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PubMed1995

The effect of 25 years of water fluoridation in Newcastle assessed in four surveys of 5-year-old children over an 18-year period.

In 1994, the dental health of 496 5-year-old children who had lived in continuously fluoridated (at 1.0 mg F/litre) Newcastle was compared with the dental health of 436 children of the same age in non-fluoridated (less than 0.1 mg F/litre) south east Northumberland. The study also reported changes in the dental health of 5-year-old children in four surveys in these areas during the period 1976 to 1994. The mean dmft of children in the fluoridated area was 1.33 compared with 2.41 in the non-fluoridated area--a difference of 1.08 per child (45%). The corresponding dmfs scores were 2.80 in the fluoridated area and 5.77 in the non-fluoridated area--a difference of 2.97 tooth surfaces per child (52%). Thirty-nine per cent of children in the fluoridated area had experienced dental caries, compared with 55% in the non-fluoridated area. Only 10% of children in the fluoridated area had experienced dental caries in more than four teeth, compared with 22% in the non-fluoridated area. The prevalences of lifetime experience of toothache, extractions and general anaesthesia for dental extractions were greater in the non-fluoridated area than in the fluoridated area. When the results of this survey were compared with the results of similar surveys in the same areas in 1976, 1981 and 1987, it appeared that there has been a further reduction in dental caries levels following the levelling off observed between 1976 and 1981.

Chi-Square Distribution↗
PubMed2003

Fluoride content of still bottled waters available in the North-East of England, UK.

OBJECTIVE: The aims of this study were to measure the fluoride content of still bottled waters on sale in the UK and to estimate and compare the fluoride intake from tap and bottled water for British children. METHODS: Three bottles of 25 commercial brands of bottled water were purchased from supermarkets, grocery stores and health shops in the North-East of England. All samples were still spring, mineral or distilled waters, sold in plastic bottles. The fluoride content of all samples was determined, in duplicate, using a Fluoride Ion Selective Electrode. RESULTS: The mean (+/- SD) fluoride content of the bottled waters was 0.08 (+/- 0.08) mg L(-1) with a range from 0.01-0.37 mg L(-1) which is below the accepted standard for optimally fluoridated water. The mean fluoride intake for 4-18-year-olds when the source of water intake is solely fluoridated tap water was estimated to be 0.26 mg F per day; compared with 0.16 mg F per day, when a combination of tap and bottled water is consumed. CONCLUSIONS: Bottled water, from those sampled, is unlikely to make an important contribution to total fluoride intake in British diets. Consumption of bottled water containing a negligible amount of fluoride in preference to fluoridated tap water might result in less than optimal fluoride ingestion in young people.

Adolescent↗
PubMed2004

Epidemiological studies of tooth wear and dental erosion in 14-year-old children in North West England. Part 1: The relationship with water fluoridation and social deprivation.

OBJECTIVE: The effect of water fluoridation upon dental erosion/tooth wear in the UK has not been investigated. This study aimed to compare the prevalence of tooth wear in 14-year-old schoolchildren in non-fluoridated and fluoridated districts of North West (NW) England. The influence of deprivation and tooth brushing was also investigated. DESIGN: A random sample of 10% of the 14-year-old population in NW England was selected and stratified according to fluoridation status as determined from water authority postcode listings. METHODS: Tooth wear was scored on the labial, incisal and palatal/lingual surfaces of the 12 anterior teeth and the occlusal surfaces of the first molars. Enamel wear was scored 0, dentine was scored 1 or 2, dependent on whether less than or more than a third of the surface had exposed dentine. Secondary dentine or pulpal exposure scored 3. Townsend deprivation scores were gained from residential post codes. RESULTS: A total of 2,351 children were examined, of which 637 (27%) lived in the one fluoridated district of South Cheshire and 1,714 (73%) lived in 11 non-fluoridated districts. Fifty-three per cent of the children had exposed dentine with significantly more males affected than females (p<0.001). In the fluoridated district, significantly fewer children had exposed dentine on labial and palatal smooth surfaces (p<0.001) but no differences were found for incisal and occlusal surfaces. The interaction of fluoridation and tooth brushing twice per day resulted in a significant (30%) reduction in erosion. Smooth surface wear was more prevalent in children resident in affluent areas. CONCLUSION: Children in non-fluoridated districts are 1.5 times more likely to have smooth surface wear compared with children in fluoridated districts. Fluoridation and use of fluoridated toothpaste twice a day provide added protection from dental erosion. The risk of tooth wear is greater with increasing affluence.

