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Lavalle-Carrasco J, Vergara-Onofre M, González-González R, Bologna-Molina R, Isiordia-Espinoza MA, Gaona E, Molina-Frechero N. A Systematic Review and Meta-Analysis of the Relationship Between the Severity of Dental Fluorosis and Fluoride Biomarkers in Endemic Areas. Biol Trace Elem Res 2023; 201:1051-1062. [PMID: 35397104 DOI: 10.1007/s12011-022-03227-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Jesús Lavalle-Carrasco
- Dental Sciences, Autonomous Metropolitan University Xochimilco (UAM), 04960, Mexico City, Mexico
| | - Marcela Vergara-Onofre
- Division of Biological and Health Sciences, Autonomous Metropolitan University Xochimilco (UAM), 04960, Mexico City, Mexico
| | - Rogelio González-González
- Department of Research, School of Dentistry, Juarez University of the Durango State (UJED), 34000, Durango, Mexico
| | - Ronell Bologna-Molina
- Department of Research, School of Dentistry, Juarez University of the Durango State (UJED), 34000, Durango, Mexico
- Molecular Pathology Area, School of Dentistry, University of the Republic (UDELAR), 11200, Montevideo, Uruguay
| | - Mario Alberto Isiordia-Espinoza
- Institute of Research in Medical Sciences, Department of Clinics, Los Altos University Center, University of Guadalajara (UdG), 47650, Tepatitlán de Morelos, Jalisco, Mexico
| | - Enrique Gaona
- Division of Biological and Health Sciences, Autonomous Metropolitan University Xochimilco (UAM), 04960, Mexico City, Mexico
| | - Nelly Molina-Frechero
- Division of Biological and Health Sciences, Autonomous Metropolitan University Xochimilco (UAM), 04960, Mexico City, Mexico.
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Martins JR, Díaz-Fabregat B, Ramírez-Carmona W, Monteiro DR, Pessan JP, Antoniali C. Salivary biomarkers of oxidative stress in children with dental caries: Systematic review and meta-analysis. Arch Oral Biol 2022; 139:105432. [PMID: 35500456 DOI: 10.1016/j.archoralbio.2022.105432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/02/2021] [Accepted: 04/10/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess the relationship between salivary biomarkers of oxidative stress and dental caries in children. METHODS Studies conducted in children up to 12 years old comparing salivary biomarkers of oxidative stress such as malondialdehyde (MDA), superoxide dismutase (SOD), uric acid, and total antioxidant capacity (TAC), considering children with dental caries lesions and caries-free ones were selected. In addition, salivary parameters such as salivary flow, pH, buffering capacity, calcium and total protein levels were evaluated. A systematic literature review was carried out in 8 databases. The standardized mean difference (SMD) was measured using inverse variance as a statistical method and random effects as an analysis model, corresponding to a 95% confidence interval (CI). RESULTS The TAC levels were higher in children affected by dental caries compared to caries-free ones (control group), regardless of age (SMD 2.66, CI 1.33, 3.98), or gender (SMD 0.98, CI 0.56, 1.39). When adjusted for normalized protein, MDA levels were lower in the dental caries group than in the control group (SMD -16.51, CI -29.02, -4.00), and SOD levels were higher in the dental caries group (SMD 5.09, CI 0.01.10.18). The total protein concentration in saliva of children with dental caries was higher than in the control group, regardless of age (SMD 0.98, CI 0.27, 1.69), or gender (SMD 0.77, CI 0.45, 1.10). The salivary parameters assessed had lower levels in children affected by dental caries (p < 0.05). CONCLUSIONS The levels of oxidative stress biomarkers and salivary parameters are altered in saliva of children with dental caries.
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Affiliation(s)
- Jordana Resende Martins
- Department of Preventive and Restorative Dentistry, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Beatriz Díaz-Fabregat
- Department of Preventive and Restorative Dentistry, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Wilmer Ramírez-Carmona
- Department of Preventive and Restorative Dentistry, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Douglas Roberto Monteiro
- Department of Preventive and Restorative Dentistry, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil; Postgraduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP, Brazil
| | - Juliano Pelim Pessan
- Department of Preventive and Restorative Dentistry, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Cristina Antoniali
- Department of Basic Sciences, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil.
