Severe Fluorosis Research Articles

REVIEW OF MODERN APPROACHES TO DENTAL FLUOROSIS MANAGEMENT

Dental fluorosis is caused by ingesting too much fluoride while the teeth are developing. Poltava region belongs to Buchach fluorine hydrogeological province which ground waters are characterized by a high content of fluorine. Such districts as Myrgorod, Lubny, Gadyach, Globino, Mashivka, Shyshaky and Novy Sanzshary have fluoride concentration in drinking water from 2,5 tо 7 mg/l. It is known that the overdose of fluoride has deleterious effect on enamel development, generating a hypomineralized porous subsuperfacial enamel. Mild fluorosis transforms into moderate fluorosis with brown pigmentation over time and increasing the severity of fluorosis is associated with increasing the patient`s dissatisfaction.
 There are a few different ways that dental fluorosis can be treated. Local remineralisation therapy is the most careful way to reduce or eliminate fluorosis spots. Enamel microabrasion removes the outer porous enamel with pumice after it has been partly demineralized by the acid; topical fluoride that remineralized the enamel follows microabrasion. A teeth whitening can return teeth to their former glory in a single visit. Infiltration technique is the novel approach to fluorosis management which masks white spots. Veneers or crowns are the next option that restores teeth gleaming appearance. Unfortunately, previous reviews that have analyzed contemporary methods of fluorosis treatment didn’t determine their indications depending on the disease severity and the enamel maturation.
 Purpose of the study was to systematize the methods of dental fluorosis management offered last years and to determine the indications for their use depending on the severity of the disease and the maturity of the tooth enamel. Searching strategy for identification of scientific publications published between the years 2009 - May 2019 was conducted by reviewers independently through Google. The search strategy included keywords "dental fluorosis management", «teeth whitening», «teeth microabrasion», «infiltration for fluorosis treatment» and it was complementated by checking references of the relevant review articles and the eligible studies for additional useful publications.
 Over the last 10 years few articles were dealt with minerals, vitamins, adaptogens, antitoxicants prescription for fluorosis management. Such tooth pastes as «R.O.C.S» and «Novyi zhemchuh calcium» showed efficacy in local remineralisation therapy of fluorosis in children. Infiltration technique was used for mild fluorosis management and in combination with whitening for moderate fluorosis treatment in children. Different tooth whitening techniques were offered and only some of them include local remineralisation therapy that can stabilize clinical result. Carbamide and orthophosphoric acid were utilized for whitening of immature fluorosis teeth. Microabrasion in children's teeth was effective in combination with following fluoridation, for example Tooth Moose.
 Direct and indirect restorations are considered the treatment of choice for moderate to severe cases of fluorosis given the optimum aesthetics, wear resistance, biocompatibility, and long-term results. Whereas veneers and crowns are indicated in mature fluorosis teeth, choice of direct composite restorations doesn’t depend on tooth maturity.
 Treatment of fluorosis of various severities in children should include endogenous use of medicines that increase the enamel remineralisation. Local remineralisation therapy is indicated for mild fluorosis in immature teeth and for moderate fluorosis in combination with bleaching and microabrasion. Infiltration technique is recommended for mild fluorosis management and in combination with whitening for moderate fluorosis treatment in children. In the case of inefficiency of minimally invasive methods or severe fluorosis, direct or indirect restorations are conducted. Promising direction in fluorosis treatment is the development of new methods for fluorosis management, including general and local remineralization therapy, as well as infiltration technique.

The association between the prevalence of dental fluorosis and the socio-economic status and area of residence of 12-year-old students in Uruguay

Objective: This study investigates the association between the prevalence and severity of dental fluorosis, the socio-economic status (SES) and area of residence among 12-year-old schoolchildren in Uruguay.Material and methods: The study was descriptive, cross-sectional, explanatory and observational. Subjects considered eligible were born in 1999 and had their parents’ or guardian’s prior consent. A questionnaire was used to identify SES according to Centro de Investigaciones Económicas Institute on four levels. Dental fluorosis was determined using the Thylstrup–Fejerskov (TF) index.Results: Of the 1544 students examined, 45.0% showed dental fluorosis. A TF index 1–2 was recorded in 29.3% of the subjects, TF 3 in 20.9%, TF 4 in 6.7% and TF 5–9 in 2.1%. In area 1 (the capital Montevideo city), 84.8% of the subjects had dental fluorosis, a value that was significantly higher than in the inland region (area 2, 24.4%) and border departments (area 3, 22.5%) (x2 = 27.92, p < .0001). Students from families with a low socio-economic level showed less prevalence of dental fluorosis than those with a high level (x2 = 14.58, p = .002).Conclusion: Significant differences exist in the prevalence of dental fluorosis in relation to place of residence and socio-economic level.