Adolescent↗
PubMed1967

Enzymic hydrolysis of the carbon-fluorine bond of alpha-D-glucosyl fluoride by rat intestinal mucosa. Localization of intestinal maltase.

1. alpha-d-Glucosyl fluoride was hydrolysed by an extract of rat intestinal mucosa. The pH optimum was 6.6 and the K(m) 0.4mm at 20 degrees . Activity was assayed by release of either glucose or fluoride. 2. The alpha-d-glucosyl fluoride-hydrolase activity of the extract was associated with both mutarotase and alpha-d-glucosidase activities. 3. Tris (5mm) inhibited both the alpha-d-glucosidase and alpha-d-glucosyl fluoride-hydrolase activities by 55% but did not inhibit mutarotase. The K(i) of tris for both enzyme activities was 2mm. 4. The extract did not hydrolyse melibiose and lactose. Mutarotase used both alpha-d-glucose and beta-l-arabinose as substrates but the glucosyl fluoride-hydrolase activity did not extend to beta-l-arabinosyl fluoride. 5. The thermal stability of alpha-d-glucosidase and alpha-d-glucosyl fluoride hydrolase was identical. Mutarotase was more thermolabile. 6. A preparation of the brush border of intestinal epithelial cells contained both alpha-d-glucosyl fluoride-hydrolase and alpha-d-glucosidase activities. In each precipitate and washing the ratio of the two activities was the same. All the mutarotase activity was in the first supernatant. 7. Agidex, a fungal amyloglucosidase, cleaved glucosyl fluoride in addition to maltose. Tris inhibited both activities and in each case the K(i) was 3mm. 8. The probable identity of alpha-d-glucosyl fluoride hydrolase with alpha-d-glucosidase is discussed and a possible mechanism for the reaction suggested. 9. Incubation of intestinal slices with alpha-d-glucosyl fluoride led to complete hydrolysis in 30min. The glucose rapidly entered the cell and was metabolized, leaving the fluoride in the incubation medium. This constitutes a further proof that the intestinal alpha-d-glucosidase, although on the brush border, is located outside the site of active transport of sugars.

Animals↗
PubMed2000

Effects of self-applied topical fluoride preparations in orthodontic patients.

The purpose of this study was to compare the effectiveness of toothbrushing followed by fluoride rinsing, fluoride gel brushing, or fluoride gel dentifrice brushing alone in controlling the demineralization that often follows orthodontic treatment. Seventy-eight consecutive adolescent patients undergoing orthodontic care were divided into 3 groups: group 1 (control) used a low-potency, high-frequency fluoride rinse; group 2 used a high-potency, high-frequency fluoride brush-on gel; and group 3 used a high-potency, high-frequency fluoride gel dentifrice. When pretreatment levels of demineralization were subtracted from posttreatment values, both gel groups displayed a significant difference (P < .05) in smooth surface demineralization sites when compared to controls. Reversal of white-spot lesions occurred in 15% of sites that exhibited pathology as a result of the fluoride and preventive regimen. These results indicate that a daily use of a 5000-ppm fluoride gel along with toothbrushing with a fluoride paste or brushing twice daily with a 5000-ppm fluoride dentifrice alone provides greater protection beyond that of tooth-brushing with a fluoride paste (1000 ppm) and rinsing with a 0.05% sodium fluoride rinse.

Adolescent↗
PubMed2001

Suppression of pulmonary antibacterial defenses mechanisms and lung damage in mice exposed to fluoride aerosol.

