Severity Of Dental Fluorosis Research Articles

An inverse relationship between dental fluorosis and Molar Incisor Hypomineralization in Mexican schoolchildren in an area with a high concentration of fluoride in drinking water: A cross-sectional study.

To evaluate the association between the frequency and severity of dental fluorosis and Molar Incisor Hypomineralization (MIH) in 8-12-year-old schoolchildren living in an area with a high concentration of fluoride in the drinking water. The present cross‑sectional study was conducted on Mexican children (n = 573) selected from one community presenting a drinking water fluoride concentration of 1.39 ppm/F. The prevalence of dental fluorosis was ascertained using the Thylstrup and Fejerskov Index (TFI). The presence and severity of MIH was evaluated using the European Academy of Pediatric Dentistry (EAPD) criteria. A multinomial regression model was used to estimate the odds ratio (OR) and the 95% confidence intervals (CI), using the severity of MIH as the result. The prevalence of MIH was 37.7% and, by severity, was 16.1% mild, 14.3% moderate, and 7.3% severe. The prevalence of dental fluorosis in permanent dentition was 70.9% (TFI ≥1) and, by severity, was 29.2% (TFI = 0), 45.6% (TFI 1-3) and 25.3% (TFI ≥4), while 54.5% of subjects were found to have poor oral hygiene. Schoolchildren with fluorosis (TFI ≥4) were 49% less likely [OR = 0.51; p = 0.025] to present mild MIH than children with fluorosis (TFI <4). Similarly, children with fluorosis (TFI ≥4) were 53% [OR = 0.47; p = 0.019] and 62% [OR = 0.38; p = 0.036] less likely to present moderate and severe MIH than children with fluorosis (TFI <4). An inverse relationship between the presence of fluorosis and MIH was found. The results obtained by the present study may contribute to both the early identification of disorders affecting the enamel and the creation and implementation of long-term oral health prevention, promotion, and intervention programs in the affected population.

Salivary proteomic signatures in severe dental fluorosis

The relationship between dental fluorosis and alterations in the salivary proteome remains inadequately elucidated. This study aimed to investigate the salivary proteome and fluoride concentrations in urine and drinking water among Thai individuals afflicted with severe dental fluorosis. Thirty-seven Thai schoolchildren, aged 6–16, were stratified based on Thylstrup and Fejerskov fluorosis index scores: 10 with scores ranging from 5 to 9 (SF) and 27 with a score of 0 (NF). Urinary and water fluoride levels were determined using an ion-selective fluoride electrode. Salivary proteomic profiling was conducted via LC–MS/MS, followed by comprehensive bioinformatic analysis. Results revealed significantly elevated urinary fluoride levels in the SF group (p = 0.007), whereas water fluoride levels did not significantly differ between the two cohorts. Both groups exhibited 104 detectable salivary proteins. The NF group demonstrated notable upregulation of LENG9, whereas the SF group displayed upregulation of LDHA, UBA1, S100A9, H4C3, and LCP1, all associated with the CFTR ion channel. Moreover, the NF group uniquely expressed 36 proteins, and Gene Ontology and pathway analyses suggested a link with various aspects of immune defense. In summary, the study hypothesized that the CFTR ion channel might play a predominant role in severe fluorosis and highlighted the depletion of immune-related salivary proteins, suggesting compromised immune defense in severe fluorosis. The utility of urinary fluoride might be a reliable indicator for assessing excessive fluoride exposure.

Severe magnitude of dental and skeletal fluorosis and its impact on society and environment in a part of Manbhum-Singhbhum Plateau, India

