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PubMed1988

Fluoride and fluoridation.

To date, many of the ways of controlling tooth decay involve the use of fluorides. Either systemically via fluoridated water and tablets, or, topically, with fluoride-containing toothpaste and mouthrinses. There is now evidence that the prevalence of dental caries is declining in communities with unfluoridated water, as well as in those with fluoridated water. This phenomenon may be related to an increase of fluoride in the food chain; the unintentional ingestion of fluoride-containing dental health products; and the increasing contamination of the total environment with fluoride emissions and solid wastes from many industries. The apparent usefulness of fluoride as a preventive against dental caries does not mean that unnecessary exposure to the element should be tolerated. Fluoride at very low concentrations is phytotoxic and harmful to livestock; and in man, excessive intakes of fluoride over many years may lead to a well-defined disorder--skeletal fluorosis. In addition, a number of recent studies have suggested that fluoride may be genotoxic.

Adolescent↗
PubMed1990

Enamel fluoride uptake affected by site of application: comparing sodium and amine fluorides.

In enamel fluoride uptake studies, the most frequently sampled site is the middle third of the buccal surface. Because different parts of the enamel surface vary in fluoride concentration, the present study investigated fluoride uptake at contrasting sites using two different topical agents. One was a neutral aqueous solution of sodium fluoride containing 2% w/w of fluoride, and the second was an aqueous solution of two amine fluorides containing 1% w/w of fluoride. The enamel of 10 pairs of clinically sound extracted human premolars was etched initially and after treatment with one of these agents on the cervical and middle thirds of the buccal surface and on the proximal surface, yielding the pre- and post-treatment fluoride concentrations of these sites at depths of 5 and 10 microns from the surface. Enamel treated with the amine F solution had significantly higher fluoride uptakes at all sites compared to the NaF-treated specimens. The differences in uptake from the two agents varied with site, being smallest for the buccal middle third enamel and greatest for the proximal enamel. It is suggested that these results relate to possible differences in enamel maturation or to the presence of initial proximal caries, and the greater affinity of amine fluoride for porous enamel. The findings emphasise the importance of obtaining site-specific data in the study of fluoride in enamel.

Adolescent↗
PubMed2006

Effects of individual and combined exposure to sodium arsenite and sodium fluoride on tissue oxidative stress, arsenic and fluoride levels in male mice.

Arsenic and fluoride are potent toxicants, widely distributed through drinking water and food and often result in adverse health effects. The present study examined the effects of sodium meta-arsenite (100 mg/l in drinking water) and sodium fluoride (5 mg/kg, oral, once daily), administered either alone or in combination for 8 weeks, on various biochemical variables indicative of tissue oxidative stress and cell injury in Swiss albino male mice. A separate group was first exposed to arsenic for 4 weeks followed by 4 weeks of fluoride exposure. Exposure to arsenic or fluoride led to a significant depletion of blood delta-aminolevulinic acid dehydratase (ALAD) activity and glutathione (GSH) level. These changes were accompanied by increased level of blood and tissues reactive oxygen species (ROS) level. An increase in the level of liver and kidney thiobarbituric acid reactive substance (TBARS) along with a concomitant decrease in the activities of superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx) and reduced GSH content were observed in both arsenic and fluoride administered mice. The changes were significantly more pronounced in arsenic exposed animals than in fluoride. It was interesting to observe that during combined exposure the toxic effects were less pronounced compared to the effects of arsenic or fluoride alone. In some cases antagonistic effects were noted following co-exposure to arsenic and fluoride. Arsenic and fluoride concentration increased significantly on exposure. Interestingly, their concentration decreased significantly on concomitant exposure for 8 weeks. However, the group which was administered arsenic for 4 weeks followed by 4 weeks of fluoride administration showed no such protection suggesting that the antagonistic effect of fluoride on arsenic or vice versa is possible only during interaction at the gastro intestinal sites. These results are new and interesting and require further exploration.

Alanine Transaminase↗
PubMed1999

Dental plaque fluoride and pH in children exposed to different water fluoride levels.

