The Safety of Fluoride Compounds and Their Effect on the Human Body-A Narrative Review

Sustainable Fluoride Determination in Selected Infant Juices Available on the Serbian Market: Health Risk Assessment

Increased exposure to fluoride in food and beverages become a global concern in the last few decades. Infant juices and food, besides breast milk, are the main sources of fluoride intake throughout infancy. Monitoring fluoride levels in such formulations is crucial to ensure the youngest consumers' safety and optimal health. This study aimed to determine the fluoride of selected infant juices from four different producers available on the Serbian market, using fluoride ion-selective electrode. The fluoride content varies between 0.0845 and 0.2810 mg/L, which is below acceptable level (0.7 mg/L). The health risk assessment for children 6 to 48 months of age associated with fluoride in infant juices was evaluated as a non-carcinogenic risk based on estimated daily intake according to USEPA guidelines, including the HQ index. All calculated HQs are less than 1, suggesting no adverse effect after exposure to the fluorides via investigated juices. Since children, especially infants, are highly vulnerable to the harmful effects of fluoride, it is essential to monitor all sources that could be critical in fluorosis development. It is important to highlight fluoride as a toxic element and enforce stricter controls on infant feeding, emphasizing the urgency and importance of this matter.

A preclinical study on effect of betanin on sodium fluoride induced hepatorenal toxicity in Wistar rats

BACKGROUND

Excessive fluoride exposure leads to increased oxidative stress and lipid peroxidation, causing harmful effects on the metabolic organs in the human body. Betanin, a pigment obtained from beetroot, is seen to have powerful anti-inflammatory and antioxidant. The study was conducted to determine the role of betanin in fluoride induced hepato-renal toxicity in Wistar rats.

METHODS

Twenty four rats were divided into four groups. Group Ⅰ (control) rats received 1 mL distilled water; group Ⅱ rats were administered 10 mg/kg of sodium fluoride (NaF); group Ⅲ received 10 mg/kg NaF and 50 mg/kg (low dose) betanin; group Ⅳ received 10 mg/kg NaF and 200 mg/kg (high dose) betanin. Animals were dosed orally for 90 days. Various markers of liver and kidney function as well as oxidative stress were measured. Liver and kidney samples were examined for histopathology.

RESULTS

Animals in group Ⅱ had significantly increased levels of serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, creatinine, and blood urea nitrogen compared to the NaF + betanin treated animals (group Ⅲ & Ⅳ). Malondialdehyde, nitric oxide levels were significantly lower in rats treated with NaF + betanin (low and high dose). Histologically, in group II rats, signs of interstitial nephritis were seen in the kidneys while liver sections showed clear indication of features of fatty liver and inflammatory cell infiltration. Treatment with betanin alleviated the severity of histopathological changes induced by NaF.

CONCLUSIONS

Betanin significantly ameliorated NaF-induced oxidative stress and inflammation, therefore, has potential to be used as protective agent against fluoride induced hepato-renal toxicity.

Chitosan-sodium dodecyl sulfate nanoparticles: a promising approach for enhancing antibacterial activity against Streptococcus mutans of grapefruit seed extract

In this study, grapefruit seed extract (GSE)-loaded nanoparticles (GNPs) were formed through ionic gelation between chitosan (CS) and sodium dodecyl sulfate (SDS) to improve antibacterial activity against oral bacteria, such as Streptococcus mutans, and to demonstrate the impact of particle size on antimicrobial activity. Particle size was negatively correlated with the antibacterial effect; the smaller GNPs showed significantly higher antimicrobial activity than the other particles. The optimal formulation of the smaller GNPs was determined using response surface methodology (RSM). The optimized GNPs improved antibacterial activity, which was approximately 3.5 times higher than that of free GSE (p < 0.05). Moreover, the GNPs were effective at reducing bacterial growth, achieving a reduction of more than 3 log10 CFU/mL within the first 3 h and complete inhibition of bacterial growth after 9 h. This study suggests that nanoencapsulation significantly enhances its antibacterial activity against oral bacteria.