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Campos FDAT, Caldas ATLD, Santos CAOD, Silva SA, Vieira APDSB, Viana Filho JMC, Buzalaf MAR, Sampaio FC, Cardoso CDAB. Effect of dentifrices with different pH and fluoride concentrations on fluoride levels in biofilm and nails: an RCT. Braz Oral Res 2022; 36:e043. [PMID: 35293508 DOI: 10.1590/1807-3107bor-2022.vol36.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE to evaluate the effect of dentifrice pH and fluoride concentration ([F]) on fluoride uptake on the biofilm and nails of children from a non-fluoridated area. METHODS two hundred and twenty-eight two- to four-year-old children were randomly allocated into 3 groups according to the type of dentifrice: G1: 1100 μg F/g, pH 4.5 (n = 76); G2: 750 μg F/g, pH 4.5 (n = 74); and G3: 1100 μg F/g, pH 7.0 (n = 78). Nails were collected at 4, 8, and 12 months after starting dentifrice use and biofilm was collected 5 and 60 minutes after toothbrushing. The concentrations of F in nails and biofilm were analyzed by HMDS facilitated diffusion. Data were analyzed by Kruskal-Wallis/Mann-Whitney's test and the comparison between biofilm collection times was done using Wilcoxon test (p £ 0.05). RESULTS a significant reduction of [F] in biofilm was observed 60 minutes after toothbrushing, regardless of the dentifrice used. However, 5 minutes after toothbrushing, G1 had a significantly higher [F] compared to G2 and G3, and 60 minutes after toothbrushing, [F] was significantly higher for G1 and G2 compared to G3. G1 and G3 had significantly higher [F] in the nails compared to G2. CONCLUSION a lower dentifrice concentration is a relevant factor for the reduction of excessive fluoride intake. The use of a low-F acidified dentifrice combines the reduction of fluoride uptake with caries prevention by leading to greater incorporation of F into the biofilm over time.
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Affiliation(s)
| | | | | | - Silmara Andrade Silva
- Centro Universitário de João Pessoa - Unipê, Department of Dentistry, João Pessoa, PB, Brazil
| | | | | | | | - Fábio Correia Sampaio
- Universidade Federal da Paraíba - UFPB, Department of Clinical and Social Dentistry, João Pessoa, PB, Brazil
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Dental Fluorosis according to Birth Cohort and Fluoride Markers in an Endemic Region of Colombia. ScientificWorldJournal 2021; 2021:6662940. [PMID: 33746635 PMCID: PMC7960045 DOI: 10.1155/2021/6662940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 01/21/2023] Open
Abstract
Objectives To analyze changes in the dental fluorosis (DF) incidence according to a birth cohort and explore current exposure to DF in a case series. Methods Repeated cross-sectional study of two periods: 2015 and 2018. Two standardized examiners registered DF using the Thylstrup-Fejerskov index in permanent teeth of children aged 7–18 years. Period and birth cohort frequencies were estimated by a generalized linear model, binomial family, and logarithmic link function. Period estimates are presented as prevalence ratios (PR) and birth cohort estimates as cumulative incidence ratios (RR); 95% confidence intervals and P values are reported. In a subsample of 37 volunteers (12.29 ± 2.63 years), the fluoride (F) concentration in toenails was measured using the HMDS diffusion method and an ion-specific electrode. Other samples from the local environment such as food, soil, and coal were also collected. Results In 274 children, we found that nonsignificant increases between periods (PR = 1.17; 95% CI: 0.89–1.55) were not explained by birth cohort effects. A total of 37.8% of the subsample had a toenail F concentration ≥2 μg F/g. The salty snacks and seasoning had the highest F concentrations among local environmental samples. Conclusion In this population with a high DF frequency according to birth cohort and the evaluated period, the study of soil, coal, and food samples indicated a continued F exposure. F concentration found in the toenails shows a moderate F exposure; nearly a third of the children and adolescents exceeded the adopted threshold of 2 μg F/g. It is important to monitor and explore changes in exposure in highly affected population.