The aims of this study were to determine plaque fluoride concentrations in children not exposed to topical fluorides but to different fluoride levels in the drinking water (0.1 and 2.0 ppm), and to observe whether plaque fluoride was related to plaque pH. Twenty-five children (6 to 7 years old) were selected from two rural villages in Brazil. A sub-set of subjects was examined for resting and fermenting plaque pH before sampling. A maximum of 14 sites was studied in each subject (vestibular and interproximal of first molars and central incisors). Plaque fluoride was extracted and measured with an inverted fluoride electrode under oil. Amounts of plaque were determined by protein analysis. Mean values in the 0.1 ppm village were 1.3 ngF/mg of plaque wet weight (SD = 1.1) and in the 2.0 ppm village 2.5 ngF/mg (SD = 2.1) and were not statistically different (Kruskal-Wallis test, P = 0.09). Plaque fluoride varied considerably from site to site in the same mouth. Combining sites in all subjects, plaque fluoride concentrations were positively related to resting and fermenting pH (regression analysis, P< 0.01-0.001, adjR2 = 0.12-0.31). On an individual basis the same trend was found for fermenting, but not for resting pH. In conclusion, our findings showed a moderate influence of water fluoride upon dental plaque fluoride concentrations and give some support to the theory that low fermenting pH may contribute to the release of bound plaque fluoride.

Analysis of Variance↗
PubMed1981

Fluoride balance studies in ambulatory healthy men with and without fluoride supplements.

Fluoride balances were determined in healthy adult males under metabolic ward conditions. This is the first fluoride study to use the diffusion method in exploring the balances of subjects ingesting basal (i.e., everyday) diets with deionized water for cooking and drinking. Certain groups were given daily supplements of 5 or 10 mg. fluoride as sodium fluoride in divided doses with meals. Fluoride was measured in the diets, sodium fluoride tablets, urine, feces, and serum. Approximately 90% of the fluoride excreted was found in the urine and the remainder in the feces in all groups. In the control subjects, fluoride balances were uniformly negative (mean of -0.40 mg/day); in contrast, balances were uniformly positive (mean of +1.38 and +2.88 mg/day, respectively) in subjects receiving 5 or 10 mg F supplements daily. Serum ionic fluoride concentration increased proportionally to fluoride intake and averaged 0.016, 0.029, and 0.040 ppm in the control, 5-mg and 10-mg groups, respectively. These fluoride supplements did not cause any clinical or laboratory abnormality in any subjects.

Adult↗
PubMed1995

Effects of lifelong consumption of fluoridated water or use of fluoride supplements on dental caries prevalence.

This study was undertaken to determine the prevalence of dental caries in children ages 6-14, from fluoridated and non-fluoridated areas in British Columbia, Canada, and the effects of receiving certain fluoride preventive procedures during childhood. Children from two communities were surveyed using a modified Decayed, Missing and Filled Tooth Surface Index (D1D2MFS). Questionnaires on the use of various fluoride preventive practices and residence histories during childhood were collected. Completed questionnaires were returned and exams were performed on 1131 children. Crude caries prevalence scores for the different fluoride exposure groups were tested for differences in dental age and the level of educational attainment of parents and/or guardians. No significant group differences were found. The 110 children with lifelong exposure only to fluoridated water had 35%, or 0.88 (S.D. = 2.91), fewer decayed or filled tooth surfaces per child (P < 0.07) than children with no reported exposure to systemic fluorides. For the 122 children who had taken fluoride supplements for 4 yr or more, 0.67 fewer decayed and filled tooth surfaces (26% reduction) were observed per child when compared to children with no exposure to fluoridated water or supplements. For children who used fluoride supplements for less than 4 yr, no significant benefits were observed. Approximately 75% of the caries prevalence for control and fluoride-exposed groups was on pit and fissured surfaces. Reductions by surface type showed savings on both smooth and pit and fissured surfaces.

Adolescent↗
PubMed1997

Digital radiographic measurement of approximal caries progression in fluoridated and non-fluoridated areas of Rio de Janeiro, Brazil.

