The relationships between low levels of urine fluoride on children's intelligence, dental fluorosis in endemic fluorosis areas in Hulunbuir, Inner Mongolia, China

Fluoride Exposure and Children's IQ Scores: A Systematic Review and Meta-Analysis

Importance

Previous meta-analyses suggest that fluoride exposure is adversely associated with children's IQ scores. An individual's total fluoride exposure comes primarily from fluoride in drinking water, food, and beverages.

Objective

To perform a systematic review and meta-analysis of epidemiological studies investigating children's IQ scores and prenatal or postnatal fluoride exposure.

Data Sources

BIOSIS, Embase, PsycInfo, PubMed, Scopus, Web of Science, CNKI, and Wanfang, searched through October 2023.

Study Selection

Studies reporting children's IQ scores, fluoride exposure, and effect sizes.

Data Extraction and Synthesis

Data were extracted into the Health Assessment Workplace Collaborative system. Study quality was evaluated using the OHAT risk-of-bias tool. Pooled standardized mean differences (SMDs) and regression coefficients were estimated with random-effects models.

Main Outcomes and Measures

Children's IQ scores.

Results

Of 74 studies included (64 cross-sectional and 10 cohort studies), most were conducted in China (n = 45); other locations included Canada (n = 3), Denmark (n = 1), India (n = 12), Iran (n = 4), Mexico (n = 4), New Zealand (n = 1), Pakistan (n = 2), Spain (n = 1), and Taiwan (n = 1). Fifty-two studies were rated high risk of bias and 22 were rated low risk of bias. Sixty-four studies reported inverse associations between fluoride exposure measures and children's IQ. Analysis of 59 studies with group-level measures of fluoride in drinking water, dental fluorosis, or other measures of fluoride exposure (47 high risk of bias, 12 low risk of bias; n = 20 932 children) showed an inverse association between fluoride exposure and IQ (pooled SMD, -0.45; 95% CI, -0.57 to -0.33; P < .001). In 31 studies reporting fluoride measured in drinking water, a dose-response association was found between exposed and reference groups (SMD, -0.15; 95% CI, -0.20 to -0.11; P < .001), and associations remained inverse when exposed groups were restricted to less than 4 mg/L and less than 2 mg/L; however, the association was null at less than 1.5 mg/L. In analyses restricted to low risk-of-bias studies, the association remained inverse when exposure was restricted to less than 4 mg/L, less than 2 mg/L, and less than 1.5 mg/L fluoride in drinking water. In 20 studies reporting fluoride measured in urine, there was an inverse dose-response association (SMD, -0.15; 95% CI, -0.23 to -0.07; P < .001). Associations remained inverse when exposed groups were restricted to less than 4 mg/L, less than 2 mg/L, and less than 1.5 mg/L fluoride in urine; the associations held in analyses restricted to the low risk-of-bias studies. Analysis of 13 studies with individual-level measures found an IQ score decrease of 1.63 points (95% CI, -2.33 to -0.93; P < .001) per 1-mg/L increase in urinary fluoride. Among low risk-of-bias studies, there was an IQ score decrease of 1.14 points (95% CI, -1.68 to -0.61; P < .001). Associations remained inverse when stratified by risk of bias, sex, age, outcome assessment type, country, exposure timing, and exposure matrix.

Conclusions and Relevance

This systematic review and meta-analysis found inverse associations and a dose-response association between fluoride measurements in urine and drinking water and children's IQ across the large multicountry epidemiological literature. There were limited data and uncertainty in the dose-response association between fluoride exposure and children's IQ when fluoride exposure was estimated by drinking water alone at concentrations less than 1.5 mg/L. These findings may inform future comprehensive public health risk-benefit assessments of fluoride exposures.

Impact of high lodine and fluoride intake on children's IQ in rural China

BACKGROUND

Excessive intake of both fluorine and iodine can lead to various health effects. The potential influence of excessive fluorine and iodine intake on the intelligence of school-age children has become a notable concern.

OBJECTIVES

To investigate the relationship between urinary fluoride (UF) levels, urinary iodine (UI) levels, and intelligence quotient (IQ).

METHODS

This study involved 711 children aged 8 to 12 from rural Jiangsu, China. Water iodine levels were measured using As3+-Ce4+ catalytic spectrophotometry, while UI levels were determined using inductively coupled plasma mass spectrometry. Fluoride levels in urine and drinking water were measured using the ion-selective electrode method. Children's cognitive function, evaluated through IQ scores, was assessed using the Combined Raven's Test. The results were considered significant at the P < 0.05 level.

RESULTS

The average IQ score was 107.6, the median UF was 281 µg/L, and the median UI was 1.39 mg/L. The correlation coefficient (β) and confidence interval (95%CI) for UF and UI on IQ were - 3.34 (-4.14, -2.43) and - 3.31 (-4.19, -2.41), respectively (P < 0.001, P < 0.001). UF > 1.4 mg/L and UI ≥ 300 µg/L were negatively correlated with IQ scores in all school-age children (P < 0.001, P < 0.001), with β and 95% CIs of -3.59 (-5.45, -1.74), -4.06 (-5.91, -2.21), respectively. The interaction term (UF > 1.4 mg/L: UI ≥ 300 µg/L) was negatively correlated with IQ scores in all (P = 0.041) and female school-age children (P = 0.007), with β and 95%CIs of -4.43 (-8.66, -0.19) and - 8.87 (-15.16, -2.40), respectively.

CONCLUSIONS

High levels of both fluoride and iodine intake negatively affect the IQ of school-age children. Monitoring and regulating these elements in children's diets is essential to prevent cognitive impairment.

Correlation of fluoride intake with haemoglobin level and intelligence quotient in 8-12 year aged children: an observational study from India

BACKGROUND

Fluorosis caused by excess intake of fluoride can affects various soft tissues of the body, such as the gastrointestinal tract, blood, brain tissues and thyroid gland apart from dental fluorosis and skeletal fluorosis. Nonskeletal fluorosis is considered reversible if diagnosed early and treated promptly. Therefore, diagnostic methods that can be easily performed even by primary health care workers and depict any ongoing health problems, should be validated. Dental fluorosis, assessment of fluoride in urine and water are tests that fulfill these requirements. To date, no study has correlated haemoglobin (Hb) with dental fluorosis; moreover, studies focusing on intelligence quotient (IQ) had conflicting results and need further research. Hence, study was conducted to determine any relationship among different fluoride assessment parameters (severity of dental fluorosis, fluoride level in urine and drinking water) with IQ status and hemoglobin level of children aged 8-12 years, affected with or without dental fluorosis.

METHODS

A total of 300 children aged 8-12 years were evaluated for dental fluorosis via Dean's index, IQ level via Raven's coloured progressive matrices test, Hb level, and fluoride content in water and urine.

RESULTS

Water fluoride, age and gender were significantly associated with Hb. Intelligence was significantly related to urinary fluoride levels. Presence or absence of dental fluorosis and its severity were not significantly related to IQ or Hb.

CONCLUSIONS

Excess fluoride intake has adverse effects on hematological parameters and children's cognitive neurodevelopment, which were evaluated by current fluoride exposure markers, i.e., water and urinary fluoride. However, dental fluorosis cannot be used as a definitive assessment marker for these conditions, as it is not significantly correlated with these conditions.

Controllable and selective fluoride precipitation from phosphate-rich wastewater

Industrial wastewater containing high levels of fluoride and phosphate poses significant environmental challenges and results in the waste of non-renewable resources. This study investigates the use of La(OH)3 as a precipitating agent to selectively remove and separate fluoride from phosphate in such wastewater. The findings indicate that fluoride removal efficiency is highly dependent on the pH level and La(OH)3 dosage. Using Response Surface Methodology, the optimal conditions for fluoride precipitation were identified as a pH range of 1.0 to 2.5, a reaction time of 60-80 min, a La/3F molar ratio of 2.0, and reaction temperature of 25 °C. Under these parameters, the fluoride removal efficiency exceeded 96.9 %, while phosphate removal remained around 7.2 %. Further Density Functional Theory calculations and characterization confirmed La(OH)3 has a strong affinity for fluoride than phosphate under acidic conditions, leading to the formation of a LaF3 precipitate without forming LaPO4, effectively separating fluoride from phosphate. These results demonstrate an efficient strategy for treating wastewater with high fluoride and phosphate content, enabling the selective precipitation and recovery of these elements for sustainable management.

Longitudinal associations between early-life fluoride exposures and cardiometabolic outcomes in school-aged children

BACKGROUND/AIM

Fluoride is a natural mineral present in food, water, and dental products, constituting ubiquitous long-term exposure in early childhood and across the lifespan. Experimental evidence shows fluoride-induced lipid disturbances with potential implications for cardiometabolic health. However, epidemiological studies are scarce. For the first time, we evaluated associations between repeated fluoride measures and cardiometabolic outcomes in children.

METHODS

We studied ∼ 500 Mexican children from the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) cohort with measurements on urinary fluoride at age 4, and dietary fluoride at ages 4, 6, and 8 years approximately. We used covariate-adjusted linear mixed-effects and linear regression models to assess fluoride associations with multiple cardiometabolic outcomes (ages 4-8): lipids (total cholesterol, HDL, LDL, and triglycerides), glucose, HbA1c, adipokines (leptin and adiponectin), body fat, and age- and sex-specific z-scores of body mass index (zBMI), waist circumference, and blood pressure.

RESULTS

Dietary fluoride intake at age 4 was associated with annual increases in triglycerides [β per-fluoride-doubling = 2.02 (95 % CI: 0.37, 3.69)], cholesterol [β = 1.46 (95 % CI: 0.52, 2.39)], HDL [β = 0.39 (95 % CI: 0.02, 0.76)], LDL [β = 0.87 (95 % CI: 0.02, 1.71)], and HbA1c [β = 0.76 (95 % CI: 0.28, 1.24)], and decreased leptin [β = -3.58 (95 % CI: -6.34, -0.75)] between the ages 4 and 8. In cross-sectional analyses at age 8, higher tertiles of fluoride exposure were associated with increases in zBMI, triglycerides, glucose, and leptin (p-tertile trend < 0.05). Stronger associations were observed in boys at year 8 and in girls prior to year 8 (p-sex interaction < 0.05). Fewer but consistent associations were observed for urinary fluoride at age 4, indicating increased annual changes in HDL and HbA1c with higher fluoride levels.

