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Comparative uptake of fluoride from sodium fluoride, ammonium fluoride, and barium fluoride in rat teeth when predominantly administered in the pre-eruptive stage of development.

A comparative study was undertaken which focused on the systemic uptake of sodium fluoride (NaF), ammonium fluoride (NH4F), and barium fluoride (BaF2) in rat pups. Two critical achievements made this comparative study possible: (a) the demonstration of significant increases in fluoride (F) uptake-deposition in the treatment group pups relative to control group rats as a result of stomach tube feeding; and (b) the demonstration of clear-cut differences in F concentration levels between the treatment groups as a result of this stomach tube-systemic uptake. Data were reliable and significant enough to suggest that, of the 3 compounds in question, NH4F is absorbed most successfully in a systemic fashion, whereas BaF2 is the least absorbed.

Ammonia

Urinary fluoride excretion in children using potassium fluoride containing salt or sodium fluoride supplements.

With the introduction of fluoridated domestic salt in France in 1986, questions have arisen with respect to its efficacy in caries prevention. It has been of interest to compare the urinary excretion of fluoride in children who consume fluoridated salt to that in children who take fluoride tablets. Ninety-three schoolchildren, 10-14 years of age, participated in the study and were divided into four groups: group I consumed fluoridated salt with every meal; group II ate at a school restaurant once a day and consequently consumed fluoridated salt at only their evening meal, as fluoridated salt is not authorized for use in collective restaurants; group III consisted of children taking fluoride tablets (1.0 mg F/day) exclusively, and group IV did not receive any systemic administration of fluoride for prevention and constituted a low-fluoride control group. Total 24-hour urine samples were collected from all subjects. The average daily urinary flow rates varied from 0.51 to 0.68 ml/min, but showed no statistically significant differences among the groups. The average urinary fluoride concentrations were 0.60, 0.30, 0.99, and 0.28 mg/l, respectively, for groups I-IV. The mean 24-hour urinary fluoride concentrations and excretion rates for children who consumed fluoridated salt at all meals (group I) were not statistically different from those using tables (group III). There were also no statistically significant differences between groups II and IV. The differences between urinary fluoride concentrations and excretion rates of groups I and III, as compared with group IV, were statistically significant.

Administration, Oral

Current regulations and recommendations concerning water fluoridation, fluoride supplements, and topical fluoride agents.

In recent years, an increase in the prevalence of dental fluorosis, mostly of the very mild to mild category, has been seen in the United States. This paper therefore discusses the safety of dental fluoride products, primarily with respect to the risk of dental fluorosis due to chronic ingestion of these products by pre-school children. No change is indicated in the optimal fluoride level (0.7 to 1.2 ppm) for water fluoridation. A reduction in the dosage of fluoride supplements is recommended for children aged from three to six years (14.5 to 22 kg body weight) residing in communities with less than 0.7 ppm F. Physicians, pharmacists, and dentists need to be better educated in correctly prescribing fluoride supplements; such prescriptions should be based on the fluoride concentration of the domestic water supply and the child's weight/height/age. No change is recommended in the concentration of fluoride used in dentifrices and mouthrinses. The US Food and Drug Administration should require more explicit labeling of fluoride products with regard to avoidance of ingestion, use of small amounts, and need for supervised use by pre-school children. The efficacy of water fluoridation, fluoride supplements, and topical fluoride agents has been amply documented elsewhere.

Child

[Uptake of fluoride into enamel and its effect on acid resistance by application of fluoride-releasing sealant--Part 1. Comparison with acid phosphate fluoride].

The newly developed fluoride-releasing sealant (F + sealant) used in this experiment is expected to have the combined cariostatic effects of a sealant and fluoride. The purpose of this study was to investigate F + sealant's effects on the enamel in regard to the uptake of fluoride and resistance to acid. F + sealant's effect was compared to that of acid phosphate fluoride (APF) which has effect as topical fluoride applicant. Bovine teeth applied with F + sealant or APF were immersed for 4 weeks in a pH 7.0 phosphate buffer at 37 degrees C. After 4 weeks of immersion, each tooth was biopsied with pH 1.0 sodium acetate-hydrochloric acid buffer. The fluoride and calcium in the biopsy samples were analyzed by means of fluoride ion electrode and atomic absorption spectroscopy, respectively. The following results were obtained: (1) The fluoride in the enamel was significantly increased by the incorporation of fluoride from the F + sealant. Almost all fluoride in the surface enamel was found to be fluorapatite by the method of alkaline extraction. (2) The amount of fluoride increased by APF application was about 50% of that of F + sealant application. (3) The calcium released from the enamel treated with F + sealant or APF decreased by 13% and 9%, respectively, compared to that without treatment.

