Fluorosis. Antivet contra ácido clorhídrico / fluoride. Antivet vs hydrochloric acid

Introducción: La fluorosis dental es una hipomineralización del esmalte producida como respuesta a la ingesta de fluor por un periodo prolongado durante la formación del esmaltado. Es una alteración irreversible, que clínicamente se caracteriza por la presencia de delgadas líneas blanquecinas distribuidas en el esmalte dental correspondientes a la disposición de las periquimatías, y en grados más avanzados de la enfermedad se odservan cambios en toda la superficie del esmaltado que adquiere un aspecto opaco, como de piedra caliza. En los niveles más severos de flurosis dental, la presencia de hipomineralización, y el aumento en la porosidad del esmalte dental propicia la pérdida de porciones importantes de su estructura, produciendo fracturas, por lo que se deteriora la apariencia y funcionalidad de los dientes afectados. (1) La OMS recomienda que el valor de referencia para el fluoruro en el agua potable es de 1,5 mg /1.(2) El flúor es un gas halógeno, el más electronegativo de los elementos de la tabla periódica, con número atómico 19, prácticamente no existe libre en la naturaleza, sino asociado a otros elementos como: calcio y sodio. La principal vía de incorporación del flúor en el organismo humano es la digestiva. Es absorbido rápidamente en la mucosa del intestino delgado y del estómago, por un simple fenómeno de difusión. Una en los tejidos, depositándose preferentemente en los tejidos duros; se elimina por todas las vías de excreción, principalmente por orina. La cantidad de flúor en el organismo es variable y depende de la ingestión, inhalación, absorción y eliminación, así como de las características de los compuestos. Generalmente se concentra en huesos, cartílagos, dientes y placa bacteriana. El depósito de flúor varía con la edad y la excreción. En los niños, el 50% se fija en huesos y dientes en formación; en adultos, se deposita básicamente en huesos. (3) Existen diversos métodos para su eliminación. En esta investigación se realizaron 18 procedimientos a pacientes de ambos sexos. La metodología fue dividir en dos grupos de 8 personas cada uno, en el cual se utilizó Antivet en el primer grupo y ácido clorhídrico al 18% en el segundo grupo. Los casos fueron seleccionados al azar y posteriormente se observaron los cambios clínicos con cada grupo. En el primer grupo de personas que utilizaron Antivet, se mostró que en casos severos de fluorosis no era un método tan eficaz, ya que no elimina por completo las manchas marrones, sin embargo, es un procedimiento muy bueno para uso clínico cuando los grados de fluorosis son menores. En el segundo grupo de personas que utilizaron ácido clorhídrico al 18% se demostró la eficacia del tratamiento en fluorosis de grados avanzados, donde el esmalte está más del 50% dañado, por lo que es un excelente método de tratamiento con el debido control en su manipulación. Objetivo: Saber diferenciar los tipos de materiales y conocer los diferentes métodos para eliminación de flúor así como mostrar la diferencia entre tratamientos. Metodología: El tipo de estudio es explicativo y con el cual se espera contribuir al desarrollo del conocimiento científico. Su realización supone el ánimo de contribuir al desarrollo del saber científico. Consistió en seleccionar 16 pacientes, masculinos y femenonos y de distintas edades de entre 15 y 40 años. Se dividieron al azar, en 2 grupos de 8 personas cada uno para tratarlos con 2 productos diferentes. El primer grupo fue tratado con ácido clorhídrico al 18% y el segundo grupo con la marca comercial Antivet. Resultado y conclusión: La fluorosis dental es causada por ingestas excesivas de flúor. El uso del ácido clorhídrico es corrosivo, su aroma es penetrante y los cuidados con el paciente son mayores, ya que un mal uso al tener contacto con piel o mucosa creará necrosis. El Antivet tiene desventajas de costo y disponibilidad, pero su ventaja es que brinda más seguridad en su manipulación.