In endemic fluorosis areas in China associated with coal burning, indoor airborne fluoride pollution is severe. To determine the effects of fluoride aerosols on pulmonary antibacterial defense mechanisms and lung damage, mice were exposed to various concentrations of fluoride aerosol (2, 5, or 10 mg/m3) or filtered air (control) for 14 d, 4 h/d in an inhalation chamber. Bactericidal activity against Staphylococcus aureus in the lung and the number and profile of free pulmonary cells, protein content, and lactate dehydrogenase (LDH) activity in bronchoalveolar lavage (BAL) fluid were assessed. Urinary fluoride concentration, an indicator of fluoride exposure, increased in proportion to fluoride aerosol concentration in the chamber. Wet lung weight was significantly higher on d 14 in mice exposed to 10 mg/m3 than in controls. Pulmonary bactericidal activity against S. aureus was concentration-dependently suppressed at 5 and 10 mg/m3 fluoride. The number of alveolar macrophages (AMs) in the BAL fluid of the mice not bacterially challenged decreased significantly at 10 mg/m3 fluoride. The number of polymorphonuclear leukocytes and lymphocytes increased significantly at 10 mg/m3 fluoride exposure. The concentration of total protein (TP) and albumin in BAL supernatant increased significantly at 5 and 10 mg/m3 fluoride exposure, and LDH activity rose markedly at the higher fluoride concentration. Data indicate that fluoride inhalation produces pulmonary cellular alterations that are associated with a diminished ability to cope with infectious bacteria.

Aerosols↗
PubMed1987

Influence of dietary magnesium on fluoride bioavailability in the rat.

A factorial experiment was conducted with weanling rats fed a purified diet to determine the influence of dietary magnesium (200, 500 or 2500 ppm) as the carbonate on fluoride bioavailability (2 or 10 ppm as sodium fluoride). After 6 wk, rats fed the lowest magnesium-containing diets had significant reductions of plasma and femur magnesium. Higher dietary fluoride prevented accumulation of calcium in the kidneys of magnesium-deficient rats. Rats fed the lowest magnesium-containing diets had significantly more fluoride in their femurs and molar teeth than other groups at both levels of fluoride, whereas rats fed diets containing 5 times normal magnesium had less fluoride in their femurs and molars. The magnitude of the magnesium effect was considerably greater in rats fed diets containing 10 ppm fluoride compared to 2 ppm, indicating a highly significant, level-dependent interaction between magnesium and fluoride. Five-day metabolic studies conducted during wk 3 and 6 showed that low dietary magnesium significantly enhanced fluoride absorption, whereas high dietary magnesium significantly reduced fluoride absorption. Fluoride retention values simply reflected absorptive changes, which indicates that the site of the interaction between magnesium and fluoride is at the intestinal level, most likely involving insoluble complex formation.

Animals↗
PubMed1998

Chronic fluoride exposure does not cause detrimental, extraskeletal effects in nutritionally deficient rats.

On the basis of observations that endemic fluorosis occurs more often in malnourished populations, a series of studies tested the hypothesis that deficient dietary intake of calcium, protein or energy affects fluoride metabolism so that the margin of safe fluoride exposure may be reduced. The objective of the investigation was to determine whether changes in fluoride metabolism in nutritionally deficient rats resulted in manifestation of any extraskeletal toxic fluoride effects not observed in healthy animals. This investigation included two studies, one that monitored the effect of calcium deficiency on the effects of chronic fluoride exposure, and a second study that observed fluoride effects in rats that were deficient either in protein or in energy and total nutrient intake. Control and experimental rats received drinking water containing 0, 0.26 (5), 0.79 (15) or 2.63 (50) mmol fluoride/L (mg/L) for 16 or 48 wk. Control rats were fed optimal diets and experimental rats were fed diets deficient in calcium (Study 1) or protein (Study 2). An additional group of experimental rats (Study 2) was provided with a restricted amount of diet; thus these rats were deficient in energy and total nutrient intake. The intake, excretion and retention of fluoride were monitored; after the rats were killed, tissue fluoride levels and biochemical markers of tissue function were analyzed. Bone marrow cells were harvested from some of the rats, after 48 wk of treatment, for determining the frequency of sister chromatid exchange, a marker of genetic damage. Although there were significant differences among fluoride treatment groups in fluoride excretion and retention that resulted in significantly greater fluoride levels in tissues of the experimental rats, we were unable to detect any harmful, extraskeletal biochemical, physiologic or genetic effects of fluoride in the nutritionally deficient rats.