Condition of mineralized tooth tissue in a population of 15-year-old adolescents living in a region of Ukraine with slightly exceeded fluorine concentration in the water.

Fluorine is a common element in nature; however, the difference between a beneficial dose and a toxic dose for the organisms is small. The main source of fluoride for humans is water in addition to food. The aim of this study was to estimate the degree of severity of pathological changes, namely, caries or fluorosis, in the mineralized tooth tissue of 15-year-old adolescents with respect to their hygienic and nutritional habits, and the content of fluorine in drinking water, soil and plant products. 100 adolescents aged 15 from schools in Sosniłka, L'viv region, were examined. The condition of mineralized tooth tissue was evaluated by the caries severity, expressed by the mean number D3MFT, caries frequency and value of the SIC index. Fluorine in plant material and soil were determined according to the PN-G-04543:1982 standard, and water according to the PN-EN ISO 10304 - 1: 2009+ AC: 2012 standard. Severity of caries disease expressed by the D3MFT number in the examined group of 15-year-olds was 3.39; in the group of girls - 3.08, and in the group of boys - 3.76. In the examined group, the average number of teeth with fluorosis was 7.59. Value of the SIC index among the examined population of students (n-31) was 6.26: 5.89 (n-18) for girls and 7.31 (n-13) for boys. Fluorine concentration in the water was 0.78 - 1.25(mg·dm-3). In the soil, it also did not vary across the sampled areas and amounted, on average, to 176 mg·dm-3. The biggest fluorine content noted in the dry mass of beetroots was 3.50 (mg F· kg), and the lowest - 3.34 (mg F· kg). Close to optimal fluorine content lowers caries severity and frequency of fluorosis. Optimal fluorine content in drinking water and food does not require additional diet supplementation.

Fluoride Revolution and Dental Caries: Evolution of Policies for Global Use

Epidemiological studies over 70 y ago provided the basis for the use of fluoride in caries prevention. They revealed the clear relation between water fluoride concentration, and therefore fluoride exposure, and prevalence and severity of dental fluorosis and dental caries. After successful trials, programs for water fluoridation were introduced, and industry developed effective fluoride-containing toothpastes and other fluoride vehicles. Reductions in caries experience were recorded in many countries, attributable to the widespread use of fluoride. This is a considerable success story; oral health for many was radically improved. While previously, water had been the only significant source of fluoride, now there are many, and this led to an increase in the occurrence of dental fluorosis. Risks identified for dental fluorosis were ingestion of fluoride-containing toothpaste, water fluoridation, fluoride tablets (which were sometimes ingested in areas with water fluoridation), and infant formula feeds. Policies were introduced to reduce excessive fluoride exposure during the period of tooth development, and these were successful in reducing dental fluorosis without compromising caries prevention. There is now a much better understanding of the public perception of dental fluorosis, with mild fluorosis being of no aesthetic concern. The advantages of water fluoridation are that it provides substantial lifelong caries prevention, is economic, and reduces health inequalities: it reaches a substantial number of people worldwide. Fluoride-containing toothpastes are by far the most important way of delivering the beneficial effect of fluoride worldwide. The preventive effects of conjoint exposure (e.g., use of fluoride toothpaste in a fluoridated area) are additive. The World Health Organization has informed member states of the benefits of the appropriate use of fluoride. Many countries have policies to maximize the benefits of fluoride, but many have yet to do so.