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Lavalle-Carrasco J, Molina-Frechero N, Nevárez-Rascón M, Sánchez-Pérez L, Hamdan-Partida A, González-González R, Cassi D, Isiordia-Espinoza MA, Bologna-Molina R. Recent Biomarkers for Monitoring the Systemic Fluoride Levels in Exposed Populations: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010317. [PMID: 33406716 PMCID: PMC7795285 DOI: 10.3390/ijerph18010317] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
Fluorides are compounds that can be found in the minerals of soil with volcanic rocks. Different populations are exposed to high levels of fluorides through drinking water that, due to their chronic intake, cause several types of damage to health. Nails and hair, denominated as recent biomarkers, have been employed for monitoring systemic fluoride from long-term exposure to fluorides. The aim of this study was to perform a systematic review of the use of recent biomarkers for monitoring systemic fluoride levels in exposed populations and verify their validity in the measurement of the fluorine (F-) concentration within the body. A digital search was performed in the databases PubMed/Medline, Springer Link, Cochrane, and Scopus of original articles that employed recent biomarkers for monitoring systemic F-. Seventeen articles were included in this analysis; the recorded variables were the F- amount in each assessed biomarker, source of exposure, and total daily fluoride intake (TDFI). TDFI was associated with F- in nails and hair, as well as the exposure through drinking water. In conclusion, recent biomarkers are adequate for monitoring the systemic fluoride levels by evaluating the chronic/subchronic exposure through different sources, mainly drinking water, considering nails better than hair for this purpose.
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Affiliation(s)
- Jesús Lavalle-Carrasco
- Dental Sciences, Health Care Department, Autonomous Metropolitan University Xochimilco (UAM), Mexico City 04960, Mexico;
| | - Nelly Molina-Frechero
- Health Care Department, Autonomous Metropolitan University Xochimilco (UAM), Mexico City 04960, Mexico; (L.S.-P.); (A.H.-P.)
- Correspondence:
| | - Martina Nevárez-Rascón
- Faculty of Dentistry, Autonomous University of Chihuahua (UACH), Chihuahua 31000, Mexico;
| | - Leonor Sánchez-Pérez
- Health Care Department, Autonomous Metropolitan University Xochimilco (UAM), Mexico City 04960, Mexico; (L.S.-P.); (A.H.-P.)
| | - Aida Hamdan-Partida
- Health Care Department, Autonomous Metropolitan University Xochimilco (UAM), Mexico City 04960, Mexico; (L.S.-P.); (A.H.-P.)
| | - Rogelio González-González
- Department of Research, School of Dentistry, Juarez University of the Durango State (UJED), Durango 34000, Mexico; (R.G.-G.); (R.B.-M.)
| | - Diana Cassi
- Department of Surgical, Medical, Dental and Morphological Science, University of Modena, 41121 Modena, Italy;
| | - Mario Alberto Isiordia-Espinoza
- Institute of Research in Medical Sciences, Department of Clinics, Los Altos University Center, University of Guadalajara (UdG), Tepatitlán de Morelos, Jalisco 47650, Mexico;
| | - Ronell Bologna-Molina
- Department of Research, School of Dentistry, Juarez University of the Durango State (UJED), Durango 34000, Mexico; (R.G.-G.); (R.B.-M.)