BackgroundNumerous approaches have been adopted to evaluate limited freshwater resources and the associated health hazards due to excessive amounts of fluoride in drinking water. The study aims to assess the degree and severity of dental and skeletal fluorosis and examine the broader effects of fluorosis on human health and society in the Manbhum-Singhbhum Plateau region, India.MethodsThe Community Fluorosis Index (CFI) and Dean’s Index have been used to measure the magnitude and severity of dental and skeletal fluorosis. Questionnaire surveys, Focus Group Discussions (FGDs), and appropriate statistical methods have been applied to identify the social impacts. Risk-prone zones have been identified through overlay analysis using geoinformatics.ResultsAbout 54.60% of people in 67 villages of this part of the Manbhum-Singhbhum Plateau are affected in varying degrees of fluorosis ranging from very mild to mild, moderate, and severe dental fluorosis. Among these 67 villages, Janra (Manbazar I) and Hijla (Barabazar) have the most severely affected people. School dropout (n = 426), social isolation (n = 149), remarriage (n = 21), and physically disabled (n = 75) have also been reported. The study shows that about 414.29 km2 of the Manbhum-Singhbhum Plateau comes under the high-risk-prone category.ConclusionsThe societal and environmental awareness of the fluorosis-affected individuals is almost absent in this region. Economic hardships, lack of education, inadequate health care facilities, water scarcity, and lack of awareness increase the magnitude of health hazards and societal vulnerability of the people in this region, who are largely dependent on natural resources.

Evaluation of fluoride exposure using disability-adjusted life years and health risk assessment in south-western Iran: A novel Monte Carlo simulation

Consumption of fluoride-contaminated water is a worldwide concern, especially in developing countries, including Iran. However, there are restricted studies of non-single-value health risk assessment and the disease burden regarding fluoride intake nationwide. Prolonged exposure to excessive fluoride has been linked to adverse health effects such as dental and skeletal fluorosis. This can lead to under-mineralization of hard tissues, causing aesthetic concerns for teeth and changes in bone structure, increasing the risk of fractures. As such, we aimed to implement probability-based frameworks using Monte Carlo methods to explore the potential adverse effects of fluoride via the ingestion route. This platform consists of two sectors: 1) health risk assessment of various age categories coupled with a variance decomposition technique to measure the contributions of predictor variables in the outcome of the health risk model, and 2) implementing Monte Carlo methods in dose-response curves to explore the fluoride-induced burden of diseases of dental fluorosis and skeletal fractures in terms of disability-adjusted life years (DALYs). For this purpose, total water samples of 8053 (N=8053) from 57 sites were analyzed in Fars and Bushehr Provinces. The mean fluoride concentrations were 0.75 mg/L and 1.09 mg/L, with maximum fluoride contents of 6.5 mg/L and 3.22 mg/L for the Fars and Bushehr provinces, respectively. The hazard quotient of the 95th percentile (HQ>1) revealed that all infants and children in the study area were potentially vulnerable to over-receiving fluoride. Sobol’ sensitivity analysis indices, including first-order, second-order, and total order, disclosed that fluoride concentration (Cw), ingestion rate (IRw), and their mutual interactions were the most influential factors in the health risk model. DALYs rate of dental fluorosis was as high as 981.45 (uncertainty interval: UI 95 % 353.23–1618.40) in Lamerd, and maximum DALYs of skeletal fractures occurred in Mohr 71.61(49.75–92.71), in Fars Province, indicated severe dental fluorosis but mild hazard regarding fractures. Residents of the Tang-e Eram in Bushehr Province with a DALYs rate of 3609.40 (1296.68–5993.73) for dental fluorosis and a DALYs rate of 284.67 (199.11–367.99) for skeletal fractures were the most potentially endangered population. By evaluating the outputs of the DALYs model, the gap in scenarios of central tendency exposure and reasonable maximum exposure highlights the role of food source intake in over-receiving fluoride. This research insists on implementing defluoridation programs in fluoride-endemic zones to combat the undesirable effects of fluoride. The global measures presented in this research aim to address the root causes of contamination and help policymakers and authorities mitigate fluoride's harmful impacts on the environment and public health.