CONCLUSION

Dietary fluoride exposures in early- and mid-childhood were associated with adverse cardiometabolic outcomes in school-aged children. Further research is needed to elucidate whether these associations persist at later ages.

Regional and racial/ethnic inequalities in public drinking water fluoride concentrations across the US

BACKGROUND

Although the US Centers for Disease Control and Prevention (CDC) considers fluoridation of community water systems (CWSs) to be a major public health achievement responsible for reducing dental disease, recent epidemiologic evidence suggests that chronic exposure to population-relevant levels of fluoride may also be associated with adverse child neurodevelopmental outcomes. To our knowledge, a nationally representative database of CWS fluoride concentration estimates that can be readily linked to US epidemiologic cohorts for further study is not publicly available. Our objectives were to evaluate broad regional and sociodemographic inequalities in CWS fluoride concentrations across the US, and to determine if county-level racial/ethnic composition was associated with county-level CWS fluoride.

METHODS

We generated CWS-level (N = 32,495) and population weighted county-level (N = 2152) fluoride concentration estimates using over 250,000 routine compliance monitoring records collected from the US Environmental Protection Agency's (EPA) Third Six Year Review (2006-2011). We compared CWS-level fluoride distributions across subgroups including region, population size served, and county sociodemographic characteristics. In county-level spatial error models, we also evaluated geometric mean ratios (GMRs) of CWS fluoride per 10% higher proportion of residents belonging to a given racial/ethnic subgroup.

RESULTS

4.5% of CWSs (serving >2.9 million residents) reported mean 2006-2011 fluoride concentrations ≥1500 µg/L (the World Health Organization's guideline for drinking water quality). Arithmetic mean, 90th, and 95th percentile contaminant concentrations were greatest in CWSs reliant on groundwater, located in the Southwest and Eastern Midwest, and serving Semi-Urban, Hispanic communities. In fully adjusted spatial error models, the GMR (95% CI) of CWS fluoride per a 10% higher proportion of county residents that were Hispanic/Latino was 1.16 (1.10, 1.23).

IMPACT STATEMENT

We find that over 2.9 million US residents are served by public water systems with average fluoride concentrations exceeding the World Health Organization's guidance limit. We also find significant inequalities in community water system fluoride concentration estimates (2006-2011) across the US, especially for Hispanic/Latino communities who also experience elevated arsenic and uranium in regulated public drinking water systems. Our fluoride estimates can be leveraged in future epidemiologic studies to assess the potential association between chronic fluoride exposure and related adverse outcomes.

Unraveling gene expression and genetic instability in dental fluorosis: Investigating the impact of chronic fluoride exposure

Chronic fluoride exposure, even in small quantities, when continuously ingested by the human population, can lead to a significant public health concern known as fluorosis. Our understanding of the effects of fluoride on human health, as well as its potential to impact DNA, is limited. The present study aimed to assess genetic instability in 20 individuals diagnosed with dental fluorosis and 20 individuals without the condition from the state of Rio Grande do Sul, Brazil. The participants' dental fluorosis was evaluated using the Thylstrup-Fejerskov index (TF). To further evaluate genetic instability, several assays were conducted, including the alkaline and modified (+FPG) comet assay (using a visual score, VS), the buccal micronucleus (MN) cytome (BMCyt) assay, the cytokinesis-block MN (CBMN-Cyt) assay, and the measurement of telomere length (TL). In addition, the study utilized tools from Systems Biology to gain insights into the effects of fluoride exposure on humans, which aided in the selection and evaluation of mRNA expression levels of specific genes, namely PPA1 (inorganic pyrophosphatase 1), AQP5 (Aquaporin 5), and MT-ATP6 (Mitochondrially Encoded Adenosine Triphosphate Synthase Membrane Subunit 6). Furthermore, fluoride levels in the blood and urine were assessed using an ion-selective electrode, along with the evaluation of the inflammatory response in serum. The group with dental fluorosis exhibited 2.18 times higher MN frequencies specifically when assessed using the CBMN-Cyt assay, in comparison with individuals without fluorosis. Findings from the enzyme-modified comet assay indicated oxidative damage to purines in DNA. Furthermore, a decrease in TL was observed, along with elevated expression patterns of the PPA1 and AQP5 genes, and significant alterations in cytokine release. Significant correlations were identified between the TF and age, as well as the levels of necrotic cells. Additionally, noteworthy correlations were established between fluoride levels and the levels of MN, VS, and MT-ATP6. Although dental fluorosis results from fluoride exposure, our research highlights the potential influence of this condition on genomic instability and gene expression. Consequently, our findings stress the importance of continuously monitoring populations with a high incidence of dental fluorosis to enhance our comprehension of how genomic instability might correlate with the origins and consequences of health problems in these individuals.

Exploration of the SIRT1-mediated BDNF-TrkB signaling pathway in the mechanism of brain damage and learning and memory effects of fluorosis

Introduction

Fluoride is considered an environmental pollutant that seriously affects organisms and ecosystems, and its harmfulness is a perpetual public health concern. The toxic effects of fluoride include organelle damage, oxidative stress, cell cycle destruction, inflammatory factor secretion, apoptosis induction, and synaptic nerve transmission destruction. To reveal the mechanism of fluorosis-induced brain damage, we analyzed the molecular mechanism and learning and memory function of the SIRT1-mediated BDNF-TrkB signaling pathway cascade reaction in fluorosis-induced brain damage through in vivo experiments.

Methods

This study constructed rat models of drinking water fluorosis using 50 mg/L, 100 mg/L, and 150 mg/L fluoride, and observed the occurrence of dental fluorosis in the rats. Subsequently, we measured the fluoride content in rat blood, urine, and bones, and measured the rat learning and memory abilities. Furthermore, oxidative stress products, inflammatory factor levels, and acetylcholinesterase (AchE) and choline acetyltransferase (ChAT) activity were detected. The pathological structural changes to the rat bones and brain tissue were observed. The SIRT1, BDNF, TrkB, and apoptotic protein levels were determined using western blotting.

Results

All rats in the fluoride exposure groups exhibited dental fluorosis; decreased learning and memory abilities; and higher urinary fluoride, bone fluoride, blood fluoride, oxidative stress product, and inflammatory factor levels compared to the control group. The fluoride-exposed rat brain tissue had abnormal AchE and ChAT activity, sparsely arranged hippocampal neurons, blurred cell boundaries, significantly fewer astrocytes, and swollen cells. Furthermore, the nucleoli were absent from the fluoride-exposed rat brain tissue, which also contained folded neuron membranes, deformed mitochondria, absent cristae, vacuole formation, and pyknotic and hyperchromatic chromatin. The fluoride exposure groups had lower SIRT1, BDNF, and TrkB protein levels and higher apoptotic protein levels than the control group, which were closely related to the fluoride dose. The findings demonstrated that excessive fluoride caused brain damage and affected learning and memory abilities.

Discussion

Currently, there is no effective treatment method for the tissue damage caused by fluorosis. Therefore, the effective method for preventing and treating fluorosis damage is to control fluoride intake.

Factors influencing the spatial distribution and individual variation in urinary fluoride levels in Tibet, China

Nowadays, fluorosis is the most prevalent endemic disease in Tibet and one of the most concerned public health problems in China; urinary fluoride is a common diagnostic indicator of endemic fluorosis. However, the spatial distribution and influencing factors of urinary fluoride content in Tibet remain unclear. This study aims to bridge this gap by geographically weighted regression (GWR), analyses of variance (ANOVAs), Geodetector, and stepwise multiple linear regression (MLR). To achieve this goal, this study first investigated fluoride levels in the fasting urine among 637 Tibetan residents from 73 counties in Tibet, the urinary fluoride level was chosen as an indicator of fluorosis, which can reflect the health impairment. Then we identified the potential factors that could influence the spatial distribution and individual variation of urinary fluoride levels from physical environmental and socioeconomic perspective, respectively. The results showed that urinary fluoride levels in Tibet were slightly exceeding the average value for adult urinary fluoride in China, and that residents with high urinary fluoride were mainly found in the west and east; those with low urinary fluoride were mainly found in the central-southern regions. And the urinary fluoride levels had a significantly positive correlation with water fluoride and a significantly negative correlation with average annual temperature. Urinary fluoride levels increased until age 60 and followed an inverted "U"-shaped trajectory according to annual household income (80,000 renminbi (RMB) was the inflection point); pastoralists had greater exposure to fluoride than farmers. Furthermore, the Geodetector and MLR showed that the urinary fluoride level was influenced by both physical environmental and socioeconomic factors. The socioeconomic factors such as age, annual household income and occupation had a greater impact than the physical environment on urinary fluoride concentration. These findings can provide scientific basis for preventing and controlling endemic fluorosis in the Tibetan Plateau and adjacent areas.

Association of Dental Fluorosis and Urinary Fluoride with Intelligence among Schoolchildren

Fluoride is present naturally in water and has been used worldwide for the prevention of caries. Several studies conducted in high water fluoride or endemic fluorosis areas reported that fluoride adversely affected children's cognitive function, but some studies had negative findings. This study aimed to assess the relationship between urinary fluoride, dental fluorosis, and intelligence among schoolchildren living in communities with non-fluoridated drinking water. This cross-sectional study was conducted on 562 children aged 6-12 years in Taichung, Taiwan. Each child's urinary fluoride level was determined by a fluoride-ion-selective electrode, and the dental fluorosis condition was evaluated according to the criteria of Dean's Index. The Raven's Colored Progressive Matrices-Parallel and Standard Progressive Matrices-Parallel were used to assess children's intelligence. The results showed that the mean (±standard deviation) urinary fluoride concentrations were 0.40 ± 0.27 mg/L (0.43 ± 0.23 mg/g creatinine) among participants. The prevalence of dental fluorosis was 23.67%. After extensive evaluation of potential confounders, dental fluorosis and urinary fluoride were not associated with intelligence quotient (IQ) scores or grades in the regression models. In conclusion, dental fluorosis and urinary fluoride levels were not significantly related to the IQ of schoolchildren living in areas with low drinking water fluoride.

