Incidence Of Dental Fluorosis Research Articles

Prevalence of Dental Fluorosis amongst patients attending the tertiary care hospital, Peshawar, Pakistan

Pakistan is a developing country where peoples drink any available water. In Pakistan water sources are limited and drinking water contains high level of fluoride, which causes both dental and skeletal fluorosis. Objectives: Objectives of the current study was to evaluate the incidence of dental fluorosis among patients who visits the tertiary care hospital, Peshawar and to assess the level and distribution of fluorosis. Methods: The study was carried out at Dental unit of Khyber Teaching Hospital Peshawar, from January 2021 to December 2021. All the samples were collected after the research was approved by the ethical committee. A written informed consent was taken from all the participants prior to collecting the data. Moreover, Dean’s Fluorosis Index was used to rank the extent of Dental Fluorosis. For statistical analysis SPSS, version 26 was used. Results: Among 2433 participants, females 1451/2433(59.6%) were more as compared to male (n=982/2433 (39.3%) while the dental fluorosis were more prevalent in males 414/982 (42.1%) as compared to females 568/1451 (39.1%) The fluorosis was more prevalent in age group 11-20 year 874 (89%) while only two individuals were found with dental fluorosis in age groups more than 40 years. In addition, the participants used tap water were more affected with dental fluorosis 568 (56.9%), whilst incidence of fluorosis was less in individuals drinking treated as well as other sources water 2 (1.2%). Furthermore, 620 (63%) individuals were found with local fluorosis, while 362 (37%) were found with generalize fluorosis. According to Dean’s Fluorosis Index 365 (15%) of individuals were found with very mild fluorosis while only 37 (1.5%) individuals were affected by severe type of fluorosis. Conclusion: In this study, the fluorosis incidence in Pakistan were prevalent and need continual monitoring, and sources contributing to total fluoride intake in Pakistan need further investigation. Furthermore, for fluorosis prevention education and community awareness are necessary, and prompt conciliation to relegate the effects on dental health.

Prevalence of Dental Fluorosis amongst patients attending the tertiary care hospital, Peshawar, Pakistan

Pakistan is a developing country where peoples drink any available water. In Pakistan water sources are limited and drinking water contains high level of fluoride, which causes both dental and skeletal fluorosis. Objectives: Objectives of the current study was to evaluate the incidence of dental fluorosis among patients who visits the tertiary care hospital, Peshawar and to assess the level and distribution of fluorosis. Methods: The study was carried out at Dental unit of Khyber Teaching Hospital Peshawar, from January 2021 to December 2021. All the samples were collected after the research was approved by the ethical committee. A written informed consent was taken from all the participants prior to collecting the data. Moreover, Dean’s Fluorosis Index was used to rank the extent of Dental Fluorosis. For statistical analysis SPSS, version 26 was used. Results: Among 2433 participants, females 1451/2433(59.6%) were more as compared to male (n=982/2433 (39.3%) while the dental fluorosis were more prevalent in males 414/982 (42.1%) as compared to females 568/1451 (39.1%) The fluorosis was more prevalent in age group 11-20 year 874 (89%) while only two individuals were found with dental fluorosis in age groups more than 40 years. In addition, the participants used tap water were more affected with dental fluorosis 568 (56.9%), whilst incidence of fluorosis was less in individuals drinking treated as well as other sources water 2 (1.2%). Furthermore, 620 (63%) individuals were found with local fluorosis, while 362 (37%) were found with generalize fluorosis. According to Dean’s Fluorosis Index 365 (15%) of individuals were found with very mild fluorosis while only 37 (1.5%) individuals were affected by severe type of fluorosis. Conclusion: In this study, the fluorosis incidence in Pakistan were prevalent and need continual monitoring, and sources contributing to total fluoride intake in Pakistan need further investigation. Furthermore, for fluorosis prevention education and community awareness are necessary, and prompt conciliation to relegate the effects on dental health.