Animals↗
PubMed2004

Determining the optimal concentration of fluoride in drinking water in Pakistan.

OBJECTIVES: This study was designed to determine the optimal concentrations of fluoride for drinking water in Pakistan. Clinical dental examination of 1020 school children aged 12 years was carried out in 19 cities of Pakistan. Correlation between concentrations of water fluoride, caries and fluorosis was investigated by analyzing the data on fluoride concentrations in drinking water in the sampled population for which the caries and the fluorosis levels were also measured. METHODS: The optimal level of fluoride in drinking water is universally calculated by applying the equation of Galagan and Vermillion, which permits the calculation of water intake as a function of temperature. The annual mean maximum temperatures (AMMT) recorded during the last 5 years were collected from the meteorological centres of the 28 divisional headquarter stations. The average AMMT of Pakistan is 29 degrees C at which the optimal fluoride in drinking water of Pakistan was calculated to be 0.7 ppm. As drinking habits differ in various parts of the world, determination of optimal concentration of fluoride for drinking water in Pakistan was performed using a modified Galagan and Vermillion equation, which applies a correction factor of 0.56 to the equation. The optimal fluoride in drinking water in Pakistan using this modified equation was determined to be 0.39 ppm. RESULTS: Observation of the correlation showed that a fluoride concentration of 0.35 ppm in drinking water was associated with maximum reduction in dental caries and a 10% prevalence of fluorosis. CONCLUSIONS: Determining the most appropriate concentrations of fluoride in drinking water is crucial for communities. It is imperative that each country calculates its own optimal level of fluoride in drinking water based on the dose-response relationship of fluoride in drinking water with the levels of caries and fluorosis. Climatic conditions, dietary habits of the population and other possible fluoride exposures need to be considered in formulating these recommendations.

Cariostatic Agents↗
PubMed2004

Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach.

Despite great improvements in the oral health of populations across the world, problems still persist particularly among poor and disadvantaged groups in both developed and developing countries. According to the World Oral Health Report 2003, dental caries remains a major public health problem in most industrialized countries, affecting 60-90% of schoolchildren and the vast majority of adults. Although it appears that dental caries is less common and less severe in developing countries of Africa, it is anticipated that the incidence of caries will increase in several countries of that continent, due to changing living conditions and dietary habits, and inadequate exposure to fluorides. Research on the oral health effects of fluoride started around 100 years ago; the focus has been on the link between water and fluorides and dental caries and fluorosis, topical fluoride applications, fluoride toothpastes, and salt and milk fluoridation. Most recently, efforts have been made to summarize the extensive database through systematic reviews. Such reviews concluded that water fluoridation and use of fluoride toothpastes and mouthrinses significantly reduce the prevalence of dental caries. WHO recommends for public health that every effort must be made to develop affordable fluoridated toothpastes for use in developing countries. Water fluoridation, where technically feasible and culturally acceptable, has substantial advantages in public health; alternatively, fluoridation of salt and milk fluoridation schemes may be considered for prevention of dental caries.

Child↗
PubMed1975

The effect of pH upon fluoride uptake in intact enamel.

The relationship between pH and fluoride uptake in intact enamel of permanent premolars was investigated by using: (1) a sodium fluoride dentifrice, (2) a potassium fluoride + manganese chloride dentifrice, and (3) a sodium fluoride solution of the same fluoride concentration. The first part of this paper deals with the in vitro uptake of fluoride from dentifrice slurries and from sodium fluoride solutions of different pH ranging from 7.1 to 4.5. This investigation showed that there was no significant difference between the agents but that the effect of the pH was significant. The uptake of fluoride in the form of fluorapatite was more than five times larger at the lower pH level. The second part of the paper deals with the rate of fluoride uptake (increase in fluoride content) from dentifrices in the same pH range. It was shown that the three agents gave the same initial rate of fluoride uptake (about 50 parts/10(6)/min) at pH 6 and that the rate of fluoride uptake in the outer layer of the enamel was proportional to the hydrogen ion activity.