Fluoride exposure and cognitive neurodevelopment: Systematic review and dose-response meta-analysis

Many uncertainties still surround the possible harmful effect of fluoride exposure on cognitive neurodevelopment in children. The aim of this systematic review and meta-analysis was to characterize this relation through a dose-response approach, by comparing the intelligence quotient (IQ) scores in the highest versus the lowest fluoride exposure category with a random-effects model, within a one-stage dose-response meta-analysis based on a cubic spline random-effects model. Out of 1996 potentially relevant literature records, 33 studies were eligible for this review, 30 of which were also suitable for meta-analysis. The summary mean difference of IQ score, comparing highest versus lowest fluoride categories and considering all types of exposure, was -4.68 (95% confidence interval-CI -6.45; -2.92), with a value of -5.60 (95% CI -7.76; -3.44) for drinking water fluoride and -3.84 (95% CI -7.93; 0.24) for urinary fluoride. Dose-response analysis showed a substantially linear IQ decrease for increasing water fluoride above 1 mg/L, with -3.05 (95% CI -4.06; -2.04) IQ points per 1 mg/L up to 2 mg/L, becoming steeper above such level. A weaker and substantially linear decrease of -2.15 (95% CI -4.48; 0.18) IQ points with increasing urinary fluoride emerged above 0.28 mg/L (approximately reflecting a water fluoride content of 0.7 mg/L). The inverse association between fluoride exposure and IQ was particularly strong in the studies at high risk of bias, while no adverse effect emerged in the only study judged at low risk of bias. Overall, most studies suggested an adverse effect of fluoride exposure on children's IQ, starting at low levels of exposure. However, a major role of residual confounding could not be ruled out, thus indicating the need of additional prospective studies at low risk of bias to conclusively assess the relation between fluoride exposure and cognitive neurodevelopment.

A Systematic Review and Meta-Analysis of the Relationship Between the Severity of Dental Fluorosis and Fluoride Biomarkers in Endemic Areas

The intake of high concentrations of fluoride, mainly through drinking water, diet and fluoridated dentifrices, produces fluorosis, which in its early stages is manifested as dental fluorosis (DF). To recognize exposure to fluoride in endemic areas and to evaluate the risk of developing health impairment, the WHO has established several biomarkers that are used to determine systemic fluorine (F-) exposure. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the relationship between the severity of DF and fluoride biomarkers in endemic areas. The protocol of this study was previously registered as CRD42021244974. A digital search was carried out in PubMed/Medline, SpringerLink, Scopus, Cochrane and Google Scholar by employing the keywords "urine", "nails", "hair", "plasma", "saliva" and "dental fluorosis" for the original studies with content associated with F- for the biomarkers and DF. The mean difference was established as the effect measure for the meta-analysis. Seven studies fulfilled the eligibility criteria, among which five assessed urine and two employed nails as fluoride biomarkers. A positive significant difference was found between the biomarkers and the severity of DF (0.27, p < 0.001) and individually for each biomarker (urine: 0.14, p = 0.001; nails: 0.88, p < 0.05). The F- concentration in urine and nails is correlated with the severity of DF, with the most evident differences between healthy individuals and those with mild severity. Both biomarkers are adequate to assess this relationship in endemic areas of fluoride and DF.

Association between dental fluorosis prevalence and inflammation levels in school-aged children with low-to-moderate fluoride exposure

Inflammation mediates the neurological deficits caused by fluoride. Thus, whether inflammation is the underlying mechanism of dental fluorosis (DF) in school-aged children is worth exploring. A cross-sectional study was conducted to investigate the association between inflammation and the prevalence and severity of DF with low-to-moderate fluoride exposure. Fasting morning urine and venous blood samples were collected from 593 children aged 7-14 years. The fluoride content in the water and urine samples was measured using a fluoride ion-selective electrode assay. The levels of interleukin-1β (IL-1β) and C-reactive protein (CRP) were detected using an enzyme-linked immunosorbent assay. The Dean's index was used when performing dental examinations. Regression, stratified, and mediation analyses were performed to analyze the association between fluoride exposure, inflammation, and DF prevalence. In the adjusted regression models, the prevalence of mild DF was 1.723-fold (95% confidence interval [CI]:1.612, 1.841) and 1.594-fold (1.479, 1.717) greater than that of normal DF for each 1 mg/L increase in water and urinary fluoride content, respectively. The prevalence of mild DF increased by 3.3% for each 1 pg/mL increase in the IL-1β level and by 26.0% for each 1 mg/L increase in the CRP level. Stratified analysis indicated a weaker association between fluoride concentration and DF prevalence in boys than in girls, and susceptibility in the boys was reflected by the association of IL-1β with very mild and moderate DF prevalence. For every 1 mg/L increase in water and urinary fluoride levels, the proportion of IL-1β-mediated effects on the prevalence of mild DF was 10.0% (6.1%, 15.8%) and 8.7% (4.8%, 15.2%), respectively, and the proportion of CRP-mediated effects was 9.2% (5.5%, 14.9%) and 6.1% (3.3%, 11.0%), respectively. This study indicates that the DF prevalence may be sex-specific. Inflammatory factors may partially mediate the increased prevalence of mild DF in school-aged children with low-to-moderate fluoride exposure.

The Relationship between Fluoride Exposure and Cognitive Outcomes from Gestation to Adulthood-A Systematic Review

Chronic exposure to high levels of fluoride may cause health concerns, including in cognitive function. This study reviewed the evidence on the association between fluoride exposure and cognitive outcomes in children from gestation up to 18 years old. A literature search was conducted for studies on pregnant women and children below 18, exposed to any source of fluoride, and assessed with a validated cognitive tool. The data were analyzed using a systematic narrative synthesis approach and by subgroup: study design, age of participants, levels of fluoride exposure and methodological quality. Our search retrieved 15,072 articles, of which 46 met the inclusion criteria. Only 6 of the studies had a longitudinal design; the remainder were cross-sectional. The levels of fluoride exposure were ≥2 mg/L in 27 studies and <2 mg/L in 13 studies; 6 studies did not report levels of fluoride exposure. Only 1 of 5 studies graded as excellent quality showed a negative association between fluoride exposure and cognitive outcomes, whereas 30 of 34 poor and fair quality studies reported a negative association. The overall evidence from this review suggests that high fluoride exposure might be associated with negative cognitive outcomes in children. However, more longitudinal studies with high methodological quality are needed on this topic.

Water quality and probabilistic non-carcinogenic health risk of groundwater: a half decadal scenario change in Vadodara

Groundwater is essential to secure the safety of water supply in Vadodara, Gujarat. In this study, groundwater samples were collected from various part of the city which separated in 12 wards. The present study contains analyses of 720 groundwater samples gathered from various tube and open wells and analyzed for fluoride and other physicochemical parameters during 2014 and 2019. The results indicated that fluoride and TDS were high and the overall water quality was poor in the study area. Gastrointestinal and other health-related issues increased due to higher TDS in east, north and northeast regions. Likewise, hierarchical cluster analysis also indicated that TDS and chloride-rich water. Fluoride concentration was observed in the range of 0.66-1.61 mg/l (2014) and 0.86-1.77 mg/l (2019) which indicates that 62% samples are unfit for drinking purpose, which could cause dental and skeletal fluorosis. The water quality index (WQI) indicated lack of excellent water in the studied area in the last half-decade. As per WQI calculation suggest that 82.12% (2014) and 69.00% (2019) of groundwater samples represent poor, very poor and unsuitable categories, whereas remaining 17.85% (2014) and 31.00% (2019) of the samples represent good category for drinking purposes in entire Vadodara, Gujarat. Marginal improvement in the groundwater quality is reported due to good rainfall in 2019. Health risks associated with high fluoride drinking water were assessed for various age groups of inhabitants such as children, infants and adults. The non-carcinogenic hazard quotient estimated by oral intake was 1.38-3.36 (2014) and 1.79-3.70 (2019) for infants; 0.69-1.68 (2014) and 0.90-1.85 (2019) for children, whereas 0.07-0.18 (2014) and 0.10-0.20 (2019) for adults. Therefore, infant and children are relatively at higher health risk due to the intake of fluoride-rich drinking water than adult in the studied region. Both indices were indicated contaminated water or closer to contamination which induced non-carcinogenic health risk on citizens. Thus, the comprehensive results of present study can be used as a baseline data and valuable tool for government authorities for long-term monitoring, health monitoring and sustainable development of Vadodara, Gujarat.

Arsenic and fluoride co-exposure through drinking water and their impacts on intelligence and oxidative stress among rural school-aged children of Lahore and Kasur districts, Pakistan

Arsenic (As), and fluoride (F^-) are potent contaminants with established carcinogenic and non-carcinogenic impacts on the exposed populations globally. Despite elevated groundwater As and F^- levels being reported from various regions of Pakistan no biomonitoring study has been reported yet to address the co-exposure impact of As and F^- among school children. We aimed to investigate the effects of these two contaminants on dental fluorosis and intelligence quotient (IQ) along with the induction of oxidative stress in rural children under co-exposed conditions. A total of 148 children (5 to 16 years old) from the exposed and control group were recruited in the current study from endemic rural areas of Lahore and Kasur districts, Pakistan having elevated As and F^- levels in drinking water than permissible limits. We monitored malondialdehyde and its probable association with antioxidants activity (SOD, CAT, and GR) as a biomarker of oxidative stress. GSTM1/T1 polymorphisms were measured to find the impact of As on health parameters. Mean urinary concentrations of As (2.70 vs. 0.016 µg/L, P < 0.000) and F^- (3.27 vs. 0.24 mg/L, P < 0.000) as well as the frequency of dental fluorosis were found elevated among the exposed group. The cases of children with lower IQ were observed high in the exposed group. Additionally, lower concentrations of antioxidants (SOD, CAT, and GR) were found suggesting high susceptibility to F^- toxicity. The findings suggest that F^- accounted for high variations in health parameters of children under the co-exposure conditions with As.