Introduction: Dental fluorosis is a hypomineralization of the enamel produced due to fluoride intake for a prolonged time during enamel formation. It is an irreversible alteration, which is clinically characterized by the presence of thin whitish lines distributed in the dental enamel corresponding to the disposition of the perikymata. In more advanced degrees of the disease, changes are observed in the entire enamel surface, which acquires an opaque appearance, like limestone. In the most severe levels of dental fluorosis, the presence of hypomineralization and increased porosity of the dental enamel leads to the loss of essential portions of its structure, producing fractures, thus deteriorating the appearance and functionality of the affected teeth. (1) The WHO recommends that the reference value for fluoride in drinking water is 1.5 mg/l. (2) Fluoride is a halogen gas, the most electronegative of the periodic table elements, with atomic number 19. It practically does not exist free in nature but is associated with other elements such as calcium and sodium. The primary way of incorporating fluorine into the human organism is through the digestive system. It is rapidly absorbed in the mucosa of the small intestine and stomach by a simple phenomenon of diffusion. Once absorbed, fluoride passes into the blood and is distributed in the tissues, preferentially deposited in hard tissues; it is eliminated by all excretion routes, mainly by the urine. The amount of fluoride in the body is variable and depends on ingestion, inhalation, absorption, elimination, and the characteristics of the compounds. It is generally concentrated in bones, cartilage, teeth, and bacterial plaque. Fluoride deposition varies with age and excretion. In children, 50% is fixed in bones and teeth information; it is basically deposited in bones in adults. (3) There are various methods for its elimination. In this research, 18 procedures were performed on patients of both sexes. The methodology was divided into two groups of 8 persons each, in which Antivet was used in the first group and 18% hydrochloric acid in the second group. The cases were randomly selected, and subsequently, the clinical changes were observed in each group. In the first group of people who used Antivet, it was shown that in severe cases of fluorosis, it was not such an effective method since it does not completely eliminate the brown stains. However, it is a very effective method for clinical use when the degrees of fluorosis are lower. In the second group of people who used 18% hydrochloric acid, the effectiveness of the treatment was demonstrated in advanced degrees of fluorosis, where the enamel is more than 50% damaged, making it an excellent method of treatment with due control in its manipulation. Objective: To differentiate the types of materials and to know the different methods for fluoride elimination as well as to show the difference between treatments. Methodology: The type of study is explanatory, and it is expected to contribute to the development of scientific knowledge. It was carried out to contribute to the development of scientific knowledge. It consisted of selecting 16 patients of both sexes and of different ages between 15 and 40 years old. They were randomly divided into two groups of 8 persons, each to be treated with two different products. The first group was treated with 18% hydrochloric acid, and the second group with the comercial brand Antivet. Result and conclusion: Dental fluorosis is caused by excessive fluoride intake. Hydrochloric acid is corrosive, its aroma is penetrating, and the care with the patient is greater since a wrong use when in contact with skin or mucosa will create necrosis. Antivet has disadvantages of cost and availability, but its advantage is that it provides more safety in its handling.

Prevalencia de fluorosis en menores de 4 a 15 años, según índice de Dean y su asociación con el nivel de flúor presente en el agua de consumo / Prevalence of fluorosis in children between 4 and 15 years of age according to Dean's index and its association with the level of fluoride present in drinking

Resumen Objetivo. Identificar la prevalencia de fluorosis en menores de 4 a 15 años de edad, según índice de Dean y su asociación con el nivel de flúor presente en el agua de consumo en la provincia de Cotopaxi. Previa una autorización de participación por parte de sus padres y aprobación del comité de la Universidad Central del Ecuador. Métodos. Fueron examinados 115 participantes en las edades de 4 a 15 años, siguiendo protocolos de registro fotográfico validados tras verificar y cumplimiento de criterios de inclusión. A su vez, se evaluaron muestras de agua de abastecimiento que fueron recolectadas según los protocolos adecuados y examinadas según la presencia de flúor. Las fotografías obtenidas fueron analizadas por tres evaluadores certificados y entrenados en la diferenciación de los grados de fluorosis según Dean mediante índice Kappa. Resultados. Los valores emitidos por cada evaluador fueron recolectados tabulados y procesados mediante el programa SPSS, y la prueba estadística de Chi cuadrado y correlación de Spearman, evidenciando ausencia de una relación estadísticamente significativa, entre las variables analizadas. Conclusión. La presencia de fluorosis de leve a moderada en la población analizada no guarda relación con el porcentaje de flúor presente en las aguas de consumo.

Abstract Objective. Identify the prevalence of fluorosis in children between 4 and 15 years of age according to the Dean's index, and determine its association with the level of fluoride present in drinking water from Cotopaxi province. Subsequent to the authorization by their parents and approval by the committee of the Central University of Ecuador Methods. 115 participants between the ages of 4 to 15 years old were examined following validated photographic registration protocols, after verifying and fulfilling the inclusion criteria, along with the supply water samples were collected following the adequate protocols and examined for the presence of fluoride. The obtained photographs were analyzed by three certified evaluators, who were trained in the differentiation of the degrees of fluorosis according to Dean by means of the Kappa index. Results. The values emitted by each evaluator were tabulated and processed through the SPSS program, using the statistical test of Chi-square and Spearman's correlation. The absence of a statistically significant relationship between the variables was observed. Conclusion: The presence of mild to moderate fluorosis in the analyzed population is not related to the percentage of fluoride present in drinking water.

Fluorose por ingestão voluntária de pasta fluoretada após os 5 anos de idade: relato de caso e discussão da importância da educação em saúde bucal na 1a infância / Fluorosis from voluntary ingestion of fluoride paste after 5 years of age: case report and discussion of the importance of health education in early childhood