Child↗
PubMed1988

Fluoride acquisition on and in human enamel during topical application in vitro.

Fluoride acquisition during topical fluoride treatment was studied after different time intervals, at different concentrations and at different pH. The effects of pretreating the enamel with Ca++, and of pre-etching were also tested. Four experimental groups of repeated measures design were established. Chemical assessments were made of the amounts of fluoride formed on (as alkali soluble fluoride, i.e., calcium fluoride) and in enamel (as firmly bound fluoride). The depositions on enamel were also demonstrated by SEM. The amounts of alkali soluble fluoride on enamel increased with time, concentration, pH-decrease and calcium availability. The time of exposure seemed to be the major factor. The amounts of fluoride deposited on enamel outranged by far (greater than 70%) the amounts of fluoride acquired in the enamel. The formation of alkali soluble fluoride on enamel is probably limited by the availability of calcium ions. It is suggested that the fluoride on enamel may protect the enamel surface and serve as a reservoir of fluoride.

Calcium↗
PubMed1976

In vitro treatment of human root surfaces with fluorides.

Two-minute topical applications with four different fluoride compounds, acidulated phosphate fluoride, sodium fluoride, sodium monofluorophosphate and stannous fluoride, were evaluated for ability to reduce the acide solubility of human root surfaces in vitro. Each fluoride was in aqueous solution with the fluoride level adjusted to 1.23 percent and the pH native. Rectangular windows were prepared on root surfaces and control versus test differences were invariably studied within teeth and not between teeth. Sodium fluoride and sodium monofluorophosphate solutions reduced root surface solubility by approximately 30 percent while acidulated phosphate fluoride and stannous fluoride were more than 2.5 times more effective, the solubility reduction exceeding 80 percent. Root surfaces thus are similar to enamel in their reactions to topically applied fluorides. Based upon these results the clinician should choose between acidulated phosphate fluoride and stannous fluoride when making the choice of a single treatment compound for office application.

Dental Cementum↗
PubMed1989

Effectiveness of water fluoridation.

The efficacy of communal water fluoridation in reducing dental caries has been reviewed based on surveys conducted in the last decade of caries prevalence in fluoridated and nonfluoridated communities in the United States as well as in Australia, Britain, Canada, Ireland, and New Zealand. The efficacy is greatest for the deciduous dentition, with a range of 30-60 percent less caries in fluoridated communities. In the mixed dentition (ages 8 to 12), the efficacy is more variable, about 20-40 percent less caries. In adolescents (ages 14-17), it is about 15-35 percent less caries. Current data on caries prevalence in adults and seniors are extremely limited and include several populations living in communities with higher than optimal fluoride levels. For these adults and seniors, a range of 15-35 percent less caries would also apply. Viewed in toto, the current data for children, adolescents, adults and seniors show a consistently and substantially lower caries prevalence in fluoridated communities. For an accurate measurement of the efficacy of water fluoridation in reducing dental caries, it is essential that only persons with a record of continuous or long-term residency in fluoridated versus nonfluoridated areas be included in such assessments. Because of the high geographic mobility in our society and the widespread use of fluoride dentifrices, supplements, and other topical fluoride agents, such comparisons are becoming more difficult to conduct. Accordingly, the effectiveness (rather than the efficacy) of water fluoridation has decreased as the benefits of other forms of fluoride have spread to communities lacking optimal water fluoridation.

DMF Index↗
PubMed1993

A half-century of community water fluoridation in the United States: review and commentary.

