Potential risk of dental fluorosis associated with different baby formulas and water brands marketed in Spain.

Despite efforts to promote breastfeeding, many babies aged <6 months receive only baby formula reconstituted with bottled water. The intake of high levels of fluoride during amelogenesis has been associated with hypomineralization of the tooth enamel, with aesthetic and mechanical repercussions. The objective of this study was to determine the potential risk of dental fluorosis associated with baby formulas marketed in Spain. We measured 26 baby formulas frequently consumed in Spain; 17 brands for babies aged <6 months, 5 for those aged >6 months, and 4 ready-to-use brands. They were prepared with 4 types of water: distilled water and three brands of bottled water with different levels of fluoride. The fluoride concentration (mg/L or ppm F) was measured with an ion-specific electrode coupled to an ion analyzer. Each sample was prepared according to the manufacturer's instructions and analyzed in triplicate. A descriptive analysis was carried out. The minimum fluoride level found was 0.04 mg/L and the maximum was 1.02 mg/L. Considering the daily intake of these formulas, none exceeded the clinically-acceptable daily dose limit risk for fluorosis (0.07 mg F/day/kg body weight) when mixed with bottled water with a low level of fluoride (0.1 mg/L). However, when the same brands of formula were reconstituted with bottled water with a higher fluoride content (0.99 mg/L), they all exceeded the daily dose limit for the risk of fluorosis. As the potential risk of dental fluorosis associated with the formulas tested depends exclusively on the fluoride concentration of the waters used for reconstitution, formula packaging should contain a warning.

La concentración de fluoruro en las aguas consumidas en la Región de Murcia no es suficiente para prevenir la caries dental / Fluoride concentrations in water consumed in the Region of Murcia are not sufficient to prevent dental caries

INTRODUCCIÓN: La caries sigue siendo la enfermedad crónica más frecuente en el niño y es considerada un problema de salud pública. El flúor es la principal medida protectora contra la caries dental y el agua de consumo es la principal fuente de ingesta de flúor. Objetivo El objetivo de nuestro trabajo fue calcular la concentración de ión fluoruro en el agua de abastecimiento de 10 zonas y en 10 aguas embotelladas comercializadas en la Región de Murcia. MATERIAL Y MÉTODOS: La concentración de fluoruro en las aguas se determinó con un electrodo ion-selectivo para flúor previamente calibrado con patrones de fluoruro preparados con TISAB II. RESULTADOS: En el agua de abastecimiento, se detectaron concentraciones de fluoruro entre 0.09 y 0.18 mgF/L (ppm) en las aguas embotelladas la concentración de fluoruro varió desde 0.04 a 0.50 ppm. CONCLUSIONES: El fluoruro está presente en aguas consumidas en la Región de Murcia pero en concentraciones que no alcanzan niveles preventivos para la caries dental. Es necesario prescribir suplementos de flúor en niños con alto riesgo de caries y para ello se deben contabilizar todas las fuentes externas de flúor, incluido el agua

INTRODUCTION: Dental caries remains the most frequent chronic disease in childhood and is considered a public health problem. Fluoride has proven effectiveness in the prevention of caries and drinking water is the main source of fluoride intake. The objective of this study was to determine fluoride concentrations in tap water from 10 areas and in 10 bottled waters sold in the Region of Murcia. MATERIALS AND METHODS: The concentration of fluoride in water was determined using a fluoride ion-selective electrode with a direct technique previously calibrated with standard fluoride concentrations prepared with TISAB II. RESULTS: In tap water, fluoride concentrations from 0.09 to 0.18 mgF/L (ppm) were detected; in bottled waters the concentration of fluoride varied from 0.04 to 0.50 ppm. CONCLUSION: Fluoride is present in the water consumed in the Region of Murcia but in concentrations that do not prevent dental caries. Fluoride supplements should be prescribed in children at high risk of caries, and for this, all external sources of fluoride intake, including water, must be accounted for

Concentración de flúor y metales pesados en aguas embotelladas: medidas barrera frente a caries dental y fluorosis / Fluoride and heavy metals concentration in bottled waters: barrier measures against dental caries and fluorosis

FUNDAMENTOS: El consumo diario de agua fluorada es una de las medidas mas beneficiosas en la prevención de la caries dental. El objetivo de este estudio fue analizar el contenido de flúor y metales pesados en el agua mineral natural embotellada disponible en los comercios de España. MÉTODOS: Se realizó un estudio descriptivo y transversal a lo largo de 2019, analizando 20 marcas de aguas embotelladas comercializadas en España en ese año. Se midió principalmente la concentración de flúor (partes por millón/mililitro) (ppm/ml), que fue analizada con un electrodo ion-específico (modelo Orión 96-09, Orion Research, Cambridge) acoplado a un analizador de iones (Orion EA-940). Los metales pesados se analizaron mediante ICP-MS (Agilent modelo 7900). Se realizó un estudio estadístico descriptivo de los datos. RESULTADOS: El valor mínimo de flúor encontrado fue de 0,05 ppm y el máximo de 0,95 ppm. El 80% de las marcas analizadas contenían menos de 0,6 ppm F. Solamente una marca superó las 0,8 ppm F. Cromo y arsénico fueron los metales pesados presentes en todas las marcas, sin superar la dosis máxima. Ninguna marca de agua embotellada indicaba los metales pesados en la etiqueta, y solo una marca indicó la concentración de flúor en la etiqueta. CONCLUSIONES: Existe una gran variabilidad en la composición química de las aguas embotelladas comercializadas en España. La mayoría tienen una concentración de fluoruro inferior a la recomendada para prevenir la caries dental, por lo que se necesitaría un aporte extra de flúor. En las aguas embotelladas analizadas existen metales pesados, pero no superan las dosis máximas establecidas por la legislación

BACKGROUND: The daily consumption of fluoridated water is one of the most beneficial measures in dental caries prevention. The objective of this paper was to analyze the content of fluorine and heavy metals in the bottled natural mineral water available in stores in Spain. METHODS: A descriptive and transversal study was done throughout 2019. Analysing a total of 20 bottled waters marketed in Spain during this year. Mainly, fluoride concentration (ppm/ml) was analyzed with an ion-specific electrode (Orion model 96-09, Orion Research, Cambridge, MA) coupled to an ion analyzer (Orion EA-940). The heavy metals were analyzed by ICP-MS (Agilent model 7900). A descriptive statistical study of the data was carried out. RESULTS: The minimum value of fluorine found was 0.05 ppm and the maximum 0.95 ppm. 80% of the brands analyzed contain less than 0.6 ppm F. Only 1 brand exceeds 0.8 ppm F. Chromium and arsenic were the heavy metals present in all brands, without exceeding the maximum dose. No brand of bottled water indicated heavy metals on the label, and only 1 mark indicated the fluoride concentration on the label. CONCLUSIONS: There is a great variability in the chemical composition of bottled waters marketed in Spain. Most have a fluoride concentration lower than that recommended to prevent tooth decay, which would require an extra supply of fluoride. In the bottled waters analyzed there are heavy metals but they did not exceed the maximum doses established by legislation