Fluoride resistance in fibroblasts is conferred via reduced susceptibility to oxidative stress and apoptosis.

Chronic fluoride exposure from drinking water may result in endemic fluorosis. To better understand the mechanisms by which some people are resistant to fluorosis, here we investigated the effect of treatment with NaF (sodium fluoride) on production of reactive oxygen species (ROS), morphological changes in mitochondria, the mRNA expression of Fas ligand (Fas-L), and the protein expression of cleaved caspase-3 in regular L-929 cells and fluoride-resistant (FR) L-929 cells. While morphological changes indicative of apoptosis and a network of fragmented mitochondria were observed in regular L-929 cells after NaF treatment, there were no morphological changes in FR L-929 cells after NaF treatment. Treatment with 10 mm NaF induced a significant difference in the production of ROS, triggered the expression of cleaved caspase-3, and upregulated the mRNA expression of Fas-L in regular L-929 cells. However, there was no significant production of ROS in FR L-929 cells. Additionally, cleaved caspase-3 and upregulated Fas-L were not detected in FR L-929 cells. These results suggest that FR fibroblasts are resistant to oxidative stress and apoptosis induced by fluoride.

Disrupted Iron Storage in Dental Fluorosis.

Enamel formation and quality are dependent on environmental conditions, including exposure to fluoride, which is a widespread natural element. Fluoride is routinely used to prevent caries. However, when absorbed in excess, fluoride may also lead to altered enamel structural properties associated with enamel gene expression modulations. As iron plays a determinant role in enamel quality, the aim of our study was to evaluate the iron metabolism in dental epithelial cells and forming enamel of mice exposed to fluoride, as well as its putative relation with enamel mechanical properties. Iron storage was investigated in dental epithelial cells with Perl's blue staining and secondary ion mass spectrometry imaging. Iron was mainly stored by maturation-stage ameloblasts involved in terminal enamel mineralization. Iron storage was drastically reduced by fluoride. Among the proteins involved in iron metabolism, ferritin heavy chain (Fth), in charge of iron storage, appeared as the preferential target of fluoride according to quantitative real-time polymerase chain reaction, Western blotting, and immunohistochemistry analyses. Fluorotic enamel presented a decreased quantity of iron oxides attested by electron spin resonance technique, altered mechanical properties measured by nanoindentation, and ultrastructural defects analyzed by scanning electron microscopy and energy dispersive x-ray spectroscopy. The in vivo functional role of Fth was illustrated with Fth+/- mice, which incorporated less iron into their dental epithelium and exhibited poor enamel quality. These data demonstrate that exposure to excessive fluoride decreases ameloblast iron storage, which contributes to the defective structural and mechanical properties in rodent fluorotic enamel. They raise the question of fluoride's effects on iron storage in other cells and organs that may contribute to its effects on population health.

Evaluation of dentin permeability of fluorotic permanent teeth.

OBJECTIVE: The in vitro permeability characteristics of dentin have been studied extensively and used to evaluate the efficacy of various preventative and restorative procedures. The aim of this in vitro study was to precisely determine the dentin permeability of fluorotic premolar teeth using an electronic hydraulic conductance measurement system with photosensors and to compare the data with healthy premolars. METHODS: In total, 40 fluorotic and healthy premolar teeth with complete root formation that were extracted for orthodontic purposes and had no caries, restoration, fractures, or cracks were selected for this study. Teeth were classified according to a modified form of the dental fluorosis index of Thylstrup and Fejerskov. The dentin discs were placed in an electronic hydraulic conductance measurement system equipped with photosensors, which was designed for measurements of dentin permeability. The amount of distilled water passed through each dentin disc (µL/min) under a constant pressure was determined. Dentin permeability data of the fluorotic and healthy teeth were recorded and analyzed statistically. RESULTS: The present study showed that fluorosis influenced the volume of fluid that passed through the dentin and the dentin permeability was decreased, whereas dental fluorosis severity was increased in permanent teeth. CONCLUSION: The number of teeth with fluorosis is increasing, depending on fluorine sources, so more appropriate treatments will need to be evaluated by standardizing the methods employed in related studies.