The effect of fluoridation on approximal caries progression was investigated using serial digitized bitewing images and conventional film images of 290 12-16-year-old schoolchildren who were lifetime residents of either Rio de Janeiro (a fluoridated area) or Mangaratiba and Angra dos Reis (non-fluoridated areas) in the state of Rio de Janeiro, Brazil. One examiner scored a maximum of 28 approximal surfaces of posterior teeth per subject using both methods. The intraexaminer reliability for rating lesion depth with digital images was comparable with that of the conventional bitewing films (namely, intraclass correlation of 0.99 and weighted Kappa scores of 0.82, respectively). Approximal surface D1S was 3.17 +/- 0.25 (sx) in fluoridated areas and 6.64 +/- 0.44 in non-fluoridated areas. After 1 year, the rate of caries progression in approximal surfaces was significantly lower in the fluoridated areas (0.54 +/- 0.14) as compared with the non-fluoridated areas (1.41 +/- 0.20) using Pitts' scoring system for conventional bitewing radiographs (P < 0.001). Similarly, the digital radiographic method was able to detect subtle differences in approximal caries progression in the enamel and the dentin (overall mean: 0.34 mm/year in fluoridated areas vs 0.49 mm/year in non-fluoridated areas, P < 0.05). The two radiographic methods were strongly correlated (rs = 0.7). Assuming a constant rate over time, these results indicate that lesion progression from the outer half of the enamel into the outer half of the dentin takes approximately 3-4 years in schoolchildren from the fluoridated areas compared to 2 1/2 years in the non-fluoridated areas.

Adolescent↗
PubMed2004

Low-levels of fluoride in plaque and saliva and their effects on the demineralisation and remineralisation of enamel; role of fluoride toothpastes.

AIM: To summarise support for current consensus on the likely means by which fluoride toothpastes reduce caries and review some relevant studies of the effect of low levels of fluoride on the demineralisation and remineralisation of enamel. The major anti-caries effect of fluoride toothpastes is thought to result from small but protracted elevations in levels of fluoride in plaque and saliva. Fluoride incorporated into enamel systemically does not reduce enamel solubility sufficiently to exert an anti-caries effect. Fluoride has the potential to exert an anti-caries benefit largely through three mechanisms; inhibition of demineralisation, promotion of remineralisation and interference with bacterial growth and metabolism. However, the low levels of fluoride thought to influence caries are insufficient to have a significant effect via the latter mechanism. Thus reductions in caries resulting from the use of fluoride toothpastes can be linked to modification of the demineralisation/remineralisation balance by direct effects on dental mineral exerted topically by low levels of fluoride. Numerous in vitro studies have shown that low levels of fluoride, typical of those found after many hours in resting plaque and saliva, and resulting from the regular use of fluoride toothpastes, can have a profound effect on enamel demineralisation and remineralisation.

Cariostatic Agents↗
PubMed1998

In vitro enamel and cementum fluoride uptake from three fluoride-containing composites.

The incorporation of fluoride into restorations is desirable because of its cariostatic action. The purpose of this study was to determine fluoride release and fluoride uptake by enamel and cementum from three visible light-cured fluoride-containing composites. Seven circular discs of each composite were prepared and the amount of fluoride released into distilled water was determined at daily intervals for 14 days and then after 30, 60 and 90 days. The fluoride concentration in enamel and cementum was determined in three successive depths by an acid etch biopsy procedure. The composite slabs were made and ligated to the enamel and cementum surfaces and the teeth were immersed in synthetic saliva for 7 days. After removal of the composite slabs, three successive biopsies were again performed. Then the teeth were immersed in 1 M KOH for 24 h and similar biopsies done. The fluoride concentrations were adjusted to standardized depths of 10microm, and the total and bound fluoride uptake calculated. The amounts of fluoride released were significantly different among the three composites. The fluoride released decreased sharply after 1 day and then gradually reached a plateau. As for the enamel and cementum fluoride uptake, FluorEver showed the largest uptake followed by FluoroCore and then Pertac-Hybrid.

Acid Etching, Dental↗
PubMedDate not supplied

Fluoride in plaque fluid, plaque, and saliva measured for 2 hours after a sodium fluoride monofluorophosphate rinse.