Do methylenetetrahydrofolate dehydrogenase, cyclohydrolase, and formyltetrahydrofolate synthetase 1 polymorphisms modify changes in intelligence of school-age children in areas of endemic fluorosis?

BACKGROUND

Excessive exposure to fluoride can reduce intelligence. Methylenetetrahydrofolate dehydrogenase, cyclohydrolase, and formyltetrahydrofolate synthetase 1 ( MTHFD1 ) polymorphisms have important roles in neurodevelopment. However, the association of MTHFD1 polymorphisms with children's intelligence changes in endemic fluorosis areas has been rarely explored.

METHODS

A cross-sectional study was conducted in four randomly selected primary schools in Tongxu County, Henan Province, from April to May in 2017. A total of 694 children aged 8 to 12 years were included in the study with the recruitment by the cluster sampling method. Urinary fluoride (UF) and urinary creatinine were separately determined using the fluoride ion-selective electrode and creatinine assay kit. Children were classified as the high fluoride group and control group according to the median of urinary creatinine-adjusted urinary fluoride (UF Cr ) level. Four loci of MTHFD1 were genotyped, and the Combined Raven's Test was used to evaluate children's intelligence quotient (IQ). Generalized linear model and multinomial logistic regression model were performed to analyze the associations between children's UF Cr level, MTHFD1 polymorphisms, and intelligence. The general linear model was used to explore the effects of gene-environment and gene-gene interaction on intelligence.

RESULTS

In the high fluoride group, children's IQ scores decreased by 2.502 when the UF Cr level increased by 1.0 mg/L (β = -2.502, 95% confidence interval [CI]:-4.411, -0.593), and the possibility for having "excellent" intelligence decreased by 46.3% (odds ratio = 0.537, 95% CI: 0.290, 0.994). Children with the GG genotype showed increased IQ scores than those with the AA genotype of rs11627387 locus in the high fluoride group ( P   <  0.05). Interactions between fluoride exposure and MTHFD1 polymorphisms on intelligence were observed (Pinteraction < 0.05).

CONCLUSION

Our findings suggest that excessive fluoride exposure may have adverse effects on children's intelligence, and changes in children's intelligence may be associated with the interaction between fluoride and MTHFD1 polymorphisms.

Intrauterine and Postnatal Exposure to High Levels of Fluoride Is Associated with Motor Impairments, Oxidative Stress, and Morphological Damage in the Cerebellum of Offspring Rats

Fluoride (F) is abundantly present on Earth and plays a beneficial role in human health. However, exposure to high doses of F can be a risk, mainly in endemic fluorosis regions. In light of this, we investigated the effects of F exposure during the intrauterine and postnatal periods of rats, in doses similar to those recommended in drinking water and the levels of F in regions with endemic fluorosis, on the offspring rats’ cerebellum. Pregnant rats were divided into three groups: control (received ultrapure water only), 10 mg F/L, and 50 mg F/L for a period of 42 days (21 days gestation and 21 days lactation). At the end of the lactation period, the male pups were evaluated by behavioral tests, morphological markers, and biochemistry assays. The results pointed out that 50 mg F/L exposure during the intrauterine and lactational period of rats is capable of promoting oxidative stress in the cerebellum with a decrease in Purkinje cell density and myelin basic protein compromise, which could be associated with functional motor impairments. In addition, although 10 mg F/L exposure promoted redox alterations, it did not affect other parameters evaluated, highlighting the safe use of F in low doses.

Chloride-salinity as indicator of the chemical composition of groundwater: empirical predictive model based on aquifers in Southern Quebec, Canada

The present study first describes the variations in concentrations of 12 chemical elements in groundwater relative to salinity levels in Southern Quebec (Canada) groundwater systems, and then uses this data to develop an empirical predictive model for evaluating groundwater chemical composition relative to salinity levels. Data is drawn from a large groundwater chemistry database containing 2608 samples. Eight salinity classes were established from lowest to highest chloride (Cl) concentrations. Graphical analyses were applied to describe variations in major, minor, and trace element concentrations relative to salinity levels. Results show that the major elements were found to be dominant in the lower salinity classes, whereas Cl becomes dominant at the highest salinity classes. For each of the major elements, a transitional state was identified between domination of the major elements and domination of Cl. This transition occurred at a different level of salinity for each of the major elements. Except for Si, the minor elements Ba, B, and Sr generally increase relative to the increase of Cl. The highest Mn concentrations were found to be associated with only the highest levels of Cl, whereas F was observed to be more abundant than Mn. Based on this analysis of the data, a correlation table was established between salinity level and concentrations of the chemical constituents. We thus propose a predictive empirical model, identifying a profile of the chemical composition of groundwater relative to salinity levels, to help homeowners and groundwater managers evaluate groundwater quality before resorting to laborious and costly laboratory analyses.

Exploring a variance decomposition approach integrated with the Monte Carlo method to evaluate groundwater fluoride exposure on the residents of a typical fluorosis endemic semi-arid tract of India

This study appraised the groundwater fluoride (F^-) endemicity and the exposure levels under the Central Tendency Exposure (CTE) condition and the Reasonable Maximum Exposure (RME) condition on the residents of the semi-arid parts of the Birbhum district of Peninsular India using a Variance Decomposition (Sobol Sensitivity Indices) approach combined with Monte Carlo Simulations. The study finds the national scale drinking water standard limit for F^- (1.5 mg L^-1) is inappropriate for the present survey area where F^- concentration in groundwater varied between 0.26 and 11.82 mg L^-1 and ~54.5% of the samples (N = 400) exceeded this limit. Therefore, estimated the optimum F^- concentration of 0.733 mg L^-1 for the region using the method recommended by the World Health Organization (WHO) to calculate the optimum F^- limit at a regional scale. The average value of F^- concentrations for this region (1.71 mg L^-1) is considerably higher than the estimated optimum concentration or even the maximum permissible limits recommended for the subtropical regions (0.5-0.7 mg L^-1). The exposure analysis revealed the infants and children as potentially vulnerable populations compared to adolescents and adults of the study area for CTE and RME scenarios. The multi-exposure pathways indicated oral intake as the main exposure pathway whereas exposure through dermal contact was insignificant for the residents of all age groups of this region. Based on the first, second and total order Sobol Sensitivity Indices, F^- concentration (C) in groundwater, the groundwater ingestion rate and their combined interaction are the greatest significant parameters for the oral exposure model whereas C and its interaction effects with the proportion of the skin surface area in contact with groundwater as the utmost sensitive variables for the dermal health risks assessment model. The present study insists the inhabitants to intake defluoridated groundwater.

Relationship between fluoride exposure and count of Streptococcus mutans in supragingival biofilm of mexican scholar children

Background/purpose

The use of fluoride is known to reduce the risk of dental caries. There is limited information on the relationship between Streptococcus mutans (S. mutans) and fluoride exposure. This study investigated the association between the count of S. mutans on supragingival biofilm and fluoride exposure of scholar children.

Materials and methods

In this cross-sectional study, 56 children from 9 to 11 years of age were selected. Fluoride concentration in drinking water, urine and saliva of each participant were assessed. The count of S. mutans was estimated by calculating the DNA copy number through a quantitative real time polymerase chain reaction (qPCR) assay. Also, sociodemographic data, oral and general health information and variables related to caries risk were evaluated. A stepwise multiple linear regression was performed in all caries related predictor variables with the count of S. mutans as the dependent variable.

Results

The multiple linear regression analysis showed that the concentration of fluoride in saliva (β = −3.029, p < 0.001) and urine (β = −2.057, p = 0.017), time of last visit to the dentist (β = 1.968, p = 0.001), plaque index (β = 1.637, p = 0.006) and number of surfaces with codes 3–6 (D_3-6MFS) of ICDAS II criteria (β = 0.283, p = 0.076) were significantly associated with the count of S. mutans (Adjusted R square = 0.427, p < 0.001).

Conclusion

Fluoride levels in urine and saliva were negatively associated with the count of S. mutans in supragingival biofilm. Plaque index, D_3-6MFS and time of last visit to the dentist showed a positive association.

Association between fluoride exposure and behavioural outcomes of school-age children: a pilot study in China

To assess the association between fluoride exposure and children's behavioural outcomes, we recruited 325 resident school-age children (7-13 years old) lived in Tongxu County of Henan Province in China. We measured urinary fluoride (UF) concentrations using the ion-selective electrode method. Children's behavioural outcomes were assessed by Conners' Parent Rating Scale-Revised, including conduct problems, learning problems, psychosomatic problems, impulsive-hyperactive, anxiety, and ADHD index. It turned out that each 1.0 mg/L increment in UF concentration corresponded with an elevation in the psychosomatic problem score of 4.01 (95% CI: 2.74, 5.28) and a 97% (OR = 1.97, 95% CI: 1.19, 3.27) increase in the prevalence of psychosomatic problems after adjusting for potential influencing factors. The sensitivity analysis results were consistent with those observed in our preliminary analysis. Our study suggests that fluoride exposure is positively related to the behavioural problem in school-age children, psychosomatic problem in particular.