Introdução: Preocupações com a ingestão de pasta fluoretada por crianças se limita à primeira infância devido ao risco de fluorose nos dentes permanentes anteriores, mas o processo educativo para garantir uma segurança para toda a dentição tem sido negligenciado. Objetivo: Relatar um caso de fluorose dentaria em dentes caninos, pré-molares e 2o molares por ingestão voluntária de pasta fluoretada Relato do caso: Paciente de 12 anos, 65 kg, procurou atendimento odontológico devido a insatisfação com a coloração dos dentes posteriores. Constatou-se que os dentes caninos, pré-molares e segundo molares, superiores e inferiores apresentavam opacidades tipo fluoróticas, estando os demais normais. Entre as possíveis causas, a principal recaiu sobre o modo que a criança passou a escovar os dentes após os 5 anos de idade. Foi relatado que ela voluntariamente escovava seus dentes 6x/dia sem cuspir. Foram feitas análises da concentração de fluoreto da água consumida pela paciente e nas pastas usadas. Também foi feito teste de excreção de fluoreto urinário pela paciente, solicitando para ela escovar os dentes cuspindo ou engolindo toda a pasta em uso. Resultados: Na água foi encontrado 0,74 mg F/L e nas pastas usadas 1.357 e 1.426 mg F solúvel/ kg. Na urina foi encontrado 0,90 e 1,35 mg F, respectivamente, cuspindo ou engolindo a pasta após as escovações. Foi estimado que a partir dos 5 anos de idade, a criança se submeteu à dose de 0,17 mg F/dia/kg de peso corpóreo, a qual é 2,4 vezes maior que o limite superior de risco de fluorose. Conclusão: O caso relatado sugere ser uma consequência de falha do processo de educação em saúde na 1a infância quanto ao uso racional de dentifrício fluoretado.

Introduction: Concerns about children's intake of fluoride toothpaste are limited to infancy due to the risk of fluorosis in the permanent anterior teeth, but the educational process to ensure safety for the entire dentition has been neglected. Objective: To report a case of dental fluorosis in canine, premolar and 2nd molar teeth caused by voluntary ingestion of fluoride toothpaste. Case report: A 12- year-old patient, 65 kg, search dental care due to dissatisfaction with the color of the posterior teeth. It was diagnosticated that the superior and inferior canine, premolar and second molar teeth had fluorotic opacities, and the other teeth are sound. Among the possible causes, the main one was the way the child started brushing their teeth after 5 years of age. It was reported that she voluntarily brushed her teeth 6x/day without spitting. Analyzes of the fluoride concentration in the water consumed by the patient and in the toothpastes used were performed. A urinary fluoride excretion test by the patient, requesting her to brush her teeth by spitting out or swallowing all the toothpaste in use, was made. Results: Fluoride concentration in the water was 0.74 mg F/L and 1,357 and 1,426 mg F/kg in the toothpastes pastes used. In urine test, 0.90 and 1.35 mg F were found, respectively, spitting or swallowing the toothpaste after brushing. It was estimated that from 5 years of age, the child was submitted a dose of 0.17 mg F/day/kg of body weight, which is 2.4 times the upper limit for an acceptable fluorosis. Conclusion: The reported case suggests that it is a consequence of the failure of the health education process in early childhood regarding the rational use of fluoride toothpaste.

Prevalence of Dental Caries and Dental Fluorosis among 7-12-Year-Old School Children in an Indian Subpopulation: A Cross-Sectional Study

ABSTRACT Objective: To assess the prevalence of dental caries and fluorosis among 7-12-year-old school children in Muradnagar, India. An additional objective was to determine the relationship between dental caries and fluorosis in the studied population. Material and Methods: A total of 1500 school children aged between 7 to 12 years, and both genders were randomly selected for the present study. The selected participants were divided into three groups based upon age, viz 7-8 year (group I), 9-10 year (group II) and 11-12 year (group III). Sterile mouth mirrors and explorers were used for the detection of caries. The water samples were collected to assess the fluoride concentration. The data collected were tabulated and statistically analysed using Chi-square, ANOVA, Spearman's correlation and t-test wherever applicable. Results: Out of 1500 participants, 54.1% were females and 45.9% were males. The prevalence of dental caries and fluorosis was 89.3% and 93.7%, respectively. The prevalence of caries increased with age (p<0.05) and females showed a higher prevalence in both the dentitions. Most dental fluorosis was 'very mild' (40.1%). Prevalence of dental fluorosis increased with age and males showed more fluorosis than females. A negative relationship was found between dental caries and fluorosis (p<0.05). Conclusion: Dental caries and fluorosis are the public health problems in Muradnagar; therefore, preventive programs should be organized to increase awareness among the general people.

In vivo effect of fluoride combined with amoxicillin on enamel development in rats

Abstract Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. Objective: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. Methodology: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). Results: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. Conclusion: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.

Gene expression of collagen type I alpha 2 and its relationship with dental fluorosis

Objective: to compare the gene expression levels of collagen type I alpha 2 (COL1A2) in children with and without dental fluorosis. methods: cross-sectional study involving 92 children between 5 and 12 years of age. socio-demographic characteristics, the presence of dental fluorosis by means of the Thylstrup-Fejerskov index, and gene expression analysis of COL1A2 in peripheral blood samples by reverse transcription polymerase chain reaction (RT-PCR) assays, were described. for the descriptive analysis, measures of central tendency, dispersion and proportions were used. differences between the groups (p<0.05) were established by the student t-test. results: mean age was 8.6 (SD=1.9) years, 51.1 percent were female; 54 children were diagnosed with fluorosis and 38 without fluorosis; prevalence of dental fluorosis was 58.7 percent (95 percent CI: 48.4 percent -68.9 percent). gene expression of COL1A2 was statistically significantly lower (p<0.05) in the participants with dental fluorosis. conclusion: there are differences in the expression levels of the COL1A2 gene among the population under study. therefore, COL1A2 may be potentially involved in the development of dental fluorosis.