Ceramic veneers for severe dental fluorosis

Ceramic veneers for severe dental fluorosis

Association of COL1A2 (PvuII) gene polymorphism with risk and severity of dental fluorosis – A case control study

IntroductionDental fluorosis is a foremost public health problem in many countries, including India. Very few studies investigated gene polymorphism and risk of dental fluorosis. Genetic polymorphisms in Collagen Type I, alpha 2 (COL1A2) gene, found to be linked with bone pathogenesis, may affect the tooth formation resulting in the vulnerability to dental fluorosis. AimTo assess the association between COL1A2 (PvuII) gene polymorphism and risk as well as severity of dental fluorosis. MethodsThe present case control study was conducted among participants with (n = 60) and without (n = 60) dental fluorosis. Dental fluorosis was assessed using Modified Dean’s fluorosis index (1942). The PvuII polymorphisms (in exon 25) inside the COL1A2 gene were genotyped by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) procedure. Statistical analysis were carried out with Chi-square test and Odds Ratio (OR) was determined with multivariate logistic regression analysis. ResultsThe genetic polymorphism in COL1A2 PvuII was found to be associated with the risk of dental fluorosis which was highly significant (p < 0.001). The odds ratio was 31.4 times [OR = 31.9, 95% CI: 3.9–48.7] higher for the homozygous PP genotype group and 4.0 times [OR = 4.0, 95% CI: 1.0–10.7] higher for the heterozygous Pp genotype. ConclusionGenetic polymorphism of COL1A2 was found to be associated with dental fluorosis. The present study provides an insight for identification of the population who may subsist at risk of developing dental fluorosis in their later life.

Dental Fluorosis Trends in US Oral Health Surveys: 1986 to 2012.

Dental fluorosis has been assessed only 3 times in nationally representative oral health surveys in the United States. The first survey was conducted by the National Institute of Dental Research from 1986 to 1987. Subsequently, the National Health and Nutrition Examination Survey (NHANES) conducted fluorosis assessments from 1999 to 2004 and more recently from 2011 to 2012. A large increase in prevalence and severity of fluorosis occurred between the 1986-1987 and 1999-2004 surveys. To determine whether the trend of increasing fluorosis continued in the 2011-2012 survey. We analyzed publicly available data from the 2011-2012 NHANES, calculating fluorosis prevalence and severity using 3 measures: person-level Dean's Index score, total prevalence of those with Dean's Index of very mild degree and greater, and Dean's Community Fluorosis Index. We examined these fluorosis measures by several sociodemographic factors and compared results with the 2 previous surveys. Analyses accounted for the complex design of the surveys to provide nationally representative estimates. Large increases in severity and prevalence were found in the 2011-2012 NHANES as compared with the previous surveys, for all sociodemographic categories. For ages 12 to 15 y-an age range displaying fluorosis most clearly-total prevalence increased from 22% to 41% to 65% in the 1986-1987, 1999-2004, and 2011-2012 surveys, respectively. The rate of combined moderate and severe degrees increased the most, from 1.2% to 3.7% to 30.4%. The Community Fluorosis Index increased from 0.44 to 0.67 to 1.47. No clear differences were found in fluorosis rates among categories for most of the sociodemographic variables in the 2011-2012 survey. Large increases in fluorosis prevalence and severity occurred. We considered several possible spurious explanations for these increases but largely ruled them out based on counterevidence. We suggest several possible real explanations for the increases. The results of this study greatly increase the evidence base indicating that objectionable dental fluorosis has increased in the United States. Dental fluorosis is an undesirable side effect of too much fluoride ingestion during the early years of life. Policy makers and professionals can use the presented evidence to weigh the risks and benefits of water fluoridation and early exposure to fluoridated toothpaste.

Prevalence and Severity of Dental Caries and Fluorosis in 8 Year-old Children With or Without Fluoride Supplementation

Prevalence and Severity of Dental Caries and Fluorosis in 8 Year-old Children With or Without Fluoride Supplementation

Relationship between fluoride exposure, orthopedic injuries and bone formation markers in patients with coal-burning fluorosis