Dietary fluoride intake during pregnancy and neurodevelopment in toddlers: A prospective study in the progress cohort

Foods and beverages provide a source of fluoride exposure in Mexico. While high fluoride concentrations are neurotoxic, recent research suggests that exposures within the optimal range may also pose a risk to the developing brain. This prospective study examined whether dietary fluoride intake during pregnancy is associated with toddlers' neurodevelopment in 103 mother-child pairs from the PROGRESS cohort in Mexico City. Food and beverage fluoride intake was assessed in trimesters 2 and 3 using a food frequency questionnaire and Mexican tables of fluoride content. We used the Bayley-III to evaluate cognitive, motor, and language outcomes at 12 and 24 months of age. Adjusted linear regression models were generated for each neurodevelopment assessment time point (12 and 24 months). Mixed-effects models were used to consider a repeated measurement approach. Interactions between maternal fluoride intake and child sex on neurodevelopmental outcomes were tested. Median (IQR) dietary fluoride intake during pregnancy was 1.01 mg/d (0.73, 1.32). Maternal fluoride intake was not associated with cognitive, language, or motor outcomes collapsing across boys and girls. However, child sex modified the association between maternal fluoride intake and cognitive outcome (p interaction term = 0.06). A 0.5 mg/day increase in overall dietary fluoride intake was associated with a 3.50-point lower cognitive outcome in 24-month old boys (95 % CI: -6.58, -0.42); there was no statistical association with girls (β = 0.07, 95 % CI: -2.37, 2.51), nor on the cognitive outcome at 12-months of age. Averaging across the 12- and 24-month cognitive outcomes using mixed-effects models revealed a similar association: a 0.5 mg/day increase in overall dietary fluoride intake was associated with a 3.46-point lower cognitive outcome in boys (95 % CI: -6.23, -0.70). These findings suggest that the development of nonverbal abilities in males may be more vulnerable to prenatal fluoride exposure than language or motor abilities, even at levels within the recommended intake range.

Association between fluoride exposure and kidney function in adults: A cross-sectional study based on endemic fluorosis area in China

BACKGROUND

The kidney toxicity of fluoride exposure has been demonstrated in animal studies, and a few studies have reported kidney function injury in children with fluoride exposure. However, epidemiological information for the effects of long-term fluoride exposure on adult kidney function remains limited.

METHODS

We conducted a cross-sectional investigation in Wenshui County, Shanxi Province to examine the association between fluoride exposure and kidney function in adults, and a total of 1070 adults were included in our study. Urinary fluoride concentrations were measured using the national standardized ion selective electrode method. And markers of kidney function injury (urinary NAG, serum RBP, serum Urea, serum C3, serum UA and serum αl-MG) were measured using automatic biochemical analyzer. Multivariate linear regression analysis and binary logistic regression model were used to assess the relationship between urinary fluoride and markers of kidney function injury.

RESULTS

Urinary fluoride was positively correlated with urinary NAG and serum Urea, negatively correlated with serum C3. In multivariate linear regression models, every 1 mg/L increment of urinary fluoride was associated with 1.583 U/L increase in urinary NAG, 0.199 mmol/L increase in serum Urea, 0.037 g/L decrease in serum C3 after adjusting for potential confounding factors. In the binary logistic regression model, higher levels of urinary fluoride were associated with an increased risk of kidney function injury. Determination of kidney function based on urinary NAG, every 1 mg/L increment in the urinary fluoride concentrations was associated with significant increases of 22.8% in the risk of kidney function injury after adjusting for potential confounding factors. Sensitivity analysis for the association between urinary fluoride concentrations and markers of kidney function (urinary NAG, serum Urea, and serum C3) by adjusting for the covariates, it is consistent with the primary analysis.

CONCLUSIONS

Our study suggests that long-term fluoride exposure is associated with kidney function in adults, and urinary NAG is a sensitive and robust marker of kidney dysfunction caused by fluoride exposure, which could be considered for the identification of early kidney injury in endemic fluorosis areas.

The cholinergic system, intelligence, and dental fluorosis in school-aged children with low-to-moderate fluoride exposure

Disruption of cholinergic neurotransmission can affect cognition, but little is known about whether low-to-moderate fluoride exposure affects cholinergic system and its effect on the prevalence of dental fluorosis (DF) and intelligence quotient (IQ). A cross-sectional study was conducted to explore the associations of moderate fluoride exposure and cholinergic system in relation to children's DF and IQ. We recruited 709 resident children in Tianjin, China. Ion selective electrode method was used to detect fluoride concentrations in water and urine. Cholinergic system was assessed by the detection of choline acetyltransferase (ChAT), acetylcholinesterase (AChE) and acetylcholine (ACh) levels in serum. Compared with children in the first quartile, those in fourth quartile the risk of either developing DF or IQ < 120 increased by 19% and 20% for water and urinary fluoride. The risk of having both increased by 58% and 62% in third and fourth quartile for water fluoride, 52% and 65% for urinary fluoride. Water fluoride concentrations were positively associated with AChE and negatively associated with ChAT and ACh, trends were same for urinary fluoride except for ACh. The risk of either developing DF or having non-high intelligence rose by 22% (95%CI: 1.07%, 1.38%) for the fourth quartile than those in the first quartile of AChE, for having the both, the risk was 1.27 (95%CI: 1.07, 1.50), 1.37 (95%CI: 1.17, 1.62) and 1.44 (95%CI: 1.23, 1.68) in second, third and fourth quartiles. The mediation proportion by AChE between water fluoride and either developing DF or IQ < 120 was 15.7%. For both to exist, the proportion was 6.7% and 7.2% for water and urinary fluoride. Our findings suggest low-to-moderate fluoride exposure was associated with dysfunction of cholinergic system for children. AChE may partly mediate the prevalence of DF and lower probability of having superior and above intelligence.

Diagnosis of Dental Fluorosis Using Micro-Raman Spectroscopy Applying a Principal Component-Linear Discriminant Analysis

Dental fluorosis is an irreversible condition caused by excessive fluoride consumption during tooth formation and is considered a public health problem in several world regions. The objective of this study was to evaluate the capability of micro-Raman spectroscopy to classify teeth of different fluorosis severities, applying principal component analysis and linear discriminant analysis (PCA-LDA), and estimate the model cross-validation accuracy. Forty teeth of different fluorosis severities and a control group were analyzed. Ten spectra were captured from each tooth and a total of 400 micro-Raman spectra were acquired in the wavenumber range of 250 to 1200 cm⁻¹, including the bands corresponding to stretching and bending internal vibrational modes ν₁, ν₂, ν₃, and ν₄ (PO₄³⁻). From the analysis of the micro-Raman spectra an increase in B-type carbonate ion substitution into the phosphate site of the hydroxyapatite as fluorosis severity increases was identified. The PCA-LDA model showed a sensitivity and specificity higher than 94% and 93% for the different fluorosis severity groups, respectively. The cross-validation accuracy was higher than 90%. Micro-Raman spectroscopy combined with PCA-LDA provides an adequate tool for the diagnosis of fluorosis severity. This is a non-invasive and non-destructive technique with promising applications in clinical and epidemiological fields.

Fluoride exposure and children's intelligence: Gene-environment interaction based on SNP-set, gene and pathway analysis, using a case-control design based on a cross-sectional study

BACKGROUND

Excessive fluoride exposure has been associated with intelligence loss, but little is known about gene-fluoride interactions on intelligence at SNP-set, gene and pathway level.

OBJECTIVES

Here we conducted a population-based study in Chinese school-aged children to estimate the associations of fluoride from internal and external exposures with intelligence as well as to explore the gene-fluoride interactions on intelligence at SNP-set, gene and neurodevelopmental pathway level.

METHODS

A total of 952 resident children aged 7 to 13 were included in the current study. The fluoride contents in drinking water, urine, hair and nail were measured using the ion-selective electrode method. LASSO Binomial regression was conducted to screen the intelligence-related SNP-set. The gene-fluoride interactions at gene and pathway levels were detected by the Adaptive Rank Truncated Product method.

RESULTS

The probability of high intelligence was inversely correlated with fluoride contents in water, urine, hair and nail (all P < 0.001). The SNP-set based on rs3788319, rs1879417, rs57377675, rs11556505 and rs7187776 was related to high intelligence (P = 0.001) alone and by interaction with water, urinary and hair fluoride (P = 0.030, 0.040, 0.010), separately. In gene level, CLU and TOMM40 interacted with hair fluoride (both P = 0.017) on intelligence. In pathway level, Alzheimer disease pathway, metabolic pathway, signal transduction pathway, sphingolipid signaling pathway and PI3K-AKT signaling pathway interacted with fluoride on intelligence in men.

CONCLUSIONS

Our study suggests that fluoride is inversely associated with intelligence. Moreover, the interactions of fluoride with mitochondrial function-related SNP-set, genes and pathways may also be involved in high intelligence loss.

A novel ICT-based chemosensor for F- and its application in real samples and bioimaging

A novel colorimetric and fluorescent chemosensor MQS-Si with intramolecular charge transfer character has been designed and synthesized. The chemosensor shows exclusively "off-on" fluorescence response toward F^- at 620 nm in HEPES (pH 7.4): DMSO solution (7:3, v/v), which is attributed to the specific cleavage of Si-O bond. The ultrasensitive detection limit for F^- in the fluorescence measurement is down to 30 nM. Application of the chemosensor has been demonstrated by selective detection of F^- in drinking water, urine and serum samples and fluorescence imaging of F^- in living cells and zebrafish, which proves that MQS-Si has a promising application in vitro and in vivo detection of F^- and may be utilized for the diagnosis of fluorosis and esteofluorosis.

