Dietary Fluoride Intake by Children Receiving Different Sources of Systemic Fluoride

There has been no comparison of fluoride (F) intake by pre-school children receiving more traditional sources of systemic F. The aim of this study was to estimate the dietary F intake by children receiving F from artificially fluoridated water (AFW-Brazil, 0.6-0.8 mg F/L), naturally fluoridated water (NFW-Brazil, 0.6-0.9 mg F/L), fluoridated salt (FS-Peru, 180-200 mg F/Kg), and fluoridated milk (FM-Peru, 0.25 mg F). Children (n = 21-26) aged 4-6 yrs old participated in each community. A non-fluoridated community (NoF) was evaluated as the control population. Dietary F intake was monitored by the ""duplicate plate"" method, with different constituents (water, other beverages, and solids). F was analyzed with an ion-selective electrode. Data were tested by Kruskall-Wallis and Dunn`s tests (p < 0.05). Mean (+/- SD) F intake (mg/Kg b.w./day) was 0.04 +/- 0.01(b), 0.06 +/- 0.02(a,b), 0.05 +/- 0.02(a,b), 0.06 +/- 0.01(a), and 0.01 +/- 0.00(c) for AFW/NFW/FS/FM/NoF, respectively. The main dietary contributors for AFW/NFW and FS/FM/NoF were water and solids, respectively. The results indicate that the dietary F intake must be considered before a systemic method of fluoridation is implemented.

No relationship between subchronic fluoride intake and DNA damage in Wistar rats

Fluoride has been widely used in dentistry because it is an effective caries prophylactic agent. However, excess fluoride may represent a hazard to human health, especially by causing injury on the genetic apparatus. Genotoxicity tests form an important part of cancer research and risk assessment of potential carcinogens. In the current study, the potential DNA damage associated with exposure to fluoride was assessed by the single cell gel ( comet) assay in peripheral blood, oral mucosa and brain cells in vivo. Male Wistar rats were exposed to sodium fluoride (NaF) at a 0, 7 and 100 ppm dose for drinking water during 6 weeks. The results pointed out that NaF did not contribute to the DNA damage in all cellular types evaluated as depicted by the mean tail moment and tail intensity. These findings are clinically important since they represent an important contribution to the correct evaluation of the potential health risk associated with dental agents exposure. Copyright (C) 2004 S. Karger AG, Basel.

Fluoride Intake from Meals Served in Daycare Centres in Municipalities with Different Fluoride Concentrations in the Water Supply

Purpose: The aim of this study was (1) to determine the fluoride content in the meals served to children aged up to 36 months in daycare centres of two municipalities with different levels of fluoride in the water supply, (2) to calculate the mean fluoride ingested daily by the children when consuming those meals and (3) to analyse the contribution of this consumption to the development of dental fluorosisMaterials and Methods: Samples of the meals served to the children were collected during a whole week. The fluoride content of the samples of solid foods and milk was analysed using an ion-specific electrode combined with reference electrode after diffusion facilitated by hexamethyldisiloxane Samples of beverages were buffered with an equal volume of total ionic strength adjustment buffer and analysed using a combined electrode. The results were compared using the Mann Whitney testResults: Mean fluoride contents of the meals were of 0.204 +/- 0 179 and 0.322 +/- 0.242 mu g F/mL (P < 0.05), respectively, in the municipalities with low and adequate fluoride content. Daily fluoride intake in the former was 0.013 +/- 0.003 mg/kg body weight/day and in the latter was 0.012 +/- 0 001 mg/kg body weight/day (P > 0 05)Conclusions: The children were not exposed to dental fluorosis in the daycare centres However, the risk cannot be ignored, considering the meals and the use of fluoridated dentifrices at home may also contribute to fluoride intake.