Acidulated Phosphate Fluoride

Fluoride bioavailability from immediate-release sodium fluoride with calcium carbonate compared with slow-release sodium fluoride with calcium citrate.

The circadian variation in serum fluoride was compared between treatment with immediate-release sodium fluoride (IR-NaF) (30 mg) and calcium carbonate (500 mg calcium) and slow-release sodium fluoride (SR-NaF) (25 mg) and calcium citrate (400 mg calcium) in seven patients with postmenopausal osteoporosis maintained on long-term fluoride treatment. During 12 h following a dose of SR-NaF, serum fluoride levels could be largely kept within the therapeutic window (believed to be 95-190 ng/ml or 5-10 mumol/l). In contrast, IR-NaF produced a wide circadian fluctuation with peak-to-trough change of about 200 ng/ml. Compared to SR-NaF, IR-NaF caused a significantly higher peak fluoride concentration in serum (322 vs. 158 ng/ml), and greater area under the curve (2269 vs. 1321 ng.h/ml) and urinary fluoride (6.72 vs. 3.80 mg/12 h). Thus, fluoride absorption from IR-NaF was twice as high as that from SR-NaF.

Aged

The prevalence of developmental defects of enamel in 15-16-year-old children residing in three districts (natural fluoride, adjusted fluoride, low fluoride) in the north east of England.

Developmental defects of enamel were assessed in 15-year-old children born and continuously resident in three communities in the north east of England. In naturally fluoridated Hartlepool (F = 1.0-1.3 ppm), artificially fluoridated Newcastle (F = 1.0 ppm) and non-fluoridated Middlesbrough (F < 0.2 ppm) 361, 356 and 376 children respectively were examined. Conventional clinical recording and a photographic technique where colour slides are assessed at random were used and compared. Scoring in both assessments was done by using a modified version of both the Murray and Shaw index and the developmental defects of enamel index. In the clinical assessment more white lines and diffuse opacities were found in the fluoridated areas than in the non-fluoridated area. More opacities were recorded using the photographic assessment than with the clinical assessment, but a similar trend of an increased prevalence of white lines and diffuse opacities was observed using the photographic method. Overall, there was only a small increase in the prevalence of milder forms of enamel defects in fluoridated compared with non-fluoridated areas.

Adolescent

Fluoride retention after rinsing with sodium fluoride and amine fluoride.

Fluoride retention from fluoride rinses (250 ppm F), calculated from F-concentrations and volumes of expectorates, and fluoride clearance, determined in whole saliva samples collected 1, 5 and 10 minutes after rinsing, were studied in 70 adults. F-retention from a 1:1 oleylamine-cetylaminefluoride rinsing solution (15 ml. 15 sec) was 410 mjg F, from a sodium fluoride rinse 343 mug F. 563 mug F were retained from a 30-sec amine fluoride rinse. Fluoride clearance was significantly slower after cetylaminefluoride rinses than after NaF rinses. Prerinsing with sodium lauryl sulfate or cetylaminechloride annihilated the F clearance superiority of cetylaminefluoride over NaF.

Adult

Effect of an acute maternal fluoride dose on fetal plasma fluoride levels and enamel fluoride uptake in guinea pigs.

We conducted this study to measure maternal plasma, fetal plasma, and fetal enamel fluoride concentrations for four hours following an oral F dose to near-term pregnant guinea pigs. We placed female guinea pigs on de-ionized (Group I) or 3-ppm-F (Group II) drinking water prior to breeding and during gestation. On the 57th day of gestation, we administered a maternal dose of NaF solution (0.6 mg F/kg) by stomach tube. We collected samples of maternal plasma, fetal plasma, and fetal enamel at baseline, at 15 and 30 min, and at one, two, and four h after administration of the dose. We assayed samples for F using a modification of the micro-diffusion and ion-specific electrode method. Group I mean baseline F values were: maternal plasma, 0.016; fetal plasma, 0.002; and fetal enamel, 7.0 ppm. Group II mean values were: 0.055, 0.004, and 19.0 ppm. After the maternal fluoride dose, the mean maternal plasma [F] rose sharply for 30 to 60 min and declined to about 50% of peak values by four h. Fetal plasma [F] changed less in absolute values, but similarly to maternal changes relative to baseline. Fetal enamel mean [F] rose more in Group II than in Group I. Baseline F status had an important effect on F uptake in fetal enamel following an acute maternal fluoride dose.