FLUOROSIS PREVALENCE AT DIFFERENT REGIONS OF THE EARTH (LITERATURE REVIEW)

The aim of the study is to analyze the literature about the fluorosis prevalence and the factors which lead to dental and bone fluorosis. The search for articles published in 2016-2023 was conducted by the authors in Scopus and Web of Science scientific data bases using the keywords “fluorosis”, “dental fluorosis”. To classify the severity of dental fluorosis, the index of developmental defects of enamel (DDE), the index of tooth surface fluorosis (TSIF), and mostly Dean’s index Thylstrup &amp; Fejerskov Index (TFI) are used. The risk factors for dental fluorosis include living in regions with high level of fluoride, drinking water with high level of fluoride or salt fluoridation, drinking bottled water, use of fluoride toothpastes among preschool children, early weaning, and use of infant formula for long time, and, as well as, a hot climate and high fluoride content in soil and food. The studies from India and China demonstrated that the average concentration of dental fluorosis and skeletal fluorosis at fluoride contained 6 mg/l. The prevalence of dental fluorosis in NorthernTanzania, where the fluorine content in daily drinking water is 3.6 mg/l, reaches 75,22%. In Ethiopia, where fluorine content is 5.09 mg/l, the prevalence of skeletal fluorosis ranges from 55.1% to 72.4%. In Kenya, the fluoride content in drinking water reaches 72 mg/l, so the prevalence of dental fluorosis is 80%. The prevalence of dental fluorosis is lower in South Western Saudi Arabia and Iran where fluoride level is lower. In Jordan, the prevalence of dental fluorosis reaches 39.9% due to the high fluoride content in miner rocks. Skeletal fluorosis is wide spread in some areas of Pakistan due to the contamination of ground water by industrial production. The prevalence of mild dental fluorosis is 39% in New castle where water is fluoridated, and 24% in non-fluoridated Manchester in England. Dean’s index and TFI index are mostly used to classify these variety of fluorosis. Various factors affect the appearance of dental and bone fluorosis worldwide, so the prevalence of fluorosis varies from 11,1 up to 100%.

Water pollution with fluoride in the Republic of Moldova and its impact on oral health

Water quality, especially drinking water quality, is one of the most essential requirements for the survival of not only mankind but all terrestrial life on Earth. As a determining factor of health, the quality of drinking water must correspond to sanitary regulations, and the violation of the water protection regime results in pollution. Water pollution is one of the major threats to public health in the Republic of Moldova. According to data compiled by the Yale Center for Environmental Law and Policy, globally, the Republic of Moldova was placed 83rd out of 180 countries in terms of drinking water quality, the first place being occupied by the countries with the highest drinking water quality. The „age-standardized life-years lost per 100,000 people due to exposure to unsafe drinking water (Daily rate)” is a measure used to evaluate the quality of water. The Daly score for the Republic of Moldova in 2022 was 50.0. The Republic of Moldova is considered a biogeochemical zone with regard to some chemical elements in the environment, including the content of fluorine in groundwater, soil, and subsequently in food products. The analysis of water samples taken by the National Public Health Center of the Republic of Moldova demonstrated that in 90% of cases, water sources subjected to laboratory investigations for microbiological and chemical parameters (boron, fluorine, and nitrates) do not meet the requirements. The present study was a prospective, observational one, the main objective of which was to evaluate the epidemiological dental characteristics of children from the fluorosis-endemic area of the Republic of Moldova. The study targeted 520 12- and 15-year-old children from Fălești district, where the fluoride concentration in drinking water exceeds 16 times the permissible norm of 16.2 ppm/l. Thus, the prevalence of dental fluorosis in this locality (Dean index ≥1) was 98.7 for 12-year-old children and 100% for 15-year-old adolescents. The prevalence of dental caries was 51.2% with an intensity of 2.1 for 12-year-old children, and for 15-year-old children, the prevalence was 67.1% with an intensity of 3.5. Children’s age and severity of dental fluorosis were independent predictors of dental caries intensity. Thus, a positive correlation was established between the severity of dental fluorosis and the intensity of dental caries in both study groups and in all groups of teeth. The percentage of children with a COAD index (decayed, filled, or absent teeth) ≥1 was higher in those whose Dean index was ≥ 5 in the second molar compared to other groups of teeth. Conclusion. Dental fluorosis remains the most common dental disease in fluorosis-endemic areas, and the severity of fluorosis increases with increasing fluoride concentrations in drinking water. Contrary to the previously established opinion, tooth decay also develops in children from endemic areas of fluorosis, and its frequency and intensity are directly correlated with the concentration of fluoride in drinking water. The higher the concentration of fluoride, the higher the values of the prevalence indices and intensity of dental caries. Republic of Moldova performs suboptimally in the prevention of oral diseases in the pediatric population, and the implementation of dental disease prevention programs would have major implications for improving dental morbidity.

