Total Fluoride Intake Research Articles

Effect of bottled fluoridated water to prevent dental caries in primary teeth: study protocol for a phase 2 parallel-group 3.5-year randomized controlled clinical trial (waterBEST)

BackgroundFluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles.MethodswaterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo-controlled, parallel-group trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first 4 years of life. Two hundred children living in eastern North Carolina, USA, and aged 2–6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child’s home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children’s water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child’s fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit.DiscussionwaterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has the potential to prevent early childhood caries in a large segment of the US population that currently does not benefit from fluoridated public water.Trial registration ClinicalTrials.gov NCT04893681. Registered on March 2022. Last update posted on 10 October 2023. https://clinicaltrials.gov/study/NCT04893681?cond=Dental%20Caries%20in%20Children&term=fluoride&locStr=North%20Carolina,%20USA&country=United%20States&state=North%20Carolina&distance=50&rank=1

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.

Patterns of fluoride intake from 6 to 17 years of age: The Iowa Fluoride Study.

This article reports on estimated daily fluoride intake from water, other beverages and selected foods, dentifrice, and dietary fluoride supplements by both individual sources, and all sources combined, among 787 children participating in the Iowa Fluoride Study (IFS) from 6 to 17 years of age. Total daily fluoride intake (mg F) and fluoride intake per kilogram bodyweight (mg F/kg bw) were estimated using responses to questionnaires sent every 3-6months. Dietary assessments included frequencies and amounts of beverage intake for the previous week from water, milk, ready-to-drink beverages, beverages made by adding water to concentrate or powder, and selected foods with substantial water content. Descriptive statistics and bivariate and multivariable analyses with linear mixed models were used to assess associations with each of mg F and mg F/kg bw. Mean combined dietary fluoride (mg F) from all sources examined in the study increased slightly with age, whereas the fluoride intake per kg bw decreased with age. Age, sex, and socioeconomic status were significantly associated with fluoride intake (mg F and mg F/kg bw). Each year increase in age was associated with a 0.02-mg increase in fluoride consumption, on average, after adjusting for the effects of covariates. Daily mean fluoride intakes from single and combined sources were relatively stable, while the intake of fluoride per kg bw decreased from 6 to 17 years of age. Fluoridated water was the major source of ingested fluoride, contributing over 50% of total daily intake at all ages.

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.

Fractional urinary fluoride excretion and nail fluoride concentrations in normal, wasted and stunted 4–5 year-old children in Nepal

IntroductionIt has been suggested that undernourished children are more likely to develop dental fluorosis. We investigated the effects of nutritional status on systemic fluoride metabolism including the proportion of ingested fluoride excreted through urine (i.e. fractional urinary fluoride excretion - FUFE) and fluoride concentration in nail clippings in children, aged 4−5 years, in Nepal. MethodsNutritional status was evaluated using weight-for-age (wasting) and height-for-age (stunting) indices. Total daily fluoride intake (TDFI) was estimated from diet and toothpaste ingestion and 24 -h urine collected to assess daily urinary fluoride excretion (DUFE). FUFE was calculated by dividing DUFE by TDFI. Nail clippings (finger and toe) were collected and analysed for fluoride concentration. ResultsOf the 100 children who participated, 89 provided information to assess FUFE and 51 children provided nail samples. Overall, 86.5 % of the 89 children were wasted and 39.3 % were stunted.When the samples were pooled into binary (affected and non-affected) categories, mean TDFI and mean DUFE were statistically significantly higher in the 77 wasted children (57.7 and 29.7 μg/kgbw/d, respectively) than the 12 non-wasted children (39.4 and 17.0 μg/kgbw/d, respectively). TDFI and DUFE were also statistically significantly higher in the 35 stunted children (65.1 and 34.5 μg/kgbw/d, respectively) than in the 54 non-stunted children (48.8 and 23.7 μg/kgbw/d, respectively). However, mean FUFE was similar in all groups. There were no statistically significant differences in fluoride concentration of either fingernails or toenails among the different categories of wasting, while mean fingernail fluoride concentration was statistically significantly higher in stunted (5.4 μg/g) than in non-stunted children (3.5 μg/g). ConclusionOur study found no significant effect of nutritional status on the proportion of ingested fluoride excreted in urine (and consequently the proportion retained in the body). These findings suggest that nutritional status may be less likely to be a main risk factor for the development of dental fluorosis than children's dietary habits or total fluoride intake.