Administration, Oral

Fluoride in dog parotid saliva after intravenous administration of sodium fluoride, sodium monofluorophosphate, and calcium fluoride.

Sodium fluoride, sodium monofluorophosphate, or calcium fluoride, in amounts equivalent to 0.5 mg/kg, were given intravenously to dogs and the effect on parotid saliva F was determined. Significant (P less than 0.01) differences in saliva F levels were related to the ionization of NaF, the hydrolysis of the PO3F ion, and the insolubility of CaF2.

Animals

The effect of residence and social class on dental caries experience in 15-16-year-old children living in three towns (natural fluoride, adjusted fluoride and low fluoride) in the north east of England.

Caries experience in 1374 children aged 15-16 years from three towns in the north east of England with varying concentrations of fluoride in drinking water, was determined. The mean DMFT values for 15-year-old continuous residents was 1.7 in Hartlepool (natural F 1.0-1.3 ppm), 2.5 in Newcastle (F adjusted to 1.0 ppm) and 3.3 in Middlesbrough (F = 0.2 ppm). Forty per cent of Hartlepool 15-year-olds were caries free, compared with 30% in Newcastle and 24% in Middlesbrough. Caries prevalence for both Hartlepool and Newcastle 'continuous residents' was lower than for non-continuous residents, whereas in Middlesbrough, the low fluoride area, non-continuous residents had a lower DMF value than those who had lived in Middlesbrough all their lives. There was a slight trend in both Newcastle and Middlesbrough for DMFT values to increase from social class I to social class V, but no discernable trend was observed in Hartlepool. The results for Hartlepool 15-year-olds were very similar to those reported by Weaver in 1949.

Adolescent

[Urinary excretion of fluorides in inhabitants of the Canton Vaud who consume fluoridated salt as compared with that of the inhabitants of neighboring cantons who consume nonfluoridated salt].

In the Swiss canton of Vaud (512000 inhabitants) the salt available for human consumption has been fluoridated since 1969 by adding 250 mg F- per kg of salt. The urinary excretion of fluoride has been investigated in large samples of the population in 1970 and in 1974. The present study reports the results of the 1974 study, in which the urinary fluoride excretion of persons living in the canton of Vaud was compared to that of a smaller sample of people living in small townships across the border of the canton, in which neither edible salt nor water are fluoridated. The concentration of fluoride in 444 single samples of urine from adult persons living in the canton of Vaud was 1.06 +/- 0.03 mg/l, in 40 subjects living two townships across the border 0.62 +/- 0.06 mg/l. The excretion of fluoride per 24 hrs has been evaluated by measuring simultaneously the creatinine concentration in the urine samples under the assumption of constant creatinine and fluoride excretion within 24 hour periods. The calculated fluoride excretion in 366 subjects living in the canton of Vaud was 1.14 +/- 0.03 mg/24 hrs, that of 40 subjects living outside of the canton 0.60 +/- 0.05 mg/24 hrs when the figure inserted for the excretion of creatinine within 24 hours was taken from a study of Rowe [9]. A few data reported suggest that the mean excretion of creatinine in the urine of normal subjects living in Switzerland was only 67% of that measured in the U.S. by Rowe. Total fluoride excretions calculated under this assumption were 0.76 +/- 0.02 mg/24 hrs for persons living in Vaud vs. 0.40 +/- 0.04 mg/24 hrs in the subjects living outside of Vaud. The concentrations of fluoride found in the urine of the adult subjects of the present study did not differ significantly from those found in school children aged 7-15 living in the same communities. Concentrations of fluoride in urine appear to have increased since 1970 in subjects living in the canton of Vaud. This fact may indicate that a steady state equality between intake and urinary excretion of fluoride had not yet been reached in 1970. In 366 urine samples of subjects living in Vaud in 1974, the concentration of fluoride in urine could be represented as a linear regression on the concentration of creatinine. The slope of this regression was smaller than unity indicating an enhanced fluoride excretion at higher rates of urine flow and a depressed excretion at low rates of urine flow. The occurrence of diurnal variations in the urinary excretion of fluoride or of creatinine could not be excluded in the present study. The urinary excretion of fluoride exceeded 2.5 mg/24 hr in approximately 2% of the subjects living in the canton of Vaud but was smaller than 0.8 mg/24 hr in approximately 18%. It was concluded that fluoridation of salt at the level indicated should be an effective measure for the prevention of dental caries. It was, furthermore, concluded that salt fluoridation at the level indicated does not present any risk of toxicity.