- Molecular Pathology Area, School of Dentistry, University of the Republic (UDELAR), Montevideo 11200, Uruguay
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Vidyadharan M, Issac JS, Joseph AM, Joseph A, John D, Varadharaju VK. Comparative Evaluation of Hair, Fingernails, and Toenails as Biomarkers of Fluoride Exposure: A Cross-Sectional Study. J Int Soc Prev Community Dent 2020; 10:269-278. [PMID: 32802772 PMCID: PMC7402265 DOI: 10.4103/jispcd.jispcd_52_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 11/04/2022] Open
Abstract
Background The increased prevalence of fluorosis has led to a search for biomarkers of fluoride exposure. Among the biomarkers of sub-chronic exposure to fluoride, hair, fingernails, and toenails have the advantage of being noninvasively collected, easily transported, and stored. Objective The objective of this study was to comparatively evaluate coronal hair, fingernails, and toenails as biomarkers of fluoride exposure from drinking water; the study was designed as a population-based observational cross-sectional study. Materials and Methods A population-based observational cross-sectional study was conducted in 60 children (20 subjects per group) of ages 12-17 years in three villages of Nilakottai block, Dindigul district, Tamil Nadu, India (Thomaspuram, Bangalapatti, and Singampatti). The fluoride concentration in the household drinking water was analyzed and compared with the fluoride content in the coronal hair, fingernail, and toenail clippings, which was estimated by potentiometric method (fluoride-ion-selective electrode) and expressed in ppm (parts per million). A two-tailed probability value of P < 0.05 was considered significant. Results The mean fluoride concentration in drinking water was 0.63ppm in Thomaspuram, 1.63ppm in Bangalapatti, and 2.92ppm in Singampatti. The mean fluoride content in hair samples was 2.84ppm, 4.67ppm, and 6.53ppm; fingernail clippings was 2.99ppm, 4.94ppm, and 6.84ppm; and toenail clippings was estimated as 3.13ppm, 5.10ppm, and 7.24ppm in Thomaspuram, Bangalapatti, and Singampatti residents, respectively. The mean fluoride content in the hair, fingernails, and toenails was significantly higher as compared to the mean fluoride content in the drinking water (viz., toenail fluoride > fingernail fluoride > hair fluoride). Conclusion Coronal hair, fingernails, and toenails are useful biomarkers for both sub-chronic and chronic fluoride exposure from drinking water. Due to ample sample availability and the highest fluoride content, toenails are the most suitable biomarkers of fluoride exposure from drinking water.
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Affiliation(s)
- Mathew Vidyadharan
- Department of Pedodontics and Preventive Dentistry, PMS College of Dental Sciences and Research Centre, Trivandrum, Kerala, India
| | - Jyothi S Issac
- Department of Pedodontics and Preventive Dentistry, PMS College of Dental Sciences and Research Centre, Trivandrum, Kerala, India
| | - Angel M Joseph
- Department of Substitutive Dental Sciences, College of Dentistry, Majmaah University-Al-Zulfi, Al Majma'ah, Saudi Arabia
| | - Ashwin Joseph
- Department of Pedodontics and Preventive Dentistry, Pushpagiri College of Dental Sciences, Thiruvalla, India
| | - Dhanya John
- Department of Conservative Dentistry and Endodontics, Annoor Dental College and Hospital, Ernakulam, Kerala, India
| | - Vinutha K Varadharaju
- Department of Substitutive Dental Sciences, College of Dentistry, Majmaah University-Al-Zulfi, Al Majma'ah, Saudi Arabia
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Idowu OS, Duckworth RM, Valentine RA, Zohoori FV. Biomarkers for the Assessment of Fluoride Exposure in Children. Caries Res 2020; 54:134-143. [PMID: 31962326 DOI: 10.1159/000504166] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/14/2019] [Indexed: 11/19/2022] Open
Abstract
Due to practical difficulties in quantifying fluoride exposure, the ability of various biomarkers to predict exposure has been investigated previously. However, the results are inadequate for validation of their application and usefulness. This study aimed to investigate the association between contemporary/recent biomarkers of fluoride exposure and total daily fluoride intake (TDFI) of children with large differences in fluoride exposure through drinking water. TDFI was assessed in 61 healthy 4- to 5-year-old children who provided at least 1 biomarker sample; 32 lived in a low-fluoride area (0.04 mg F/L) and 29 lived in a high-fluoride area (3.05 mg F/L). Validated questionnaires were administered to evaluate fluoride intake from diets (including water) and toothpaste ingestion. Daily urinary fluoride excretion (UFE) and fluoride concentrations in plasma, fasting whole saliva, hair, and nails (toenails/fingernails) were evaluated and related to total fluoride exposure. TDFI, UFE, and fluoride concentrations of biomarkers were statistically significantly higher in the high-fluoride area than in the low-fluoride area. There was a strong statistically significant positive correlation between TDFI and UFE (ρ = 0.756, p < 0.001); plasma fluoride concentration (ρ = 0.770, p < 0.001); and toenail fluoride concentration (ρ = 0.604, p < 0.001). The statistically significant positive correlation between TDFI and fingernail fluoride concentration (ρ = 470, p < 0.001) as well as between TDFI and fasting whole saliva fluoride concentration (ρ = 0.453, p = 0.001) was moderate, whereas it was weak between TDFI and hair fluoride concentration (ρ = 0.306, p = 0.027). In conclusion, the current study confirmed the suitability of 24-h urine samples for estimating fluoride exposure in children. The strong correlations between TDFI and fluoride in plasma and toenails also suggest these biomarkers may be considered for health risk assessments of fluoride in children who are susceptible to development of dental fluorosis.
