Fluoride-binding by the organic matrix of developing bovine enamel

Proton microprobe assessment of the distribution of fluoride in the enamel and dentine of developing central incisors of sheep and changes induced by daily fluoride supplements

Ten sheep were given 0.5 mg fluoride (F) and 10 sheep 0.2 mg F/kg body wt orally for periods of 1-6 months while 8 sheep received no additional F. One incisor from each sheep was sectioned longitudinally in the midline and, using the proton microprobe, multiple scans for calcium and F were made across the enamel and dentine. F was determined by proton-induced gamma-ray emission and calcium by X-ray emission. Tooth length and hence the stage of ameloblast activity for each of the 28 teeth at the start of the experiment was determined using a tetracycline marker. In addition, the stage of enamel development of the eight control teeth (no dietary F) at the time of their extraction was assessed from their macroscopic appearance. Continuous changes in F levels occurred in both enamel and dentine throughout tooth development and also in the mature enamel and associated dentine after ameloblast regression. All scans for all stages of tooth development and all F treatments showed a high F concentration at the enamel surface. Early in the secretory phase, a wide-based F peak occupied the entire width of the enamel with a similar F peak in the dentine. In the control teeth, no consistent increase in F concentration occurred at the enamel surface during later development. When F supplements were started early in the maturation phase an increase in F concentration only at the enamel surface was recorded. When F supplements were also given during the secretory phase, higher F concentrations were recorded not only at the enamel surface but also for the inner enamel and dentine plateau. These findings, based on a small number of sheep, indicate that further research is needed to clarify the method and control of F uptake and to determine the changes in these processes during the different stages of tooth development.

Fluoride binding by matrix proteins in rat mineralizing tissue

Chronic fluoride exposure in vivo results in alterations in the formation of mineralizing tissues. One possible mechanism for the formation of fluorosed tooth enamel and bone is a binding of fluoride to matrix proteins, resulting in an alteration in their structure and function. Studies were designed to investigate fluoride binding to matrix proteins in vivo and their possible role in fluorosis. Rats were given either 0 or 100 parts/10(6) fluoride in drinking water for 6 weeks to allow the formation of fluorotic mineralizing tissues. The animals were killed by CO2 inhalation, and the enamel and bone were analysed for fluoride and calcium. Matrix binding by fluoride in enamel was determined after extraction of proteins from undemineralized matrix. In bone, the matrix was demineralized and F, Ca and P were determined in both ashed and unashed samples. The studies showed ionic binding of fluoride to the matrix in both enamel and bone, possibly associated with calcium binding by the matrix. There was no difference in the amount of matrix-bound fluoride in control as compared to fluorosed bone or maturation-stage enamel. This indicates that although matrix proteins can bind fluoride, it is not likely that this mechanism is important in the formation of fluorosed mineralizing tissues.

Biological mechanisms of fluorosis and level and timing of systemic exposure to fluoride with respect to fluorosis

Enamel fluorosis can occur following either an acute or chronic exposure to fluoride during tooth formation. Fluorosed enamel is characterized by a retention of amelogenins in the early-maturation stage, and by the formation of a more porous enamel with a subsurface hypomineralization. The mechanisms by which fluoride affects enamel development include specific effects on both the ameloblasts and on the developing enamel matrix. Maturation-stage ameloblast modulation is more rapid in fluorosed enamel as compared with control enamel, and proteolytic activity in fluorosed early-maturation enamel is reduced as compared with controls. Secretory enamel appears to be more susceptible to the effects of fluoride following acute fluoride exposure, such as may occur with the use of fluoride supplements. However, both human and animal studies show that the transition/early-maturation stage of enamel formation is most susceptible to the effects of chronic fluoride ingestion at above-optimal levels of fluoride in drinking water.