Adult

Effect of fluoride addition on ionized calcium in salivary sediment and in saliva containing various amounts of solid calcium fluoride.

The aim of the present study was to estimate the fluoride concentrations necessary for the precipitation of calcium fluoride or calcium fluoride-like substances in saliva and salivary sediment, in the presence of various amounts of chemically pure calcium fluoride. Fluoride was added in increments to whole saliva to which solid calcium fluoride had been added. The ionized calcium concentration was determined immediately after centrifugation. In salivary sediments and saliva with no calcium fluoride added the ionized calcium concentration was nearly independent of the fluoride concentration added below 10 and 20 mmol/l, respectively, and at fluoride concentration above 15 and 25 mmol/l, respectively, nearly no ionic calcium was detected. In the presence of calcium fluoride the ionized calcium concentration decreased rapidly with increasing concentrations of fluoride. The more calcium fluoride added, the lower the ionized calcium concentration at a certain fluoride level. The results suggested that in the in vivo-situation, caries preventive measures based on frequent oral exposure to low concentrations of fluoride may provide calcium fluoride or calcium fluoride-like substances, which will serve as a reservoir for fluoride.

Calcium

Oral fluoride retention after use of fluoride dentifrices.

Fluoride is the only extensively clinically proven means of reducing dental caries. Despite a large body of epidemiological data on the effectiveness of fluoride, delivered in the form of dentifrices, mouthrinses, drinking water, etc., the precise mode of action of fluoride is not completely understood. The purpose of this paper is to report an investigation of the link between oral fluoride levels and applied fluoride dose from dentifrices. Human salivary fluoride clearance studies and equilibrium baseline studies of fluoride in saliva and plaque have been carried out with dentifrices which contained 1,000, 1,500 and 2,500 micrograms fluoride per gram as sodium monofluorophosphate. After a single brushing with a fluoride dentifrice, salivary fluoride decreased in two distinct phases: an initial rapid phase which lasted for 40-80 min, depending on the individual, and a second slow phase lasting for several hours. The latter phase is believed to be due to fluoride released from an oral fluoride reservoir. During regular repeated use of the test dentifrices, the equilibrium baseline fluoride concentration, attained in both saliva and plaque between one application and the next, increased significantly compared with placebo values. Such elevated baseline fluoride concentrations also increased with increasing Na2FPO3 content of the dentifrices. The present work supports the concept that labile fluoride, stored in an oral fluoride reservoir at the time of treatment application, may maintain a prolonged protective effect against dental caries.

Adult

[Fluoride excretion in schoolchildren with differing systemic fluoride care].

The aim of the present study was to collect data on urinary fluoride output in 8-16-year old students exposed to either drinking water fluoridation (DWF), or domestic salt fluoridation (DSF). Spot urine samples were collected in the canton of Basel-Stadt (DWF, n = 123), in the canton of Berne (DSF, n = 264), in the county of Davos (DSF, n = 241), and in the city of Winterthur (DSF, n = 40). Furthermore, fluoride concentrations were determined in plasma samples drawn from 33 students from Winterthur. The urinary fluoride concentrations were higher in Basel and Davos (0.62 +/- 0.35 mg/l; 0.61 +/- 0.42 mg/l) than in Berne and Winterthur (0.46 +/- 0.42 mg/l; 0.50 +/- 0.31 mg/l). A relatively high natural fluoride content (0.3 mg/l) in the drinking water explained the difference in urine fluoride concentration between students from Davos and the two other regions with domestic salt fluoridation (Berne, Winterthur). The average fluoride concentration in plasma was 12.7 +/- 3.8 ng/ml. We concluded that, in general, the supply with fluoride consumed with fluoridated domestic salt is close to the level obtained with drinking water fluoridation. However, in areas with very low systemic fluoride supplementation through the drinking water this level might not be reached with salt as the only source of systemic fluoride. Also, the data confirmed the safety of domestic salt fluoridation.