Hydrogeochemistry and health hazards of fluoride-enriched groundwater in the Tarim Basin, China

Fluoride (F−) enrichment reduces the availability of groundwater resources in the arid region, and it is thus important to investigate the hydrogeochemistry and health hazards of fluoride-enriched groundwater. Seventy-two groundwater samples (20 unconfined samples from the piedmont plain, 22 unconfined samples and 30 shallow confined samples from the alluvial plain) were collected in the Tarim Basin of China to illustrate the geochemical processes driving the F− enrichment and the incidence of dental fluorosis. The patterns of average ions contents in groundwater are Na+ > Ca2+ > Mg2+ > K+ and SO42− > Cl− > HCO3− > NO3− > F−. The highest F− concentration (average 2.16 mg/L) is observed in unconfined groundwater in the alluvial plain, while the lowest (average 0.63 mg/L) is recorded in unconfined groundwater in the piedmont plain. Approximately 5.0% of unconfined groundwater in the piedmont plain, 90.9% of unconfined groundwater and 33.3% of shallow confined groundwater in the alluvial plain contain F− concentrations exceeding 1.0 mg/L (Chinese drinking water standard). Mineral dissolution, cation exchange, and evaporation play a significant role in the formation of solutes in groundwater. High-F- groundwater is mostly associated with SO4·Cl–Na·Ca, SO4·Cl–Na·Mg, and SO4·Cl–Na types water. Thermodynamic simulations reveal that the dissolution of F-bearing minerals (e.g., fluorite) significantly controls the F− contents in groundwater. High concentrations of F− are closely related to high HCO3−, high Na+, high salinity, cation exchange, and evaporation. This demonstrates that high F− concentrations are caused by the increase in fluorite solubility due to high ionic strength, Ca2+ consumption and the desorption of F− from solid surfaces under alkaline conditions. Mixing with the upper unconfined groundwater plays a vital role in the enrichment of F− in shallow confined groundwater in the alluvial plain. The health risk assessment based on Dean's classification indicates that the percentage prevalence of fluorosis for boys aged 6 to 18 is 15.5% for Yecheng (YC), 18.4% for Zepu (ZP), 33.3% for Shache (SC), 29.8% for Maigaiti (MG), and 44.9% for Bachu (BC), while that for girls of the same age is 14.3% for YC, 24.3% for ZP, 42.2% for SC, 41.4% for MG, and 45.3% for BC. For male and female adults aged between 19 and 68, the percentage prevalence of fluorosis is: YC (11.5%, 12.0%), ZP (18.3%, 20.0%), SC (35.4%, 35.0%), MG (32.5%, 39.7%), and BC (42.4%, 44.3%). It is obvious that younger generation, especially girls, suffers from more severe dental fluorosis. This study has implications for the effective management of high-F- groundwater in arid regions.

Geochemical megaprovince of fluorine and endemic fluorosis in the middle São Francisco river, Minas Gerais-Bahia, Brazil

While conducting the National Program of Environmental Geochemistry and Medical Geology in the states of Minas Gerais and Bahia, the research team Geological Survey of Brazil – CPRM detected a large area with high levels of fluorine in the geochemical results of the soil, stream sediment and surface water. Fluorine levels were detected by an ion-selective electrode (stream sediment and soil samples) or by ion chromatography (water samples). In this low-density survey, the minimum, maximum and median fluorine grades found at the water samples were 0.005 mg/L, 7.56 mg/L and 0.05 mg/L. For the soil, the samples were 15 mg/L, 1720 mg/L and 152 mg/L, and for the stream sediment, the samples were 35 mg/L, 1076 mg/L and 262 mg/L. The region covers 25 municipalities where studies by researchers from Federal Universities of Minas Gerais and Bahia have detected a high incidence of dental fluorosis, especially where public supply is made via deep wells in the Fissure-Karst Aquifer of the Bambuí Group. Moreover, the study area is highly favorable to the mineral deposit of fluorite and secondary Pb-Zn. Because the area is much larger (99,000 km2) than the other known fluorite provinces of Brazil (Santa Catarina is 2,000 km2 and Vale do Ribeira is 5,000 km2), the designation of Geochemical Megaprovince of Fluorine in the Middle São Francisco River, Brazil, is suggested for this region.

