The epidemiology of dental caries in relation to environmental trace elements

Metal mixtures and oral health among children and adolescents in the National Health and Nutrition Examination Survey (NHANES), 2017-2020

INTRODUCTION

Dental caries is the most common non-communicable human disease, yet little is known about the role of environmental metals, despite teeth consisting of a hard matrix of trace elements. We conducted a cross-sectional study of associations between environmental metals and objective assessment of dental caries and subjective assessments of oral health among a representative sample of U.S. children and adolescents.

METHODS

Data were from the 2017-March 2020 pre-pandemic data file of the National Health and Nutrition Examination Survey (NHANES). To account for metal mixtures, we used weighted quantile sum (WQS) regression to estimate the joint impact of multiple trace elements assessed in blood and urine with oral disease outcomes.

RESULTS

The blood metal mixture index was associated with a 32% (95% CI: 1.11, 1.56) increased risk of decayed surfaces while the urine metal mixture index was associated with a 106%, RR (95% CI = 2.06 (1.58, 2.70) increased caries risk. For both blood and urine, Mercury (Hg) had the largest contribution to the mixture index followed by Lead (Pb). The WQS blood metal mixture index was also significantly associated with poorer self-rated oral health, although the magnitude of the association was not as strong as for the objective oral disease measures, RR (95% CI) = 1.04 (1.02, 1.07).

DISCUSSION

Increased exposure to a metal mixture was significantly related to poorer objective and subjective oral health outcomes among U.S. children and adolescents. These are among the first findings showing that metal mixtures are a significant contributor to poor oral health.

Plant and fungal food components with potential activity on the development of microbial oral diseases

This paper reports the content in macronutrients, free sugars, polyphenols, and inorganic ions, known to exert any positive or negative action on microbial oral disease such as caries and gingivitis, of seven food/beverages (red chicory, mushroom, raspberry, green and black tea, cranberry juice, dark beer). Tea leaves resulted the richest material in all the detected ions, anyway tea beverages resulted the richest just in fluoride. The highest content in zinc was in chicory, raspberry and mushroom. Raspberry is the richest food in strontium and boron, beer in selenium, raspberry and mushroom in copper. Beer, cranberry juice and, especially green and black tea are very rich in polyphenols, confirming these beverages as important sources of such healthy substances. The fractionation, carried out on the basis of the molecular mass (MM), of the water soluble components occurring in raspberry, chicory, and mushroom extracts (which in microbiological assays revealed the highest potential action against oral pathogens), showed that both the high and low MM fractions are active, with the low MM fractions displaying the highest potential action for all the fractionated extracts. Our findings show that more compounds that can play a different active role occur in these foods.

Inhibition of selenium metabolism in the oral pathogen Treponema denticola

In this report we provide evidence that the antimicrobial action of stannous salts and a gold drug, auranofin, against Treponema denticola is mediated through inhibition of the metabolism of selenium for synthesis of selenoproteins.

Evaluation of Laser Ablation Inductively Coupled Plasma Mass Spectrometry for the Quantitative Determination of Lead in Different Parts of Archeological Human Teeth

The lead content of teeth or tooth-parts has been used as a biomarker of cumulative lead exposure in clinical, epidemiological, environmental, and archaeological studies. Through the application of laser ablation inductively coupled plasma mass spectrometry, a pilot study of the micrometer-scale distribution and quantification of lead was conducted for two human teeth obtained from an archeological burial site in Manhattan, New York, USA. Lead was highly localized within each tooth, with accumulation in circumpulpal dentine and cementum. The maximum localized lead content in circumpulpal dentine was remarkably high, almost 2000 μg g(-1), compared to the mean enamel and dentine content of about 5 μg g(-1). The maximum lead content in cementum was approximately 700 μg g(-1). The large quantity of cementum found in the teeth suggested that the subjects had hypercementosis (excess cementum formation) of the root, a condition reported to have been prevalent among African-American slave populations. The distribution of lead in these human teeth was remarkably similar to the distribution that we previously reported in the teeth of present-day lead-dosed goats. The data shown demonstrate the feasibility of using laser ablation inductively coupled plasma mass spectrometry to examine lead exposure in archaeological studies.