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Affiliation(s)
- Oladipo S Idowu
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Ralph M Duckworth
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Ruth A Valentine
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fatemeh Vida Zohoori
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom,
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Sah O, Maguire A, Zohoori FV. Effect of altitude on urinary, plasma and nail fluoride levels in children and adults in Nepal. J Trace Elem Med Biol 2020; 57:1-8. [PMID: 31541876 DOI: 10.1016/j.jtemb.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A greater prevalence of dental fluorosis has been reported in higher- versus lower-altitude communities. This study, for the first time, examined several aspects of fluoride metabolism in children, aged 4-5 years, and their parent, living at lower altitude (<78 m) and higher altitude (>1487) areas in Nepal. METHODS The study assessed total daily fluoride intake (TDFI), 24 h urinary fluoride excretion (UFE), and fluoride concentrations of toe- and finger-nail (FCtoenail, FCfingernail) in children and parents as well as fluoride concentration of plasma (FCplasma) in parents. Fractional urinary fluoride excretion (FUFE) was calculated as the ratio between UFE and TDFI. FCtoenail, FCfingernail and FCplasma were normalised for TDFI by dividing the variables by TDFI and the ratio was reported as the percentage. RESULTS In total, 89 children and 80 parents took part in the study: 42 children and 41 parents from the lower altitude area; 47 children and 39 parents from the higher altitude area. Fluoride concentration of drinking water was significantly (P < 0.001) higher at lower altitude (0.395 mg F/l) than at higher altitude (0.104 mg F/l). TDFI was significantly (p < 0.001) higher in both children and parents living in lower altitude than those living at higher altitude. There was a statistically significant (p = 0.044) difference in the mean FUFE of children living at lower altitude (53%) and higher altitude (46%). However, no significant difference in FUFE was found between parents living at lower altitude (47%) compared with higher altitude (41%). In both children and parents, no statistically significant differences in normalised FCtoenail, FCfingernail were found between the two altitude areas. However, normalised FCplasma was statistically significantly (P = 0.005) higher in parents living at higher altitude (0.15%) compared with those living at lower altitude (0.11%). CONCLUSION The results suggest that higher altitude living results in decreased urinary fluoride excretion, and consequently increased fluoride retention in children for a given dose (amount) of fluoride.
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Affiliation(s)
- O Sah
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - A Maguire
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - F V Zohoori
- School of Health and Social Care, Teesside University, Middlesbrough, UK.
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Abstract
Since the classical epidemiological studies by Dean, it has been known that there should be an optimum level of exposure to fluoride that would be able to provide the maximum protection against caries, with minimum dental fluorosis. The "optimal" daily intake of fluoride for children (0.05-0.07 mg per kilogram bodyweight) that is still accepted worldwide was empirically determined. In the present review, we discuss the appropriateness of the current guidance for fluoride intake, in light of the windows of susceptibility to caries and fluorosis, the modern trends of fluoride intake from multiple sources, individual variations in fluoride metabolism, and recent epidemiological data. The main conclusion is that it is very difficult to think about a strict recommendation for an "optimal" range of fluoride intake at the individual level in light of existing knowledge of 1) the mechanisms of action of fluoride to control caries, 2) the mechanisms involved in dental fluorosis development, 3) the distinct factors that interfere in the metabolism of fluoride, and 4) the windows of susceptibility to both dental caries and fluorosis development. An "optimal" range of fluoride intake is, however, desirable at the population level to guide programs of community fluoridation, but further research is necessary to provide additional support for future decisions on guidance in this area. This list includes the effect of factors affecting fluoride metabolism, clinical trials on the effectiveness of low-fluoride dentifrices to prevent caries in the primary dentition, and validation of biomarkers of exposure to fluoride.