Fluoridation cessation and children's dental caries: A 7-year follow-up evaluation of Grade 2 schoolchildren in Calgary and Edmonton, Canada.

ObjectivesWe examined the effect of fluoridation cessation on children's dental caries experience in the Canadian cities of Calgary (cessation in 2011) and Edmonton (still fluoridated).MethodsWe used a pre‐post cross‐sectional design with comparison group. We studied Grade 2 schoolchildren (approximately 7 years old) 7‐8 years after fluoridation cessation in Calgary, thus capturing children born after cessation occurred. Data collection included a dental examination conducted in school by calibrated dental hygienists, a questionnaire completed by parents, and fingernail clippings for a small subsample. Our overall analytic approach was twofold. We first examined differences in dental caries experience (deft and DMFT, and smooth surface caries based on defs and DMFS) between Calgary and Edmonton and over time (comparing 2018/2019 data to pre‐cessation and early post‐cessation surveys in our setting). Second, we evaluated whether differences were likely to reflect fluoridation cessation in Calgary, rather than other factors.ResultsThe prevalence of caries in the primary dentition was significantly higher (P < .05) in Calgary (fluoridation cessation) than in Edmonton (still fluoridated). For example, crude deft prevalence in 2018/2019 was 64.8% (95% CI 62.3‐67.3), n = 2649 in Calgary and 55.1% (95% CI 52.3‐57.8), n = 2600 in Edmonton. These differences were consistent and robust: they persisted with adjustment for potential confounders and in the subset of respondents who were lifelong residents and reported usually drinking tap water; they had widened over time since cessation; and they were corroborated by assessments of dental fluorosis and estimates of total fluoride intake from fingernail clippings. Findings for permanent teeth were less consistent, which likely reflects that 7‐year‐olds have not had the time to accumulate enough permanent dentition caries experience for differences to have become apparent.ConclusionsOur findings are consistent with an adverse impact of fluoridation cessation on children's dental health in Calgary and point to the need for universal, publicly funded prevention activities—including but not limited to fluoridation.

Exposure Assessment of Fluoride Intake Through Commercially Available Black Tea (Camellia sinensis L.) from Areas with High Incidences of Chronic Kidney Disease with Undetermined Origin (CKDu) in Sri Lanka.

Fluoride is a beneficial trace element for human health as its deficiency and excess levels can cause detrimental health effects. In Sri Lanka, dry zone regions can have excessive levels of fluoride in drinking water and can cause dental and skeletal fluorosis. In addition to drinking water, traditional habits of tea consumption can cause an additional intake of fluoride in the population. A total number of 39 locally blended black tea samples were collected from a village where chronic kidney disease with undetermined origin (CKDu) is prevalent. In addition, unblended tea samples were obtained from tea-producing factories. The fluoride contents in infusions of 2% weight per volume (w/v) were measured using calibrated ion-selective fluoride electrodes. The mean fluoride content was 2.68±1.03 mg/L in loose tea, 1.87±0.57mg/L in packed tea samples, and 1.14±0.55 mg/L in unblended tea. Repeated brewing of the same tea leaves showed that over 50% of fluoride leached into the solution in the first infusion. An estimate of the daily total average fluoride intake via tea consumption per person is 2.68 mg per day. With groundwater in many dry zone regions in Sri Lanka showing high fluoride levels that exceed 0.5 mg/L, the additional daily intake can rapidly exceed recommended thresholds of 2 mg/day. This can add to adverse health impacts that might also relate to CKDu.

Fluoride exposure and factors affecting dental caries in preschool children living in two areas with different natural levels of fluorides