The nearly 50-year history of community water fluoridation is reviewed with the major emphasis on the benefits and safety of fluoridation. Other aspects of water fluoridation also described include the apparent reduction in measurable fluoridation benefits because of the abundance of other fluoride sources, the diffusion of fluoridation effects into fluoride-deficient communities, preeruptive and posteruptive effects, technical and cost aspects, sociopolitical and legal issues that affect the successful fluoridation of communities, and alternatives to community water fluoridation. The majority of studies have evaluated the effectiveness of water fluoridation on the permanent teeth of children, while there are fewer studies on deciduous teeth and in adults; the relationship between fluoride ingestion and bone health needs further clarification; the sociopolitical issues of fluoridation need to be better understood.

Cost-Benefit Analysis↗
PubMed2004

Problems in exposure assessment of fluoride in drinking water.

OBJECTIVES: We developed a source documentation approach that identified fluoride content of drinking water at the state or local level to estimate fluoride concentrations from public water systems. We then compared estimates from this approach with estimates obtained from a single source, the 1992 Centers for Disease Control and Prevention (CDC) Fluoridation Census. METHODS: We used residential histories from a case-control study. For each residence we attempted to determine fluoride concentrations using the 1992 CDC Fluoridation Census. For the source documentation method we utilized multiple sources from state and local contacts to verify and collect additional data. We compared the fluoride estimates obtained by the two methods. RESULTS: When fluoride values were found using both methods, there was good correlation (Kendall's tau = 0.85; 95% confidence interval = 0.79, 0.90) and concordance was 96 percent. We obtained over 99 percent of the fluoride values needed using source documentation as compared to 49 percent of the values needed when we used a single publication. When fluoride values were missing using the 1992 CDC Fluoridation Census, 21 percent had source documentation estimates of at least 0.7 ppm. CONCLUSIONS: Researchers need to consider limitations of using a secondary data source to estimate fluoride in drinking water, particularly in studies where exposure to fluoride is the primary exposure of interest.

Cariostatic Agents↗
PubMed2006

Fluoride-containing restorative materials.

Dental practitioners are exposed to an increasing number of dental materials, which claim the benefits of fluoride release. The purpose of this paper is to critically review the literature of these materials. Glass ionomers, resin modified glass ionomers, compomers, resin composites, fissure sealants and amalgam are discussed. It is clear that a long-term measurable release of fluoride can be observed from certain restorative materials, in vitro, particularly glass ionomer cement, resin modified glass ionomer cement, fluoridated cements, fluoridated dental amalgam and certain fissure sealants. In general, the rate of fluoride release is not constant but exhibits a relatively rapid initial rate, which decreases with time. However, the fluoride release profiles may be dependent on specific formulation and on experimental design and sampling methods. These materials may feature greater longevity, a reduced incidence of marginal failure, an elevated concentration of fluoride in contingent plaque, together with an antibacterial action when compared with non-fluoride releasing materials. In addition, fluoride-releasing materials may perform better in caries inhibition in artificial caries model studies than non-fluoridated materials. While any, or all, of these anti-cariogenic effects may be associated with fluoride release, a direct relationship between fluoride release profiles and such effects has not been determined in vivo.

Cariostatic Agents↗
PubMed1977

Fluoride uptake by Streptococcus mutans 6715.

The short-term kinetics of fluoride uptake by cells from 20- to 22-h cultures of Streptococcus mutans strain 6715 were studied using rapid filtration and centrifugation techniques. Saline-suspended organisms were diluted with fluoride-containing solutions buffered at four different pH values (2.0, 4.0, 5.5, and 8.2). Fluoride disappearance from the medium was inversely related to pH and to the duration of the exposure at any given pH. The uptake was rapid and extensive at the lower pH values and decreased as the pH increased. Media fluoride concentrations subsequently increased; i.e., fluoride was released from the cells. The presence of glucose, cyanide, or iodoacetate did not influence the results. However, preincubation of the cells in fluoride-free buffers, followed by the addition of fluoride, reduced fluoride uptake markedly. Cell-to-media pH gradients were determined by the distribution of 14C-labeled 5,5-dimethyl-2,4-oxazolidinedione. Fluoride uptake was found to be a function of the magnitude of the pH gradient (P less than 0.001). It is hypothesized that fluoride uptake occurs by the diffusion of hydrogen fluoride and the subsequent trapping of ionic fluoride.

Biological Transport↗