Fluorosis endémica en localidades del Paraguay / Endemic fluorosis in localities of Paraguay

Es bien conocida la utilización de fluoruros en la prevención de caries, administrados en forma sistémica o aplicados en forma tópica sobre las piezas dentarias. La fluoración del agua, en países como Estados Unidos, está instalada desde 1945, con concentraciones de flúor entre 0,7 y 1,2 mg/L recomendadas por el Servicio de Salud Pública (PHS). La fluorosis dental es una condición irreversible y constituye la primera señal visible de que un niño ha sido sobreexpuesto a fluoruros8. Es producida por el consumo de altas concentraciones de flúor en el periodo de formación de los dientes, provocando deficiencia estética y biológica, lo que predispone a la aparición de caries, sensibilidad dental, maloclusión, y problemas de autoestima por la apariencia de las piezas dentarias con repercusiones en salud pública dado los altos costos de los tratamientos restauradores9,(AU)

Caries and fluoridated water in two Brazilian municipalities with low prevalence of the disease / Cárie e água fluoretada em dois municípios brasileiros com baixa prevalência da doença

ABSTRACT OBJECTIVE To analyze the association between exposure to fluoridated water and dental caries in a context of widespread use of fluoride toothpaste in Brazil, in a scenario of low prevalence of the disease. METHODS This is a cross-sectional observational study, of the census type, in the form of a double population-based epidemiological survey carried out in two municipalities of the state of São Paulo in 2014. The sample consisted of adolescents aged 11 and 12 years, exposed (n = 184) or not exposed (n = 128) to fluoridated water for at least five years. The populations studied lived in communities of the same geographic region and had small demographic size and similar socioeconomic classification, differing only in the exposure (Silveiras) or not exposure (São José do Barreiro) to fluoridated water. The experience, magnitude, and degree of polarization of dental caries in these populations were analyzed using the DMFT and SiC indexes, and the association was tested using Pearson's chi-square statistics and prevalence ratio between those not exposed and those exposed to fluoridated water. RESULTS Although caries experience (DMFT ≥ 1) was not associated with exposure to fluoridated water (chi-square = 1.78; p = 0.18; α = 5%), a significant difference was observed in the magnitude with which the disease reached the population: the means of DMFT were 1.76 in those exposed and 2.60 in those not exposed and the means of SiC were 4.04 and 6.16, respectively. The degree of polarization, indicated by the percentage of subjects with DMFT = 0, was different, being it higher (41.8%) in subjects exposed and lower (34.3%) in subjects not exposed. The prevalence ratio between those not exposed and those exposed was 1.13, indicating little expressiveness in prevalence difference. CONCLUSIONS Exposure to fluoridated water implied lower mean values for the DMFT and SiC indexes, even in the presence of the concomitant exposure to fluoridated toothpaste, in a scenario of low prevalence of the disease, and with a similar pattern of caries distribution in the populations analyzed.

RESUMO OBJETIVO Analisar a associação entre a exposição à água fluoretada e cárie dentária, em contexto de uso generalizado de creme dental fluoretado no Brasil, em cenário de baixa prevalência da doença. MÉTODOS Realizado estudo observacional transversal, de tipo censitário, na modalidade de duplo inquérito epidemiológico populacional, em dois municípios paulistas em 2014. Participaram adolescentes de 11 e 12 anos, imersos na sua condição de exposição (n = 184) ou não exposição (n = 128) à água fluoretada, há pelo menos cinco anos. As populações avaliadas residiam em comunidades da mesma região geográfica, de pequeno porte demográfico e com classificação socioeconômica similar, diferenciando-se apenas pela condição de exposição à água fluoretada (Silveiras) e de não exposição (São José do Barreiro). A experiência, a magnitude e o grau de polarização da cárie dentária nessas populações foram analisadas por meio dos índices CPOD e SiC e a associação foi testada empregando-se as estatísticas qui-quadrado de Pearson e razão de prevalência entre não expostos e expostos à água fluoretada. RESULTADOS Embora a experiência de cárie (CPOD ≥ 1) não tenha se associado com a exposição à água fluoretada (qui-quadrado = 1,78; p = 0,18; α = 5%), observou-se expressiva diferença na magnitude com que a doença atingiu a população: as médias CPOD foram de 1,76 em expostos e 2,60 em não expostos e as médias SiC foram de 4,04 e 6,16, respectivamente. O grau da polarização, indicado pela porcentagem de indivíduos com CPOD = 0, foi diferente, maior (41,8%) em expostos e menor (34,3%) em não expostos. A razão de prevalência entre não expostos e expostos foi de 1,13, indicando pouca expressividade na diferença das prevalências. CONCLUSÕES A exposição à água fluoretada implicou menores valores médios dos índices CPOD e SiC, ainda que em presença de exposição concomitante a dentifrício fluoretado, em cenário de baixa prevalência da doença e padrão similar de distribuição de cárie nas populações analisadas.