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Affiliation(s)
- M A R Buzalaf
- 1 Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Brazil
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Sousa ETD, Alves VF, Maia FBM, Nobre-dos-Santos M, Forte FDS, Sampaio FC. Influence of Fluoridated Groundwater and 1,100 Ppm Fluoride Dentifrice on Biomarkers of Exposure to Fluoride. Braz Dent J 2018; 29:475-482. [DOI: 10.1590/0103-6440201801959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/25/2018] [Indexed: 11/21/2022] Open
Abstract
Abstract This research aimed to determine the influence of fluoridated groundwater and 1,100 ppm fluoride dentifrice on biomarkers of exposure to fluoride in preschoolers. A cross-sectional study was performed on thirty preschoolers recruited from naturally fluoridated and non-fluoridated areas (n=15). Total Daily Fluoride Intake (TDFI) from diet and dentifrice, and Daily Urinary Fluoride Excretion (DUFE) was measured over 24 h. Nails samples were collected twice during 30 days. Fluoride analyses were performed using a fluoride-ion-specific electrode. Data were evaluated using the Student and paired t-test, Pearson correlation analysis, multiple linear regression analysis (α≤0.05). Fluoridated groundwater and dentifrice were the dominant sources (r2 > 0.83) of TDFI in children from a naturally fluoridated and a non-fluoridated area, respectively. A positive correlation between TDFI and DUFE (r=0.50), and between [F] in fingernails and toenails (r=0.60) were found in children from a naturally fluoridated area. The [F] in nails of finger and toe were not correlated to TDFI. The consumption of fluoridated groundwater influenced the fluoride concentration in urine. In addition, the use of 1,100 ppm fluoride dentifrice did not influence the fluoride concentration in urine and fingernails.
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Rango T, Vengosh A, Jeuland M, Whitford GM, Tekle-Haimanot R. Biomarkers of chronic fluoride exposure in groundwater in a highly exposed population. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 596-597:1-11. [PMID: 28411405 PMCID: PMC5528157 DOI: 10.1016/j.scitotenv.2017.04.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/29/2017] [Accepted: 04/04/2017] [Indexed: 05/04/2023]
Abstract
This study examined the relation between fluoride (F-) concentrations in fingernail clippings and urine and the prevalence and severity of enamel fluorosis (EF) among Ethiopian Rift Valley populations exposed to high levels of F- in drinking water. The utility of fingernail clippings as a biomarker for F- exposure and EF was also assessed for the first time in a high-F- region. The study recorded the EF status of 386 individuals (10 to 50years old), who consume naturally contaminated groundwater with widely varying F- concentration (0.6-15mg/L). The mean F- concentrations among residents of communities with primary reliance on groundwater were 5.1mg/kg (range: 0.5-34mg/kg) in fingernails and 8.9mg/L (range: 0.44-34mg/L) in urine. We show strong positive correlations between F- in drinking water and 12-hour urinary excretion (r=0.74, p<0.001, n=287), fingernail F- content (r=0.6, p<0.001, n=258), and mean individual measures of EF severity as measured using the Thylstrup and Fejerskov (TF) Index (r=0.42, p<0.001, n=316). The data indicate that both fingernail and urine measures are good biomarkers for F- exposure and EF outcomes, the latter being slightly more sensitive. Cases of moderate/severe EF were significantly more common among younger subjects (10 to 15years old) than older subjects (mostly >25years old) (p<0.001), consistent with their greater exposure to F- during early childhood, which is the only period of life the enamel is at risk of fluorosis. In this younger population, EF may be useful as a biomarker for identifying individuals with other potential health effects that depend on a specific age window of susceptibility. The finding of exceptionally high F- concentrations in water, fingernail clippings and urine in this region should motivate further investigations of other potential health consequences such as bone disease and abnormalities in the function of the neurological and endocrine systems.
