Skeletal fluorosis due to excessive tea and toothpaste consumption.

We describe the case of a 53-year-old woman who presented with a metatarsal fracture and was found to have a bone mineral density (BMD) T-score of +11 in the lumbar spine and +7.6 in the hip. Subsequent investigation revealed very high serum, urine and tissue fluoride levels, associated with excessive tea and toothpaste consumption. The case emphasises the need to exclude fluorosis in individuals with unexpectedly high BMD levels.

Plaque fluoride concentrations in a community without water fluoridation: effects of calcium and use of a fluoride or placebo dentifrice.

The results of a recent study by Whitford et al. [Caries Res 2002;36:256-265] with subjects whose drinking water was fluoridated led to two major conclusions: (1) Compared to the use of a placebo dentifrice, plaque fluoride concentrations ([F]) throughout much of the day are not significantly increased by the use of an F dentifrice but (2) they are positively related to plaque [Ca] (p = 0.0001). The present double-blind, double-crossover study with 16 subjects used the same protocol and was done to: (1) determine the effects of the use of an F dentifrice on salivary and plaque [F] in a community without water fluoridation and (2) further examine the relationship between plaque [Ca] and [F]. Following the use of an F dentifrice or placebo for one week, whole saliva and plaque were collected 1.0 and 12 h after the last use of the products. The study was repeated to include rinsing with a 20 mmol/l CaCl(2) solution immediately before the use of the dentifrices. The CaCl(2) rinse had only minor effects on salivary [Ca] and [F] and none on the plaque concentrations. Unlike the results found in the fluoridated community, all salivary and plaque [F] associated with the use of the F dentifrice were significantly higher than those associated with the use of the placebo. The results suggest that the cariostatic effectiveness of an F dentifrice should be greater in areas without water fluoridation. As noted previously, plaque [F] were positively related to plaque [Ca] (p = 0.0001).

Effects of caffeine on fluoride, calcium and phosphorus metabolism and calcified tissues in the rat.

This 6-week study was designed to determine the effects of graded doses of caffeine intake (3, 25 or 100 mg/kg per day) on the metabolic balance and tissue concentrations of fluoride, calcium and phosphorus in Sprague-Dawley rats. Caffeine intake did not affect the absorption, urinary excretion or balance of fluoride, the plasma, bone or enamel concentrations of fluoride, nor the occurrence of incisor enamel fluorosis. Neither did it affect the metabolism of calcium or phosphorus except that the urinary excretion of calcium was increased. This effect, however, was not sufficient to influence significantly calcium balance. The ash content of the femur epiphysis and bone mineral content of the tibia were significantly reduced only in the group exposed to the highest dose of caffeine. These effects on bone were not significantly related to the balance of calcium or phosphorus. It was concluded that caffeine, even at an extremely high level of intake, has no detectable effect on the balance or tissue concentrations of fluoride, calcium or phosphorus in the rat.

Lack of significant effect of coffee and caffeine on fluoride metabolism in rats.

It has been reported that rat plasma fluoride (F) concentrations are higher by up to 100% when F is administered ig in coffee or a caffeine solution compared with when it is administered in water. It was hypothesized that the consumption of caffeinated beverages has contributed to the prevalence of dental fluorosis. The present studies were done to determine the physiological mechanisms for these effects. For approximately 2 h after F was administered in coffee, plasma F concentrations were higher than when administered in water, decaffeinated coffee, or a caffeine solution (3 mg/kg), but the intergroup differences were small and generally not statistically significant. The 4-hour plasma AUC values did not differ with statistical significance. There were no differences among the groups in the renal or extrarenal (skeletal) clearances of F, which suggested that the higher plasma F concentrations in the coffee groups may have been due to a slight and transient increase in absorption rate. The possibility that caffeine per se might elevate endogenous plasma F and calcium concentrations was excluded after caffeine (25 mg/kg) ig without F was given. In addition, the renal excretion, clearance, and fractional renal clearance of calcium did not differ among the groups. The results indicated that decaffeinated coffee and caffeine had no effect on F metabolism, whereas caffeinated coffee appeared to increase the initial absorption rate but not the 4-hour bio-availability.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of protein deficiency and fluoride on bone mineral content of rat tibia.

This study examined the effects of chronic protein deficiency and fluoride administration (10 mg/kg/day), separately or in combination, on rat tibia properties. Protein deficiency increased the bone fluoride concentration and reduced the bone mineral content (BMC) especially at the proximal or growing end which contains mainly cancellous bone. Fluoride administration also reduced BMC, but to a lesser extent, and it resulted in proximal tibia fluoride concentrations that were nearly twice those of the distal tibia. The interaction between fluoride administration and the protein content of the diet on BMC was nonsignificant, suggesting that the effects were additive, not multiplicative or synergistic. Fluoride administration, but not protein deficiency, increased bone magnesium levels. It is hypothesized that the reduction in BMC in the areas where the fluoride concentrations were the highest was due to a localized toxic effect of fluoride.