Lead associated caries development in children living in a lead contaminated area, Thailand

In an observational cross-sectional design, a sample of 292 children aged 6-11 years from two primary schools around a shipyard area, known to be an area contaminated with lead (from the industry), were examined to verify the cariogenicity of lead. The number of decayed and filled surfaces on deciduous teeth (dfs), and the number of decayed, missing, and filled surfaces on permanent teeth (DMFS), the salivary flow rate, pH, buffer capacity, oral hygiene, Lactobacillus spp. and mutans streptococci counts were recorded. The mean (range) of DMFS and dfs were respectively 1.3 (range 0-17) and 13.2 (range 0-45); and the geometric mean blood lead level (PbB) and SD were 7.2 and 1.5 microg/dl. The level of dfs, but not DMFS correlated with the blood lead level (R(s)=0.25, p=0.00 / R(s)=0.09, p=0.14). The odds ratio for DMFS>or=1 and dfs>5 for a doubling of PbB after adjusting for other factors were 1.28 (95%CI, 0.81-2.04; p value=0.35) and 2.39 (95%CI, 1.36-4.20; p value=0.004), respectively. The cariogenicity of lead is evident in deciduous teeth but not in permanent teeth for this age group.

Spatial distribution of lead in the roots of human primary teeth

Lead remains one of the most hazardous metals in our environment. The concentrations of lead in coronal dentine and enamel have previously been reported but limited information is available regarding lead levels in radicular dentine and cementum. This study reports the distribution of lead in 26 roots of 16 human maxillary primary teeth from seven individuals. In addition, calcium and phosphorous concentrations were also measured to detect any variations in the degree of mineralization in different regions of the roots. The mean lead concentration in these roots was 1.67 +/- 1.43 microg/g, which is comparable to other studies. In all cases there were higher lead concentrations in the apices of non-resorbed roots of primary maxillary teeth relative to middle and cervical regions. The findings reported here are of potential significance during the process of physiological root resorption whence periapical tissue may be exposed to higher levels of lead.

Soils: their implications to human health

This paper reviews how the health of humans is affected by the world's soils, an association that to date has been under appreciated and under reported. Soils significantly influence a variety of functions (e.g. as a plant growth medium; its importance on the cycling of water; as a foundation for buildings) that sustains the human population. Through ingestion (either deliberate or involuntary), inhalation and dermal absorption, the mineral, chemical and biological components of soils can either be directly beneficial or detrimental to human health. Specific examples include: geohelminth infection and the supply of mineral nutrients and potentially harmful elements (PHEs) via soil ingestion; cancers caused by the inhalation of fibrous minerals or Rn gas derived from the radioactive decay of U and Th in soil minerals; and tetanus, hookworm disease and podoconiosis caused by skin contact and dermal absorption of appropriate soil constituents. Human health can also be influenced in more indirect ways as soils interact with the atmosphere, biosphere and hydrosphere. Examples include: the volatilisation of persistent organic pollutants (POPs) from soils and their subsequent global redistribution that has health implications to the Aboriginal people of the Arctic; the frequent detrimental chemical and biological quality of drinking and recreational waters that are influenced by processes of soil erosion, surface runoff, interflow and leaching; and the transfer of mineral nutrients and PHEs from soils into the plants and animals that constitute the human food chain. The scale and magnitude of soil/health interactions are variable, but at times a considerable number of people can be affected as demonstrated by the extent of hookworm infection or the number of people at risk because they live in an I-deficient environment. Nevertheless, it can often be difficult to establish definite links between soils and human health. This, together with the emergence of new risks, knowledge, or discoveries, means that there is considerable scope for research in the future. Such investigations should involve a multidisciplinary approach that both acquires knowledge and ensures its dissemination to people in an understandable way. This requires an infrastructure and finance that governments need to be responsive to.

Influence of lead on the cariostatic effect of fluoride co-crystallized with sucrose in desalivated rats

OBJECTIVE

Results from previous studies have shown that pre- and perinatal exposure to lead enhances susceptibility of rats to development of dental caries. A possible explanation for this phenomenon may be that lead complexes with fluoride and renders F insoluble and unable to exert its cariostatic effects.