Impact psychologique, qualité de vie et traitements des patients adultes souffrant de fluorose dentaire dans une région endémique au nord du Nigeria

Objectif : Evaluer l'impact de la Fluorose Dentaire (FD) sur la Qualité de Vie (QdV) et déterminer les traitements nécessaires parmi les adultes affectés qui fréquentent la clinique dentaire d'un Centre Hospitalier Universitaire dans un lieu endémique.Matériels et méthodes : L'évaluation de tous les patients consécutifs adultes fréquentant les cliniques de diagnostic et de restauration orales a été menée pour diagnostiquer la FD en utilisant l'indice de fluorose de Dean. L'impact de la FD sur la QdV avait été évaluée avec les questionnaires abrégées sur le profil de la santé bucco-dentaire (OHIP-14). La comparaison des résultats d'impact avait été menée en utilisant le test t de Student, les statistiques ANOVA, et les corrélations entre les caractéristiques des sujets et l'impact avait été évalué avec un modèle de régression multiple. Résultats : La fluorose dentaire a été diagnostiquée chez 172 sujets avec une moyenne d'âge de 27,89 ans (SD : 7,763), alors que 11,6% des sujets avait consulté la clinique à cause de FD. La moyenne OHIP-14 était de 2,4967 (SEM : 0,2394) avec le score le plus élevé pour le malaise psychologique 0,8930, (SEM : 0,0738), et le handicap psychologique soit 0,7942, (SEM : 0,0752), alors que ceux qui étaient préoccupés par l'apparence de leurs dents avaient les notes les plus élevées soit 0,61 (SEM : 0,05). La sévérité de l'impact psychologique était corrélée au motif de consultation (P = 0,00). Aucune association n'avait trouvée concernant l'impact et le sexe (P = 0,64), l'impact et le groupe d'âges (P = 0,32), et l'impact et la profession (P = 0,29). Des associations similaires ont été constatées concernant l'impact psychologique.Conclusion : L'impact général était faible, mais surtout en raison des effets psychologiques sur les malades avec une faible QdV et ressenti par ceux qui cherchaient un traitement et ceux qui avaient les fluoroses dentaires les plus sévères

Heterocontrole da fluoretação da água de abastecimento público em cidades do estado de Goiás, Brasil / External control of fluoridation in public water supply systems in the state of Goiás, Brazil

Resumo A adição do flúor na água é um método empregado na redução de cárie dentária. O controle da fluoretação é importante para manter a sua eficiência e, ao mesmo tempo, evitar o risco de ocorrência de fluorose, fruto do consumo de água com flúor em excesso. O objetivo deste trabalho foi avaliar a adequação dos níveis do fluoreto na água distribuída à população do estado de Goiás, Brasil. Foram analisadas 5.039 amostras de água coletadas em 225 municípios de Goiás, entre 2011 e 2013. Os resultados foram analisados por sazonalidade, tipo de manancial e localização geográfica. Ocorreu uma variação entre ausência e 2,5 mg F/L, com 28,2% das amostras entre 0,6 e 0,8 mg F/L e 39,1% entre 0,55 e 0,84 mg F/L. No período de chuva ocorreu um maior número de resultados atípicos e maiores valores quando comparados ao período da seca. Verificou-se que os sistemas abastecidos por água proveniente de mananciais subterrâneos possuem um menor controle de fluoreto quando comparados a sistemas provenientes de mananciais superficiais. Observou-se menores concentrações nas amostras coletadas no Norte e Leste goianos, com menos de 7,5% entre 0,6 e 0,8 mg F/L, para aquelas coletadas de sistemas de abastecimento que utilizam água de manancial subterrâneo com adição de fluoreto, existindo dificuldades na manutenção dos seus teores.

Abstract The addition of fluoride to the public water supply is a method used for reducing tooth decay. In this sense, the control of fluoridation is important for maintaining its efficiency and, at the same time, for avoiding the risk of fluorosis as a result of the consumption of water with excess of fluoride. The objective of this study was to evaluate the adequacy of fluoride levels in the water distributed to populations of the state of Goiás, Brazil. Towards this aim, 5,039 water samples collected between 2011 and 2013 in 225 municipalities of the state of Goiás were analyzed for fluoride level. The results were assessed with regard to season, type of water source and geographic location. Fluoride levels were found to vary between complete absence and 2.5 mg F/L, with 28.2% of the samples being between 0.6 and 0.8 mg F/L, and 39.1% between 0.55 and 0.84 mg F/L. The rainy season produced a greater number of atypical results and higher values than the dry period. The systems supplied by groundwater sources were shown to have a limited control of fluoride concentration compared to systems supplied by surface water sources. Lower concentrations of fluoride were found in samples collected in the North and East Mesoregions of Goiás, with less than 7.5% being between 0.6 and 0.8 mg F/L, which systems are mainly supplied by groundwater sources with fluoride addition .

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.