Poor oral health and the risk of esophageal squamous cell carcinoma in Malawi.

Esophageal squamous cell carcinoma (ESCC) is the second most common cancer in Malawi. Risk factors for this cancer in Malawi are poorly understood. Poor oral health has previously been linked to increased ESCC risk in other high-incidence regions, including parts of Eastern and Southern Africa. We assessed the relationship between oral health and ESCC risk in a sex, age and location frequency-matched case-control study based at two hospitals in Lilongwe, Malawi from 2017 to 2020. Trained interviewers used a structured questionnaire and direct observation to collect data on demographics; behaviors; oral hygiene habits; the sum of decayed, missing or filled teeth (DMFT score); oral mucosa status; lip depigmentation and dental fluorosis via a visual scale. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI), adjusted for known and suspected ESCC risk factors. During the study period, 300 cases and 300 controls were enrolled. Subjects in the highest tertile of DMFT score (≥7) had an increased risk of ESCC with an adjusted OR of 1.96 (95% CI: 1.16-3.36) compared to those with a DMFT score of 0. Severe dental fluorosis was associated with a statistically nonsignificant increased risk of ESCC (adjusted OR = 2.24, 95% CI: 0.97-5.49) compared to individuals with no fluorosis. Associations with oral mucosa status, lip depigmentation and toothbrushing method and frequency were mostly null or uncertain. Poor oral health, indicated by a higher DMFT score, was associated with increased ESCC risk in Malawi. Dental fluorosis is another possible risk factor in this population, but further evaluation is necessary to clarify any effects of fluorosis on ESCC risk.

Esthetic rehabilitation of dental fluorosis with CAD-CAM generated yttria-stabilized zirconia and glass-ceramic laminate veneers

Dental fluorosis is a growing public health problem. Its manifestation could compromise esthetics and function. Several treatment modalities have been proposed to manage mild to severe dental fluorosis. Treatment options varied from bleaching to full coverage crowns. This clinical report demonstrates the use of two different ceramic biomaterials for the treatment of two different levels of fluorosis.

A Door-to-Door Prevalence Survey of Dental Fluorosis in Tindigani, a Village in the Hai District of Northern Tanzania.

Fluoride in excess of the World Health Organisation limit of 1.5mg/L in drinking water can cause dental fluorosis (DF) in developing teeth. DF is a significant problem in the Hai District of Northern Tanzania, where there is limited access to safe piped water and groundwater is high in fluoride. A door-to-door prevalence survey of residents of Tindigani village was undertaken to assess current prevalence and severity of DF in the Hai District, and the effectiveness of previous interventions to promote low-fluoride drinking water, following a prevalence survey in 2009. DF was graded by trained assessors, utilising dental photography, and drinking water sources were sampled for chemical analysis. DF was endemic in the 563 people assessed, with a prevalence of 79.4% (CI=76.1-82.7%). Prevalence and severity were found to be higher in permanent teeth than deciduous teeth. Fluoride concentrations in non-piped water sources ranged from 2.5-38.6mg/L. Despite more households reporting the use of low-fluoride, piped water sources, compared to 2009 (82.8% versus 62%), DF remains a significant problem in Tindigani and other such communities where low-fluoride drinking water is not easily and reliably accessible. Policy makers must prioritise reliable access to low-fluoride water, especially for children as their permanent dentition develops.

