surveys undertaken in 2007/8 and 2011/12 (NHS Dental Epidemiology programme for England), and 2014/15 (Public Health England Dental Public Health Epidemiology Programme). Evidence about the possible reasons for the observed reduction in caries levels was drawn from a range of national sources.Main outcomes measures Severity and prevalence of caries at dentinal level as measured by visual means alone among children aged five years.Results Reasons relating to changes in methods used in the survey, deprivation and ethnicity were rejected, along with community level interventions, as reasons for whole population level change. The factor relating to reduced sugar intake was neither rejected nor sustained. Reasons relating to increased fluoride availability, in particular that for increased concentration in children's toothpastes, was sustained.Conclusions The reduction in caries levels among 5-year-olds has most likely been brought about by the wider availability of children's toothpaste containing at least 1,000 ppm fluoride, along with other factors.

An observation of the concentration and type of fluoride compound present in "over-the-counter" adult toothpastes available in Saudi Arabia

Objectives: This study was performed to observe the type and level of fluoride compounds existent in 'over-the-counter' (OTC) adult toothpastes available in the open market of Saudi Arabia and to compare them with local and international guidelines. Materials and Methods: More than 100 hyper stores, shops and pharmacies of Dammam and Al Khobar cities were selected randomly and searched for the availability of fluoride containing adult toothpastes. Only toothpastes in which fluoride was present as an active ingredient were included and name of the compound of fluoride and its concentration stated on the packaging of the toothpaste were noted. Results: There were 59 different commercial brands of OTC toothpastes in which sodium fluoride was found in 59.3% of the toothpaste brands (35 of 59), 32.2% of the brands (19 of 59) had sodium monofluorophosphate, 3.3% toothpaste brands (2 of 59) had a combination of sodium fluoride and sodium monofluorophoshpate as an active ingredient, and 5% of the brands (3 of 59) mentioned the fluoride concentration in parts per million (ppm) but did not indicate the type of compound of fluoride present in them. Fluoride concentration found in toothpastes ranged between 1,000-1,470 ppm. Conclusions: Types of fluoride compounds found in toothpastes were consistent with internationally published guidelines. However, majority of toothpastes had 1,450 ppm fluoride which was consistent with Gulf Cooperation Council (GCC) and European guidelines but exceeded the normal range set by United States Food and Drug Administration (US-FDA) and American Dental Association (ADA). Care should be taken when these toothpastes are being used to prevent possible side-effects of fluoride over-exposure.