Sodium monofluorophosphate (NaMFP) and sodium fluoride (NaF) are the two most common sources of fluoride used in currently marketed fluoride dentifrices. The purpose of this study was to investigate the effect of mouth rinses containing NaF or NaMFP on the concentrations of fluoride, or the MFP ion, in saliva, whole plaque, and plaque fluid. Twelve subjects abstained from tooth brushing for 48 h, fasted overnight, and then rinsed 1 min with 12 mmol/l (228 ppm [microg/g] F) NaF or NaMFP in the morning. Before the rinse and at 30, 60 and 120 min afterwards, upper and lower molar and premolar plaque samples and whole saliva samples were collected. Aliquots of plaque fluid and centrifuged saliva were obtained from these samples, and the whole plaque residue acid extracted. The F and MFP concentrations were then measured in these samples using ultramicro methods. For both rinses, a higher concentration of plaque fluid fluoride was found at lower molar sites while the reverse was true for the whole plaque fluoride. Furthermore, for both rinses, plaque fluid, whole plaque, but not salivary, fluoride concentrations were above baseline at 120 min. Following the NaMFP rinse, a substantial amount of unhydrolyzed MFP was found in plaque fluid and saliva. Although there was a very large range in these measurements, fluoride in plaque fluid (excluding fluoride in unhydrolyzed MFP) and whole plaque were significantly (p<0.05) greater after the NaF rinse at all time periods. In saliva, the NaF rinse produced a statistically significant greater salivary fluoride (excluding fluoride in unhydrolyzed MFP) only at 60 min. The lack of a clear correlation between these measurements and clinical studies suggest a novel mechanism may enhance the effectiveness of NaMFP dentifrices.

Adult↗
PubMed2006

Fluoride intake from food and liquid in Japanese children living in two areas with different fluoride concentrations in the water supply.

The purpose of this study was to estimate the average daily amount of fluoride from the diet ingested by Japanese children of ages susceptible to dental fluorosis in two areas with different fluoride concentrations in the water supply. Thirty-eight children aged 2-8 years participated in a survey of fluoride intake. Twenty-one out of 38 children lived in an area in which the community water fluoride concentration was an average of 0.555 ppm (moderate fluoride area: MFA), and 17 lived in a low fluoride area (LFA), which ranged between 0.040 and 0.131 ppm. To measure the fluoride intake, diets were collected with a duplicate-diet technique. The fluoride concentrations in each sample were measured using the diffusion technique of Taves and the electrode technique. Meanwhile, after clinical examinations for dental caries and fluorosis, 228 subjects aged 13-15 years were selected for analysis from the same communities. The mean DMFT in the MFA was significantly lower than that in the LFA. The severest grade of dental fluorosis observed was 'very mild' according to Dean's fluorosis index in both areas. The total daily fluoride intakes were 0.0252-0.0254 mg F/kg/day in the MFA and 0.0126-0.0144 mg F/kg/day in the LFA. Differences in the fluoride concentration of drinking water in this study were reflected in the fluoride intake from the diet in a typical Japanese diet.

Adolescent↗
PubMed1995

Fluoride distribution of rat molar cementum in relation to age and fluoride levels in the drinking water.

The present study was undertaken to determine the fluoride distribution profile in rat molar cementum with age in relation to fluoride in drinking water. Fifty-four female Wistar rats were used for the experiment. Before the experiment 6 rats were killed under chloroform anesthesia at 4 weeks of age as controls. The remaining 48 rats were divided into two groups: a control group given distilled water and the other group given water containing 100 ppm fluoride ad libitum. Six rats from each group were killed at the ages of 6, 12, 24, and 48 weeks. The fluoride distribution in the molar cementum was analyzed from the surface to the cementodentinal junction by abrasive microsampling. The fluoride concentrations in molar cementum from control rats on distilled water remained relatively constant until 24 weeks. A small increase then occurred between 24 and 48 weeks. The fluoride concentration in cementum from rats drinking water containing 100 ppm fluoride increased markedly with age, both in outer and inner regions of the molar cementum for all rats. On the other hand, the fluoride concentration in the cementum of older rats drinking water with 100 ppm fluoride was significantly higher in the outer than in the inner region of the cementum. It was concluded that the fluoride distribution in rat molar cementum may increase throughout life in relation to the fluoride level in the drinking water.

Age Factors↗
PubMedDate not supplied

Nails as biomarkers of fluoride in children of fluoridated communities.