Bioethical considerations about water fluoridation: a critical review / Consideraciones bioéticas de la fluoración del agua: una revisión crítica

Dental caries is one of the oral pathologies with greater burden of disease in the Chilean population. Fluoridation of drinking water has been used as a caries prevention strategy. However, its application as a public policy has been questioned since its implementation. The aim of this article is to analyze whether fluoridation of drinking water is a justified measure in reducing the incidence and prevalence of caries from the perspective of bioethics, taking into account the current evidence on its effectiveness. The arguments reviewed are based on the belief that water fluoridation is effective and, in general terms, ethically acceptable. A recent systematic review concludes that there is not enough evidence to support fluoridation as a public policy. There is a gap of knowledge that ought to be closed so that public health authorities can assess the significance of the intervention and make a democratic decision on its continuation or suspension based on scientific evidence. This decision should be informed and disseminated within the community.

La caries dental constituye una de las patologías orales con mayor carga de enfermedad en población chilena. Una estrategia empleada para prevención de caries ha sido la fluoración del agua potable, cuya aplicación como política pública ha sido cuestionada desde su implementación. El objetivo de este trabajo es analizar si la fluoración del agua potable resulta una medida justificada para reducir la incidencia y prevalencia de caries desde la perspectiva de la bioética, teniendo en cuenta la evidencia actual sobre su efectividad. Los argumentos revisados se basan en la convicción de la efectividad de la fluoración del agua, considerando la intervención en términos generales como éticamente aceptable. A la luz de la revisión sistemática publicada recientemente, no existiría evidencia suficiente que avale esta política pública. Actualmente existe una brecha de conocimiento que debiese ser cerrada con la finalidad de que las autoridades de salud pública puedan evaluar la trascendencia de la intervención y tomar una decisión democrática acerca de la continuidad o suspensión de la estrategia preventiva con base científica, informada y socializada con la comunidad.

Dental fluorosis and its influence on children’s life

This study verified the prevalence of dental fluorosis in 12-year-old children and its association with different fluoride levels in the public water supply, and evaluated the level of perception of dental fluorosis by the studied children. To assess fluorosis prevalence, clinical examinations were performed and a structured instrument was used to evaluate the self-perception of fluorosis. The water supply source in the children’s area of residence since birth was used as the study criterion. In total, 496 children were included in the study. Fluorosis was diagnosed in 292 (58.9%) children; from these, 220 (44.4%) children were diagnosed with very mild fluorosis, 59 (11.9%) with mild fluorosis, 12 (2.4%) with moderate fluorosis, and 1 (0.2%) child with severe fluorosis. A significant association (p = 0.0004) was observed between the presence of fluorosis and areas with excessive fluoride in the water supply. Among the 292 children that showed fluorosis, 40% perceived the presence of spots in their teeth. The prevalence of fluorosis was slightly high, and the mildest levels were the most frequently observed. Although most of the children showed fluorosis to various degrees, the majority did not perceive these spots, suggesting that this alteration did not affect their quality of life.

Co-relation of body mass index, dental caries and periodontal status with fluorosis in different high fluoridated areas of Haryana state, India.

Background and Aim: The aim of the present study is to compare the effect of corticotomy versus prostaglandin E1 injection in human subjects on rate of tooth movement, anchorage loss and their effect on crest bone height and root length. Settings and Design: Clinical interventional study. Split mouth design was used. Materials and Methods: Study was done on 32 regular orthodontic patients. A volume of 100 mcg of prostaglandin E1 was injected on the right side once in 2 weeks and on the left side corticotomy was performed, and canine retraction was started on both sides simultaneously. The rate of space closure and anchorage loss was assessed with casts. The root length and crestal bone height changes were assed with IOPAs. The comparison of rate of tooth movement, anchorage loss, crestal bone height and root length changes between the sides were statistically analyzed using paired t-test. Results: The average rate of space closure on right side was 0.36 mm/week with a standard deviation of 0.05 mm/week and on the left side average rate of space closure was 0.40 mm/week with a standard deviation of 0.04 mm/week. The difference between the rate of closure between the right side and left where found to be statistically significant (P = 0.003). The anchorage loss, the crestal bone height changes and root length changes were not statistically significant. Conclusion: The rate of tooth movement was significantly more with corticotomies when compared with given dose of prostaglandin injection.

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. .

Evidence-based recommendation on toothpaste use

Toothpaste can be used as a vehicle for substances to improve the oral health of individuals and populations. Therefore, it should be recommended based on the best scientific evidence available, and not on the opinion of authorities or specialists. Fluoride is the most important therapeutic substance used in toothpastes, adding to the effect of mechanical toothbrushing on dental caries control. The use of fluoride toothpaste to reduce caries in children and adults is strongly based on evidence, and is dependent on the concentration (minimum of 1000 ppm F) and frequency of fluoride toothpaste use (2'/day or higher). The risk of dental fluorosis due to toothpaste ingestion by children has been overestimated, since there is no evidence that: 1) fluoride toothpaste use should be postponed until the age of 3-4 or older, 2) low-fluoride toothpaste avoids fluorosis and 3) fluorosis has a detrimental effect on the quality of life of individuals exposed to fluoridated water and toothpaste. Among other therapeutic substances used in toothpastes, there is evidence that triclosan/copolymer reduce dental biofilm, gingivitis, periodontitis, calculus and halitosis, and that toothpastes containing stannous fluoride reduce biofilm and gingivitis.