Prevalence and risk factors of dental fluorosis among children aged 8–12 years in Shandong province of China

ABSTRACT This study was to investigate the prevalence and severity of children’s dental fluorosis (DF) in Shandong and identified the potential risk factors for DF. A total of 87 villages in Shandong were investigated to calculate the prevalence of DF and Community Fluorosis Index (CFI) in 2018–2019. Six hundred and seventy children were enrolled to identify the potential risk factors using univariate and multivariate logistic regressions. Goodman–Kruskal Gamma was used to explore the factors related to the severity of DF. In 87 villages, 1249 of 8700 (14.36%) children still have DF. The prevalence of DF in most villages was below 40% in 2018–2019. Water fluorine concentration when selected for the study and urinary fluorine concentration were related to the risk of DF (P < 0.001). Some eating habits, like lower frequency of eating fresh vegetables, eggs, and beans, were associated with the risk of DF (P < 0.001). The high water fluorine concentration, and lower frequency of eating fresh vegetables, eggs, and beans were also related to the severity of DF (P < 0.001). DF in children in Shandong province is still a common endemic disease. This study tries to provide a useful guide for the prevention and control of DF.

Managing dental fluorosis: A guide to improving appearance of the teeth

Too much consumption of fluoride during tooth formation causes the disorder known as dental fluorosis, leading to changes in their appearance and structure. The severity of dental fluorosis is typically classified into different stages based on the visual appearance of the teeth. Mild cases of dental fluorosis may not require any treatment, and the condition may improve over time as the enamel continues to mineralize. In more severe cases, treatment options include teeth whitening, dental bonding, veneers, and crowns. While treatment can improve the appearance of the teeth, it cannot reverse the damage that has already occurred to the enamel surface. Therefore, it is important to take steps to prevent further damage by monitoring fluoride intake and practicing good oral hygiene. Regular dental checkups and cleanings can also help to identify and manage any issues related to dental fluorosis. Overall, dental fluorosis is a cosmetic issue which has got nothing to do with functional changes related to a tooth and appropriate treatment can help to improve the appearance of the affected teeth. In this article we will see various aspects of dealing with dental fluorosis right from its etiology to management.

A National Study Exploring the Association Between Fluoride Levels and Dental Fluorosis

While the effects of fluoride on health have been widely researched, fewer high-quality studies examine the association of fluoride levels in water and dental fluorosis. To investigate the association between fluoride exposure from drinking water and dental fluorosis. This cross-sectional study used the 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey (NHANES) data (January 1, 2013, through December 31, 2016). NHANES uses a complex sampling technique to develop nationally representative sample estimates of the US population that consists of interviews and physical assessments. Children and adolescents aged 6 to 15 years were included because NHANES contains their data for all 3 forms of fluoride measures: plasma fluoride levels, water levels of fluoride, and dietary fluoride supplementation. Data were analyzed from January 1 to April 30, 2023. Water and plasma fluoride levels were measured by laboratory personnel. Dietary fluoride supplement data were self-reported. The Dean's Fluorosis Index was used to evaluate fluorosis status for each tooth. The dental fluorosis severity value was based on the second most affected tooth. Independent variables included plasma and water fluoride concentrations and dietary fluoride supplementation. An independent samples t test was used to compare fluoride exposures between groups, and Pearson correlation assessed the association between plasma and water fluoride levels. To assess whether fluoride exposures were associated with dental fluorosis, logistic regression analyses were conducted. There were 1543 participants in the 2013-2014 NHANES cycle (weighted proportion male, 51.9%; mean [SD] age, 11.0 [2.7] years) and 1452 in the 2015-2016 cycle (weighted proportion male, 52.6%; mean [SD] age, 11.1 [2.8] years). A weighted 87.3% exhibited some degree of fluorosis in the 2013-2014 cycle and 68.2% in the 2015-2016 cycle. Higher fluoride levels in water and plasma were significantly associated with higher odds of dental fluorosis (adjusted odds ratios, 2.378 [95% CI, 2.372-2.383] in the 2013-2014 cycle and 1.568 [95% CI, 1.564-1.571] in the 2015-2016 cycle). The findings of this cross-sectional study suggest that exposure to higher concentrations of fluoride in water and having higher plasma levels of fluoride were associated with a greater risk of dental fluorosis. Further research can help policy makers develop policies that balance substantial caries prevention with the risk of dental fluorosis.