PURPOSE: The objective of this study was to verify the use of nails as biomarkers of chronic fluoride (F) exposure from the diets of children living in communities with negligibly or optimally fluoridated water. METHODS: Fifteen 2- to 6-year-old children living in Bauru-São Paulo (fluoridated) and 15 lifelong residents of Itápolis-São Paulo (nonfluoridated) participated in the study. Fluoride concentrations in nails and duplicate diet were analyzed with the electrode, following hexamethyldisiloxane (HMDS)-facilitated diffusion. Data were analyzed by student's t-test and linear regression (P < .05). RESULTS: Mean fluoride concentrations ([microg/g) in fingernails and toenails of Bauru children were 3.56 +/- 1.3 and 2.81 +/- 1.29, respectively, and for Itápolis children 2.29 +/- 1.25 and 1.58 +/- 0.59, respectively. The differences between Bauru and Itápolis children, as well as between fluoride concentrations in fingernails and toenails, were statistically significant. The estimated fluoride intake from the diet was significantly higher for Bauru children (0.55 +/- 0.61 mg) when compared to Itápolis children (0.09 +/- 0.06 mg). A significant positive correlation was found between the mean of fingernail and toenail fluoride concentrations and estimated fluoride intake from the diet (r = 0.57). CONCLUSIONS: This study's preliminary data suggests that fingernails and toenails may be used as biomarkers of chronic fluoride exposure from the diet. Additional studies are necessary to determine the predictive values, sensitivity, and specificity of this biomarker so that nails are used to differentiate children at the age of dental fluorosis risk and who live in communities with negligibly or optimally fluoridated water.

Biomarkers↗
PubMed1991

Fluoride intake and its safety among heavy tea drinkers in a British fluoridated city.

Tea-drinking in very young children has been studied in a British city. The results suggested that the fluoride in tea would, in some cases, be sufficient to influence caries. Clinical findings to some extent supported this. The main purpose of the investigation reported here was to determine maximum possible fluoride intake in adults who were heavy tea drinkers in a fluoridated city and relate it to toxic thresholds. Heavy tea drinkers were traced through Health Visitors and voluntary organizations and the volumes and fluoride concentrations of their drinks were measured. Even the highest intake found (9 mg) is below the probable intake in Bartlett, Texas (8 ppm of fluoride), in relation to which no undesirable symptoms have been reported (Leone et al. 1954). This confirms the safety of fluoridation. The effects on fluoride concentration of evaporating soft and hard fluoride-containing waters to small bulk were compared. The results showed ceilings of 3 ppm of fluoride in hard water and about 14 ppm in soft water, much higher than the levels expected on the basis of the usually stated solubility of CaF2 (16 or 8 ppm of fluoride). However, under normal household conditions, it is most unlikely that dangerous levels of fluoride would be ingested from boiled water.

Adult↗
PubMed1994

The relationship between plaque index scores, fluoride content of plaque, plaque pH, dental caries experience and fluoride concentration in drinking water in a group of primary school children.

The aim of this study was to determine the relationship between fluoride in drinking water, plaque and dental caries experience in a sample of primary school children from a fruit farming (mainly grapes) area. The children who qualified for the study (n = 177) were placed into three groups according to the concentration of fluoride in their drinking water namely, less than 0.4 ppm (group A), between 0.4 and 1.6 ppm (group B) and more than 1.6 ppm (group C). Most children (78.5%) did not have a toothbrush. Plaque scores were significantly lower in groups B and C. A statistically significant inverse correlation was observed between plaque scores and fluoride content of plaque (p < 0.05). Plaque pH did not differ significantly between the groups. The concentration of fluoride in plaque was high and increased with increasing concentration of fluoride in the drinking water. Dental caries experience was relatively low in primary (dmft = 2.15; 2.07; 1.79) (p > 0.05) and permanent teeth (DMFT = 1.22; 1.43; 1.38) (p > 0.05). Paradoxically, there was also no significant inverse correlation between dental caries experience and fluoride concentration in drinking water. However, the significant inverse correlation between fluoride content of plaque and caries experience supports the contention that fluoride can be accumulated in plaque and act as a reservoir which provides prolonged elevated levels of fluoride to produce a cariostatic effect. It is postulated that the high fluoride levels in the plaque reservoir is responsible for the relatively low caries experience, the significant differences in caries experience between the groups and the poor correlation between dental caries experience and fluoride concentration in drinking water.