Estimation of Toothpaste Fluoride Intake in Preschool Children

The objective of this study was to estimate the intake of toothpaste fluoride used by children aged 2 to 6 years (n=87) treated at a hospital of a medium-sized city (Campina Grande, PB) in the Northeastern region of Brazil. Data regarding sociodemographic characteristics of families and children's toothbrushing were collected from questionnaire-based interviews with parents/guardians, and the amount of fluoride used during toothbrushing was estimated using a precision scale for assessment of the risk of dental fluorosis, considering a cutoff value of 0.07 mgF/kg body weight/day. Fluoride content in the toothpastes was analyzed using a specific fluoride electrode. Data were analyzed using descriptive and inferential statistics using the chi-square and Fisher's exact tests (α=0.05). Considering the use of the derice, the risk of fluorosis in the children was 19.5%. There was significant association (p<0.05) between the risk of fluorosis, brushing frequency, type of derice and who performed the child's oral hygiene. It was concluded that a high percentage of children in the studied sample used toothpaste inappropriately and were at risk of developing dental fluorosis.

Resumo O objetivo do presente trabalho foi estimar a ingestão de flúor de derícios utilizados por crianças de 2 a 6 anos de idade (n=87) atendidas em um hospital de médio porte (Campina Grande, PB) na região nordeste do Brasil. Os dados envolveram características sócio-demográficas e escovação dentária das crianças através de uma entrevista com formulário específico, aplicado aos pais/responsáveis, e a quantidade de flúor utilizada na escovação da criança, por meio de balança de precisão, para avaliação do risco de fluorose dentária, considerando o ponto de corte 0,07 mgF/kg peso corporal/dia. O conteúdo de flúor nos cremes dentais foi analisado utilizando eletrodo específico. Os dados foram trabalhados sob a forma de estatística descritiva e inferencial usando o testes do Qui-quadrado de Pearson e Exato de Fisher (α= 0,05). Levando-se em consideração o uso do derício, o risco de fluorose das crianças pesquisadas foi 19,5%. Houve associação significativa entre o risco de fluorose, a frequência de escovação, o tipo de derício e quem realiza a higiene bucal da criança (p<0,05). Concluiu-se que elevada parcela das crianças usavam o derício de forma inadequada e apresentaram risco de fluorose. .

Water fluoridation in 40 Brazilian cities: 7 year analysis

Objectives: Fluoride levels in the public water supplies of 40 Brazilian cities were analyzed and classified on the basis of risk/benefit balance. Material and Methods: Samples were collected monthly over a seven-year period from three sites for each water supply source. The samples were analyzed in duplicate in the laboratory of the Center for Research in Public Health - UNESP using an ion analyzer coupled to a fluoride-specific electrode. Results: A total of 19,533 samples were analyzed, of which 18,847 were artificially fluoridated and 686 were not artificially fluoridated. In samples from cities performing water fluoridation, 51.57% (n=9,720) had fluoride levels in the range of 0.55 to 0.84 mg F/L; 30.53% (n=5,754) were below 0.55 mg F/L and 17.90% (n=3,373) were above 0.84 mg F/L (maximum concentration=6.96 mg F/L). Most of the cities performing fluoridation that had a majority of samples with fluoride levels above the recommended parameter had deep wells and more than one source of water supply. There was some variability in the fluoride levels of samples from the same site and between collection sites in the same city. Conclusions: The majority of samples from cities performing fluoridation had fluoride levels within the range that provides the best combination of risks and benefits, minimizing the risk of dental fluorosis while preventing dental caries. The conduction of studies about water distribution systems is suggested in cities with high natural fluoride concentrations in order to optimize the use of natural fluoride for fluoridation costs and avoid the risk of dental fluorosis.

Seven years of external control of fluoride levels in the public water supply in Bauru, São Paulo, Brazil

Fluoridation of the public water supplies is recognized as among the top ten public health achievements of the twentieth century. However, the positive aspects of this measure depend on the maintenance of fluoride concentrations within adequate levels. Objective: To report the results of seven years of external control of the fluoride (F) concentrations in the public water supply in Bauru, SP, Brazil in an attempt to verify, on the basis of risk/benefit balance, whether the levels are appropriate. Material and Methods: From March 2004 to February 2011, 60 samples were collected every month from the 19 supply sectors of the city, totaling 4,641 samples. F concentrations in water samples were determined in duplicate, using an ion-specific electrode (Orion 9609) coupled to a potentiometer after buffering with TISAB II. After the analysis, the samples were classified according to the best risk-benefit adjustment. Results: Means (±standard deviation) of F concentrations ranged between 0.73±0.06 and 0.81±0.10 mg/L for the different sectors during the seven years. The individual values ranged between 0.03 and 2.63 mg/L. The percentages of the samples considered “low risk” for dental fluorosis development and of “maximum benefit” for dental caries prevention (0.55-0.84 mg F/L) in the first, second, third, fourth, fifth, sixth, and seventh years of the study were 82.0, 58.5, 37.4, 61.0, 89.9, 77.3, and 72.4%, respectively, and 69.0% for the entire period. Conclusions: Fluctuations of F levels were found in the public water supply in Bauru during the seven years of evaluation. These results suggest that external monitoring of water fluoridation by an independent assessor should be implemented in cities where there is adjusted fluoridation. This measure should be continued in order to verify that fluoride levels are suitable and, if not, to provide support for the appropriate adjustments.