Nature and mechanisms of dental fluorosis in animals

Recent studies of dental fluorosis in animals have been reviewed. The aim was to describe studies which have provided information which may be relevant to explaining the mechanisms involved in human dental fluorosis. Studies on rats, sheep, and pigs have provided details of dosage regimens which produce lesions which resemble those described in human fluorosis. In the pig and rat, the plasma fluoride concentrations associated with these dental lesions are of the same order of magnitude as those which may occur in man. Three different kinds of studies in different species have shown that fluoride affects processes occurring during enamel maturation. One study on rats has indicated that fluoride may reduce matrix removal during maturation by an effect on enamel proteases. Many studies have demonstrated accumulation of fluoride in secretory enamel and that fluoride concentrations in maturation enamel are lower than in secretory enamel. This phenomenon had previously been explained by the binding of fluoride to enamel proteins, but recent studies indicate that such binding does not occur. The hypothesis that enamel fluorosis might be caused by general effects of fluoride on calcium metabolism has not been supported by more recent studies. It was concluded that, although the mechanisms involved in dental fluorosis remain obscure, recent animal studies do seem to have provided new information which may prove to be important for our understanding of mechanisms whereby fluoride causes dental fluorosis in man.

Fluoride and enamel defects

The concentration of fluoride in drinking water is the major determinant of the prevalence and severity of dental fluorosis in a community. Fluorosis is more prevalent and discernible in permanent teeth than in primary teeth; the intensity can range from barely perceptible, whitish striations in enamel to confluent pitting and dark staining. The traditional belief is that fluorosis is produced only during the secretory stages of ameloblastic activity. Some recent reports suggest that the maturation stages of enamel development are as important as or even more important than the secretory stages as the time when fluorosis can be produced. The question of timing remains unresolved. Many questions also remain about general and individual physiologic variations in relation to susceptibility to dental fluorosis. Good criteria for differential diagnosis exist to distinguish dental fluorosis from non-fluoride enamel opacities. An increasing number of reports indicates that the prevalence of fluorosis may be increasing among children in fluoridated and non-fluoridated communities. Reasons for the increases may relate to misuse of dietary fluoride supplements, ingestion of fluoride toothpastes, or increasing amounts of fluoride in foods or the atmosphere. The intensity of the increased fluorosis is in the milder categories and is not generally unsightly. It should be recognized that a small amount of fluorosis may be an alternative to a greater prevalence of dental caries, a disease that may produce cosmetic problems and sequelae worse than those produced by fluorosis.

Possible function of matrix proteins in fluoride incorporation into enamel mineral during porcine amelogenesis

The present study was undertaken to elucidate the mechanism of fluoride incorporation into secretory enamel mineral, with porcine enamel used as a model. Although the fluoride content in the enamel varied greatly among the animals, we observed that the fluoride-to-calcium ratio in the enamel tissue was maximal at the beginning of the secretory stage; the F/Ca ratio decreased (and leveled off) with the advancement of mineralization. In vitro work showed that some of the fluoride in the secretory enamel tissue was removed with the extraction of organic matter, mostly amelogenins. Furthermore, coating hydroxyapatite crystals with enamel matrix proteins resulted in a retardation of fluoride incorporation into the crystals when exposed to fluoride solutions, as a result of an inhibition of apatite reprecipitation. We also confirmed that the growth kinetics of fluoridated apatite onto HA seeds decreased with increasing coverage of the seed surface with the enamel proteins. All the results of the present study strongly suggest that the fluoride incorporation into enamel mineral during the secretory stage may be regulated by the kinetics of mineralization, which is highly dependent on the driving force for precipitation and the presence of proteinaceous inhibitors, mainly amelogenins.

The in vitro uptake of fluoride by secretory and maturation stage bovine enamel

The objectives of this study were to determine the specific surface area of secretory-stage and of maturation-stage enamel, to compare the fluoride uptake by isolated enamel at these two stages on a surface-area basis, and to examine the effect of the organic matrix on the fluoride uptake by whole enamel. Fetal bovine secretory and maturation stage enamel samples were collected, and a portion of the enamel at each developmental stage was treated with hydrazine for removal of the organic matrix. The specific surface areas of the enamel mineral, as determined by the multi-point BET method, were 59.3 m2/g in the secretory stage and 37.9 m2/g in the maturation stage. Whole and deproteinated enamel samples were equilibrated in buffered solutions containing 10(-5) to 10(-3) mol/L fluoride, and the uptake was measured with a fluoride specific electrode. The results indicate that the in vitro fluoride uptake was controlled solely by the surface area of the apatitic mineral and that the organic matrix did not contribute to the fluoride uptake.