Fluoride, Thyroid Hormone Derangements and its Correlation with Tooth Eruption Pattern Among the Pediatric Population from Endemic and Non-endemic Fluorosis Areas.

AIM: To comparatively evaluate the status of fluoride in the body with thyroid activity in the pediatric population of endemic fluorosis areas. The present study also attempted to elucidate whether any correlation exists between fluoride and thyroid hormone derangement with delayed tooth eruption. MATERIALS AND METHODS: A total of 400 pediatric subjects were included in the present study. All the patients were divided into two broad groups; groups A and B. Group A included 200 subjects who belonged to the endemic fluorosis area while Group B included remaining 200 subjects, who belonged to the fluorosis non-endemic area. Group B subjects were taken as control. Group A subjects were further divided into two study groups as follows: Group A1: 100 Pediatric subjects with dental fluorosis, and Group A 2: A total of one hundred pediatric subjects without dental fluorosis. Dean's index of fluorosis was calculated in all the patients. Blood samples were collected and were sent to a laboratory for assessment of thyroid hormone levels. All the results were subjected to statistical analysis by Statistical Package for the Social Sciences (SPSS) software. RESULTS: Mean thyroid stimulating hormone (TSH), water fluoride levels, urine fluoride levels and serum fluoride levels of subjects in group 1 were found to be significantly higher than that of subjects of group 2. Delayed tooth eruption was absent in subjects of group B while it was present in 100 subjects of group A. Thyroid hormone level derangement was seen in 54 percent subjects of group B, while it was seen in 67.5% subjects of group A. CONCLUSION: Positive correlation exists between fluorosis and thyroid functional activity. However; the tooth eruption pattern is independent up on the thyroid hormone derangement. CLINICAL SIGNIFICANCE: Delayed tooth eruption and alteration in thyroid hormone levels can occur in subjects of the endemic fluoride areas. Therefore, adequate measures should be taken for controlling such adverse effects.

[Mineral composition of mixed saliva in patients with dental fluorosis]. / Mineral'nyi sostav smeshannoi sliuny u patsientov s fliuorozom zubov.

The aim of the study was to assess the mineral composition of mixed saliva in dental fluorosis patients undergoing treatment with microabrasion and bleaching. The study included 60 patients aged 18-35 years with various forms of dental fluorosis. Group 1 included 40 patients in which enamel microabrasion was performed, group 2 - 20 patients with microabrasion and bleaching. Mixed saliva composition was analyzed with Olimpus automatic analyzing device. Dental fluorosis treatment in both groups resulted in saliva mineral composition changed associated with enamel demineralization which proves the necessity for calcium and phosphate containing compositions in these treatment groups.

Effect of fluoride on salivary immunoglobulins and sialic acid.

OBJECTIVE:: The aim of our study was to evaluate the effect of fluoride on salivary immunoglobulin and sialic acid levels in children with dental fluorosis and healthy teeth who live in places with high fluoride concentration in drinking water. METHOD:: Fifty-one (51) healthy children between 6 and 12 years old with no caries were randomly selected from primary schools enrolled in the dental-care program operated by the Department of Pediatric Dentistry. The children were divided into two groups: group I comprised 26 children with dental fluorosis [Thylstrup-Fejerskov Dental Fluorosis Index (TFI) = 4] who lived in Isparta (2.7-2.8 ppm), and group II consisted of 25 children without dental fluorosis who were born in low-fluoride areas and had lived in Isparta for only the previous two years. Stimulated and unstimulated saliva were collected and analyzed for fluoride, salivary immunoglobulins and sialic acid levels. RESULTS:: Sialic acid level was correlated negatively with age. Levels of secretory immunoglobulin A (sIgA) and secretory immunoglobulin G (sIgG) were higher in children with dental fluorosis compared with those in group II, although these differences were not significant. CONCLUSION:: Increased sIgA and sIgG levels may arrest the progression of caries in subjects with dental fluorosis. Given the risks of dental fluorosis, further studies of the effects of different fluoride levels in drinking water on salivary composition of children with mixed dentition are needed to confirm the results of our study and to provide data for comparison.

Effects of laser etching on shear bond strengths of brackets bonded to fluorosed enamel.