Fluoride Release from Two Commercially Available Dental Fluoride Gels-In Vitro Study

Fluoride has remained the most important ingredient in the prevention of tooth decay for many years. Therefore, fluoride prophylaxis should be highly individualized to provide patients with maximum benefits while minimizing the risk of toxic effects. This study aims to compare the degree of fluoride ion release from two commercially available dental fluoride gels (Fluormex and Fluor Protector Gel) in five different physiological solutions as well as their effect on pH. The concentration of fluoride ions and pH of tap water, distilled water, demineralized water, NaCl, and artificial saliva were evaluated before and after 48 h after dissolving and incubating the same amounts of gels. The concentration of fluoride ions was higher in solutions containing Fluormex than Fluor Pro-tector Gel (p < 0.05), with the highest concentration in demineralized water (16,917 ppm). It was accompanied by a decrease in pH below the critical value of 5.5 in all solutions except tap water. Not only the composition of the gel but also the chemical composition of the environment affects the release of fluoride ions. No relationship was found between the change in pH and the concentration of fluoride ions.

The Role of SIRT1-BDNF Signaling Pathway in Fluoride-Induced Toxicity for Glial BV-2 Cells

Chronic fluorosis is often accompanied by neurological symptoms, leading to attention, memory and learning ability decline and causing tension, anxiety, depression, and other mental symptoms. In the present study, we analyzed the molecular mechanisms of SIRT1-BDNF regulation of PI3K-AKT, MAPK, and FOXO1A in F-treated BV2 cells. The cytotoxic effect of sodium fluoride (NaF) on BV2 cells was assessed using Cell Counting Kit-8 (CCK-8), crystal violet, and 5-ethynyl-2'-deoxyuridine (EdU) staining. Cell cycle progression and apoptosis were evaluated through flow cytometry and western blotting. Reactive oxygen species (ROS) levels, oxidative stress, and inflammatory markers were measured by ROS staining, microplate reader assays, and western blotting. The role of SIRT1 in fluoride-induced toxicity for glial cells was determined using the SIRT1 activator SRT1720. The experiments demonstrated that NaF was toxic to BV2 cells, inhibited their proliferative ability, halted their cell cycle progression, triggered cellular apoptosis, promoted cellular oxidative stress (detected by ROS, SOD, MDA, GSH-Px, T-AOC) and associated protein NQO-1 and HO-1, and elevated inflammatory mediator associated protein IL-1and IL-6 expression). The fluoride-exposed groups had reduced SIRT1, BDNF, TrkB, PI3K, AKT, and MAPK protein expression levels, and increased FOXO1A protein expression. SRT1720 mitigated the harmful effects of NaF, stimulated cell proliferation and cell cycle progression, decreased apoptosis, reduced oxidative stress and inflammatory factors, elevated SIRT1, BDNF, TrkB, PI3K, AKT, and MAPK protein levels, and suppressed FOXO1A protein expression. The results indicate that NaF potentially harms glial cells by suppressing SIRT1 activation, and SIRT1 significantly mitigated the damage. Furthermore, the SIRT1 signaling pathway might regulate the nerve damage caused by fluoride poisoning and may be a protective factor in treating fluoride-induced brain injury.

Impact of fluorosis on molecular predictors in pathogenesis of type 2 diabetes associated microvascular complications

AIM

This review presents specific insights on the molecular underpinnings of the connection between fluorosis, type 2 diabetes, and microvascular complications, along with the novel biomarkers that are available for early detection.

SUMMARY

Fluoride is an essential trace element for the mineralization of teeth and bones in humans. Exposure to higher concentrations of fluoride has harmful effects that significantly outweigh its advantageous ones. Dental fluorosis and skeletal fluorosis are the common side effects of exposure to fluoride, which affect millions of individuals globally. Alongside, it also causes non-skeletal fluorosis, which affects the population suffering from non-communicable diseases like diabetes by impacting the soft tissues and causing diabetic microvascular complications. Previous studies reported the prevalence range of these diabetic complications of neuropathy (3-65 %), nephropathy (1-63 %), and retinopathy (2-33 %). Fluoride contributes to the development of these complications by causing oxidative stress, cellular damage, degrading the functioning capability of mitochondria, and thickening the retinal vein basement.