Evaluation of threshold response and appropriate electrode placement site for electric pulp testing in fluorosed anterior teeth: An in vivo study.

Accurate diagnosis is key to success. Diagnosing the pulpal status in varied clinical situations poses a challenge to the clinician. Electric pulp test (EPT) is one of the valuable attempts in evaluating the sensibility of pulp tissue. The aim of this study was to find out and compare the threshold levels and optimal electrode placement site for EPT in fluorosed and nonfluorosed anterior teeth. Eighty volunteers recruited for this study were divided into two groups based on the incidence of dental fluorosis. Electric pulp testing was done on either of the central incisors in fluorosed and nonfluorosed group. Four sites on each crown were tested 4 times with digitest electric pulp tester, and the mean of the threshold responses was recorded. The data were analyzed with SPSS, version 11. Means of variables from each location were compared using one-way ANOVA and Tukey's post-hoc test while the critical level of significance was set at P < 0.05. The mean and standard deviation of threshold levels in fluorosed teeth were greater when compared to that of nonfluorosed teeth at all sites with incisal edge showing the least mean threshold levels for both the groups (P > 0.05). Within the limitations of this study, it can be concluded that fluorosed teeth respond to higher threshold levels than the non-fluorosed teeth, and incisal edge was the optimal electrode placement site.

Expression of sonic hedgehog signaling pathw ay and its inhibition by cyclopamine in rat liver with chronic fluorosis

To investigate the expression of sonic hedgehog (Shh) signaling pathway in liver fluorosis and to explore related mechanism. To establish animal model, 48 normal SD rats (aged 4-5 weeks) were randomly divided into 4 groups (12 each): control group, fluoriosis group, blocking group and blocking control group. After 6 months, the blocking group and blocking control group were injected intraperitoneally once every 2 days for 3 times with 10 mg/kg cyclopamine or dimethysulfoxide, respectively. Rats were sacrificed at the end of the experiment and the fluoride content in urine and liver function was determined. The expression of Shh and Gli1 protein and mRNA in hepatocytes was detected by immunohistochemistry and real-time fluorescence quantitative PCR, respectively. The fluoride contents in the urine and the incidence of dental fluorosis increased in the fluoride and blocking control groups as compared with those in the control group, but decreased in the blocking group compared with those of the fluoride and blocking control group. Compared with the control group, the titers of aspartate transaminase (AST) and alanine transaminase (ALT) significantly increased, while the activity of total protein and albumin decreased in the fluoride and blocking control groups. Compared with the fluoride and blocking control groups, the activity of the ALT slightly declined and the AST, total protein and albumin slightly increased in the blocking group. Histologically, the cells were disorganized and swollen with cytoplasmic clearing (balloon cells), compared with the control group. The expression of Shh and Gli1 significantly increased in all but the control group. Compared with the fluoride and blocking control groups, the expression of Shh and Gli1 declined in the blocking group. The overexpression and cyclopamine inhibition of the Shh signaling pathway are closely related to the content of fluoride in the liver. The Shh signaling pathway plays an important role in the pathogenesis of liver injury caused by fluorosis, suggesting a preventive and therapeutic target of the disease.

Fluorine in Water and Dental Fluorosis in a Community of Queretaro State Mexico

The community La Llave, Queretaro State, Mexico, has not been identified by the sanitary authorities as living in a hazard area related to dental fluorosis. However; a high concentration of fluoride is found in their drinking water causing them dental fluorosis. Physical-chemical analysis was carried out in the groundwater sources to determine the prevalence of dental fluorosis risk and caries accordingly to criteria of The World Health Organization, and 154 school children of ages 10 to 13 years were examined. As a result, 1.9 mg/L of fluorine concentration in drinking water was obtained; dental fluorosis presence was detected in the school children with an incidence of about 98%, in 47% of cases severe fluorosis with a dental caries index of 3.06 was traced. The groundwater sources in La Llave community contains fluorine above the limits dictated by Mexican regulations, producing serious repercussions on the health of school children, with an unnaturally high incidence of dental fluorosis.