Effect of fluoride intake on carbohydrate metabolism, glucose tolerance, and insulin signaling

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of fluoride intake on insulin sensitivity and insulin signal transduction

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fluoride intake from regular and low fluoride dentifrices by 2-3-year-old children: Influence of the dentifrice flavor

This study evaluated the fluoride intake from dentifrices with different fluoride concentrations ([F]) by children aged 24-36 months, as well as the influence of the dentifrice flavor in the amount of fluoride ingested during toothbrushing. Thirty-three children were randomly divided into 3 groups, according to the [F] in the dentifrices: G-A (523 μgF/g), G-B (1,062 μgF/g) and G-C (1,373 μgF/g). Dentifrices A and B are marketed for children, while dentifrice C is a regular product. The amount of F ingested was indirectly obtained, subtracting the amount expelled and the amount left on the toothbrush from the amount initially loaded onto the brush. The results were analyzed by ANOVA, Tukey's test and linear regression analysis (p < 0.05). Children ingested around 60% of the dentifrice loaded onto the brush, but no significant differences were seen among the groups (p > 0.05). Mean daily fluoride intake from dentifrice for G-A, G-B and G-C was 0.022 a, 0.032 a and 0.061 b mg F/kg body weight, respectively (p < 0.01). There was a strong positive correlation (r = 0.86, p < 0.0001) between the amount of dentifrice used and the amount of fluoride ingested during toothbrushing. The results indicate the need for instructing children's parents and care givers to use a small amount of dentifrice (< 0.3 g) to avoid excessive ingestion of fluoride. The use of low-[F] dentifrices by children younger than 6 years also seems to be a good alternative to minimize fluoride intake. Dentifrice flavor did not influence the percentage of fluoride intake.

Effects of chronic fluoride intake on the antioxidant systems of the liver and kidney in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The relationship between calcium and fluoride intake, pregnancy and lactation and the risk of height loss in white women

This study was designed to investigate the effect of calcium and fluoride intake, and parity and lactation on the risk of spinal osteoporosis. Height loss was used as a surrogate measure for spinal fractures by taking advantage of documented changes in height found during the 25-year follow-up of the Charleston Heart Study cohort. Women who had lost 2-4" in height or who had no change in height during the follow-up period were defined as case and comparison subjects respectively. Calcium intake when the subjects were "about 25" and in the recent past, average intake of fluoride over 25 years, and parity and history of breastfeeding were ascertained by questionnaire from 54 case and 77 comparison subjects. Low calcium intake in the past decreased the risk of height loss (age-adjusted OR = 0.3, 95%CI: 0.1-0.96) although several potentially important confounding variables could not be adjusted for. There was no association between risk of height loss and present calcium intake (OR = 0.8, 95%CI: 0.3-2.6 for low versus high intake) after adjustment for past calcium intake. High fluoride intake decreased the risk of height loss (adjusted OR = 0.4, 95%CI: 0.1-1.2). The effect of fluoride or calcium intake in the present was modified by the level of the other nutrient. Compared to a low intake of both calcium and fluoride, a high intake of one increased the risk of height loss (crude OR = 3.3 for high fluoride/low calcium, crude OR = 6.0 for high calcium/low fluoride) although a high intake of both was slightly protective (crude OR = 0.7). It is estimated that a "high" nutrient intake in this population was greater than 850mg/day for calcium and 2mg/day for fluoride. After adjustment for age, increasing parity decreased the risk of height loss in women who had never breastfed (OR = 0.2, 95%CI: 0.01-1.7 for 4 or more children). Women who had breastfed were also at lower risk of height loss than nulliparous women (OR = 0.3, 95%CI: 0.1-1.2 for 4 or more children) although at any level of parity, breastfeeding women had a greater risk of height loss than did non-breastfeeding women. ^

Fluoride ingestion from food items and dentifrice in 2-6-year-old Brazilian children living in a fluoridated area using a semiquantitative food frequency questionnaire