AIM: To evaluate the effects of laser etching on the shear bond strengths (SBS) and failure modes of brackets bonded to fluorosed enamel. MATERIALS AND METHODS: This in vitro study included 34 fluorosed and 34 nonfluorosed teeth. Teeth were divided into four subgroups according to the etching procedure: Group (A) normal enamel etched with 37% phosphoric acid for 15 s, Group (B) nonfluorosed enamel etched with erbium:yttrium aluminum garnet (Er: YAG) laser for 15 s, Group (C) fluorosed enamel etched with 37% phosphoric acid for 30 s, Group (D) fluorosed enamel etched with Er: YAG laser for 30 s. After bonding of the premolar metal brackets, specimens were subjected to the thermal cycles. After SBS test, modified adhesive remnant index (ARI) by using stereomicroscope and failure modes with a scanning electron microscope (SEM) was determined. After bonding, one specimen from each group was examined under SEM to identify enamel-resin interfaces. ANOVA and Tukey post-hoc tests were used to compare the SBS values. The Kruskal-Wallis and Chi-square tests were used to analyze the distribution of ARI scores and failure modes of groups. RESULTS: The highest mean SBS value (17.56 ± 1.05 MPa) was found in Group A, while the lowest (12.25 ± 0.96 MPa) in Group D. Significant differences were found in the SBS test and failure modes among all groups. The differences between ARI scores of the groups were not significant. CONCLUSION: According to our findings, laser etching reduced the SBS of brackets bonded to fluorosed teeth, but provided clinically acceptable SBS values.

Effect of fluoride on salivary immunoglobulins and sialic acid

Summary Objective: The aim of our study was to evaluate the effect of fluoride on salivary immunoglobulin and sialic acid levels in children with dental fluorosis and healthy teeth who live in places with high fluoride concentration in drinking water. Method: Fifty-one (51) healthy children between 6 and 12 years old with no caries were randomly selected from primary schools enrolled in the dental-care program operated by the Department of Pediatric Dentistry. The children were divided into two groups: group I comprised 26 children with dental fluorosis [Thylstrup-Fejerskov Dental Fluorosis Index (TFI) = 4] who lived in Isparta (2.7-2.8 ppm), and group II consisted of 25 children without dental fluorosis who were born in low-fluoride areas and had lived in Isparta for only the previous two years. Stimulated and unstimulated saliva were collected and analyzed for fluoride, salivary immunoglobulins and sialic acid levels. Results: Sialic acid level was correlated negatively with age. Levels of secretory immunoglobulin A (sIgA) and secretory immunoglobulin G (sIgG) were higher in children with dental fluorosis compared with those in group II, although these differences were not significant. Conclusion: Increased sIgA and sIgG levels may arrest the progression of caries in subjects with dental fluorosis. Given the risks of dental fluorosis, further studies of the effects of different fluoride levels in drinking water on salivary composition of children with mixed dentition are needed to confirm the results of our study and to provide data for comparison.

Groundwater fluoride contamination and its possible health implications in Indi taluk of Vijayapura District (Karnataka State), India.

Groundwater fluoride concentration and fluoride-related health problems were studied in twenty-two villages of Indi taluk of Vijayapura district, Karnataka, India. Present study (2015) was also used to compare groundwater fluoride concentration in same 22 villages with previous government report (2000). Groundwater fluoride concentrations of 62 bore wells of 22 villages were analyzed by using an ion-sensitive electrode. A total of 660 adults and 600 children were screened for fluorosis symptoms and signs. Sixty clinically suspected fluorosis patients' urine samples were further analyzed for fluoride. The mean value (1.22 ± 0.75 mg/L) of fluoride concentration of 62 bore wells and 54.83 % bore wells with ≥1.0 mg/L of fluoride concentrations in Indi taluk indicates higher than the permissible limit of drinking water fluoride concentration recommended for India. Clinical symptoms like arthritis, joint pains, gastrointestinal discomfort and lower limb deformities with high urinary fluoride concentrations in some subjects suggest fluorosis. Results also showed an increase in groundwater fluoride concentration of the same 22 villages between previous and present study. Preliminary arthritis symptom of the villagers could be due to drinking fluoride-contaminated water. Increase in fluoride concentration with time to the bore wells definitely indicates future danger.