BackgroundSuccessful oral health interventions must be based on the specific needs of the population that they serve. Evaluation of habits related to dental caries development and estimation of fluoride exposure in a target group of young patients helps to plan effective and safe caries prevention strategies. ObjectivesThe study aimed to evaluate factors affecting dental caries experience and sources of fluoride exposure in preschool children living in two areas: with optimal and low natural content of fluoride in drinking water. Materials and methodsThe study included a group of 73 children of both sexes aged 4–7 years attending two kindergartens in Środa Wielkopolska and Turek (Wielkopolska Voivodeship, Poland), where the content of fluoride in drinking water according to data obtained in the sanitary station ranged from 0.68 to 0.74 mg/L (optimal concentration of fluoride) and from 0.19 to 0.30 mg/L (low concentration of fluoride), respectively. Parents of patients completed a survey about diet, hygiene, and dental care, taking into account the child's fluoride exposure. The calibrated dentist assessed the oral health condition using a mirror, a CPI probe, and a headlamp. Oral hygiene was recorded using the Silness and Löe plaque index, caries experience by calculating the numbers of decayed, missing, and filled primary, and permanent teeth (dmf and DMF, respectively) while caries frequency by calculating the percentage of children with caries experience above 0. In order to assess the fluoride concentrations in urine and drinking water, parents were asked to provide a urine sample collected on fasting and a tap water sample. Fluoride concentrations were assessed using a 09–37 (MARAT) fluoride ion-selective electrode and a RAE 111 silver-chloride reference electrode. Statistical analysis was conducted using the data analysis software system Statistica (version 12, StatSoft, Inc. 2014), assuming a statistical significance level p < 0.05. ResultsNo statistically significant differences were found between caries indices of the examined children in each kindergarten (p > 0.05). Urinary fluoride levels were higher in children who tended to swallow toothpaste or used fluoride rinses and positively correlated with fluoride concentrations in the drinking water. Dental caries experience in the examined children depended on the effectiveness and frequency of oral hygiene procedures and dietary habits. ConclusionsThe strategy aimed at improving the oral health of the examined group of children should include accomplishing oral hygiene, promoting a non-cariogenic diet, and, finally, controlling fluoride exposure from at-home fluoride products. Caries prevention program ought to be adjusted to individual characteristics of each child, taking into consideration oral hygiene practices, dietary habits and total fluoride intake.

Beverage Intakes and Toothbrushing During Childhood Are Associated With Caries at Age 17 Years

BackgroundSugar-sweetened beverages (SSBs) have been associated with childhood caries; however, associations among lifelong beverage intakes and adolescent caries have received less attention. ObjectiveTo investigate associations between beverage intakes during childhood and adolescence and caries experience at 17 years of age, while adjusting for fluoride intakes and toothbrushing. DesignDescriptive model analyses were conducted on data collected from a longitudinal birth cohort study. Participants/settingParticipants included Iowa Fluoride Study members (n = 318) recruited at birth between 1992 and 1995 with at least 6 beverage questionnaires completed from ages 1 to 17 years and a caries examination at age 17. ExposurePredictors included mean daily milk, juice (100% juice and juice drinks before age 9), SSB (including juice drinks after age 9), and water/sugar-free beverage (SFB) intakes; daily fluoride intakes; and daily toothbrushing frequencies for ages 1 to 17. Main outcome measuresThe outcome was dental caries count at age 17, adjusted for the number of scored tooth surfaces (decayed and filled surfaces attack rate [DFSAR]). Statistical analyses performedUnivariable generalized linear models were fit for each predictor and the outcome DFSAR. Multivariable models assessed combined effects of beverage types, fluoride variables, toothbrushing, sex, and baseline socioeconomic status. ResultsBased on multivariable models, each 8 oz of additional daily juice and water/SFB decreased expected DFSAR by 53% (95% confidence interval [CI]: 17%-73%) and 29% (95% CI: 7%-46%), respectively, and 8 additional oz SSBs increased expected DFSAR by 42% (95% CI: 5%-92%), after adjustment for other beverage intakes, toothbrushing, total fluoride intake excluding SSB fluoride (non-SSB total fluoride), sex, and baseline socioeconomic status. Each additional daily toothbrushing event decreased expected DFSAR by 43% (95% CI: 14%-62%) after adjustment for beverage intakes, non-SSB total fluoride intake, sex, and baseline SES. ConclusionsHigher juice and water/SFB intakes and more toothbrushing were associated with lower caries at age 17, while higher SSB intakes were associated with higher caries.

Health risk assessment of co-occurrence of toxic fluoride and arsenic in groundwater of Dharmanagar region, North Tripura (India)