Probiotic alleviate fluoride-induced memory impairment by reconstructing gut microbiota in mice

Fluoride which is widespread in our environment and food due to its geological origin and industrial pollution has been identified as a developmental neurotoxicant. Gut-brain axis provides new insight into brain-derived injury. We previously found the psychoactive effects of a probiotic strain, Lactobacillus johnsonii BS15 against fluoride-induced memory dysfunction in mice by modulating the gut-brain axis. In this study, we aimed to detect the link between the reconstruction of gut microbiota and gut-brain axis through which probiotic alleviate fluoride-induced memory impairment. We also added an hour of water avoidance stress (WAS) before behavioral tests and sampling, aiming to demonstrate the preventive effects of the probiotic on fluoride-induced memory impairment after psychological stress. Mice were given fluoridated drinking water (sodium fluoride 100 ppm, corresponding to 37.8 ± 2.4 ppm F¯) for 70 days and administered with PBS or a probiotic strain, Lactobacillus johnsonii BS15 for 28 days prior to and throughout a 70 day exposure to sodium fluoride. Results showed that fluoride increases the hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis and reduces the exploration ratio in novel object recognition (NOR) test and the spontaneous exploration during the T-maze test in mice following WAS, which were significantly improved by the probiotic. 16S rRNA sequencing showed a significant separation in ileal microbiota between the fluoride-treated mice and control mice. Lactobacillus was the main targeting bacteria and significantly reduced in fluoride-treated mice. BS15 reconstructed the fluoride-post microbiota and increased the relative abundance of Lactobacillus. D-lactate content and diamine oxidase (DAO) activity, two biomarkers of gut permeability were reduced in the serum of probiotic-inoculated mice. ZO-1, an intestinal tight junction protein was reduced by fluoride in mRNA, and its protein levels were increased by the probiotic treatment. Moreover, the hippocampus which is essential to learning and memory, down-regulated mRNA level of both the myelin-associated glycoprotein (MAG), and protein levels of brain-derived neurotrophic factor (BDNF), including the improvement of cAMP response element-binding protein (CREB) by BS15 in fluoride-exposed mice after WAS. Via spearman correlation analysis, Lactobacillus displayed significantly positive associations with the behavioral tests, levels of nerve development related factors, and intestinal tight junction proteins ZO-1, and negative association with TNF-α of the hippocampus, highlighting regulatory effects of gut bacteria on memory potential and gut barrier. These results suggested the psychoactive effects of BS15 on fluoride-induced memory dysfunction after psychological stress. In addition, there may be some correlations between fluoride-induced memory dysfunction and reconstruction of gut microbiota. AVAILABILITY OF DATA AND MATERIALS: 16S rRNA sequencing reads have uploaded to NCBI. The accession code of 16S rRNA sequencing reads in the National Center for Biotechnology Information (NCBI) BioProject database: PRJNA660154.

Dental Fluorosis: the Risk of Misdiagnosis-a Review

Fluoride has been considered as the single factor most frequently responsible for causing enamel mottling. However, in humans, either endogenous and/or exogenous factors not related to fluoride exposure may also cause enamel mottling. In this sense, various studies in the international literature have reported severe mottling of the teeth that could not be attributed to fluoride exposure. Thus, misdiagnosis of non-fluoride-induced enamel defects may occur frequently. Reports of unexpectedly high population prevalence and individual cases of fluorosis, where such diagnoses are irreconcilable with the identified fluoride history, highlight the necessity for a more precise definition and diagnosis of dental fluorosis. Also, a more discriminating diagnostic procedure is suggested. Particularly, positive identification of environmental fluoride levels to which the communities and individuals are exposed shall be developed before the confirmation of a diagnosis of fluorosis. It is considered that a more critical methodology for the diagnosis of fluorosis will be helpful in the rational use and control of fluorides for dental health, and in the identification of factors that may induce enamel defects.

WITHDRAWN: Co-exposure effects of arsenic and fluoride on intelligence and oxidative stress in school-aged children: A cohort study

This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause.

Fluoride exposure, dopamine relative gene polymorphism and intelligence: A cross-sectional study in China

BACKGROUND

Excessive fluoride exposure is related to adverse health outcomes, but whether dopamine (DA) relative genes are involved in the health effect of low-moderate fluoride exposure on children's intelligence remain unclear.

OBJECTIVES

We conducted a cross-sectional study to explore the role of DA relative genes in the health effect of low-moderate fluoride exposure in drinking water.

METHODS

We recruited 567 resident children, aged 6-11 years old, randomly from endemic and non-endemic fluorosis areas in Tianjin, China. Spot urine samples were tested for urinary fluoride concentration, combined Raven`s test was used for intelligence quotient test. Fasting venous blood were collected to analyze ANKK1 Taq1A (rs1800497), COMT Val158Met (rs4680), DAT1 40 bp VNTR and MAOA uVNTR. Multivariable linear regression models were used to assess associations between fluoride exposure and IQ scores. We applied multiplicative and additive models to appraise single gene-environment interaction. Generalized multifactor dimensionality reduction (GMDR) was used to evaluate high-dimensional interactions of gene-gene and gene-environment.

RESULTS

In adjusted model, fluoride exposure was inversely associated with IQ scores (β = -5.957, 95% CI: -9.712, -2.202). The mean IQ scores of children with high-activity MAOA genotype was significantly lower than IQ scores of those with low-activity (P = 0.006) or female heterozygote (P = 0.016) genotype. We detected effect modification by four DA relative genes (ANKK1, COMT, DAT1 and MAOA) on the association between UF and IQ scores. We also found a high-dimensional gene-environment interaction among UF, ANKK1, COMT and MAOA on the effect of IQ (testing balanced accuracy = 0.5302, CV consistency: 10/10, P = 0.0107).

CONCLUSIONS

Our study suggests DA relative genes may modify the association between fluoride and intelligence, and a potential interaction among fluoride exposure and DA relative genes on IQ.

Fluoride exposure and intelligence in school-age children: evidence from different windows of exposure susceptibility

Background

The intellectual loss induced by fluoride exposure has been extensively studied, but the association between fluoride exposure in different susceptibility windows and children’s intelligence is rarely reported. Hence, we conducted a cross-sectional study to explore the association between fluoride exposure in prenatal and childhood periods and intelligence quotient (IQ).

Methods

We recruited 633 local children aged 7–13 years old randomly from four primary schools in Kaifeng, China in 2017. The children were divided into four groups, of which included: control group (CG, n = 228), only prenatal excessive fluoride exposure group (PFG, n = 107), only childhood excessive fluoride exposure group (CFG, n = 157), both prenatal and childhood excessive fluoride exposure group (BFG, n = 141). The concentrations of urinary fluoride (UF) and urinary creatinine (UCr) were determined by fluoride ion-selective electrode assay and a creatinine assay kit (picric acid method), respectively. The concentration of UCr-adjusted urinary fluoride (CUF) was calculated. IQ score was assessed using the second revision of the Combined Raven’s Test-The Rural in China (CRT-RC2). Threshold and saturation effects analysis, multiple linear regression analysis and logistic regression analysis were conducted to analyze the association between fluoride exposure and IQ.

Results

The mean IQ score in PFG was respectively lower than those in CG, CFG and BFG (P < 0.05). The odds of developing excellent intelligence among children in PFG decreased by 51.1% compared with children in CG (OR = 0.489, 95% CI: 0.279, 0.858). For all the children, CUF concentration of ≥1.7 mg/L was negatively associated with IQ scores (β = − 4.965, 95% CI: − 9.198, − 0.732, P = 0.022). In children without prenatal fluoride exposure, every 1.0 mg/L increment in the CUF concentration of ≥2.1 mg/L was related to a reduction of 11.4 points in children’s IQ scores (95% CI: − 19.2, − 3.5, P = 0.005).

Conclusions

Prenatal and childhood excessive fluoride exposures may impair the intelligence development of school children. Furthermore, children with prenatal fluoride exposure had lower IQ scores than children who were not prenatally exposed; therefore the reduction of IQ scores at higher levels of fluoride exposure in childhood does not become that evident.

Detrimental Effects of Sodium Fluoride on the Expression of Insulin Receptor in the Olfactory Bulb and Hippocampus of Male Mice

Fluoride exposure is associated with lowered cognitive function ability, intelligence quotient, and mental decline, especially in children. The brain insulin receptor (IR) signaling system is related to neuronal plasticity and consequent cognitive ability. In our previous study, NaF exposure decreased IR expressions in olfactory bulb (OB) and hippocampus after Y-maze test in male mice. In order to further explore whether the Y-maze test affected IR gene and protein expression levels in the OB and hippocampus under the NaF exposure, healthy male mice were randomly allotted into four groups and challenged with 0, 50, 100, and 150 mg/L NaF for three continuous months. The results showed that femur fluorine content of the NaF-exposed groups increased significantly in a dose-dependent manner. NaF significantly decreased brain protein content and organ coefficient of the treated male mice. The protein and mRNA expression levels of the IR were significantly decreased in the OB and hippocampus of the NaF-treated mice. Interestingly, indicators (brain protein content and organ coefficient) measured in the present study were significantly lower than our previous study indicators (mice tested Y-maze test), especially the expression levels of IR protein and mRNA in the same concentration groups. Taken together, these results indicated that Y-maze test could promote the expression levels of IR protein and mRNA in the OB and hippocampus, while NaF had a stronger inhibitory effect, which resulted in adverse effects on the expression levels of IR in the OB and hippocampus of male mice.

Hydrogeochemical and statistical analysis of high fluoride groundwater in northern China

Understanding the formation of high fluoride (F^-) groundwater in water-scarce northern China is critical for the sustainable development of the region. This study investigates the effects of F^- enrichment in groundwater from seven typical regions of northern China, including Datong, Guide, Junggar, Yinchuan, Taiyuan, and Tarim basins and the North China Plain. A literature survey of 534 samples of selected regions showed that 45.13% of groundwater F^- exceeded the 1.0 mg/L of Chinese drinking water guideline. Based on the geological background and hydrogeochemical analysis, in Datong and Yinchuan basins and part of the North China Plain, the main types of groundwater are soda water and controlling processes of F^- enrichment are salinization, mineral dissolution, and desorption. In Taiyuan and Guide basins with Cl-Na water type, F^- enrichment is mainly affected by salinization, cation exchange, and evaporation. The hydrogeochemical characteristics of high F^- groundwater in Tarim and Junggar basins reflect the extent of salinization and weathering dissolution of minerals in groundwater. According to PCA, the contribution of salinization and mineral dissolution to F^- enrichment is relatively high. Under the alkaline condition, groundwater with high Cl^-, HCO₃^-, and Na⁺ concentration favors F^- enrichment. Based on HCA, index clustering category I explains the influence of pH and buried depth on F^- enrichment, and category II explains the effect of different ions. It is concluded that F^- enrichment in groundwater is related to hydrogeochemical processes and hydrogeological conditions. The hydrogeochemical and alkaline conditions of groundwater are regulated by mineral dissolution, ion exchange, and evaporation, resulting in different degrees of F^- enrichment.