Fluoride metabolism and fluorosis

This paper is primarily concerned with the only proven risk associated with water fluoridation: enamel fluorosis. Its purpose is to review current methods of measuring enamel fluorosis, its aetiology and metabolism. A further objective is to identify risk factors to reduce the prevalence of enamel fluorosis and employ methods to manage such risk factors. The prevalence of enamel fluorosis is increasing in Ireland and internationally. A critical period has been identified at which teeth are most at risk of developing enamel fluorosis: 15-24 months of age for males and 21-30 months of age for females. The data included took these two factors into account. A thorough narrative review of published literature was conducted to identify studies concerning the aetiology and metabolism of enamel fluorosis. Risk factors for fluorosis were identified from these studies. As it is the pre-eruptive phase of enamel development which represents the greatest risk to developing enamel fluorosis, studies examining sources of fluoride ingestion for young children were selected. These included studies on ingestion of fluoride toothpaste by young children, fluoride supplementation and infant formula reconstituted with fluoridated water. There is evidence that the age at which tooth brushing with fluoride toothpastes is commenced and the amount of fluoride placed on the brush are important risk factors in the incidence of dental fluorosis. It is recommended that brushing should not commence until the age of 2 and that a pea-sized amount (0.25 g) of toothpaste should be placed on the brush.

Biological mechanisms of dental fluorosis relevant to the use of fluoride supplements.

Fluorosis occurs when fluoride interacts with mineralizing tissues, causing alterations in the mineralization process. In dental enamel, fluorosis causes subsurface hypomineralizations or porosity, which extend toward the dentinal-enamel junction as severity increases. This subsurface porosity is most likely caused by a delay in the hydrolysis and removal of enamel proteins, particularly amelogenins, as the enamel matures. This delay could be due to the direct effect of fluoride on the ameloblasts or to an interaction of fluoride with the proteins or proteinases in the mineralizing matrix. The specific mechanisms by which fluoride causes the changes leading to enamel fluorosis are not well defined; though the early-maturation stage of enamel formation appears to be particularly sensitive to fluoride exposure. The development of fluorosis is highly dependent on the dose, duration, and timing of fluoride exposure. The risk of enamel fluorosis is lowest when exposure takes place only during the secretory stage, but highest when exposure occurs in both secretory and maturation stages. The incidence of dental fluorosis is best correlated with the total cumulative fluoride exposure to the developing dentition. Fluoride supplements can contribute to the total fluoride exposure of children, and if the total fluoride exposure to the developing teeth is excessive, fluorosis will result.

The role of caffeinated beverages in dental fluorosis

Recent studies have demonstrated that the incidence of dental fluorosis has increased during the past decade. Greater availability and use of fluoride-containing gels, mouth rinses, dentifrices, etc., improper prescribing of fluoride supplements and ingestion of fluoride dentifrice by some children are some of the suggested determinants of dental fluorosis. However, based on the increase in consumption of tea, coffee, and other caffeine-containing beverages by the children, and the augmentative effect of caffeine on fluoride bioavailability, we theorize that the rise in incidence of dental fluorosis in North America is mainly due to the replacement of water intake by caffeine-containing beverages among the young population.

Influence of Coffee on Fluoride Metabolism in Rats

Concomitant intragastric administration of sodium fluoride and coffee resulted in a significantly higher (P less than 0.01) plasma fluoride level than intake of the same amount of fluoride with water. The same result was obtained when coffee was substituted with an equivalent amount of caffeine. Comparison of plasma fluoride levels by total area under the curve of plasma fluoride concentration versus time indicated an almost 2-fold difference. Although the mechanism(s) is not known, it appears that caffeine is responsible for the present observation. This finding could help explain the variations in the incidence of dental fluorosis among people living in optimally fluoridated communities.