Enamel crystals of mice susceptible or resistant to dental fluorosis: an AFM study.

OBJECTIVE: This study aimed to assess the overall apatite crystals profile in the enamel matrix of mice susceptible (A/J strain) or resistant (129P3/J strain) to dental fluorosis through analyses by atomic force microscopy (AFM). MATERIAL AND METHODS: Samples from the enamel matrix in the early stages of secretion and maturation were obtained from the incisors of mice from both strains. All detectable traces of matrix protein were removed from the samples by a sequential extraction procedure. The purified crystals (n=13 per strain) were analyzed qualitatively in the AFM. Surface roughness profile (Ra) was measured. RESULTS: The mean (±SD) Ra of the crystals of A/J strain (0.58±0.15 nm) was lower than the one found for the 129P3/J strain (0.66±0.21 nm) but the difference did not reach statistical significance (t=1.187, p=0.247). Crystals of the 129P3/J strain (70.42±6.79 nm) were found to be significantly narrower (t=4.013, p=0.0013) than the same parameter measured for the A/J strain (90.42±15.86 nm). CONCLUSION: enamel crystals of the 129P3/J strain are narrower, which is indicative of slower crystal growth and could interfere in the occurrence of dental fluorosis.

Enamel crystals of mice susceptible or resistant to dental fluorosis: an AFM study

Objective: This study aimed to assess the overall apatite crystals profile in the enamel matrix of mice susceptible (A/J strain) or resistant (129P3/J strain) to dental fluorosis through analyses by atomic force microscopy (AFM). Material and Methods: Samples from the enamel matrix in the early stages of secretion and maturation were obtained from the incisors of mice from both strains. All detectable traces of matrix protein were removed from the samples by a sequential extraction procedure. The purified crystals (n=13 per strain) were analyzed qualitatively in the AFM. Surface roughness profile (Ra) was measured. Results: The mean (±SD) Ra of the crystals of A/J strain (0.58±0.15 nm) was lower than the one found for the 129P3/J strain (0.66±0.21 nm) but the difference did not reach statistical significance (t=1.187, p=0.247). Crystals of the 129P3/J strain (70.42±6.79 nm) were found to be significantly narrower (t=4.013, p=0.0013) than the same parameter measured for the A/J strain (90.42±15.86 nm). Conclusion: enamel crystals of the 129P3/J strain are narrower, which is indicative of slower crystal growth and could interfere in the occurrence of dental fluorosis. .

Impaired heart rate recovery in patients with endemic fluorosis.

The objective of the present study was to determine the heart rate recovery index (HRRI), a marker of autonomic nervous system function in patients with endemic fluorosis. Forty patients with endemic fluorosis (16 men/24 women) and 40 age-, sex-, and body mass index-matched healthy controls (16 men/24 women) with normal fluoride intake were enrolled in this study. HRRI was calculated by subtracting the heart rate values at the first, second, and third minutes of the recovery phase from the peak heart rate (HRRI 1, HRRI 2, HRRI 3). Urine fluoride levels of fluorosis patients were significantly (P < 0.001) higher than control subjects as expected. HRRI 2 was significantly lower in fluorosis patients than in the controls. The incidence of abnormal HRRI 1 was significantly higher in fluorosis patients than in the controls (P < 0.05). We observed that HRRI, a marker of autonomic nervous system function, is impaired in patients with chronic fluorosis.

[Drinking-water type fluorosis treated with acupuncture of reinforcing kidney and activating spleen: a randomized controlled trial].