Distribution of fluoride in the enamel of rat incisors examined by an abrasive microsampling technique

This study was undertaken to reveal detailed changes in fluoride distribution at different developmental stages of upper incisor enamel under various fluoride administration regimes. Four groups of Wistar rats received water containing 0, 25, 50 and 100 parts/10(6) fluoride respectively for 10 weeks. Five different enamel specimens were removed from the developing enamel, excluding the matrix-formation stage. Fluoride distribution in each specimen was analysed from the surface to the enamel-dentine junction using an abrasive microsampling technique. Fluoride concentration was invariably highest at the surface and decreased sharply towards the interior at every site in both control and experimental groups. The concentration throughout the tissue increased with fluoride intake at each stage of development. The fluoride-gradient curves were similar at each of the different sites of tooth development. However, the fluoride concentration of the enamel interior was significantly higher at early maturation than at the other four sites.

Absence of in-vitro fluoride-binding by the organic matrix of developing bovine enamel

The in-vitro binding of fluoride to isolated organic matrix of secretory bovine enamel was studied by direct fluoride measurement and equilibrium dialysis. Over a wide range of protein and fluoride concentrations there was no indication of fluoride binding by the matrix in contrast to earlier reports.

The short-term uptake and retention of fluoride in developing enamel and bone

Eight- and 12-day-old rat pups were injected intraperitoneally with fluoride. Plasma, molar enamel, and bone samples were collected at observation times up to six hr after injection. In a second series, adult rats maintained for six weeks on water containing 5 ppm F were injected with fluoride. Plasma, incisor enamel, and bone samples were collected at the same observation times as those used in the first series. Fluoride assays were conducted by means of the microdiffusion, ion-selective-electrode method. In the suckling rats, plasma [F] levels peaked at 15 min and returned nearly to baseline in one hr. Significant increases in the [F] of developing enamel and bone were observed. No significant decline from the peak [F] seen in the hard tissues was observed over the six-hour period. Similar results were seen in the developing enamel of the adult rats. The data gave no evidence of a short-term reversible component of fluoride uptake in developing enamel. Apparent increases in F uptake in enamel and bone beyond peak plasma values suggest the presence of a diffusion-limiting membrane for fluoride from the extracellular fluids into the mineralizing matrix.

Ultrastructure of in-vitro recovery of mineralization capacity of fluorotic enamel matrix in hamster tooth germs pre-exposed to fluoride in organ culture during the secretory phase of amelogenesis

The recovery of mineralization capacity of fluorotic enamel matrix was investigated in 3-day-old hamster first molar tooth germs already pre-exposed in organ culture to 10 parts/10(6) F- for 24 h during the secretory phase. The germs were then cultured for another 24 h in a fresh medium without F-. The unmineralized fluorotic enamel matrix secreted in vitro eventually mineralized in the absence of F- but the orientation of the crystals compared to those in the fluorotic enamel was disturbed, especially in the younger regions of the enamel nearest cervical-loop in which the underlaying fluorotic enamel was most hypermineralized; but least disturbed in the more mature parts of the enamel organ in which the fluorotic enamel was less hypermineralized. The subsequent culture in F(-)-free medium did not abolish or reduce the degree of hypermineralization induced by F- treatment during the initial 24 h of culture. It seems that in vitro the inhibitory effect of F- on enamel matrix mineralization during the secretory phase is completely reversible when the ion is removed from the matrix environment, i.e. F(-)-induced synthesis and secretion of defective enamel matrix is not the cause of the lack of matrix mineralization. The F(-)-induced hypermineralization seems to be irreversible.