Fluoride Exposure Affects Glutamine Uptake in Müller Glia Cells

Fluoride, a pollutant present in contaminated ground water, oral care products, food, and pesticides, has deleterious effects in the structure and function of the central nervous system. Among the established neurological defects described in the exposed population, a reduced score in intelligence quotient tests in children of contaminated areas has gained attention over the past years. Maternal fluoride exposure during gestation decreases learning and memory abilities that correlate with a significant diminution of glutamate receptors expression. Since the involvement of glia cells in the maintenance and regulation of glutamatergic synapses is well-documented, in this contribution, we characterized the effect of fluoride exposure in the regulation of glia glutamine transporters. To this end, we used the Müller glia cell line, Mio-M1, and through the use of [³H]L-Glutamine uptake experiments and a Western blot approach, we demonstrate here the functional expression of system N of glutamine transporters, SNAT3 and SNAT5, in this model of human retina radial glia cells. Furthermore, these transporters interact with the glutamate transporter excitatory amino acid transporter 1, in an activity-dependent manner. Fluoride treatment reduces glutamine uptake and cell membrane [³H]glutamine surface binding, in good correlation with a decrease in SNAT3 and 5 protein levels. These results demonstrate that glia cells respond to the presence of fluoride reducing glutamine mobilization and by these means decreases glutamate turnover suggesting a disruption of glutamatergic transmission.

Spatiotemporal distribution of fluoride in drinking water and associated probabilistic human health risk appraisal in the coastal region, Bangladesh

Spatiotemporal distribution of fluoride in drinking water has been posing serious health concerns worldwide. However, in Bangladesh, to date, there is a very limited study reported the probabilistic health risks from fluoride content in drinking water. Therefore, we investigate the spatiotemporal distribution of fluoride concentration in drinking water and associated health risks in the coastal districts of Bangladesh based on randomly collected 840 groundwater samples (Dry-season = 302 and Wet-season = 538). Probabilistic health risk appraisal from fluoride was performed using the Monte-Carlo simulation and sensitivity analysis. Fluoride concentration in 11.89% (Wet-season) and 24.50% (Dry-season) of the samples exceeded the acceptable level of 1.0 mg/L, while 3.90% (Wet-season) and 7.28% (Dry-season) samples surpassed the maximum permissible limit (fluoride: 1.5 mg/L. The deficiency of fluoride content in groundwater (<0.50 mg/L) in Wet-season (60.41%) and in Dry-season (55.63%) was identified from the study area. The seasonality to the spatial change of fluoride concentration in drinking water has been explored. The mean non-carcinogenic risks e.g., hazard quotient (HQ) from the consumption of high fluoride-containing water for infants and children were mostly exceeded the threshold value 1 (HQ > 1) in both seasons. However, the risk of children and infants at the 95th percentile crossed the safe level (SL: 1) in the wet season and the risk of infants, children, teens and adults at the 95th percentile surpassed 1 in the dry season, indicating the potential adverse health effects. Apart from the high exposure, fluoride deficiency might be a severe problem in this region due to the very low concentration of fluoride (<0.50 mg/L) in drinking water. Sensitivity analyses indicate high fluoride-containing drinking water was the most contributing variables affecting the model outcome. Finally, the case-control study should be performed to examine further the health effects from the ingestion of high/low fluoride-bearing groundwater in the study area.

Maternal and fetal exposures to fluoride during mid-gestation among pregnant women in northern California

BACKGROUND

Previous studies have shown a correlation between fluoride concentrations in urine and community water fluoride concentrations. However, there are no studies of the relationship between community water fluoridation, urine, serum, and amniotic fluid fluoride concentrations in pregnant women in the US. The aim of this study was to determine the relationship between maternal urine fluoride (MUF), maternal urine fluoride adjusted for specific gravity (MUF_SG), maternal serum fluoride (MSF), amniotic fluid fluoride (AFF) concentrations during pregnancy, and community water fluoridation in Northern California.

METHODS

Archived samples of urine, serum and amniotic fluid collected from second trimester pregnant women in Northern California from 47 different communities in Northern California and one from Montana (n = 48), were analyzed for fluoride using an ion specific electrode following acid microdiffusion. Women's addresses were matched to publicly reported water fluoride concentrations. We examined whether fluoride concentrations in biospecimens differed by fluoridation status of the community water, and determined the association between water fluoride concentrations and biospecimen fluoride concentrations using linear regression models adjusted for maternal age, smoking, Body Mass Index (BMI), race/ethnicity, and gestational age at sample collection.

RESULTS

Fluoride concentrations in the community water supplies ranged from 0.02 to 1.00 mg/L. MUF, MSF , and AFF concentrations were significantly higher in pregnant women living in communities adhering to the U.S. recommended water fluoride concentration (0.7 mg/L), as compared with communities with less than 0.7 mg/L fluoride in drinking water. When adjusted for maternal age, smoking status, BMI, race/ethnicity, and gestational age at sample collection, a 0.1 mg/L increase in community water fluoride concentration was positively associated with higher concentrations of MUF (B = 0.052, 95% CI:0.019,0.085), MUF_SG (B = 0.028, 95% CI: -0.006, 0.062), MSF (B = 0.001, 95% CI: 0.000, 0.003) and AFF (B = 0.001, 95% CI: 0.000, 0.002).

CONCLUSIONS

We found universal exposure to fluoride in pregnant women and to the fetus via the amniotic fluid. Fluoride concentrations in urine, serum, and amniotic fluid from women were positively correlated to public records of community water fluoridation. Community water fluoridation remains a major source of fluoride exposure for pregnant women living in Northern California.

Health risk in children to fluoride exposure in a typical endemic fluorosis area on Loess Plateau, north China, in the last decade

Excessive and inadequate intake of fluoride may cause adverse effects in children, such as dental caries and dental fluorosis. This study reports the results of monitoring fluoride concentrations in drinking water from an endemic fluorosis region during the ten-year period (2008 through 2017). The fluoride concentration had a range of 0.03-9.42 mg L^-1 (mean = 0.55 ± 0.01 mg L^-1). Approximately 10%, 1.3% and 0.06% children are at risk for dental decay, dental fluorosis and skeletal fluorosis, respectively. Probabilistic risks for children were assessed and the fluoride endemic areas were marked by GIS mapping system. On several water consumption points, the hazard quotient (HQ) values for children were higher than 1, indicating potential non-cancer health risks due to fluoride exposure. The results of this study will help governmental agencies to develop better policies for protecting children from exposure to fluoride.

Inorganic fluoride and functions of brain

Although actively disputed and questioned, it has been proposed that chronic exposure to inorganic fluoride (F^-) is toxic for brain. The major question for this review was whether an excessive F^- intake is causally related to adverse neurological and cognitive health conditions in human beings and animals. The paper systematically and critically summarizes the findings of the studies showing positive associations between F^- intoxication and various intellectual defects, as well as of those which attempted to clarify the nature of F^- neurotoxicity. Many works provide support for a link between pre- and postnatal F^- exposure and structural and functional changes in the central nervous system responsible for neurological and cognitive disorders. The mechanisms suggested to underlie F^- neurotoxicity include the disturbances in synaptic transmission and synaptic plasticity, premature death of neurons, altered activities of components of intracellular signaling cascades, impaired protein synthesis, deficit of neurotrophic and transcriptional factors, oxidative stress, metabolic changes, inflammatory processes. However, the majority of works have been performed on laboratory rodents using such F^- doses which are never exist in the nature even in the regions of endemic fluorosis. Thus, this kind of treatment is hardly comparable with human exposure even taking into account the higher rate of F^- clearance in animals. Of special importance are the data collected on humans chronically consuming excessive F^- doses in the regions of endemic fluorosis or contacting with toxic F^- compounds at industrial sites, but those works are scarce and often criticized due to low quality. New, expertly performed studies with repeated exposure assessment in independent populations are needed to prove an ability of F^- to impair neurological and intellectual development of human beings and to understand the molecular mechanisms implicated in F^--induced neurotoxicity.

Thyroid function, intelligence, and low-moderate fluoride exposure among Chinese school-age children

BACKGROUND

Thyroid hormones (THs) are critical for brain development. Whether low-moderate fluoride exposure affects thyroid function and what the impact is on children's intelligence remain elusive.

OBJECTIVES

We conducted a cross-sectional study to examine the associations between low-moderate fluoride exposure and thyroid function in relation to children's intelligence.

METHODS

We recruited 571 resident children, aged 7-13 years, randomly from endemic and non-endemic fluorosis areas in Tianjin, China. We measured fluoride concentrations in drinking water and urine using the national standardized ion selective electrode method. Thyroid function was evaluated through the measurements of basal THs [(total triiodothyronine (TT₃), total thyronine (TT₄), free triiodothyronine (FT₃), free thyronine (FT₄)] and thyroid-stimulating hormone (TSH) levels in serum. Multivariable linear and logistical regression models were used to assess associations among fluoride exposure, thyroid function and IQ scores.

RESULTS

In adjusted models, every 1 mg/L increment of water fluoride was associated with 0.13 uIU/mL increase in TSH. Every 1 mg/L increment of urinary fluoride was associated with 0.09 ug/dL decrease in TT₄, 0.009 ng/dL decrease in FT₄ and 0.11 uIU/mL increase in TSH. Fluoride exposure was inversely related to IQ scores (B = -1.587; 95% CI: -2.607, -0.568 for water fluoride and B = -1.214; 95% CI: -1.987, -0.442 for urinary fluoride). Higher TT₃, FT₃ were related to the increased odds of children having high normal intelligence (OR = 3.407, 95% CI: 1.044, 11.120 for TT₃; OR = 3.277, 95% CI: 1.621, 6.623 for FT₃). We detected a significant modification effect by TSH on the association between urinary fluoride and IQ scores, without mediation by THs.

CONCLUSIONS

Our study suggests low-moderate fluoride exposure is associated with alterations in childhood thyroid function that may modify the association between fluoride and intelligence.