Chronic exposure to fluoride is a public health problem worldwide. We explored the relationship between fluoride exposure, orthopedic injuries and bone formation markers alkaline phosphatase (ALP), bone Gla protein (BGP) in participants with coal-burning fluorosis in Hehua Village (coal-burning fluorosis endemic area) in Zhijin County of Guizhou Province and Zhangguan Village (non-fluoride contaminated area) in Anshun City of Guizhou Province. Environmental samples were collected and fluoride contents were examined using a fluoride ion-selective electrode. Dental fluorosis and skeletal fluorosis of 295 participants from Hehua Village and 85 participants from Zhangguan Village were diagnosed with informed consent. Urinary samples and peripheral blood samples were collected from the participants to determine urinary fluoride (UF), ALP acti-vity, and BGP content. The results showed that fluoride contents in rice, pepper, corn, drinking water, clay, vegetable-grown soil, coal and indoor and outdoor air were significantly higher than those in the control area, but lower than the previously reported values. With the increases of UF concentration, the ALP activity and BGP content significantly increased, the severity of skeletal fluorosis was greater, but with no significant changes in dental fluorosis. There was positive correlation between the severity of skeletal fluorosis and ALP activity, BGP content. These results indicated that low fluoride exposure could cause orthopedic injuries. ALP and BGP could be used to eva-luate the bone turnover in patients with skeletal fluorosis, which would be useful in the auxiliary diagnosis and therapeutic evaluation of skeletal fluorosis.

Dental fluorosis and oral health in the African Esophageal Cancer Corridor: Findings from the Kenya ESCCAPE case-control study and a pan-African perspective.

There are no studies of oral health in relation to esophageal cancer in Africa, or of Eastern Africa's endemic dental fluorosis, an irreversible enamel hypo‐mineralization due to early‐life excessive fluoride intake. During 2014–18, we conducted a case–control study of squamous cell esophageal cancer in Eldoret, western Kenya. Odds ratios (AORs (95% confidence intervals)) were adjusted for design factors, tobacco, alcohol, ethnicity, education, oral hygiene and missing/decayed teeth. Esophageal cancer cases (N = 430) had poorer oral health and hygiene than controls (N = 440). Compared to no dental fluorosis, moderate/severe fluorosis, which affected 44% of cases, had a crude OR of 20.8 (11.6, 37.4) and on full adjustment was associated with 9.4‐fold (4.6, 19.1) increased risk, whilst mild fluorosis (43% of cases) had an AOR of 2.3 (1.3, 4.0). The prevalence of oral leukoplakia and tooth loss/decay increased with fluorosis severity, and increased cancer risks associated with moderate/severe fluorosis were particularly strong in individuals with more tooth loss/decay. Using a mswaki stick (AOR = 1.7 (1.0, 2.9)) rather than a commercial tooth brush and infrequent tooth brushing also independently increased risk. Geographic variations showed that areas of high esophageal cancer incidence and those of high groundwater fluoride levels have remarkably similar locations across Eastern Africa. In conclusion, poor oral health in combination with, or as a result of, high‐altitude susceptibility to hydro‐geologically influenced dental fluorosis may underlie the striking co‐location of Africa's esophageal cancer corridor with the Rift Valley. The findings call for heightened research into primary prevention opportunities of this highly fatal but common cancer.

Awareness of dental fluorosis among undergraduate dental Students in Riyadh Region; A survey based study

IntroductionFluoride protects the teeth from dental caries using the needed amount of fluoride products. Materials and methodsA Modified structured questionnaire has been validated through a pilot trial (20 responses) prior to administration that contains16 questions (appendix 1) was distributed. Other than the demographics, the data were collected from 500 participants including undergraduate male and female dental students. ResultsThe majority described the mild fluorosis appearance in the teeth according to Dean’s index appropriately as white opacity of the enamel (64%, n = 320). On the other hand, only 31.1% (n = 155) and 46% (n = 229) described the moderate and severe fluorosis appearance in the teeth according to Dean’s index appropriately. ConclusionThe dissemination and education about dental fluorosis is urgently needed and should be tailored to reach this population. The knowledge about causes of fluoride and the effect on dental fluorosis should be presented in the education.

Oestrogen receptor Rsa I gene polymorphism in osteoporosis periodontitis patients with or without dental fluorosis.