Child↗
PubMed1986

Attainment of therapeutic fluoride levels in serum without major side effects using a slow-release preparation of sodium fluoride in postmenopausal osteoporosis.

The bioavailability, biochemical effects, and safety of a slow-release preparation of sodium fluoride were examined. In 8 normal volunteers, a single administration of slow-release sodium fluoride (25 mg) caused a slow rise and gradual decline in serum fluoride concentration, thus avoiding sharp peaks produced by a rapid-release preparation. In 37 patients with postmenopausal osteoporosis, serum fluoride concentration was kept within the "therapeutic window" (95-100 ng/ml) during long-term intermittent sodium fluoride (slow-release) therapy (25 mg twice/day, given for 3 months in each 5-month cycle over five cycles). Serum fluoride was also kept within the therapeutic window in 64 patients who took sodium fluoride (slow release) continuously over 12 months. Serum osteocalcin concentration increased progressively during fluoride treatment (correlation coefficient of 0.88, p less than .001 for the relationship between serum osteocalcin and duration of therapy). Side effects to slow-release sodium fluoride therapy, assessed in 101 patients at two study sites, were minor and included diarrhea in 2 patients, nausea in 2 patients, abdominal pain and cramping in 2 patients, foot pain in 2 patients, and joint pain in 6 patients. Thus, slow-release sodium fluoride confers desired level of fluoride in serum, while providing safety of usage.

Aged↗
PubMed1990

Fluoride bioavailability from slow-release sodium fluoride given with calcium citrate.

Clinical pharmacology of slow-release sodium fluoride given with calcium citrate was examined in acute and long-term studies. Following a single oral administration of 50 mg slow-release sodium fluoride, a peak serum fluoride concentration (Cmax) of 184 ng/ml was reached in 2 h; thereafter, serum fluoride concentration declined with a T1/2 of 5.9 h. The concurrent administration of calcium citrate (400 mg calcium) gave an equivalent Tmax (time required to attain Cmax) and T1/2, but a lower Cmax of 135 ng/ml. The coadministration of a meal with fluoride also reduced Cmax but increased Tmax. The area under the serum concentration curve of slow-release sodium fluoride was reduced 17-27% by a meal or calcium citrate. Thus, calcium citrate reduced fluoride absorption and peak fluoride concentration in serum of slow-release sodium fluoride but did not affect the time required to reach peak concentration or the rate of subsequent decline. The effect of a meal was similar, except for a longer period required to reach peak serum concentration. During long-term administration of 25 mg slow-release sodium fluoride coadministered with 400 mg calcium as calcium citrate on a twice daily schedule, the trough level of serum fluoride could be kept between 95 and 190 ng/ml, believed to be the therapeutic window.

Adult↗
PubMed1990

Urinary fluoride excretion in responders and nonresponders after fluoride therapy in osteoporosis.

The aim of the study was to investigate the usefulness of urinary fluoride excretion in evaluating fluoride therapy. In a prospective study, 35 patients with osteoporosis were treated for about 44 months with a mean dosage of 31.4 mg fluoride ion per day. Urinary fluoride excretion and serum alkaline phosphatase activity were measured at 3-month intervals. Bone mineral content (BMC) was measured in L2-L4 with dual-photon absorptiometer. The mean number of BMC measurements was 5.7 per patient. The interindividual reproducibility for measurements in 10 patients was 2.1%. For each individual, the regression coefficient of BMC for the period of treatment was calculated. Responders were defined as those who had a positive value and nonresponders had 0 or a negative value. The percentage responders was 83%. Between responders and nonresponders no differences were found for age, fluoride dosage, duration of treatment, or changes in serum alkaline phosphatase activity. Urinary fluoride excretion was higher in responders than in nonresponders (p less than 0.001) and a positive correlation (p less than 0.001) was obtained between the changes in BMC and urinary fluoride excretion. In the responders, 90% had a urinary fluoride excretion greater than 8 mg/24 h. All nonresponders had a urinary fluoride excretion less than 8 mg/24 h. Urinary fluoride excretion is a valuable predictor of BMC response during fluoride therapy for osteoporosis.

Aged↗