The present study assessed the co-occurrence of fluoride and arsenic in groundwater of Dharmanagar region (Tripura, India). Co-occurrence of the two toxicants was observed in 59% of the analyzed groundwater samples (n = 71), out of which concentrations of both the toxicants exceeded the World Health Organization drinking water standards in 30% samples. Significant positive correlation (r = 0.6) was observed between groundwater fluoride (<0.005–4.8 mg/l) and arsenic (<0.003–0.044 mg/l) contents. The range of cumulative estimated daily intakes (EDI) in the studied population was: 0.07–0.1 and 0.13–0.18 mg/kg-day for the Central Tendency Exposure (CTE) and the Reasonable Maximum Exposure (RME) scenarios, respectively. The EDI (fluoride) for the children of the study area was already found to reach the ‘Tolerable Upper Intake Level’ (UL) value (0.1 mg/kg-day), and the children are thus at high risk from developing dental fluorosis. Irrespective of the CTE or RME scenario, the hazard index of fluoride (HIFluoride = 1.2–3) and that of arsenic (HIArsenic = 1.5–5) were always found to be unsafe (HI > 1) in the studied population. The estimated Cumulative Noncancerous Lifetime Hazard Index for simultaneous fluoride and arsenic exposures was calculated to be prominently high (10 and 22 for the CTE and RME scenarios, respectively). The average urinary fluoride and arsenic contents of the studied population was observed to be correlated (r = 0.46 and 0.69) with the groundwater fluoride and arsenic concentrations, respectively. The observed content of urinary fluoride (mean = 3.1 ± 1.2 mg/l) of the studied population was determined to be 65–163% of their total fluoride intakes (1.9–7.2 mg/day). The obtained results are highly alarming and thus for reducing threats to human health, the government should immediately take necessary action for supplying safe drinking water for the residents.

Fluoride content of commercial drinking water and carbonated soft drinks available in Southeastern Nigeria: dental and public health implications.

The importance of fluoride in preventing dental diseases cannot be overemphasized. The aim of this study was to determine the fluoride content of commercial bottled water, sachet water and carbonated soft drinks available in Southeastern-Nigeria at the same time, eliciting their dental and public health implications. Determination of fluoride level in water and carbonated drinks was carried out using Colorimetric-SPADNS (Trisodium 2-(4-sulfophenylazo)-1, 8-dihydroxynaphthalene-3, 6-disulfonate) method. This is a simple and rapid technique with high accuracy. 10 brands of bottled water, 10 brands of carbonated soft drinks and 20 brands of sachet water were studied. The experiment for each brand was carried out in duplicates and mean fluoride concentrations generated. Data analysis was done using SPSS version 17. Fluoride contents in mg/L of bottled water brands ranged from 0.0173 ± 0.0019 mg/L to 0.1607 ± 0.0630 mg/L [mean: 0.0442 ± 0.0184 mg/L] and that of sachet water brands was from 0.0131 ± 0.0019 mg/L to 0.1754 ± 0.1344 mg/L. Mean fluoride content of carbonated soft drinks was 0.0228 ± 0.0064 mg/L with one of the brands having as low as 0.0066 ± 0.0028 mg/L fluoride. None of the drinks investigated contained level of fluoride up to standard admissible values suggesting sub-optimal intake. As the suitability of advice on fluoride use in preventing dental abnormalities depends on the individual's total fluoride intake from drinks and other sources, a further study is warranted to relate this total with the baseline decayed missing and filled teeth of the population.

Фториды: их значение для здоровья человека в современных условиях и перспективы использования

The article highlights the current issues in modern conditions which are associated with the consumption of fluoride by the population of Russia, including individual oral care products. It is noted that fluorides have unconditional physiological significance for the human body, its health, including dental. The effectiveness of fluoride drugs and their effect on the reduction of dental caries is widely documented in foreign and domestic literature and thus it is an indisputable fact. Despite the fact that there is no generally accepted agreement on the mechanism of fluorine action, there is no doubt in its anti-caries action. The most intensive inclusion of fluorides in the composition of the hard tissues of teeth occurs during their formation and mineralization. At the end of teeth growth and mineralization, the enamel and dentin become less permeable to fluoride ions. The optimal daily intake of fluoride should range between 0.05 and 0.07 mg / kg body weight. Total fluoride intake should not exceed 0.1 mg / kg of body weight per day in order to avoid the appearance of dental and bony fluorosis. Recommendations on the use of fluoride-containing oral care products are given. It was noted that the problem of preserving the somatic and dental health of the population of Russia, including the prevention of dental caries, should be addressed in the context of climate-geographical, environmental, medical and social aspects, in the solution of which fluorides should play a significant role.

Influence of Fluoridated Groundwater and 1,100 Ppm Fluoride Dentifrice on Biomarkers of Exposure to Fluoride.