Background & objectives:There is a paucity of information on association between dental fluorosis, osteoporosis and periodontitis. The aim of this pilot study was to evaluate oestrogen receptor (ER) Rsa 1 gene polymorphism in osteoporosis periodontitis patients with and without dental fluorosis.Methods:Twenty one primary osteoporotic patients suffering from periodontitis with dental fluorosis and 20 primary osteoporotic patients suffering from periodontitis without dental fluorosis participated in this study. Periodontitis was diagnosed based on age, gender T-scores using clinical parameters such as plaque scores, gingival bleeding scores and probing pocket depth, clinical attachment level (CAL) and severity of dental fluorosis. DNA was genotyped at the RsaI RFLP (in exon 5) inside the ER gene to study ER Rsa I gene polymorphism in osteoporosis periodontitis patients with and without dental fluorosis.Results:Patients with dental fluorosis had higher degree of osteoporosis than those without fluorosis. CAL was significantly higher (P<0.05) in those with dental fluorosis compared with those without. Rr heterozygote (21.95%) was observed in patients without fluorosis whereas RR mutant homozygote was absent in both the groups. Rr wild homozygote type was seen more in the patients with fluorosis (51.21%). Significant differences were found in distribution of these genotypes between patients with and without dental fluorosis.Interpretation & conclusions:This preliminary study showed the presence of ER I gene polymorphism in osteoporosis periodontitis patients without dental fluorosis. Further studies with large sample size are needed to confirm the association shown in this preliminary study.

Sociodemographic Determinants of Dental Fluorosis in Mangaluru, Karnataka, India: An Explorative Study

Aim:To analyze the sociodemographic determinants of dental fluorosis among high school children aged 12–16 years in Mangaluru, Karnataka, India.Materials and method:A cross-sectional study was conducted. Simple random sampling technique was employed to select the three schools for the present study. Demographic details and previous medical history was assessed by administering the questionnaire to the study subjects. Presence of dental fluorosis was assessed using the World Health Organization (WHO) oral health assessment form of 2013.Results:A total of 500 students were examined for the present study. A major fraction of the study population was formed by males. It was observed that 95 participants were affected by varying severity of dental fluorosis with the prevalence of 19%. Correlation and logistic regression analysis showed the occupation of father and dietary pattern to be significantly correlated with the presence of fluorosis in study subjects. Conclusion:Prevalence and severity of the condition are found to have a huge burden in the given urban population of Mangaluru city. As the occupation of father and dietary pattern showed significant association with fluorosis, further interventional studies are recommended to be conducted considering these socioeconomic factors. Clinical significance:Results of the present study will further our understanding of the association between prevalence and social determinants of dental fluorosis, which may be critical for prevention and control of the condition.

Low-level Laser Therapy in Combination with Desensitising Agent Reduces Dentin Hypersensitivity in Fluorotic and Non-fluorotic Teeth - A Randomised, Controlled, Double-blind Clinical Trial.

Dentin hypersensitivity (DH) is a prevalent painful condition of the teeth, the management of which lies in the obliteration of patent dentinal tubules. The purpose of this study was to compare the efficacy of 5% potassium nitrate (PN), low-level laser therapy (LLLT), and combination of low-level laser therapy and 5% potassium nitrate (LLLT+PN) in patients with fluorotic and non-fluorotic hypersensitive teeth. Ninety self reporting patients with DH completed the randomised, double-blind study. Patients were equally divided into fluorosis group (FG), with moderate to moderately severe fluorosis and the non-fluorosis group (NFG) and subdivided into 3 groups to receive PN, LLLT (810 nm, 1 W) alone and LLLT+PN. Each participant had at least one tooth eliciting a response of ≥ 3 on a visual analog scale (VAS) to evaporative, thermal and electric tactile stimulus (digital scratch-o-meter). The teeth were evaluated at baseline, 30 min post treatment, 1 week, 4 weeks and 12 weeks. The magnitude of pressure applied by the scratch-o-meter was also assessed for all three interventions. Statistically, LLLT+PN was more effective in alleviating DH at all time intervals compared to baseline. However, statistically significant results (p ˂ 0.05) were seen with LLLT+PN at 12 weeks in FG. Magnitude of pressure applied showed statistically significant differences with LLLT+PN at 30 min post treatment. LLLT+PN alleviated DH at all time intervals, with a greater effect in the fluorotic group. However, LLLT+PN was more efficacious in reducing DH at 12 weeks post treatment in the fluorotic group.

Brick tea consumption is a risk factor for dental caries and dental fluorosis among 12-year-old Tibetan children in Ganzi.