Histopathological Assessment of Dental Fluorosis

Objective: This study aims to conduct a comprehensive histopathological assessment of dental fluorosis across varying levels of severity and establish correlations with observable clinical symptoms. The research also examines the relationship between fluoride concentration and the extent of fluorosis, contributing to the understanding of this oral health concern. Study Design: Secondary data analysis Methods: In order to analyze quantitative data on dental fluorosis from reliable resources like PubMed and specialized journals, the research approach used SPSS. By PRISMA principles, we also consulted grey literature for information. Descriptive statistics provided initial insights after data cleansing. Pearson's correlation revealed relationships between the severity of dental fluorosis and histological alterations. These correlations were subsequently analyzed using multiple regression techniques. A one-way ANOVA was used to analyze geographic variations in symptoms, and a meta-analytic technique guaranteed the accuracy of the data. Results: The findings underscore the strong correlation between elevated fluoride levels and heightened fluorosis severity, aligning with previous research in the field. The study emphasizes the necessity of effective fluoride regulation and monitoring in water sources to prevent the development of fluorosis. These insights hold implications for dental practices and public health strategies, necessitating community education on fluoride sources and enhanced diagnostic and treatment approaches by healthcare professionals. Conclusion: The study's outcomes underscore the significance of empirical research in enhancing public health initiatives and shaping preventive interventions. By focusing on longitudinal investigations, geographically comparative studies, and meticulous risk assessments, future research can contribute to a more nuanced understanding of fluorosis and facilitate evidence-based preventive measures. Implementing these recommendations will aid in improving our comprehension of fluorosis, safeguarding community health, and empowering individuals to make informed decisions regarding fluoride exposure. Keywords: Dental fluorosis, Fluoride concentration, Histopathological assessment, Severity, Public health initiatives.

Impact of dental fluorosis on the oral health related quality of life of adolescents in an endemic area.

Oral diseases and conditions affect the physical, social, and psychological well-being of an individual. The aim of this study was to determine the association between the severity of dental fluorosis and oral health related quality of life (OHRQoL) among 15-year-old school children residing in an endemic area for dental fluorosis in Sri Lanka. A cross-sectional study was conducted among 989, 15-year-old school children who were lifetime residents of Kurunegala district. A validated Sinhala version of the Child Perception Questionnaire (CPQ 11-14) was used to assess OHRQoL. Dental fluorosis was assessed using the Thylstrup and Ferjeskov index (TF index) while dental caries and malocclusion were assessed using the WHO Basic Methods and Dental Aesthetics Index (DAI) respectively. In addition, information pertaining to parental level of education, type of toothpaste used, frequency of toothbrushing and use of dental services was also gathered. The prevalence of dental fluorosis was 52%. The overall prevalence of impacts based on the CPQ was 38.2%. The severity of dental fluorosis was not significantly associated with the overall prevalence of impacts. However, the severity of dental fluorosis was significantly associated with three oral impacts namely "having pain in teeth, lips, jaws, or mouth", "felt irritable or frustrated" and "other children teased or called names". According to the multiple logistic regression analysis, use of dental services and moderate to severe malocclusion were significantly associated with poor OHRQoL but not dental fluorosis. The severity of dental fluorosis was not associated with OHRQoL of the participants.

A community-based study of dental fluorosis in rural children (6-12 years) from an aspirational district in Karnataka, India.