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Affiliation(s)
- Tewodros Rango
- Nicholas School of the Environment, Duke University, Durham, NC, USA.
| | - Avner Vengosh
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Marc Jeuland
- Sanford School of Public Policy, Duke University, Durham, NC, USA; Institute of Water Policy, National University of Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Gary M Whitford
- Department of Oral Biology, College of Dental Medicine, Augusta University, Augusta, GA, USA
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Linhares DPS, Garcia PV, Amaral L, Ferreira T, Cury JA, Vieira W, Rodrigues ADS. Sensitivity of two biomarkers for biomonitoring exposure to fluoride in children and women: A study in a volcanic area. CHEMOSPHERE 2016; 155:614-620. [PMID: 27155929 DOI: 10.1016/j.chemosphere.2016.04.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/22/2016] [Accepted: 04/23/2016] [Indexed: 05/15/2023]
Abstract
The natural enrichment of water with fluoride is related to natural sources such as volcanic activity, with it being documented that fluorosis, an endemic and widespread disease in volcanic areas, is associated to the ingestion of high levels of fluoride through water. Thus, in this study, we aimed to define the fluoride concentration in drinking waters of volcanic origin and compare the sensitivity of urine and nail clippings as biomarkers for fluoride exposure in adults and children. Samples of drinking water from four villages in São Miguel Island (Azores) were used and the fluoride concentration was determined, as well the fluoride content in urine and toenails clippings from 66 children and 63 adults from these villages. A validated diet questionnaire, assessing sources of fluoride, was recorded for each participant. The fluoride determination in urine and nail clipping samples was made using a fluoride-specific electrode. A positive correlation was found between the fluoride daily intake and fluoride content in children urine (rs = 0.475; p < 0.001) and in their nail clippings (rs = 0.475; p < 0.001), while in adult women, the fluoride daily intake correlated positively with fluoride content nail clippings (rs = 0.495, p < 0.001). This reveals that nail clippings are more reliable as biomarkers of chronic exposure to fluoride than urine for populations of different ages (children vs. adults). Furthermore, nail clippings are more suitable than urine fluoride levels to assess long term exposure to fluoride in areas where the exposure to fluoride in drinking water is considered within, or slightly above, the recommended legal values.
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Affiliation(s)
- Diana Paula Silva Linhares
- Department of Biology, University of the Azores, 9501-801, Ponta Delgada, Azores, Portugal; CVARG, Center for Volcanology and Geological Risks Assessment, University of the Azores, 9501-801 Ponta Delgada, Azores, Portugal.
| | - Patrícia Ventura Garcia
- Department of Biology, University of the Azores, 9501-801, Ponta Delgada, Azores, Portugal; cE3c, Centre for Ecology, Evolution and Environmental Changes and Azorean Biodiversity Group, University of the Azores, 9501-801 Ponta Delgada, Azores, Portugal.
| | - Leslie Amaral
- Department of Biology, University of the Azores, 9501-801, Ponta Delgada, Azores, Portugal; School of Sciences, University of Minho, Gualtar Campus, 4710-057, Braga, Portugal.
| | - Teresa Ferreira
- Department of Geosciences, University of the Azores, 9501-801 Ponta Delgada, Azores, Portugal; CVARG, Center for Volcanology and Geological Risks Assessment, University of the Azores, 9501-801 Ponta Delgada, Azores, Portugal.
| | - Jaime A Cury
- Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil.
| | - Waldomiro Vieira
- Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil.
| | - Armindo Dos Santos Rodrigues
- Department of Biology, University of the Azores, 9501-801, Ponta Delgada, Azores, Portugal; CVARG, Center for Volcanology and Geological Risks Assessment, University of the Azores, 9501-801 Ponta Delgada, Azores, Portugal.