OBJECTIVE: To observe the impacts of acupuncture of reinforcing kidney and activating spleen on the excretion of urinary fluoride and pain of the patients with drinking-water type fluorosis. METHODS: The randomized controlled and single-blind trial was adopted. Seventy-two cases were randomized into an observation group and a control group, 36 cases in each one. In the observation group, acupuncture was applied at Pishu (BL 20), Shenshu (BL 23), Guanyuan (CV 4), Zusanli (ST 36), etc. , three treatments a week. In the control group, the Calcium Carbonate D3 tablets were prescribed for oral administration, 600 mg each time, twice a day. The duration of treatment was 2 months. The changes of the content of urinary fluoride and pain score (by VAS) before and after treatment between two groups were compared. RESULTS: The urinary fluoride excretion was increased obviously after treatment in the observation group (P < 0.01), which was superior apparently to that in the control group [(11.06 +/- 4.54) mg/L vs. (8.30 +/- 4.14) mg/L, P < 0.05]. After treatment, VAS score was reduced significantly in either group (both P < 0.01). The result in the observation group was lower remarkably than that in the control group (1.93 +/- 1.30 vs. 3.47 +/- 2.29, P < 0.01). CONCLUSION: Acupuncture achieves the significant efficacy on the promotion of urinary fluoride excretion and pain relieving of the patients with drinking-water type fluorosis in light of reinforcing kidney and activating spleen, which is superior to the oral administration of the calcium carbonate D3 tablets.

Phenotypic variation of fluoride responses between inbred strains of mice.

Excessive systemic exposure to fluoride (F) can lead to disturbances in bone homeostasis and dental enamel development. We have previously shown strain-specific responses to F in the development of dental fluorosis (DF) and in bone formation/mineralization. The current study was undertaken to further investigate F responsive variations in bone metabolism and to determine possible relationships with DF susceptibility. Seven-week-old male mice from FVB/NJ, C57BL/6J, C3H/HeJ, A/J, 129S1/SvImJ, AKR/J, DBA/2J, and BALB/cByJ inbred strains were exposed to NaF (0 or 50 ppm as F(-)) in drinking water for 60 days. Sera were collected for F, Ca, Mg, PO(4), iPTH, sRANKL, and ALP levels. Bone marrow cells were subjected to ex vivo cell culture for osteoclast potential and CFU colony assays (CFU-fibroblast, CFU-osteoblast, CFU-erythrocyte/granulocyte/macrophage/megakaryocyte, CFU-granulocyte/macrophage, CFU-macrophage, and CFU-granulocyte). Femurs and vertebrae were subjected to micro-CT analyses, biomechanical testing, and F, Mg, and Ca content assays. DF was evaluated using quantitative fluorescence and clinical criteria. Strain-specific responses to F were observed for DF, serum studies, ex vivo cell culture studies, and bone quality. Among the strains, there were no patterns or significant correlations between DF severity and the actions of F on bone homeostasis (serum studies, ex vivo assays, or bone quality parameters). The genetic background continues to play a role in the actions of F on tooth enamel development and bone homeostasis. F exposure led to variable phenotypic responses between strains involving dental enamel development and bone metabolism.

Oral-health-related quality of life in schoolchildren in an endemic fluorosis area of Mexico.

OBJECTIVE: To evaluate the oral-health-related quality of life (OHRQoL) of children living in an endemic hydrofluorosis area. METHODS: Schoolchildren aged 8-10 years living in an area with 3.38 ppm F water concentration completed a validated Spanish version of the Child Perceptions Questionnaire (CPQ(8-10ESP)). World Health Organization (WHO) criteria were applied for the diagnosis of dental caries and malocclusion. Additionally, the Thylstrup and Fejerskov Index (TFI) was used for fluorosis diagnosis. CPQ(8-10ESP) scores and oral health status were analyzed using non-parametric tests and logistic regression models. RESULTS: Two hundred and twelve schoolchildren participated in this study. The mean CPQ(8-10ESP) score was 12.98 (SD 11.4). General oral health was rated as "poor" in 14.6%, "fair" in 41.5%, "good" in 25.9%, and "very good" in 17.9% of the children. Regarding overall well-being, half (51.6%) of the children perceived that the condition of their mouths disturbs their quality of life (QoL). Children with dental fluorosis (TF >4) had a high CPQ(8-10ESP) score in all domains (P < 0.005). Additionally, children with DMFS + dmfs >5 had higher scores in the oral symptoms, functional limitation, and emotional well-being CPQ(8-10ESP) domains (P < 0.05). Applying a CPQ(8-10ESP) cutoff point of 32, the OR values for severe malocclusion, caries, and fluorosis were 5.2 (P = 0.034), 4.6 (P = 0.006), and 5.1 (P = 0.007), respectively. CONCLUSIONS: Malocclusion, caries, and fluorosis were associated with a negative impact on children's QoL.