MATERIALS AND METHODS

Thus, to explore this hypothesis, 48 desalivated Sprague-Dawley rats were placed in a König-Höfer programmed feeder and received 17 meals of powdered sucrose daily, and water ad libitum as follows: group (1) plain sucrose and sterile distilled water (SDW); (2) sucrose containing 15 ppm F and SDW; (3) sucrose containing 15 ppm F and 10 ppm Pb water; (4) sucrose containing 15 ppm F and 25 ppm Pb water.

RESULTS

The highest smooth-surface, sulcal surface caries and severity scores were observed in group I. Animals that were exposed to fluoride showed reduced smooth-surface caries and severity scores. S. sobrinus counts did not differ among the groups.

CONCLUSION

Lead did not interfere with the protective effect of fluoride in the conditions of the present study.

The association of tooth lead content with dental health factors

The purpose of this study was to determine the relationships of lead content in the human tooth with the prevalence of caries, dental plaque, pH of saliva, levels of Salivalis lactobacilli (SL) and Mutans streptococci (MS), degree of dental abrasion, tooth colour and toothbrushing frequency. A total of 220 teeth (one per person) were analysed using a microwave oven digestion procedure and lead content was measured by atomic absorption spectrometry. Tooth lead content followed a logarithmic-normal distribution and it increased with the prevalence of caries. Tooth lead concentrations were positively correlated with all the considered dental health factors except the pH of saliva, for which there was a significant negative correlation. Coloured teeth and teeth subject to abrasion showed the highest lead content. The highest number of colonies of SL and MS in saliva paralleled the highest lead tooth levels. Teeth obtained from irregular brushers presented higher tooth lead contents than subjects with a regular toothbrushing frequency. Multiple logistic regression analysis showed a significant association between tooth lead levels and dental plaque surface, Salivalis lactobacilli number, dental abrasion and dental colour. We conclude that accumulation of lead in teeth is associated with those dental health factors.

Dental lead levels in the Galician population, Spain

The aim of this study was to investigate tooth lead concentrations in a Spanish population living in Coruña, Spain. A total of 220 teeth were analysed using a microwave oven digestion procedure and lead content was measured by atomic absorption spectrometry. Samples were classified according to age, sex, type of tooth, cause of extraction and place of residence. Tooth lead levels followed a logarithmic-normal distribution. The general geometric mean was 10.36 micrograms/g of tooth. There was a significant increase in teeth lead levels with advancing age. Permanent teeth showed higher values (13.09 +/- 1.07 micrograms/g, mean +/- S.E.M.) than deciduous teeth (3.96 +/- 1.07 micrograms/g). However, no differences were found between sexes. High lead concentrations were detected in pathological teeth, particularly in those with periodontal pathology, suggesting a relation between lead levels and dental disease. Nevertheless, teeth with caries did not show any significant lead increase. People living in urban areas of the coast had the highest lead teeth contamination. This is the first study in Spain which describes the tooth lead levels as a marker of lead exposure.

Trace elements in saliva and dental caries in young adults

The results of a study on Zn, Cu, Ca and Mg content in whole saliva and supernatant of young adults in relation to caries prevalence are reported. A total of 225 university students were selected for the study on the basis of voluntary participation. The salivary electrolytes showed a high intersubjective variability and females had significantly lower levels than males. In whole saliva, the trace elements were highly correlated, whereas the correlations were weaker in the supernatant. The ratio supernatant/whole saliva varied between subjects and according to the examined electrolytes. No association could be found between the measured trace elements and DMFT. When we analysed the relation with recent caries experience in the subgroup of subjects undergoing oral examinations for at least 1 year, we found evidence that the Zn/Cu molar ratios in whole saliva were significantly decreased in subjects with more than three decayed teeth compared with those with no caries (1.54 vs. 1.11, P < 0.05). No significant association was found when supernatant was analysed. We conclude that the electrolytes' levels in whole saliva might be more adequate than the levels in supernatant to evaluate the relationship with caries.