Adolescent

Critical evaluation of the composition and use of topical fluorides, with emphasis on the role of calcium fluoride in caries inhibition.

There is evidence that a major part of the fluoride which is retained on teeth during topical application is calcium fluoride or calcium fluoride-like, and that this material is relatively stable in the mouth. This is due to surface adsorption of phosphate (HPO4(2-)) ions onto the calcium fluoride surface. Calcium fluoride releases fluoride during caries challenges due to reduced concentration of HPO4(2-) at acid pH. Normally, the fluoride released from calcium fluoride during caries challenges is subsequently built into hydroxyfluorapatite through dissolution/re-precipitation reactions. It appears likely that the formation of calcium fluoride from topical application agents should be increased and not reduced, as believed in the past. Increased deposition of calcium fluoride can be achieved with increased reaction time between fluoride and enamel, reduced pH of the solution, increased concentration, or pre-treatment with calcium. A reduction in pH of the agents is probably the most practical approach to increase the deposition of calcium fluoride during topical application, and clinical data support this contention. Calcium fluorides with various dissolution rates are formed during different procedures of topical application with fluoride, presumably due to incorporation of phosphate into the calcium fluoride crystals.

Animals

Fluoride pharmacokinetics in good and poor responders to fluoride therapy.

In this study, the relationship between fluoride pharmacokinetics and the response in spinal bone density to fluoride treatment was studied in 14 patients with primary osteoporosis treated with fluoride for at least 1 year. Serum concentrations and urinary excretion of fluoride were determined after ingestion of 10 mg fluoride as monofluorophosphate. The pharmacokinetic parameters were calculated according to a linear one-compartment open model. The fasting serum fluoride level was 8.8 +/- 0.98 mumol/liter. The peak serum fluoride level was 20.5 +/- 1.4 mumol/liter and was reached within 2 h after ingestion of fluoride. When the patients were divided into good and poor responders, based on whether they did or did not exhibit a change in spinal bone density of 13 mg/cc per year or more, we found that good responders had decreased renal fluoride clearance (-62 +/- 13%, p less than .02), increased maximum change in serum fluoride (+38 +/- 18%, p less than .01), increased extrarenal clearance (+62 +/- 57%, p less than .05) and increased change in serum alkaline phosphatase (ALP) (+241 +/- 169%, p less than 0.02) compared with poor responders. Our data suggest that one factor accounting for a good response is a relatively high serum level of fluoride. However, although the maximum change in serum fluoride was greater in good responders compared with poor responders, variations in fluoride levels could not explain all of the variation in spinal bone density. Therefore, we propose that in addition to differences in serum fluoride, other factors are also responsible for the good response.

Aged

Influence of dietary fluoride restriction on regulation of plasma nd soft tissue fluoride contents.

The adjustments in total fluoride concentration in plasma, bones, liver, and muscle were examined when rats were given a diet of very low fluoride content following a dietary regimen of elevated fluoride intake. The animals received a diet containing 34 ppm of fluoride and water with 50 ppm added fluoride in the 28-day initial period and in the depletion period they were given a diet containing only 0.21 ppm of fluoride and distilled water. The findings indicated a 12-fold increase in the fluoride content of the humeri after 28 days of high-flurodie intake with a greater increment by the epiphyses than by the diaphyses. During 21 days of the depletion period the skeletal fluoride was reduced by only 7.7% indicating a marked retention of fluoride during processes of bone remodeling and growth. The plasma, muscle, and liver total fluoride contents were significantly increased at the end of the period of high-fluoride intake, but these concentrations were found to be restored to base-line levels in 3-7 days of the depletion period. By comparison of the distribution of total fluoride with injected radiofluoride between tissue and plasma waters, it was concluded that muscle and liver contain bound fluoride that does not exchange completely with ionic fluoride.

Animals