Brick tea contains high concentration of fluoride. The aim of the present work was to explore whether and how the brick tea is a risk factor for dental caries and dental fluorosis among Tibetan children in Ganzi. A cross-sectional study was conducted with 368 12-year-old Tibetan children in Ganzi. Dental caries was measured by DMFT index, and dental fluorosis severity was measured by Dean's Index. Community Fluorosis Index was used to estimate public health significance of dental fluorosis. Oral health-related behaviors and awareness, dietary habits and socioeconomic status were determined by a questionnaire. Bivariate and multivariate analyses were used to determine risk factors associated with dental caries and dental fluorosis. Dental caries prevalence was 37.50%, mean DMFT was 0.84 ± 1.53, while dental fluorosis prevalence was 62.23%. Community Fluorosis Index was 1.35, indicating a medium prevalent strength of dental fluorosis. Dental fluorosis was associated with mother's regular consumption of brick tea and residence altitude, and dental caries was associated with mother's regular consumption of brick tea. Mother's regular consumption of brick tea was a risk factor for both dental fluorosis and dental caries among children. Reducing mother's brick tea consumption during pregnancy and lactation may improve oral health status of their children.

Blood is thicker than water: Flaws in a National Toxicology Program study

Municipal fluoridation was a mid-twentieth century innovation based on the medical hypothesis that consuming low doses of fluoride when young provided protection against cavities with only a small risk of mild dental fluorosis, a cosmetic effect. In the 21st century, more than half of American teens are afflicted by dental fluorosis with approximately one in five having moderate to severe dental fluorosis in at least two teeth. Scientific literature since the 1990s has found that even low doses of fluoride adversely affect cognitive-behavioral development and that deficits are correlated with the severity of dental fluorosis in afflicted individuals. Evidence of neurotoxic impact from low dose systemic exposure to fluoride prompted an investigation by a branch of the governmental agency that has promoted fluoridation policy since its 1940′s inception. This review identifies ten significant flaws in the design of an animal experiment conducted by the U.S. National Toxicology Program as part of that investigation into the neurotoxic impact of systemic prenatal and postnatal fluoride exposure. The authors hypothesize that organizational bias can and does compromise the integrity of fluoride research.

A comparison of dental fluorosis in adult populations with and without lifetime exposure to water fluoridation.

There is a lack of evidence on the proportion and severity of fluorosis in adult populations exposed and not exposed to fluoridated water over their lifetimes. The aim of this study was to compare the proportion and severity of fluorosis in adults with lifetime exposure to water fluoridation with a nonexposed sample. A secondary aim was to report the gradient of fluorosis severity by age. A cross-sectional study recruited a sample with lifetime exposure to water fluoridation and a matched, nonexposed group. 580 participants, aged 18-52years (mean 34.3, SD 9.4) and 64% female, were recruited in general dental practices located in fluoridated (Birmingham and County Durham) and nonfluoridated areas (Manchester). Three digital images were taken of their incisors and an experienced examiner who was blind to exposure status viewed the images remotely and allocated fluorosis scores using the Thylstrup and Fejerskov (TF) scale. At TF≥1 (any fluorosis), a significantly higher proportion of participants from the fluoridated area had fluorosis (F 39% NF 21.3%, P<0.001), at the threshold TF≥3 ("aesthetic concern"), the difference was no longer statistically significant (F 4.1%, NF 2.2%, P=0.25). There was a gradient by age, whereby fluorosis was highest in the youngest and lowest in the oldest age group. Although fluorosis is more common in adults with lifetime exposure to water fluoridation than those with no exposure, the aesthetic impact of fluorosis seems to diminish with age.

Occurrence of fluorosis in a population living in a high-fluoride groundwater area: Nakuru area in the Central Kenyan Rift Valley.