The present study was planned to estimate the prevalence of dental fluorosis in 6-12 years of children and its association with various drinking water sources, water, and urine fluoride levels among the subset of children under the umbrella of a larger study to address iodine deficiency disorders and iron deficiency anemia in 17 villages of Manvi and Devadurga talukas of Raichur district of Karnataka. Analysis of subset of data and urine samples of children under the umbrella of a larger cross-sectional community-based study was conducted in 17 villages of Manvi and Devadurga taluks of Raichur district. House to house survey was carried out to collect data using a semi-structured questionnaire in ODK software. Demographic details, source of drinking water, clinical assessment of dental fluorosis, and height and weight measurements were performed by trained staff. Urine and water samples were collected for fluoride level estimation. The overall prevalence of dental fluorosis and its severity-wise prevalence were estimated. Association between dental fluorosis and age, gender, type of diet, source of drinking water, height for age, BMI for age, water fluoride level, and urine fluoride level were carried out using logistic regression analysis. The prevalence of dental fluorosis was 46.0%. Mild, moderate, and severe dental fluorosis was found in 37.9, 7.8, and 0.3% of children. With the increasing age of participants, the odds of dental fluorosis were found to increase by 2-4 folds. The odds of having dental fluorosis were significantly increased with increasing water fluoride levels of 3 to 5 ppm [AOR = 3.147 (1.585-6.248); P = 0.001] in comparison with water fluoride levels of < 1 ppm. The similar trend was found with urine fluoride level > 4 ppm [AOR = 3.607 (1.861-6.990); P < 0.001]. As compared to river water, other sources of drinking water were significantly associated with higher odds of dental fluorosis. Prevalence of dental fluorosis was high in 6 to 12 years due to overexposure of fluoride from drinking water. High water and urine fluoride levels in children indicate the chronic exposure to fluoride and suggest that the population is at high risk of developing chronic fluorosis.

Distribution of Dental Fluorosis in the Southern Zone of Ecuador: An Epidemiological Study.

In recent decades, the increase in fluoride exposure has raised the numbers of dental fluorosis in fluoridated and non-fluoridated communities In Ecuador, but the last national epidemiological study on DF was conducted more than a decade ago. The objective of this cross-sectional descriptive study was to determine the prevalence, distribution and severity of dental fluorosis (DF) using the Dean index in 1606 schoolchildren aged 6 to 12 years from urban and rural environments in provinces that make up the Southern Region of Ecuador. Participants met the inclusion criteria which were age, locality, informed consent document and no legal impediment. The results are presented using percentage frequency measures and chi-square associations. The prevalence of dental fluorosis was 50.1% in the areas of Azuay, Cañar and Morona Santiago, with no significant differences (x2 = 5.83, p = 0.054). The types of DF found most frequently were very mild and mild in all provinces; a moderate degree was more prevalent in Cañar (17%). There was no significant association (p > 0.05) between sex and the presence of dental fluorosis and, with respect to severity, the most frequent degree was moderate at the age of 12 years. The prevalence of dental fluorosis in the area evaluated is high, especially in the light and very light degrees, with a tendency toward moderate levels. It is necessary to carry out studies on the factors that are predisposing to the development of this pathology in the population studied. This research is an update regarding this pathology in Ecuador, so it is concluded that it is necessary to continue developing studies based on the findings obtained, thus contributing to the public health of the country.

Analysis of multiple pathways and levels of fluoride intake in fluorosis areas of Southwest China

In the coal-burning fluorosis areas of China, over 10 million people suffer from dental fluorosis caused by multiple pathways of fluoride intake. However, the link between dental fluorosis prevalence, the geochemical distribution of fluoride, and contributions of different exposure pathways remain unclear. Here, we aimed to quantify the various fluoride exposure pathways and establish the association between dental fluorosis and fluoride intake in Southwest China. Epidemiological data on the peak time of fluorosis prevalence were combined with geochemical analyses of the fluoride content in coal and clay over a large scale, the amounts and ratios of fluoride intake through different exposure pathways were calculated, and the association between the total daily fluoride intake (TDFI) and dental fluorosis severity was analyzed. The prevalence of dental fluorosis was not significantly correlated with the fluoride geo-background of coal and clay on a large scale (P > 0.05). The co-combustion of coal and clay contained in hand-made briquettes is the main pathway of fluoride contamination, which occurs through the inhalation of polluted air and consumption of contaminated roasted products. Furthermore, the TDFI per person ranged from 2.78 to 17.32 mg, and it was significantly positively correlated with the prevalence of dental fluorosis (P < 0.05). The TDFI from breathing and eating was 1.1–3.2 mg and 1.1–15.1 mg, which accounted for 9%–54% and 40%–90% of the total TDFI, respectively. The combination of living habits and soil geochemical fluoride anomalies resulted in the higher prevalence of fluorosis in rural areas of Southwest China.