Effects of fluorosis on QT dispersion, heart rate variability and echocardiographic parameters in children.

OBJECTIVE: Chronic fluoride poisoning is called fluorosis. The aim of the study was to investigate effects of fluorosis on cardiovascular system in children by measuring QT dispersion (QTd), corrected QT dispersion (QTcd), heart rate variability (HRV) and echocardiography findings. METHODS: Thirty-five children with dental fluorosis and 26 children as control group were included in this cross-sectional study. Dean index was used for the clinical diagnosis. The fluoride levels of subjects measured by ion electrode method in spot urine higher than 0.6 ppm were included in the study. Serum electrolytes and thyroid function tests were analyzed. Electrocardiography (ECG), echocardiography and 24-hour ambulatory Holter monitorizations were applied, and all the data were analyzed for measuring HRV, and calculation of QTd and QTcd intervals. Corrected QT (QTc) intervals were determined with the Bazzett formula. Difference between the longest and shortest intervals was considered as dispersion. Statistical analysis was performed Kruskal-Wallis test and Pearson correlation test. RESULTS: Low free thyroxine hormone (FT4) (Control Group, Group 2 1.11 (0.85-1.64) ng/dL, 0.96 (0.85-1.11) ng/dL, p<0.05), calcium (Control Group, Group 1, 2, 9.80 (9.30-10.70) mg/dL, 9.60 (8.90-10.70) mg/dL, 9.50 (8.90-10.10) mg/dL, p<0.05) and high serum sodium levels (Control Group, Group 2 139 (136-142) mEq/L, 141 (138-148) mEq/L, p<0.01), increased QT (Control Group, Group 2 329.8 (300.0-363.5) msec, 351.8 (318.0-372.0) msec, p<0.05) and QTc intervals (Control Group, Group I2 390.6 (309.0-418.5) msec, 366.8 (318.2-468.5) msec, p<0.05) were found in subjects with fluorosis. No significant difference was found with respect to echocardiography and HRV variables. CONCLUSION: Endemic fluorosis is a risk factor for decrease in calcium and FT4 levels, increase in sodium levels and QT prolongation. These findings might be related with some cardiovascular system dysfunctions such as arrhythmias or syncope. Subjects with fluorosis should be monitored in terms of long QT and QTc intervals.

Health impact of supplying safe drinking water containing fluoride below permissible level on flourosis patients in a fluoride-endemic rural area of West Bengal.

BACKGROUND: The problem of high fluoride concentration in groundwater resources has become one of the most important toxicological and geo-environmental issues in India. Excessive fluoride in drinking water causes dental and skeletal fluorosis, which is encountered in endemic proportions in several parts of the world. World Health Organization (WHO) guideline value and the permissible limit of fluoride as per Bureau of Indian Standard (BIS) is 1.5 mg/L. About 20 states of India, including 43 blocks of seven districts of West Bengal, were identified as endemic for fluorosis and about 66 million people in these regions are at risk of fluoride contamination. Studies showed that withdrawal of sources identified for fluoride often leads reduction of fluoride in the body fluids (re-testing urine and serum after a week or 10 days) and results in the disappearance of non-skeletal fluorosis within a short duration of 10-15 days. OBJECTIVE: To determine the prevalence of signs and symptoms of suspected dental, skeletal, and non-skeletal fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among participants taking water with fluoride concentration above the permissible limit, and to assess the changes in clinical manifestations of the above participants after they started consuming safe drinking water. MATERIALS AND METHODS: A longitudinal intervention study was conducted in three villages in Rampurhat Block I of Birbhum district of West Bengal to assess the occurrence of various dental, skeletal, and non-skeletal manifestations of fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among the study population and the impact of taking safe water from the supplied domestic and community filters on these clinical manifestations. The impact was studied by follow-up examination of the participants for 5 months to determine the changes in clinical manifestations of the above participants after they started consuming safe drinking water from supplied domestic filters and community filter with fluoride concentration below the permissible limit. The data obtained were compared with the collected data from the baseline survey. RESULTS: The prevalence of signs of dental, skeletal, and non-skeletal fluorosis was 66.7%, 4.8-23.8%, and 9.5-38.1%, respectively, among the study population. Withdrawal of source(s) identified for fluoride by providing domestic and community filters supplying safe water led to 9.6% decrease in manifestation of dental fluorosis, 2.4-14.3% decrease in various manifestations of skeletal fluorosis, and 7.1-21.5% decrease in various non-skeletal manifestations within 5 months. Following repeated motivation of participants during visit, there was also 9.7-38.1% decrease in the usage of fluoride containing toothpaste, and 9.8-45.3% and 7.3-11.9% decrease in the consumption of black lemon tea and tobacco, respectively, which are known sources of fluoride ingestion in our body and have an effect on the occurrence of various manifestations of fluorosis following drinking of safe water from domestic and community filters. CONCLUSION: Increased prevalence of dental, skeletal, and non-skeletal fluorosis was found among the study population. Withdrawal of source(s) identified for fluoride by supplying domestic and community filters, dietary restriction, and other nutritional interventions led to decrease in manifestation of the three types of fluorosis within 5 months.