Análise proteômica da matriz do esmalte nos estágios de secreção e maturação em camundongos susceptíveis ou resistentes à fluorose dentária, expostos cronicamente ao fluoreto através da água de beber / Proteomic analysis of secretory and maturation-stage enamel matrix in mice susceptible or resistant to dental fluorosis, chronically exposed to fluoride in the drinking water

Análise proteômica da matriz do esmalte nos estágios de secreção e maturação em camundongos susceptíveis ou resistentes à fluorose dentária, expostos cronicamente ao fluoreto através da água de beber. Os mecanismos pelos quais a ingestão excessiva de fluoreto (F) durante a amelogênese levam à fluorose dentária ainda não são precisamente conhecidos. Tem sido demonstrado que determinadas linhagens de camundongos são mais susceptíveis que outras à fluorose dentária, o que faz destas linhagens o modelo ideal para se estudarem os fenômenos moleculares envolvidos nesta patologia. No presente estudo, foi empregada uma abordagem proteômica para avaliar alterações na expressão de proteínas da matriz do esmalte dentário nos estágios de secreção e maturação, em duas linhagens de camundongos com diferentes susceptibilidades à fluorose (A/J, susceptível e 129P3/J, resistente). Camundongos de ambos os gêneros, representantes das linhagens 129P3/J (n=200) e A/J (n=200) foram distribuídos em dois grupos para cada linhagem, que receberam ração com baixa concentração de F e água de beber contendo 0 (controle) ou 50 mg/L F por 6 semanas. A concentração de F foi analisada no plasma e no esmalte dos incisivos. Para a análise proteômica, foi realizada a raspagem da matriz do esmalte dos incisivos, nos estágios de secreção e maturação. Para a extração das proteínas do esmalte, foram pesados 15 mg de pó da matriz do esmalte, aos quais foi adicionado 1 mL de tampão de lise contendo uréia 7 M, tiouréia 2 M, CHAPS 4 %, DTT 1 %, anfólitos carreadores 0,5 % pH 3-10 e um coquetel de inibidores de proteases. As proteínas do esmalte extraídas para cada grupo foram separadas pela técnica de eletroforese bidimensional e posteriormente submetidas a LC-ESI-MS/MS. A concentração média (±DP) de F encontrada no plasma dos camundongos foi de 0,023±0,010 e 0,019±0,007 mg/L para os animais do grupo controle, das linhagens A/J e 129P3/J, respectivamente, e de 0,151±0,043 e de 0,252±0,060 mg/L...

he mechanisms by which excessive ingestion of fluoride (F) during amelogenesis leads to fluorosis are still not precisely known. It has been shown that certain strains of mice are more susceptible to dental fluorosis than others, which turns these strains the ideal model for studying the molecular phenomena involved in this pathology. In the present study, we employed a proteomic approach to identify and evaluate changes in protein expression of secretory and maturation-stage enamel matrix in two strains of mice with different susceptibilities to dental fluorosis (A/J, susceptible and 129P3/J, resistant). Mice of both genders, from 129P3/J (n=200) and A/J (n=200) strains were divided into two groups for each strain. They received a low-F diet and drinking water containing 0 (control) or 50 mg/L F for 6 weeks. The F concentration was analyzed in plasma and enamel incisors. For proteomic analysis, the enamel matrix of secretory and maturation stages (incisors) was scrapped. For the extraction of enamel proteins, 1 ml of lysis buffer containing 7 M urea, 2 M thiourea, 4% CHAPS, 1% DTT, 0.5% ampholytes carriers pH 3-10 and a cocktail of protease inhibitors was added to 15 mg of enamel matrix powder. The enamel proteins extracted for each group were separated by two-dimensional electrophoresis and subsequently subjected to LC-ESIMS/ MS. The mean (± SD) F concentrations found in plasma were 0.023 ± 0.010 and 0.019 ±0.007 mg/L for the control group, A/J and 129P3/J strains, respectively; and 0.151 ± 0.043 and 0.252 ± 0.060 mg/L F for A/J and 129P3/J mice, respectively, treated with water containing 50 mg/L F. Two-way ANOVA revealed significant differences between treatments (F = 658.0, p <0.0001), but not between strains (F = 3.3 p = 0.075), with was significant interaction between these criteria (F = 16.50, p = 0.0002). The mean (± SD) F concentrations in the enamel of the incisors were 471.4 ± 215.8 mg/kg and 151.7 ± 58.8 mg/kg for the control group of 129P3...