Ultrastructure of altered rat enamel beneath fluoride-induced cysts

The effect of a single injection of sodium fluoride (60 mg/kg) on the development of rat molar enamel beneath fluoride-induced subameloblastic cysts was studied by transmission electron microscopy using undecalcified sections. Three bands of altered enamel were identified and defined as the cyst surface band, the hypoplastic band, and the hypercalcified band. The irregular cyst surface band, not previously described, was found to have two components: electron-dense enamel globules and organic spherules. The electron-dense globules consisted of small, randomly arranged crystals (confirmed by selected area electron diffraction) occurring within a stippled organic matrix. The organic spherules have staining properties similar to stippled material and lack a crystalline component. They may be a form of organic material being extruded from the underlying developing enamel. The critical role of normal matrix production and ameloblast Tomes' process structure on the development of the crystal orientation and rod pattern is discussed.

Ultrastructural study of fluoride-induced in-vitro hypermineralization of enamel in hamster tooth germs explanted during the secretory phase of amelogenesis

The effects of fluoride (5, 10 and 20 parts/10(6) F-) were studied in vitro with light and electron microscopy in 5-day-old hamster maxillary second molar tooth germs explanted when most of the ameloblasts are in the secretory phase, and cultured for 24 h in the presence of F-. F- at all doses investigated induced hypermineralization of that enamel which had been secreted in vivo just prior to exposure to F-. The most intense hypermineralization was in the aprismatic enamel near the cervical loop region, where the in-vivo enamel layer was thinnest and gradually decreased (but was not abolished) with the increasing thickness of in-vivo formed enamel in the more mature parts of the enamel organ. The fluoride-induced hypermineralization in the aprismatic enamel layer did not stain at all with dilute toluidine blue solution and was therefore indistinguishable from the underlying dentine in light micrographs. The hypermineralization was due to growth in thickness of the enamel crystals, which in the aprismatic enamel layer resulted in a lateral fusion of all the enamel crystals. Thus fluoride administered during the secretory phase of enamel formation decontrols or even abolishes enamel crystal growth in length and promotes crystal growth in thickness so producing the hypermineralization of the pre-fluoride enamel. Enamel matrix secreted in the presence of fluoride did not mineralize.

Fluoride uptake and retention at various stages of rat molar enamel development

Suckling rat pups were given intraperitoneal fluoride injections at selected ages so that we could study fluoride uptake in the enamel of the maxillary first molar at various stages of enamel development. Plasma fluoride levels in six-day-old and 11-day-old pups were monitored following the intraperitoneal injection of fluoride. The findings indicate that: (1) fluoride was more easily taken up and retained during the early stages of enamel formation, but fluoride uptake can occur during all stages of enamel formation; (2) when injections were started early in enamel formation, more fluoride was contained in the enamel of the maxillary first molar at 13 days of age; and (3) the same dose of fluoride per gram body weight resulted in greater exposure to elevated plasma fluoride levels in six-day-old pups than in 11-day-old pups.

The effect of fluoride on the electrophoretic patterns of developing rat molar enamel

Rat pups were given 4 micrograms F/g X day from 3-7 days of age by intraperitoneal injection of NaF. Demineralized enamel matrix from 8- to 15-day-old rats was subjected to SDS-polyacrylamide gel electrophoresis. The results showed that there was a decrease in the relative proportion of high molecular-weight proteins with maturation. Enamel formed in the presence of F showed more abundant low molecular-weight proteins in the secretory stage and a delay in the decrease of high molecular-weight proteins with maturation. These observations indicate that F may influence the assembly or dis-assembly of early enamel proteins.

Role of the enamel organ in limiting fluoride uptake during the maturation phase of enamel development

Autoradiographs of molar teeth from 15-day-old rats that had been injected with 18F showed no tracer uptake in the late-mineralizing enamel. Autoradiographic and quantitative in vitro experiments indicated that the enamel organ limited fluoride uptake during the maturation phase of enamel formation.