Objectives: The aim of this study was to evaluate the fluoride intake of 2-6-year-old Brazilian children using a semiquantitative food frequency questionnaire (FFQ) which also estimated fluoride intake from dentifrice. Methods: The FFQ was previously validated through application to 78 2-6-year-old Brazilian children and then administered to 379 children residing in an optimally fluoridated community in Brazil (Bauru, State of Sao Paulo). The FFQ was applied to the parents and used to estimate the food intake of the children. The constituents of the diet were divided into solids, water and other beverages. The fluoride content of the diet items was analyzed with the fluoride electrode. The questionnaire also estimated fluoride intake from dentifrice. Results: The average (+/- SD) fluoride intake from solids, water, other beverages and dentifrice was 0.008 +/- 0.005; 0.011 +/- 0.004; 0.009 +/- 0.014 and 0.036 +/- 0.028 mg F/kg body weight/day, respectively, totalizing 0.064 +/- 0.035 mg F/kg body weight/day. The dentifrice and the diet contributed with 56.3% and 43.7% of the daily fluoride intake, respectively. Among the children evaluated, 31.2% are estimated to have risk to develop dental fluorosis (intake > 0.07 mg F/kg body weight/day). Conclusions: The dentifrice was the main source of fluoride intake by the children evaluated. However, the fluoride concentration in food items also significantly contributed to the daily ingestion by 2-6-year-old children. The questionnaire used seems to be a promising alternative to duplicate diet to estimate the fluoride intake at this age range and may have potential to be used in broad epidemiological surveys.

Biomarkers of Fluoride in Children Exposed to Different Sources of Systemic Fluoride

There has been no comparison between fluoride concentrations in urine and nails of children exposed to different sources of systemic fluoride. The aim of this study was to compare the relationship between fluoride intake with urinary fluoride excretion and fluoride concentrations in fingernails and toenails of children receiving fluoride from artificially fluoridated water (0.6-0.8 mg F/L, n = 25), naturally fluoridated water (0.6-0.9 mg F/L, n = 21), fluoridated salt (180-200 mg F/Kg, n = 26), and fluoridated milk (0.25 mg F, n = 25). A control population was included (no systemic fluoride, n = 24). Fluoride intake from diet and dentifrice, urinary fluoride excretion, and fluoride concentrations in fingernails/toenails were evaluated. Fluoride was analyzed with an ion-selective electrode. Urinary fluoride excretion in the control community was significantly lower when compared with that in the fluoridated cities, except for the naturally fluoridated community. However, the same pattern was not as evident for nails. Both urinary fluoride output and fluoride concentrations in fingernails/toenails were significantly correlated to total fluoride intake. However, the correlation coefficients for fluoride intake and urinary fluoride output were lower (r = 0.28, p < 0.01) than those observed for fingernails/toenails (r = 0.36, p < 0.001), suggesting that nails might be slightly better indicators of fluoride intake at the individual level.

Factors influencing fluoride ingestion from dentifrice by children

Objective: This study assessed the percentage of the amount of dentifrice loaded onto the toothbrush that is ingested by children, taking into account age, the amount of dentifrice used during toothbrushing, and the dentifrice flavor. Methods: The sample consisted of 155 children of both genders attending public kindergartens and schools in Bauru, Brazil, divided into 5 groups (n = 30-32) of children aged 2, 3, 4, 5 and 6 years old. The dentifrices used were Sorriso(TM) (1219 ppm F, peppermint-flavored) and Tandy(TM) (959 ppm F, tutti-frutti-flavored). The assessment of fluoride intake from dentifrices was carried out six times for each child, using 0.3, 0.6, and 1.2 g of each dentifrice, following a random, crossover distribution. Brushing was performed by the children or their parents/caregivers according to the home habits and under the observation of the examiner. Fluoride present in the expectorant and on toothbrush was analyzed with an ion-specific electrode after HMDS-facilitated diffusion. Fluoride ingestion was indirectly derived. Results were analyzed by 3-way repeated-measures anova and Tukey`s tests (P < 0.05) using the percent dentifrice ingested as response variable. Results: Age and percent dentifrice ingested for both dentifrices, and the three amounts used were inversely related (P < 0.0001). Percent dentifrice ingested was significantly higher after the use of Tandy(TM) under all conditions of the study when compared with Sorriso(TM) (P < 0.0001). Significant differences were observed when brushing with 0.3 g when compared with 1.2 g, for both dentifrices tested (P < 0.05). Conclusions: The results indicate that all variables tested must be considered in preventive measures aiming to reduce the amount of fluoride ingested by young children.