Impact of chronic fluorosis on left ventricular diastolic and global functions.

Sixty three patients with endemic fluorosis (36 males/27 females; mean age 33.9+/-8.6years) and 45 age, sex and body mass index (BMI) matched healthy controls (30 males/15 females; mean age 32.7+/-8.8years) were included in this study. Basic echocardiographic measurements, left ventricular diastolic parameters and left ventricular myocardial performance index (MPI) were measured. The left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Doppler. The urine fluoride levels of fluorosis patients were significantly higher than control subjects as expected (1.9+/-0.1mg/l vs 0.4+/-0.1mg/l respectively; P<0.001). Isovolumic relaxation time (IVRT) and deceleration time (DT) were significantly higher in fluorosis patients than in controls (for IVRT 106.9+/-15.6ms vs 96.7+/-12.2ms; P<0.001 and for DT 211.7+/-30.7ms vs 188.0+/-30.0ms; P<0.001, respectively). MPI was significantly higher in fluorosis patients than in controls (0.62+/-0.15ms vs 0.49+/-0.10ms; P<0.001, respectively). We have shown that chronic fluorosis patients had left ventricular diastolic and global dysfunctions.

Dental fluorosis and its association with the use of fluoridated toothpaste among middle school students of Delhi.

INTRODUCTION: Fluorosis can manifest as dental fluorosis (seen mostly in secondary dentition), skeletal fluorosis, and systemic fluorosis. Groundwater with high fluoride concentrations, diet rich in fish and tea, indoor air-pollution, and use of fluoride toothpastes may contribute considerably to total exposure. OBJECTIVE: To assess the prevalence of dental fluorosis and associated factors particularly fluoridated toothpastes, among middle school children of a resettlement colony in Delhi. MATERIALS AND METHODS: This survey was conducted among the middle school students (VI th -VIII th ) studying in three government schools of Sangam Vihar, South Delhi. Students were examined for dental fluorosis by experts. A pre-structured questionnaire was used to obtain data regarding age, source of drinking water, toothpaste used, etc. Height, weight, and hemoglobin were recorded. Two repeat visits were made. Out of 432 students enrolled in these schools, 413 students were examined. STATISTICS: Descriptive and chi-square statistics were used. RESULTS: Dental fluorosis was prevalent in 121 (29.3%) study subjects. It was significantly more in children of age 13 years or above, in those who used fluoridated toothpaste for dental cleaning (P=0.033) and in anemic children (P<0.001). However, there was no significant association of disease with gender (P=0.02), source of drinking water (P=0.417), and with BMI (P=0.826). CONCLUSION: As dental fluorosis is very common (in about one-fourth) among the middle school children, in this resettlement colony of Delhi, various control measures e.g. discouraging the fluoridated toothpastes, educating parents about fluorosis, de-fluoridation of water in the high risk areas, etc may help to tackle this situation.