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Freire I, Pessan J, Amaral J, Martinhon C, Cunha R, Delbem A. Anticaries effect of low-fluoride dentifrices with phosphates in children: A randomized, controlled trial. J Dent 2016; 50:37-42. [DOI: 10.1016/j.jdent.2016.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 11/25/2022] Open
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U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Rep 2015; 130:318-31. [PMID: 26346489 PMCID: PMC4547570 DOI: 10.1177/003335491513000408] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Amaral JG, Freire IR, Valle-Neto EFR, Cunha RF, Martinhon CCR, Delbem ACB. Longitudinal evaluation of fluoride levels in nails of 18-30-month-old children that were using toothpastes with 500 and 1100 μg F/g. Community Dent Oral Epidemiol 2014; 42:412-9. [DOI: 10.1111/cdoe.12103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 02/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jackeline G. Amaral
- Department of Pediatric Dentistry and Public Health; Araçatuba Dental School; UNESP - University of Estadual Paulista; Araçatuba Brazil
| | - Isabelle R. Freire
- Department of Pediatric Dentistry and Public Health; Araçatuba Dental School; UNESP - University of Estadual Paulista; Araçatuba Brazil
| | - Eduardo F. R. Valle-Neto
- Department of Pediatric Dentistry and Public Health; Araçatuba Dental School; UNESP - University of Estadual Paulista; Araçatuba Brazil
| | - Robson F. Cunha
- Department of Pediatric Dentistry and Public Health; Araçatuba Dental School; UNESP - University of Estadual Paulista; Araçatuba Brazil
| | - Cleide C. R. Martinhon
- Department of Pediatric Dentistry and Public Health; Araçatuba Dental School; UNESP - University of Estadual Paulista; Araçatuba Brazil
| | - Alberto C. B. Delbem
- Department of Pediatric Dentistry and Public Health; Araçatuba Dental School; UNESP - University of Estadual Paulista; Araçatuba Brazil
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Akpata ES, Behbehani J, Akbar J, Thalib L, Mojiminiyi O. Fluoride intake from fluids and urinary fluoride excretion by young children in Kuwait: a non-fluoridated community. Community Dent Oral Epidemiol 2013; 42:224-33. [PMID: 24164509 DOI: 10.1111/cdoe.12081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 09/21/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the pattern of fluid consumption, fluoride intake from the fluids and urinary fluoride excretion by children aged 1-9 years in Kuwait, a nonfluoridated community. METHODS Using the cluster sampling technique, children aged 1-9 years were chosen from 2000 randomly selected households in Kuwait. Questionnaires were then administered to their mothers to determine the children's daily fluid intake. Fluoride concentrations in tap water as well as all brands of bottled water and beverages consumed by the children were measured, using the fluoride ion-specific electrode. Fluoride excretion was determined in 400 randomly selected children, based on fluoride/creatinine ratio. RESULTS The mean daily fluid consumption by the children was high, being 1115-1545 ml. About 40% of the fluid intake was plain (tap and bottled) water and approximately 10% of the children drank bottled water exclusively. Fluoride concentration in tap water was low (0.04±SD 0.02 ppm), but was higher in bottled water (0.28±SD 0.40 ppm). Mean daily fluoride ingestion from fluids was 0.013-0.018 mg/kg body weight (bw). Even after allowing for fluoride ingestion from other sources, mean daily fluoride ingestion was still below 0.1 mg/kg bw set by the United States of America Institute of Medicine as the lowest-observed-adverse-effect level for moderate enamel fluorosis in children aged up to 8 years. Furthermore, the mean daily urinary fluoride excretion of 128-220 μg was below the provisional standard of 360-480 μg for optimal fluoride usage by children aged 3-5 years. CONCLUSION Fluoride ingestion from fluids and urinary fluoride excretion by the children were below the recommendations for optimal fluoride usage. Thus, there is room for an upward adjustment of fluoride level in public drinking water supplies in Kuwait, as a caries preventive measure.
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de Almeida Baldini Cardoso C, Mangueira DFB, Olympio KPK, Magalhães AC, Rios D, Honório HM, Vilhena FV, Sampaio FC, Buzalaf MAR. The effect of pH and fluoride concentration of liquid dentifrices on caries progression. Clin Oral Investig 2013; 18:761-7. [DOI: 10.1007/s00784-013-1031-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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