Fluorosis and cognitive development among children (6-14 years of age) in the endemic areas of the world: a review and critical analysis

The fluoride contamination in water is still a live discussion among the scientific community, because of its beneficial and injurious health effects inflicted on the human population. The magnitude of groundwater fluoride contamination is aggravated by increasing anthropogenic activities. Groundwater is supposedly the main source through which people are highly exposed to fluoride, compared with other sources of exposure. Among human populations, fluoride-related health issues span from mild effects on teeth and bones to severe kidney problems, neurotoxicity, and even cancer. Nowadays, fluoride toxicity is gaining much attention in the endemic areas due to its adverse impact on the children's cognitive function, since children are more susceptible to fluoride toxicity as compared to adults. The primary mechanism behind the neurotoxicity of fluoride is still not clearly understood. However, knowingly, fluoride disrupts the biochemical mechanism and thus alters the normal functioning of the brain. Several human studies are suggestive of lowering children's IQ who was exposed to fluoride during their childhood. The conclusive findings of past research suggest that the fluoride concentration in potable water tends to grossly affect the children's IQ level. However, the body of proof is limited, because most of the studies are concentrated in few countries, and have their own limitations and data gaps. The grave implications of fluoride toxicity, therefore, demand extensive and properly designed research to bridging the data gap in developing countries. Furthermore, spanning research work across all the endemic areas of the world could generate larger database, helping resolve the issue on a large scale.

Fluoride network and circular economy as potential model for sustainable development-A review

Fluorine is the most reactive elements among the halogen group and commonly and ubiquitously occurs as fluoride in nature. The industrial processes produce fluoride by-products causing the increase of unwanted environmental levels and consequently posing risk on human and environmental health worldwide. This review gives a fundamental understanding of fluoride networks in the industrial processes, in the geological and hydrological transport, and in the biological sphere. Numerous biological pathways of fluoride also increase the risk of exposure. Literature shows that various environmental levels of fluoride due to its chemical characteristics cause bioaccumulation resulting in health deterioration among organisms. These problems are aggravated by emitted fluoride in the air and wastewater streams. Moreover, the current waste disposal dependent on incineration and landfilling superpose to the problem. In our analysis, the fluoride material flow model still follows a linear economy and reuse economy to some extent. This flow model spoils resources with high economic potential and worsens environmental problems. Thus, we intend a shift from the conventional linear economy to a circular economy with the revival of three-dimensional objectives of sustainable development. Linkages between key dimensions of the circular economy to stimulate momentum for perpetual sustainable development are proposed to gain economic, environmental and social benefits.

Developmental fluoride neurotoxicity: an updated review

BACKGROUND

After the discovery of fluoride as a caries-preventing agent in the mid-twentieth century, fluoridation of community water has become a widespread intervention, sometimes hailed as a mainstay of modern public health. However, this practice results in elevated fluoride intake and has become controversial for two reasons. First, topical fluoride application in the oral cavity appears to be a more direct and appropriate means of preventing caries. Second, systemic fluoride uptake is suspected of causing adverse effects, in particular neurotoxicity during early development. The latter is supported by experimental neurotoxicity findings and toxicokinetic evidence of fluoride passing into the brain.

METHOD

An integrated literature review was conducted on fluoride exposure and intellectual disability, with a main focus on studies on children published subsequent to a meta-analysis from 2012.

RESULTS

Fourteen recent cross-sectional studies from endemic areas with naturally high fluoride concentrations in groundwater supported the previous findings of cognitive deficits in children with elevated fluoride exposures. Three recent prospective studies from Mexico and Canada with individual exposure data showed that early-life exposures were negatively associated with children's performance on cognitive tests. Neurotoxicity appeared to be dose-dependent, and tentative benchmark dose calculations suggest that safe exposures are likely to be below currently accepted or recommended fluoride concentrations in drinking water.

CONCLUSION

The recent epidemiological results support the notion that elevated fluoride intake during early development can result in IQ deficits that may be considerable. Recognition of neurotoxic risks is necessary when determining the safety of fluoride-contaminated drinking water and fluoride uses for preventive dentistry purposes.

Geochemical factors controlling the occurrence of high-fluoride groundwater in the western region of the Ordos basin, northwestern China

Hydrogeochemistry and isotope hydrology were carried out to investigate the spatial distribution of fluoride (F^-) and the mechanisms responsible for its enrichment in the western region of the Ordos basin, northwestern China. Sixty-two groundwater samples from the unconfined aquifer and fifty-six from confined aquifer were collected during the pre-monsoon (June 2016). Over 77% of groundwater samples from the unconfined aquifer (F^- concentration up to 13.30 mg/L) and approximately 66% from confined aquifer (with a maximum F^- concentration of 3.90 mg/L) exhibit F^- concentrations higher than the Chinese safe drinking limit (1.0 mg/L). High-F^- groundwater presents a distinctive hydrochemical characteristic: a high pH value and HCO₃^- concentration with Ca-poor and Na-rich. Mineral dissolution (e.g., feldspar, calcite, dolomite, fluorite), cation exchange and evaporation in the aquifers predominate the formation of groundwater chemistry, which are also important for F^- enrichment in groundwater. Mixing with unconfined groundwater is a significant mechanism resulting in the occurrence of high-F^- groundwater in confined aquifer. These findings indicate that physicochemical processes play crucial roles in driving F^- enrichment and that may be useful for studying F^- occurrence in groundwater in arid and semi-arid areas.

Fluoride exposure decreased learning ability and the expressions of the insulin receptor in male mouse hippocampus and olfactory bulb

Fluoride is one of the common environmental pollutants. Internal exposure to fluoride is related to the lowered cognitive function and intelligence, particularly for children. Determination of protein content in brain tissue is a means to reflect the functional development of the central nervous system. Insulin and insulin receptor (IR) signaling systems are associated with cognitive ability. The present research focused on the assessment of the expressions of IR protein and mRNA in hippocampus and olfactory bulb (OB), as well as learning and memory ability of male Kunming mice. Mice were exposed to 50, 100, and 150 mg/L NaF for 90 continuous days. The results showed that learning and memory abilities as well as protein content of male mice brain was significantly decreased by fluoride. Fluoride could inhibit the protein and mRNA expressions of the IR in the hippocampus and OB of mice. IRs mainly distributed in the olfactory nerve layer of the outermost layer of the OB, and most distributed in the hippocampal cornu ammon 3 (CA3) region, followed by the dentate gyrus (DG) and cornu ammon 1 (CA1) regions. These findings suggested that inhibition of the IR protein and mRNA expressions in the hippocampus and OB by fluoride might in part affect learning and memory ability in male mice.

Surveying Dentists' Perceptions of Caregiver Refusal of Topical Fluoride

The objective of this study was to assess dentists' perceptions of caregiver topical fluoride refusal behaviors. We administered an 8-item survey in 2015 and 2016 ( N = 582) and asked dentists about the extent to which fluoride refusal is a problem, refusal trends, comfort talking to caregivers who refuse, and perceived reasons why caregivers refuse. To examine geographic variation, we ran χ² tests between dentists' location (US West vs. non-West) and the first 3 perception measures (α = 0.05). Nearly 80% of dentists believed fluoride refusal was a problem, and 42.3% believed it was a growing problem. A significantly larger proportion of dentists who saw fluoride refusal as a problem also believed refusal was a growing problem compared to those who thought refusal was not a problem (89.6% and 41.2%, respectively; P < 0.0001). Caregiver characteristics perceived to be associated with fluoride refusal included immunization refusal (41.3%), White race (37.6%), and high income (33.7%). Thirty-seven percent of surveyed dentists were uncomfortable talking to caregivers who refused. There were no geographic differences in perceptions of fluoride refusal as a problem ( P = 0.52). A significantly larger proportion of non-West dentists believed fluoride refusal has gotten worse (non-West: 65.5%, West: 41.2%; P < 0.0001), but more dentists from the West were uncomfortable talking to caregivers who refused (West: 86%, non-West: 67.4%; P < 0.0001). Caregiver refusal of topical fluoride may be a growing problem, and many dentists are uncomfortable talking to caregivers who refuse. Additional interdisciplinary research is needed to identify the reasons why caregivers refuse fluoride, which is an important next step in developing chairside interventions that address fluoride refusal behaviors. Knowledge Transfer Statement: The results of this study can be used by researchers to develop chairside strategies to help dentists identify and manage fluoride refusal behaviors in clinical settings. This could help preserve topical fluoride as an evidence-based preventive therapy and address a growing public health problem.

Fluoride Exposure Induces Inhibition of Sodium/Iodide Symporter (NIS) Contributing to Impaired Iodine Absorption and Iodine Deficiency: Molecular Mechanisms of Inhibition and Implications for Public Health

The sodium iodide symporter (NIS) is the plasma membrane glycoprotein that mediates active iodide transport in the thyroid and other tissues, such as the salivary, gastric mucosa, rectal mucosa, bronchial mucosa, placenta and mammary glands. In the thyroid, NIS mediates the uptake and accumulation of iodine and its activity is crucial for the development of the central nervous system and disease prevention. Since the discovery of NIS in 1996, research has further shown that NIS functionality and iodine transport is dependent on the activity of the sodium potassium activated adenosine 5'-triphosphatase pump (Na+, K+-ATPase). In this article, I review the molecular mechanisms by which F inhibits NIS expression and functionality which in turn contributes to impaired iodide absorption, diminished iodide-concentrating ability and iodine deficiency disorders. I discuss how NIS expression and activity is inhibited by thyroglobulin (Tg), tumour necrosis factor alpha (TNF-α), transforming growth factor beta 1 (TGF-β1), interleukin 6 (IL-6) and Interleukin 1 beta (IL-1β), interferon-γ (IFN-γ), insulin like growth factor 1 (IGF-1) and phosphoinositide 3-kinase (PI3K) and how fluoride upregulates expression and activity of these biomarkers. I further describe the crucial role of prolactin and megalin in regulation of NIS expression and iodine homeostasis and the effect of fluoride in down regulating prolactin and megalin expression. Among many other issues, I discuss the potential conflict between public health policies such as water fluoridation and its contribution to iodine deficiency, neurodevelopmental and pathological disorders. Further studies are warranted to examine these associations.