CONCLUSION

Early diagnosis is a prompt way of prevention, and for that, biomarkers have emerged as an innovative and useful technique. This allows healthcare practitioners and policymakers in endemic areas to comprehend the molecular complexities involved in the advancement of diabetic microvascular problems in the context of high fluoride exposure.

AMPA and NMDA Receptors in Hippocampus of Rats with Fluoride-Induced Cognitive Decline

This experimental study was performed to evaluate the alterations in the expression of a few subunits composing glutamate AMPA (a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) and NMDA (N-methyl-D-aspartate) receptors in the hippocampal cells of Wistar rats in response to long-term fluoride (F-) exposure. The animals were given water with background 0.4 (control), 5, 20, and 50 ppm F- (as NaF) for 12 months. The cognitive capacities of rats were examined by novel object recognition (NOR), Y-maze test, and Morris water maze tests. RT-qPCR and Western blotting techniques were used to evaluate the expression of different AMPA and NMDA subunits at transcriptional and translational levels, respectively. Long-term F- poisoning disturbed the formation of hippocampus-dependent working spatial and long-term non-spatial memory. The expression of Gria1, Gria2, and Gria3 genes encoding different subunits of AMPA receptors were comparable in hippocampi of control and F--exposed animals, although the levels of both Grin2a and Grin2b mRNA increased. Long-term F- intake enhanced the ratio of phospho-GluA1/total-GluA1 proteins in subcellular fraction enriched with cytosolic proteins, while decreased content of GluA2 but elevated level of GluA3 were observed in subcellular fraction enriched with membrane proteins. Such changes were accompanied by increased phosphorylation of GluN2A and GluN2B subunits, higher ratios of GluN2A/GluN1 and GluN2B/GluN1 proteins in the cytosol, and GluN2A/GluN2B ratio in membranes. These changes indicate the predominance of Ca2+-permeable AMPARs in membranes and a shift between different NMDARs subunits in hippocampal cells of F--exposed rats, which is typical for neurodegeneration and can at least partially underly the observed disturbances in cognitive capacities of animals.

Fluoride in Raw Rice (Oryza sativa): a Global Systematic Review and Probabilistic Health Risk Assessment

Rice (Oryza sativa) is one of the essential staple foods highly consumed globally, with nearly 40% to 45% of the global population estimated to consume rice. Therefore, consumable rice should have low levels of harmful elements. This study investigates fluoride (F¯) content in raw rice (uncooked rice) and evaluates Probabilistic Health Risk Assessment (PHRA) through Monte Carlo simulation (MCS) due to the consumption of F¯ enriched rice. The literature review reveals that limited studies have been conducted on the investigation of F¯ in raw rice. The fluoride (F¯) concentration in raw rice varies across the studied countries, indicating the need for additional studies to facilitate a more accurate comparison. The F¯ content in raw rice varied among the studied countries, making it difficult to definitively state that the concentration of F¯ in one country is higher. However, the concentration of F¯ in raw rice in India is notably elevated. This study also highlighted the importance of investigating the F¯ content in raw rice. The study will be highly helpful for policymakers to formulate guidelines for water used for irrigation.

Anodic Production and Characterization of Biomimetic Oxide Layers on Grade 4 Titanium for Medical Applications

Biomaterials are the basis for the development of medicine because they allow safe contact with a living organism. The aim of this work was to produce innovative oxide layers with a microporous structure on the surface of commercially pure titanium Grade 4 (CpTi G4) and to characterize their properties as drug carriers. The anodization of the CpTi G4 subjected to mechanical grinding and electrochemical polishing was carried out in a solution of 1M ethylene glycol with the addition of 40 g of ammonium fluoride at a voltage of 20 V for 2, 18, 24, and 48 h at room temperature. It was found that the longer the anodization time, the greater the number of pores formed on the CpTi G4 surface as revealed using the FE-SEM method, and the greater the surface roughness determined in profilometric tests. As the anodizing time increases, the amount of the drug in the form of gentamicin sulfate incorporated into the resulting pores decreases. The most favorable drug release kinetics profile determined via UV-VIS absorption spectroscopy was found for the CpTi G4 anodized for 2 h.

