Effect of inhibition of net calcium uptake on net fluoride uptake in developing rat molars

Fluoride ingestion from toothpaste and diet in 1- to 3-year-old Brazilian children

OBJECTIVE

This study estimated the total daily fluoride intake of 1- to 3-year-old children from diet and dentifrice. The constituents of the diet were divided into solids, water, milk, and other beverages, which were analyzed separately. The correlation between fingernail fluoride concentrations and the total daily fluoride intake by children was also investigated.

METHODS

Thirty-three children, living in a fluoridated area, participated in the study. Fluoride intake from diet was monitored by the 'duplicate plate' method, investigating the different constituents of the diet. Fluoride ingested from dentifrice was determined by subtracting the amount of fluoride recovered after brushing from the amount originally placed onto the child's toothbrush. Fingernails were clipped and collected on three occasions. Fluoride was analyzed with the ion-specific electrode, after hexamethyldisiloxane-facilitated diffusion. Data were tested by anova and Tukey's post hoc tests, Student's t-tests and linear regression (P < 0.05).

RESULTS

Mean (+/-SD) fluoride intake from diet and dentifrice was 0.025 +/- 0.013 and 0.106 +/- 0.085 mg/kg body weight/day, respectively, totaling 0.130 mg/kg body weight/day. A strong positive correlation (r = 0.971, P < 0.0001) was seen between the amount of dentifrice loaded onto the brush (0.49 +/- 0.30 g) and the amount of fluoride ingested during each tooth brushing (0.59 +/- 0.45 mg). Among the constituents of the diet, water and milk had a significantly higher contribution to the fluoride intake (0.18 +/- 0.11 mg/day, P < 0.0001), when compared with solids (0.07 +/- 0.05 mg/day) and other beverages (0.07 +/- 0.04 mg/day). Mean (+/-SD) fingernail fluoride concentration on the three dates of collection was 3.11 +/- 1.14, 2.22 +/- 1.47 and 3.53 +/- 1.40 mug F/g. There was no significant correlation between fingernail fluoride concentration and the total fluoride intake.

CONCLUSIONS

Most of the children are exposed to a daily fluoride intake above the suggested threshold for dental fluorosis. The dentifrice alone is responsible for an average of 81.5% of the daily fluoride intake, while among the constituents of the diet, water and milk are the most important contributors. In addition, small variations in daily fluoride intake cannot be detected in fingernails.

Dental fluorosis: chemistry and biology

This review aims at discussing the pathogenesis of enamel fluorosis in relation to a putative linkage among ameloblastic activities, secreted enamel matrix proteins and multiple proteases, growing enamel crystals, and fluid composition, including calcium and fluoride ions. Fluoride is the most important caries-preventive agent in dentistry. In the last two decades, increasing fluoride exposure in various forms and vehicles is most likely the explanation for an increase in the prevalence of mild-to-moderate forms of dental fluorosis in many communities, not the least in those in which controlled water fluoridation has been established. The effects of fluoride on enamel formation causing dental fluorosis in man are cumulative, rather than requiring a specific threshold dose, depending on the total fluoride intake from all sources and the duration of fluoride exposure. Enamel mineralization is highly sensitive to free fluoride ions, which uniquely promote the hydrolysis of acidic precursors such as octacalcium phosphate and precipitation of fluoridated apatite crystals. Once fluoride is incorporated into enamel crystals, the ion likely affects the subsequent mineralization process by reducing the solubility of the mineral and thereby modulating the ionic composition in the fluid surrounding the mineral. In the light of evidence obtained in human and animal studies, it is now most likely that enamel hypomineralization in fluorotic teeth is due predominantly to the aberrant effects of excess fluoride on the rates at which matrix proteins break down and/or the rates at which the by-products from this degradation are withdrawn from the maturing enamel. Any interference with enamel matrix removal could yield retarding effects on the accompanying crystal growth through the maturation stages, resulting in different magnitudes of enamel porosity at the time of tooth eruption. Currently, there is no direct proof that fluoride at micromolar levels affects proliferation and differentiation of enamel organ cells. Fluoride does not seem to affect the production and secretion of enamel matrix proteins and proteases within the dose range causing dental fluorosis in man. Most likely, the fluoride uptake interferes, indirectly, with the protease activities by decreasing free Ca(2+) concentration in the mineralizing milieu. The Ca(2+)-mediated regulation of protease activities is consistent with the in situ observations that (a) enzymatic cleavages of the amelogenins take place only at slow rates through the secretory phase with the limited calcium transport and that, (b) under normal amelogenesis, the amelogenin degradation appears to be accelerated during the transitional and early maturation stages with the increased calcium transport. Since the predominant cariostatic effect of fluoride is not due to its uptake by the enamel during tooth development, it is possible to obtain extensive caries reduction without a concomitant risk of dental fluorosis. Further efforts and research are needed to settle the currently uncertain issues, e.g., the incidence, prevalence, and causes of dental or skeletal fluorosis in relation to all sources of fluoride and the appropriate dose levels and timing of fluoride exposure for prevention and control of dental fluorosis and caries.