Esthetic treatment of severe dental fluorosis using porcelain veneers: A case report

Esthetic treatment of severe dental fluorosis using porcelain veneers: A case report

Geo-Environmental Factors’ Influence on the Prevalence and Distribution of Dental Fluorosis: Evidence from Dali County, Northwest China

Residents living in areas with high fluorine environmental background will ingest excessive fluorine from the atmosphere, drinking water, food and other ways. Long-term effects of fluorine on the human body could cause people suffering from dental fluorosis and influence the sustainable development of the severe fluorosis areas. Previous studies have independently discussed the high fluoride environment in Dali County from the aspects of natural environment, drinking water quality and endemic fluorosis. This study carried out a detail investigation on dental fluorosis population in seven selected villages of Dali County, Shaanxi province, northwest China. The highest dental fluorosis index of 1.9 was found in Lianjia village located near the Anren depression, while the lowest dental fluorosis index of 0.0 was found in Jiaxi village near the Yellow River alluvium. Groundwater fluorine contents the range was 0.01 mg/L to 11.80 mg/L, with the highest value (2.6 mg/L) being observed in the 2nd terrace of Weihe River. The lowest groundwater fluorine content (0.8 mg/L) was observed in the Yellow River alluvium. Soil fluorine contents ranged from 1.18 mg/kg to 13.70 mg/kg, with its highest value (13.70 mg/kg) observed in Xinfeng village near the Anren depression. The lowest value of fluorine (1.18 mg/kg) was found in soil from the 1st terrace of Weihe River. As for the fluorine contents of corn, they ranged from 4.04 mg/kg to 7.72 mg/kg. The highest value (7.72 mg/kg) appeared in the 3rd terrace of Weihe River and the lowest value (4.04 mg/kg) in the 2nd terrace of Weihe River. The soil leaching was the dominant fluorine source of groundwater environment. Areas with severe dental fluorosis are located at the edge of the depression and the conjunction between steep slope and gentle slope. A poor correlation was found between the dental fluorosis index from the seven investigated villages and the corn fluorine content contrarily to the groundwater fluorine content, which positively correlated to the dental fluorosis index. Based on the obtained results, two recommendations were done to prevent and control dental fluorosis and accelerate the sustainable development in Dali County: to strengthen the use of low fluorine groundwater for drinking water supply, and to widely install the public water purifiers in the rural communities for purifying high-fluorine water to reduce the incidence of dental fluorosis in the population.

Microstructural Analysis of Cancellous Bone in Fluorosis Rats.

Skeletal fluorosis likely alters bone structural properties on the cortical and cancellous tissue levels in view that fluorine ion replaces bone mineral composition. Our previous study showed high bone turnover occurred in cortical bone of skeletal fluorosis. Therefore, this study further analyzed the microstructure of cancellous bone in fluorosis rats. Rats were randomly assigned into three groups: the control, low-dose fluoride group (10 mgF-/kg·day), and high-dose fluoride group (20 mgF-/kg·day). Rats were orally administered with fluoride for 1, 2, and 3 months of periods. The trabecular bone parameters of tibia were detected with micro CT and analyzed with software. The activities of glutathione peroxidase (GPX), superoxide dismutase (SOD), and the content of malondialdehyde (MDA) in serum were measured. Results showed that severity of dental fluorosis rose with the increase of dose and prolongation of fluoride exposure. Meantime, the poorer connectivity and less trabecular bone network were observed in cancellous bone of rats treated with fluoride. Data analysis indicated that fluoride treatment significantly decreased bone volume and connectivity degree, but amplified trabecular space in 1 and 2 months of periods. Intriguingly, trabecular thickness significantly decreased in 1-month high-dose fluoride group, but returned to the control in 3 months of period. Fluoride treatment mainly inhibited the GPX activity and increased the MDA level to activate oxidative stress. This study confirmed that excessive fluoride impaired cancellous bone and caused redox imbalance.