This research aimed to determine the influence of fluoridated groundwater and 1,100 ppm fluoride dentifrice on biomarkers of exposure to fluoride in preschoolers. A cross-sectional study was performed on thirty preschoolers recruited from naturally fluoridated and non-fluoridated areas (n=15). Total Daily Fluoride Intake (TDFI) from diet and dentifrice, and Daily Urinary Fluoride Excretion (DUFE) was measured over 24 h. Nails samples were collected twice during 30 days. Fluoride analyses were performed using a fluoride-ion-specific electrode. Data were evaluated using the Student and paired t-test, Pearson correlation analysis, multiple linear regression analysis (α≤0.05). Fluoridated groundwater and dentifrice were the dominant sources (r2 > 0.83) of TDFI in children from a naturally fluoridated and a non-fluoridated area, respectively. A positive correlation between TDFI and DUFE (r=0.50), and between [F] in fingernails and toenails (r=0.60) were found in children from a naturally fluoridated area. The [F] in nails of finger and toe were not correlated to TDFI. The consumption of fluoridated groundwater influenced the fluoride concentration in urine. In addition, the use of 1,100 ppm fluoride dentifrice did not influence the fluoride concentration in urine and fingernails.

Is the fluoride intake by diet and toothpaste in children living in tropical semi-arid city safe?

Data about total fluoride intake in children living in a tropical semi-arid climate city is scarce, thus we conducted this study. Fifty-eight children aged two to five years, living in a Brazilian tropical city with optimally fluoridated water were selected. Dietary samples were collected using the duplicate diet method on two non-consecutive days in the children's home toothpaste was determined by subtracting the amount of fluoride recovered after brushing from the amount placed on the toothbrush. The mean total dose (SD) of fluoride intake was 0.043(0.016) mg F·kg-1·d-1, with the major (60.6%) contribution from water. The factors associated with the ingestion of fluoride from toothpaste were fluoride concentration of the toothpaste (p = 0.03) and the use of kids toothpaste (p = 0.02). The findings suggest that children have a low fluoride intake, measured by at-home meals and use of fluoride toothpaste; drinking water is the main source of fluoride ingestion.

Exploring the short-term impact of community water fluoridation cessation on children's dental caries: a natural experiment in Alberta, Canada

ObjectivesDental caries (tooth decay) is common and can be serious. Dental caries is preventable, and community water fluoridation is one means of prevention. There is limited current research on the implications of fluoridation cessation for children's dental caries. Our objective was to explore the short-term impact of community water fluoridation cessation on children's dental caries, by examining change in caries experience in population-based samples of schoolchildren in two Canadian cities, one that discontinued community water fluoridation and one that retained it. Study designWe used a pre-post cross-sectional design. MethodsWe examined dental caries indices (deft [number of decayed, extracted, or filled primary teeth] and DMFT [number of decayed, missing, or filled permanent teeth]) among grade 2 schoolchildren in 2004/05 and 2013/14 in two similar cities in the province of Alberta, Canada: Calgary (cessation of community water fluoridation in 2011) and Edmonton (still fluoridated). We compared change over time in the two cities. For Calgary only, we had a third data point from 2009/10, and we considered trends across the three points. ResultsWe observed a worsening in primary tooth caries (deft) in Calgary and Edmonton, but changes in Edmonton were less consistent and smaller. This effect was robust to adjustment for covariates available in 2013/14 and was consistent with estimates of total fluoride intake from biomarkers from a subsample. This finding occurred despite indication that treatment activities appeared better in Calgary. The worsening was not observed for permanent teeth. For prevalence estimates only (% with >0 deft or DMFT), the three data points in Calgary suggest a trend that, though small, appears consistent with an adverse effect of fluoridation cessation. ConclusionsOur results suggest an increase in dental caries in primary teeth during a time period when community fluoridation was ceased. That we did not observe a worsening for permanent teeth in the comparative analysis could reflect the limited time since cessation. It is imperative that efforts to monitor these trends continue.

Total daily fluoride intake and fractional urinary fluoride excretion in 4- to 6-year-old children living in a fluoridated area: weekly variation?