Anion translocation through the enamel organ

The objective of this study was to determine whether cells of the secretory- and maturation-stage enamel organ of rats contain anion translocation mechanisms similar to those found in other ion-regulating epithelia. Sodium bromide (Br) was used to localize the distribution of anions in the enamel organ. Furosemide, an inhibitor of the Na-K-2Cl co-transporter and other anion transporters, was administered with NaBr or sodium fluoride (F) to investigate if halogens other than Cl can use these transport mechanisms. We obtained the data by using freeze-fracture and freeze-drying methodology in conjunction with scanning and transmission electron microscopy (SEM, TEM) and energy-dispersive x-ray spectroscopy (EDS). The secretory- and maturation-stage enamel organ prevented Br from entering the enamel matrix. Br was localized in the Tomes' processes, but not in the enamel matrix, strongly suggesting that the distal intercellular junctions of ameloblasts are "tight". Furosemide disrupted anion transport to allow not only Cl but also Br to enter the forming enamel matrix. Periodic administration of high F doses promoted the formation of bands of disrupted enamel, reflecting the periodicity of F administration. The same concentration of F administered with furosemide increased the severity of disrupted enamel, resulting in "blisters" and pits in the maturing enamel. The enamel "blisters" contained pools of small, disorganized enamel crystallites. The group receiving furosemide only displayed normal enamel structure but had increased Cl in the enamel matrix. This study provides evidence that anion transporters, possibly the Na-K-2Cl co-transporter, function to regulate anion translocation, including F, to the enamel matrix in secretory- and maturation-stage enamel organ. These mechanisms may explain why the ionic composition on the cellular side of the anion barrier is different from that of the enamel matrix.

Strategies for improving the assessment of dental fluorosis: focus on chemical and biochemical aspects

In order to assess fluoride accumulation and effects in developing dental tissues, one must determine the concentration profile of fluoride in the tissue and to assess separately the labile (i.e., free ions in fluid and ions associated with organic matter) and stable (i.e., incorporated into apatite lattice) pools of fluoride. Free fluoride ions in the mineralizing milieu markedly affect the driving force for precipitation and, as a result, the nature of precipitating crystals. The fluoride incorporated into the crystalline lattice increases the stability of the formed mineral. Improvement in the understanding of the mechanism of dental fluorosis requires more comprehensive information about the effects of fluoride on the ionic composition of the fluid phase, the nature of the initially precipitating mineral(s), the interactions between crystals and matrix proteins, and the enzymatic degradation of the proteins. Recent observations relevant to the role of fluoride in enamel formation include: (1) that there are threshold concentrations of fluoride below which the precipitation and hydrolysis of thin-platy octacalcium phosphate is facilitated but beyond which de novo apatite precipitation prevails; (2) that the presence of fluoride in the mineralizing milieu most likely affects the steady-state concentrations of mineral lattice ions; (3) that incorporation of fluoride into the stable pool is retarded by the presence of matrix proteins, particularly amelogenins, which inhibit the growth of apatite crystals; (4) that increasing the degree of fluoridation of apatite crystals enhances the adsorption of amelogenins onto the crystal surface, and (5) that amelogenins pre-adsorbed onto apatite crystals are more resistant to enzymatic cleavages by trypsin (used as a prototype of amelogeninases).

X-ray micro-analysis of the mineralization patterns in developing enamel in hamster tooth germs exposed to fluoride in vitro during the secretory phase of amelogenesis

The developing enamel from three-day-old hamster first maxillary (M1) molar tooth germs exposed to fluoride (F-) in vitro was analyzed for its mineral content by means of the energy-dispersive x-ray microanalysis technique. The aim of this study was to obtain semi-quantitative data on the F(-)-induced hypermineralization patterns in the enamel and to confirm that the increase in electron density observed in micrographs of F(-)-treated enamel (Lyaruu et. al., 1986, 1987b) is indeed due to an increase in mineral content in the fluorotic enamel. The tooth germs were explanted during the early stages of secretory amelogenesis and initially cultured for 24 hr in the presence of 10 ppm F- in the culture medium. The germs were then cultured for another 24 hr without F-. In order to compare the ultrastructural results directly with the microprobe data, we used the same specimens for both investigations. The net calcium counts (measurement minus background counts) in the analyses were used as a measure of the mineral content in the enamel. The aprismatic pre-exposure enamel, deposited in vivo before the onset of culture, was the most hypermineralized region in the fluorotic enamel, i.e., it contained the highest amount of calcium measured. The degree of the F(-)-induced hypermineralization gradually decreased (but was not abolished) in the more mature regions of the enamel. The unmineralized enamel matrix secreted during the initial F- treatment in vitro mineralized during the subsequent culture without F-. The calcium content in this enamel layer was in the same order of magnitude as that recorded for the newly deposited enamel in control tooth germs cultured without F-.(ABSTRACT TRUNCATED AT 250 WORDS)

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

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

Diffusion of fluoride through the rat enamel organ in vitro

This study investigated the diffusion of fluoride through the enamel organ in vitro. The rat molar explants used were entirely in the secretory stage or predominantly in the maturation stage of enamel formation. The removal of the enamel organ or metabolic inhibition with iodoacetate caused significant increases in enamel fluoride uptake at both stages of enamel formation. Inhibition with dinitrophenol caused a significant increase only in the maturation phase. Uptake of fluoride in enamel was related to the fluoride concentration in the medium, except in the maturation stage explants, where increasing the medium fluoride concentration from 0.05 ppm to 0.08 ppm did not significantly increase fluoride uptake at any of the three observation times. The findings indicate that the enamel organ exists as a diffusion-limiting membrane to the movement of fluoride from the extracellular fluid compartment to the developing enamel.