Epidemiological, clinical, and biochemical study of endemic dental and skeletal fluorosis in punjab.

The incidence of dental fluorosis in 46,000 children in the Punjab was assessed and compared with the fluoride content of their water supplies. Ten villages were selected for more detailed studies of skeletal as well as dental fluorosis.Factors other than the fluoride contect of the drinking water which were found to influence the incidence and the severity of fluorosis were the chemical composition of the water and in particular its calcium content; the duration of exposure; sex and occupation; nutritional status; and climatic and geological variations. The role of fluoride-containing foodstuffs has yet to be assessed.

Social and Nutritional Factors in Adolescent Osteochondritis of the Spine

Introduction The association of endemic dental fluorosis with skeletal changes in the native inhabitants of certain villages in the Madras Presidency was first reported by Shortt and others (1937). Similar bone lesions due to an excess of fluorine in drinking water have been recorded in natives in South Africa (Ockerse, 1941) and in aboriginal tribes in China (Lyth, 1946). The evidence that these changes are caused by fluorine is conclusive, for the radiological appear ances are identical with those found in industrial workers with fluorine (M0ller and Gudjonsson, 1932; Wilkie, 1940) and in the skeletal changes produced experimentally by feeding fluorine to animals (Roholm, 1937). In some cases the clinical features of endemic skeletal fluorosis resemble those seen in the type of ankylosing spondylitis (Marie Strumpell) known in this country as bamboo spine, which occurs chiefly in young men. Further more, fluorosis tends to affect the spine at a later age and it is common to both sexes. The radiological appearances are totally different (Kemp, 1946). The level of fluorine, about 3 to 4 parts per million (p.p.m.), in the drinking waters associated with bone lesions seen in India and among indigen ous populations in other parts of the world, is often no greater than the amount present in certain English waters, for example at Maldon in Essex, but in this country the social environment is never so unfavourable, and severe skeletal deformity is not seen. As a trace-element, the concentration at which fluorine is effective suggests a catalytic effect and/pr an inhibitor action on certain enzyme systems. Epidemiological studies in the United States combined with standardized grading of dental fluorosis showed less dental caries and more teeth of good structure among people who had used drinking water containing fluorine 0-5 to 1 0 p.p.m. for at least the first eight years of life, that is to say before calcification of the dental enamel is complete (vide Murray and Wilson, 1946). Observations on fluorosis and nutrition in Morocco have made it likely that the effect of fluorine on the development and structure of the dental enamel depends very much on the state of general nutrition (Murray and Wilson, 1948). In certain Oxfordshire villages where severe dental fluorosis is seen amongst the inhabitants, no evidence of developed skeletal fluorosis was found (Kemp and others, 1942), but there was a remarkable incidence of changes in the spines of children of the type described by Scheuremann (1921 and 1936) as kyphosis dorsalis juvenilis! In one school at least a third of the children were affected. The worst cases were seen in the lower social classes, among the younger members of large families, or in children with a history of defective nutrition in the early years. A group of poor Oxford city children examined at this time?the incidence of dental fluorosis in Oxford city as a whole is negligible? showed no such changes. In general the children showing the radiological changes of juvenile . osteochondritis had no complaints, yet many were deformed. The induced changes can, however, give rise to pain under conditions of strain or stress in later life. We have traced the progress of some of these cases and found that further changes have ensued in early adult life. Later we advanced further evidence to show that the occurrence of the disease was related to sustained malnutrition, and that benefit can result from improvements in the diet (Kemp and Wilson, 1947). The changes are not entirely confined to children of the poorer classes, but they certainly occur less frequently in the children of the well-to-do. Whenever we have seen a case from the higher-income groups, there has been a history of long-continued ill-health or of feeding difficulties (Kemp and Wilson, 1948). Other contributory factors are postural disturbances and the rate at which growth occurs. The original radiographs illustrating the disease have been published elsewhere (vide Kemp and Wilson, 1947). The accompanying line drawings taken from a severe case, and from a normal spine for comparison, illustrate the changes observed in this condition.