Optimization of Calcium Fluoride Crystallization Process for Treatment of High-Concentration Fluoride-Containing Semiconductor Industry Wastewater

This study utilized a fluidized bed reactor (FBR) for fluoride removal from high-concentration fluoride-ion-containing simulated semiconductor industry wastewater and recovered high-purity CaF2 crystals. The effects of hydraulic retention time (HRT), pH, Ca2+ to F- ratio, upflow velocity, seed size and seed bed height were investigated by performing lab-scale batch experiments. Considering fluoride removal and CaF2 crystallization efficiency, 5 h HRT, pH 6, seed height of 50 cm and [Ca2+]/[F-] ratio of 0.55 (mol/mol) were found to be optimum. The effect of the interaction between the important process parameters on fluoride removal was further analyzed using response surface methodology (RSM) experimental design. The results showed that all the individual parameters have a significant impact (p = 0.0001) on fluoride removal. SEM-EDX and FTIR analysis showed the composition of the crystals formed inside FBR. HR-XRD analysis confirmed that the crystalline structure of samples was mainly CaF2. The results clearly demonstrated the feasibility of silica seed material containing FBR for efficient removal and recovery of fluoride as high-purity calcium fluoride crystals.

Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods

The maintenance of oral health is a crucial aspect of general well-being; however, a significant proportion of the worldwide population experiences a range of oral diseases. Dental caries is a highly prevalent non-communicable disease globally, especially in children and adolescents. Fluoride is involved in the control of dental caries, primarily by decreasing the critical pH for dental hard tissue dissolution and decreasing enamel solubility. Due to the substantial data supporting the efficacy of fluoride in controlling dental caries, many community-level fluoridation initiatives have been devised and executed as global public health preventive interventions. These initiatives encompass the fluoridation of water, salt, and milk. Water fluoridation is considered safe and effective when fluoride levels are maintained within the recommended range (0.6 to 1.1 mg/L). Salt fluoridation has a cariostatic potential similar to that of water fluoridation, and a fluoride concentration of 250 micrograms per gram in salt is not associated with an increased risk of developing dental fluorosis. However, there is currently an effort to reduce the consumption of table salt in order to mitigate the harmful effects of excessive salt consumption. It has been hypothesized that fluoride food supplementation, such as fluoridated milk, is associated with a decrease in caries experience in permanent teeth; however, the effect is not clear in primary teeth. Public-level fluoride interventions are more cost-effective than the operative care of caries lesions and limit the burden of care. The administration of fluorides should be conducted using safe methods, limiting ingestion, and adhering to the guidelines set by international and national health agencies in each country. This is particularly important when considering children with developing dentitions. Fluoride is an important tool in the control of dental caries, but it is crucial to combine it with good oral hygiene, a healthy diet, and regular visits to a dental professional to maintain long-term oral health.

Calcium supplementation attenuates fluoride-induced bone injury via PINK1/Parkin-mediated mitophagy and mitochondrial apoptosis in mice

Excessive consumption of fluoride can cause skeletal fluorosis. Mitophagy has been identified as a novel target for bone disorders. Meanwhile, calcium supplementation has shown great potential for mitigating fluoride-related bone damage. Hence, this study aimed to elucidate the association between mitophagy and skeletal fluorosis and the precise mechanisms through which calcium alleviates these injuries. A 100 mg/L sodium fluoride (NaF) exposure model in Parkin knockout (Parkin-/-) mice and a 100 mg/L NaF exposure mouse model with 1% calcium carbonate (CaCO3) intervention were established in the current study. Fluoride exposure caused the impairment of mitochondria and activation of PTEN-induced putative kinase1 (PINK1)/E3 ubiquitin ligase Park2 (Parkin)-mediated mitophagy and mitochondrial apoptosis in the bones, which were restored after blocking Parkin. Additionally, the intervention model showed fluoride-exposed mice exhibited abnormal bone trabecula and mechanical properties. Still, these bone injuries could be effectively attenuated by adding 1% calcium to their diet, which reversed fluoride-activated mitophagy and apoptosis. To summarize, fluoride can activate bone mitophagy through the PINK1/Parkin pathway and mitochondrial apoptosis. Parkin-/- and 1% calcium provide protection against fluoride-induced bone damage. Notably, this study provides theoretical bases for the prevention and therapy of animal and human health and safety caused by environmental fluoride contamination.