Fluoride, calcium and phosphorus metabolism in the rat: comparison of 'natural ingredient' with semipurified diets.

Three groups of weanling female rats were fed different, commercially available, 'natural ingredient' diets containing 12, 28 or 45 parts/10(6) F, mainly as bone meal, for six weeks. Two other groups were fed a low-fluoride (0.76 parts/10(6)) semipurified diet. They received fluoride doses, either in the drinking water or by daily intraperitoneal injection, which were approximately equal to the average dose of the other three groups. Rats on the 'natural ingredient' diets ingested more food and water and excreted more faeces and urine, effects which were attributed to the higher amounts of dietary fibre, Na, K and Cl. Thus, at any given concentration of fluoride in the food or water, the level of fluoride ingestion and the ensuing effects would be influenced by the type of diet used. The values for fractional fluoride absorption (45-49%) and retention (38-47%) were similar among the groups given 'natural ingredient' diets. In the groups given semipurified diet, the corresponding values were about twice as high with the exception that fractional absorption was negative (-41%) in the injected group, which indicated net intestinal secretion of fluoride. Fluoride balances and tissue concentrations were highest in the groups fed the semipurified diet, even though the level of intake was not always higher. The fractional values for calcium and phosphorus absorption (41-51%) and retention (33-43%) were also similar among the groups given 'natural ingredient' diets. The corresponding values were about twice as high in the groups fed the semipurified diet. In terms of supporting maximum bone calcification, phosphorus absorption was marginal in two of the groups on the 'natural ingredient' diets.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of coffee on fluoride metabolism in rats.

Concomitant intragastric administration of sodium fluoride and coffee resulted in a significantly higher (P less than 0.01) plasma fluoride level than intake of the same amount of fluoride with water. The same result was obtained when coffee was substituted with an equivalent amount of caffeine. Comparison of plasma fluoride levels by total area under the curve of plasma fluoride concentration versus time indicated an almost 2-fold difference. Although the mechanism(s) is not known, it appears that caffeine is responsible for the present observation. This finding could help explain the variations in the incidence of dental fluorosis among people living in optimally fluoridated communities.

Enamel and dentin fluoride levels and fluorosis following single fluoride doses: a nuclear microprobe study.

Female rats were given single intraperitoneal doses of fluoride (F) (0, 4, 7, or 14 mg F/kg body weight). Plasma F levels returned to predose values within 24 h. Incisors from animals killed 35 or 70 days after the F doses had been given were analyzed for mineralization defects by microradiography, and for F and P concentrations by nuclear microprobe. At 35 days, all F-injected rats had enamel fluorosis. At 70 days, by which time the incisors would have been renewed nearly twice, fluorosis was still evident in the 14 mg/kg body weight group. The enamel and dentin F concentrations at each time point were proportional to the administered F doses that had been given weeks earlier. The F concentrations at 35 days were similar to those found at 70 days. The results support the hypothesis that, following pulse loading, F can be mobilized from the bone adjacent to the enamel organ and result in local F concentrations sufficiently large to adversely affect amelogenesis.

Effects of acid-base status and fluoride on the composition of the mineral in developing enamel and dentine in the dog.

Developing molar teeth of the dog were sectioned, embedded in copper containing polymethyl methacrylate, polished and their Ca/P and Ca/Na molar ratios investigated with the electron microprobe. The teeth were obtained at 30 days from 9 pups fed regimes of different acid-base status with or without fluoride supplementation from birth to sacrifice at 30 days. No clear trends in their Ca/P or Ca/Na ratios with variation in the diet were observed. However, evaluation of the Ca/P ratio of the enamel as a function of depth revealed that this ratio was 0.80 +/- 0.15 at the mineralization front. This suggests that in enamel brushite rather than octacalcium phosphate is the precursor phase of the mineral.

Fluoride absorption: independence from plasma fluoride levels.

The concept that there are physiologic mechanisms to homeostatically regulate plasma fluoride concentrations has been supported by results in the literature suggesting an inverse relationship between plasma fluoride levels and the absorption of the ion from the gastrointestinal tract of the rat. The validity of the relationship was questioned because of possible problems in the experimental design. The present work used four different methods to evaluate the effect of plasma fluoride levels on the absorption of the ion in rats: (i) the percentage of the daily fluoride intake that was excreted in the urine; (ii) the concentration of fluoride in femur epiphyses; (iii) the net areas under the time-plasma fluoride concentration curves after intragastric fluoride doses; and (iv) the residual amounts of fluoride in the gastrointestinal tracts after the intragastric fluoride doses. None of these methods indicated that plasma fluoride levels influence the rate or the degree of fluoride absorption. It was concluded that, unless extremely high plasma fluoride levels are involved (pharmacologic or toxic doses), the absorption of the ion is independent of plasma levels. The results provide further evidence that plasma fluoride concentrations are not homeostatically regulated.