Endemic fluorosis caused by the consumption of high-fluoride groundwater is a public health problem in Nakuru, in the Kenyan Rift Valley. The present study was carried out during the period January-February 2017 to determine the prevalence and severity of dental fluorosis among patients of two Nakuru healthcare facilities, namely St. Mary's Hospital-Gilgil and Egerton University-Njoro Dental Clinic. The patients consisted of both young and old members of the Nakuru population served with groundwater containing high levels of fluoride ranging from 0.1 to 72mg/l. The Thylstrup-Fejerskov (TF) index was used to estimate the severity of dental fluorosis. Among the patients of St. Mary's Hospital-Gilgil, the prevalence of dental fluorosis was 86% (n = 100), whereby 54% of the patients were found to have mild to moderate dental fluorosis and 32% had severe dental fluorosis. Whereas the prevalence of dental fluorosis in patients below the age of 14years was higher (92%) than in older patients (85.56%), severity was reversed (average TF = 3.77 for older patients; average TF = 2.18 for younger patients). No significant variation in severity and prevalence of dental fluorosis was recorded with respect to both genders of the patients. The dental fluorosis prevalence rate amongst the patients of the Egerton University-Njoro Dental Clinic was found to be 79.49% (n = 73). However, a comparative analysis of the two age groups revealed a much higher prevalence rate of 100% for patients below the age of 14 relative to the older patients (79.49%). While a high number of cases of dental fluorosis from both healthcare facilities were reported in patients residing in Njoro, Nakuru town, Gilgil and Bahati, the fewer cases were from Solai and Rongai. The results seem to suggest a much higher occurrence of dental fluorosis within the younger population group. This implies that rapid population growth and urbanization puts more pressure on public water resources which leads to a strong reliance on fluoride contaminated groundwater and the concomitant increased cases of dental fluorosis. Therefore, there is a need for a change of local government policy to enhance access to safe water and public education on fluorosis in the areas that were under investigation.

Dental fluorosis and a polymorphism in the COL1A2 gene in Mexican children

ObjectiveTo determine the allelic and genotypic frequencies of rs 412777 polymorphism in the Collagen type I alpha 2 chain (COL1A2) gene and the association with the severity of dental fluorosis in children between 6 and 12 years old in the State of San Luis Potosi, Mexico. DesignA cross-sectional study was designed; participants were 230 children from two rural communities of San Luis Potosí. Fluoride in drinking water and urine samples was quantified using a potentiometric method with a selective ion electrode. Dental fluorosis was diagnosed using the Thylstrup-Fejerskov index while the identification of the polymorphism was made by allelic discrimination, using allele-specific probes by real-time Polymerase chain reaction (PCR). Statistical analysis was carried out with Student’s t-test and Chi-square and Odds Ratio (OR). A confidence interval of 95% and a value of p < 0.05 were considered. ResultsThe concentration of fluoride in drinking water was 2.36 ± 0.02 mg/L in Ojo Caliente and 4.56 ± 0.07 mg/L in La Reforma, the concentration of fluoride in urine was 2.05 ± 0.62 mg/L and 2.99 ± 0.99 mg/L respectively. The prevalence of dental fluorosis was 100% and the frequency of alleles was 67% wild-type and 33% mutant allelic, alleles were found in Hardy-Weinberg equilibrium (X2 = 0.33, p = 0.89). The association between the degree of dental fluorosis and the evaluated polymorphism was statistically significant (OR = 7.10, 95% CI = 3.96–12.70, p < 0.05). ConclusionsAn association of rs 412777 polymorphism in the COL1A2 gene with dental fluorosis was found. Therefore, genetic variants represent a relevant risk factor to develop dental fluorosis, as it was proven in this study conducted in Mexican children.

Effect of phosphoric acid concentration used for etching on the microtensile bond strength to fluorotic teeth.

To evaluate the effects of different etching concentrations of phosphoric acid on the microtensile bond strength of Adper Single Bond 2 to fluorotic teeth.Deidentified extracted teeth were collected, including 30 sound teeth, 30 teeth with mild fluorosis, 30 teeth with moderate fluorosis, and 30 teeth with severe fluorosis. The teeth in each group were randomly divided into 3 subgroups (n = 10) that were subjected to acid etching using 35%, 40%, or 45% phosphoric acid. Adper Single Bond 2 (3M, Saint Paul, MN) was used as the adhesive for bonding Z250 universal resin (3M) to the etched dental enamel. Microtensile testing was used to determine the bond strength. After the microtensile test, the fractured specimens were examined under scanning electron microscopy (SEM).Both dental fluorosis and concentrations of phosphoric acid significantly affected the microshear bond strength of Adper Single Bond 2 to dental enamel. The maximum bond strength was achieved by using 40% phosphoric acid. Failure analysis showed that most failures occurred at the bonding interface. The rates of failures at the bonding interface decreased as the degree of fluorosis increased and as the concentration of phosphoric acid increased from 35% to 45%.The bond strength of fluorosis tooth was lower than that of healthy tooth, the bond strength increased with the increasing concentration of phosphoric acid, but an excessively high acid concentration can conversely lead to an apparent decline in bond strength.