Does fluoride exposure affect thyroid function? A systematic review and dose-response meta-analysis

INTRODUCTION

Fluoride exposure may have various adverse health effects, including affecting thyroid function and disease risk, but the pattern of such relation is still uncertain.

METHODS

We systematically searched human studies assessing the relation between fluoride exposure and thyroid function and disease. We compared the highest versus the lowest fluoride category across these studies, and we performed a one-stage dose-response meta-analysis for aggregated data to explore the shape of the association.

RESULTS

Most retrieved studies (27 of which with a cross-sectional design) were conducted in Asia and in children, assessing fluoride exposure through its concentrations in drinking water, urine, serum, or dietary intake. Twenty-four studies reported data on thyroid function by measuring thyroid-related hormones in blood (mainly thyroid-stimulating-hormone - TSH), 9 reported data on thyroid disease, and 4 on thyroid volume. By comparing the highest versus the lowest fluoride categories, overall mean TSH difference was 1.05 μIU/mL. Dose-response curve showed no change in TSH concentrations in the lowest water fluoride exposure range, while the hormone levels started to linearly increase around 2.5 mg/L, also dependending on the risk of bias of the included studies. The association between biomarkers of fluoride exposure and TSH was also positive, with little evidence of a threshold. Evidence for an association between fluoride exposure and blood concentrations of thyroid hormones was less evident, though there was an indication of inverse association with triiodothyronine. For thyroid disease, the few available studies suggested a positive association with goiter and with hypothyroidism in both children and adults.

CONCLUSIONS

Overall, exposure to high-fluoride drinking water appears to non-linearly affect thyroid function and increase TSH release in children, starting above a threshold of exposure, and to increase the risk of some thyroid diseases.

Worldwide Variations in Fluoride Content in Beverages for Infants

In situations where breastfeeding is impractical, milk formulas have emerged as the primary choice for infant nutrition. Numerous global studies have scrutinized the fluoride content in these formulas, uncovering fluctuations in fluoride levels directly associated with the method of preparation. This variability poses a potential risk of elevated fluoride concentrations and, consequently, an increased susceptibility to dental fluorosis in infants. The primary objective of this review is to intricately delineate the fluoride content in dairy formulas and emphasize the variability of these values concerning their reconstitution process. The review's findings reveal that, among the 17 studies assessing fluoride levels in infant formula, milk-based formulas exhibit a range of 0.01-0.92 ppm, with only two studies exceeding 1.30 ppm. Conversely, soy-based formulas demonstrate values ranging from 0.13-1.11 ppm. In conclusion, the observed variability in fluoride levels in infant formulas is ascribed to the choice of the water source employed in the preparation process. This underscores the paramount importance of meticulously adhering to recommendations and guidelines provided by healthcare professionals concerning the utilization of these formulas and their meticulous reconstitution.

Brief Narrative Review on Commercial Dental Sealants-Comparison with Respect to Their Composition and Potential Modifications

The scope of this paper is to compare different dental sealants and flow materials indicated for sealing pits and fissures considering their chemical formula. The narrative review aims to address the following questions: What is the essence of different dental sealants' activity, how does their chemical formula affect their mechanisms of caries prevention, and what makes a dental sealant efficient mean of caries prevention? Another vital issue is whether the sealants that contain fluoride, or any other additions, have potentially increased antimicrobial properties. An electronic search of the PubMed, Cochrane, Web of Science, and Scopus databases was performed. The following keywords were used: (dental sealants) AND (chemical composition). Additionally, information about composition and indications for clinical use provided by manufacturers were utilized. All of the considered materials are indicated for use both in permanent and primary dentition for sealing fissures, pits, and foramina caeca. The selection of suitable material should be made individually and adjusted to conditions of the sealing procedure and patient's needs. Cariostatic mechanisms increasing sealants' effectiveness such as fluoride release are desired in modern dentistry appreciating preventive approach. The review aims are to find crucial elements of sealants' composition which affect their cariostatic mechanisms.