Risk of development of dental fluorosis may increase with even a short-term increase in fluoride (F) intake during tooth formation. Considering the wide variations in F concentrations of different food and drinks, it is important to assess short-term differences in F intake and consequently fractional urinary F excretion (FUFE) in children, which provide an indication of F body burden. Therefore, the aim of this study was to investigate weekly variation in total daily F intake (TDFI) and its sources and fractional urinary F excretion (FUFE) in 4- to 6-year-olds living in a fluoridated area in the UK. Sixty-one children were surveyed twice with a 1-week gap between surveys. Dietary F intake was assessed by 'food-diary' and 'duplicate-plate collection'. Toothbrushing expectorate (saliva/toothpaste) was collected to estimate F intake from toothpaste ingestion. TDFI was calculated from dietary F intake and toothpaste ingestion. Daily urinary F excretion (DUFE) was estimated by collecting 24-h urine samples and FUFE was calculated from DUFE and TDFI [FUFE = (DUFE/TDFI) × 100]. The overall mean TDFI, DUFE and FUFE for all children were 0.056 (SD 0.036) mg/kgbw/day, 0.018 (SD 0.007) mg/kgbw/day and 39 (SD 20)%, respectively. The mean (95% CI) difference between the 2 weeks studied was 0.004 (-0.004, 0.011) mg/kgbw/day for TDFI, 0.002 (-0.001, 0.004) mg/kgbw/day for DUFE and 1 (-6, 8)% for FUFE. Mean TDFI and FUFE did not vary statistically significantly with week and therefore one set of data collection from a group of children living in a temperate climate could be sufficient to monitor F exposure and F body burden in community prevention programmes for oral health.

Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation.

The Republic of Ireland (RoI) is the only European Country with a mandatory national legislation requiring artificial fluoridation of drinking water and has the highest per capita consumption of black tea in the world. Tea is a hyperaccumulator of fluoride and chronic fluoride intake is associated with multiple negative health outcomes. In this study, fifty four brands of the commercially available black tea bag products were purchased and the fluoride level in tea infusions tested by an ion-selective electrode method. The fluoride content in all brands tested ranged from 1.6 to 6.1 mg/L, with a mean value of 3.3 mg/L. According to our risk assessment it is evident that the general population in the RoI is at a high risk of chronic fluoride exposure and associated adverse health effects based on established reference values. We conclude that the culture of habitual tea drinking in the RoI indicates that the total cumulative dietary fluoride intake in the general population could readily exceed the levels known to cause chronic fluoride intoxication. Evidence suggests that excessive fluoride intake may be contributing to a wide range of adverse health effects. Therefore from a public health perspective, it would seem prudent and sensible that risk reduction measures be implemented to reduce the total body burden of fluoride in the population.

Total Fluoride Intake by Children from a Tropical Brazilian City

The main sources of fluoride intake by children are fluoridated water and toothpaste. Little has been studied regarding fluoride intake from these sources in regions with tropical climates and high temperatures throughout the year. This study aimed to determine the amount of fluoride ingested from diet and tooth brushing by children who live in a city with a tropical climate. Sixty-seven children from Teresina, Piauí, Brazil, took part in this study. The city's water supply was optimally fluoridated. The duplicate-diet method was used to determine the fluoride intake from diet. The intake of fluoride from dentifrice was determined by subtracting the amount of fluoride placed on the toothbrush and that recovered after brushing. The concentration of fluoride was measured using an ion-specific electrode and is expressed as milligrams/kilogram of body weight/day. The mean (±SD) total amount was 0.071 ± 0.036 mg F/kg body weight/day, and the relative contributions of diet and toothpaste were 0.025 ± 0.010 and 0.046 ± 0.035, respectively. The factors associated with fluoride intake from toothpaste were: use of children's toothpaste (p = 0.003), use of large amounts of toothpaste (p < 0.001), and a high frequency of tooth brushing (p = 0.003). Sixty-four percent of children had an intake of less than 0.07 mg F/kg body weight/day, which is considered the upper limit for an aesthetically tolerable fluorosis risk. The results suggest that the amount of fluoride ingested by most children who live in a Brazilian city with a tropical climate is considered safe in terms of the risk of dental fluorosis.

Safety evaluation on pH and fluoride content of locally available and packaged milk as a potential factor in dental fluorosis in Jaipur, India

Abstract Objective: Milk being the most consumed food in the 1st years of life and the fluoride exposure through infant foods including milk, during the critical period of tooth development may lead to dental fluorosis. Thus, the aim of the study was to assess and compare the pH using digital pH meter and fluoride content using the spectrophotometric method of locally available and packaged milk in Jaipur. Materials and Methods: Fluoride and pH analysis were carried out among 3 milk groups: (i) Locally available milk (ii) packet milk and (iii) packaged tetra-pack milk. A total of 19 samples were included in the study. Results: The mean fluoride content was found to be 0.017 (±0.003 standard error of mean) with a range of 0.001-0.02. The pH of the milk samples was found to be in the range of 4.46-7.11. Conclusion: In view of the results of the present study, milk consumption has no major impact on total daily dietary fluoride intake, but the pH of the soy-based tetra-pack milk was found to be less than critical pH.