Fluoride and aluminum in teas and tea-based beverages

OBJECTIVE: To evaluate fluoride and aluminum concentration in herbal, black, ready-to-drink, and imported teas available in Brazil considering the risks fluoride and aluminum pose to oral and general health, respectively. METHODS: One-hundred and seventy-seven samples of herbal and black tea, 11 types of imported tea and 21 samples of ready-to-drink tea were divided into four groups: I-herbal tea; II-Brazilian black tea (Camellia sinensis); III-imported tea (Camellia sinensis); IV-ready-to-drink tea-based beverages. Fluoride and aluminum were analyzed using ion-selective electrode and atomic absorption, respectively. RESULTS: Fluoride and aluminum levels in herbal teas were very low, but high amounts were found in black and ready-to-drink teas. Aluminum found in all samples analyzed can be considered safe to general health. However, considering 0.07 mg F/kg/day as the upper limit of fluoride intake with regard to undesirable dental fluorosis, some teas exceed the daily intake limit for children. CONCLUSIONS: Brazilian and imported teas made from Camellia sinensis as well as some tea-based beverages are sources of significant amounts of fluoride, and their intake may increase the risk of developing dental fluorosis.

Urinary fluoride output in children following the use of a dual-fluoride varnish formulation

Objective: This study evaluated the bioavailability of fluoride after topical application of a dual-fluoride varnish commercially available in Brazil, when compared to Duraphat T. Material and methods: The urinary fluoride output was evaluated in seven 5-year-old children after application of the fluoride varnishes, in two different phases. In the first phase (I), children received topical application of the fluoride varnish Duofluorid XII (2.92% fluorine, calcium fluoride + 2.71% fluorine, sodium fluoride, FGM (TM)). After 1-month interval (phase II), the same amount (0.2 mL) of the fluoride varnish Duraphat (2.26% fluorine, sodium fluoride, Colgate T) was applied. Before each application all the volunteers brushed their teeth with placebo dentifrice for 7 days. Urinary collections were carried out 24 h prior up to 48 h after the applications. Fluoride intake from the diet was also estimated. Fluoride concentration in diet samples and urine was analyzed with the fluoride ion-specific electrode and a miniature calomel reference electrode coupled to a potentiometer. Data were tested by ANOVA and Tukey's post hoc test (p < 0.05). Results: There were significant differences in the urinary fluoride output between phases I and II. The use of Duofluorid XII did not significantly increase the urinary fluoride output, when compared to baseline levels. The application of Duraphat caused a transitory increase in the urinary fluoride output, returning to baseline levels 48 h after its use. Conclusions: The tested varnish formulation, which has been shown to be effective in in vitro studies, also can be considered safe.

Influence of growth rate and length on fluoride detection in human nails

This study aimed to determine the lag time between increased fluoride (F) intake and F detection in human nails, as well as the influence of nails growth rate and length on this. Ten 20- to 35-year-old volunteers received 1.8 mg F daily, for 30 days. Nail growth rate and length were determined for all fingernails and toenails. Nail samples were collected at the beginning of the study and every 2 weeks (15 collections in all) and F concentrations were determined. The growth rate was statistically higher in fingernails than in toenails. No statistically significant differences were observed between right and left sides. Growth rate was significantly greater for big toenails than for the other toenails, but this pattern was not found for fingernails. The estimated mean lag times for F detection in fingernails and toenails were 101 and 123 days, respectively. An apparent increase in fingernail F concentrations was observed 84 days after the beginning of the study, although this was not statistically different from baseline. For toenails, statistically significant increases in F concentration in relation to baseline were observed 112 and 140 days after increased F ingestion. These increases occurred within the 95% confidence intervals for the calculated mean lag time for fluoride detection in nails. Considering the large amount of sample provided by the big toenails, together with their faster growth rate, as well as the fact that toenails are less prone to environmental contamination, our data suggest that big toenails are more suitable biomarkers of fluoride intake.