Patrón de distribución de severidad de fluorosis: ¿qué nos dice sobre exposición local a fluoruros? / Padrão de distribuição de severidade da fluorose: Que nos diz sobre exposição local ao fluoretos? / Distribution pattern of enamel fluorosis severity: What is it telling us about local fluoride exposure?

Resumen Introducción y objetivo: la severidad de la fluorosis dental refleja exposición a fluoruros durante el desarrollo del esmalte. Recientemente se han reportado asociaciones entre la exposición prenatal y postnatal a fluoruros y efectos negativos en el neurodesarrollo. El objetivo de este estudio fue describir y comparar la severidad y el patrón de distribución de la fluorosis en las denticiones primaria y permanente, como base para discutir la temporalidad de la exposición en niños viviendo en áreas endémicas en el departamento del Huila. Materiales y métodos: odontólogos entrenados diagnosticaron fluorosis en 840 niños (preescolares y escolares) de cuatro municipios usando el índice de Thylstrup & Fejerskov. Para estimar la prevalencia de las diferentes severidades, cada niño se clasifico de acuerdo con la severidad más alta en boca. La distribución de la prevalencia de severidades por grupo etario y tipo de dentición se reportan como tasas de prevalencia (%). Resultados: la prevalencia en preescolares y escolares fue de 97.2% y 99.9%, respectivamente y la fluorosis moderada la más prevalente (75.6% y 63.5%, respectivamente). En ambas denticiones, la fluorosis leve fue más prevalente en los dientes anteriores que en posteriores. Las severidades moderada y severa tuvieron mayor prevalencia en dientes posteriores que en anteriores. Conclusiones: el patrón de distribución de la severidad de la fluorosis sugiere exposición prenatal y postnatal a fluoruros, por encima de los niveles recomendados. Este estudio resalta la importancia de la alidación de la fluorosis del dental como un potencial biomarcador histórico de exposición a luoruros en momentos críticos para el neurodesarrollo.

Resumo Introdução e objetivo: a severidade da fluorose dentária reflete a exposição a fluoretos durante o desenvolvimento do esmalte. Recentemente, associações entre a exposição pré-natal e pós-natal ao fluoretos e efeitos negativos no desenvolvimento neurológico foram relatadas. O objetivo deste estudo é descrever e comparar o padrão de severidade e distribuição da fluorose na dentição decídua e permanente, como intuito para a discussão sobre a temporalidade da exposição em crianças moradoras em áreas endêmicas de fluorose no departamento de Huila, Colômbia. Materiais e métodos: Cirurgiões-dentistas treinados diagnosticaram fluorose em 840 crianças (pré-escolares e escolares) de quatro municípios, utilizando o índice de Thylstrup & Fejerskov. Para estimar a prevalência dos diferentes estágios de severidade, cada criança foi classificada de acordo com o escore mais severo da boca. A distribuição da prevalência de fluorose nos diferentes estágios de severidade por faixa etária e tipo de dentição é apresentada como taxa de prevalência (%). Resultados: a prevalência de fluorose em pré-escolares foi de 97,2% e em escolares de 99,9%. Fluorose moderada foi a mais prevalente (75,6% e 63,5%, respectivamente). Em ambas as dentições, a fluorose leve foi mais prevalente nos dentes anteriores do que nos posteriores. Porém, tanto fluorose moderada como severa foram mais prevalentes nos dentes posteriores do que nos anteriores. Conclusões: o padrão de distribuição da severidade da fluorose sugere uma exposição pré- e pós-natal a fluoretos acima de níveis recomendados. Este estudo salienta a importância da validação da fluorose dentária como um potencial biomarcador histórico da exposição ao fluoretos durante momentos críticos para o neurodesenvolvimento.

Abstract Introduction and objective: dental fluorosis severity reflects fluoride exposure during dental enamel development. Recently, prenatal and postnatal exposure to fluoride has been associated with negative neurodevelopmental outcomes. The aim of this study was to describe and compare the severity and distribution pattern of dental fluorosis in the primary and permanent dentition, as a basis to discuss the timing and extent of fluoride exposure of children living in endemic areas of fluorosis in the department of Huila. Materials and methods: 840 children (preschoolers and schoolchildren) from four municipalities of the Huila Department were examined by trained dentists for dental fluorosis using the Thylstrup & Fejerskov Index. To estimate the prevalence of severities of fluorosis, each child was classified according to the most severe score. The distribution of the prevalence of enamel fluorosis severity by age-group and type of dentition were reported as prevalence rates (%). Results: Prevalence of dental fluorosis in preschoolers was of 97.2% and in schoolers of 99.9%. For both preschoolers and schoolers moderate fluorosis was the most prevalent (75.6% and 63.5%, respectively). For both primary and permanent teeth, mild fluorosis was more prevalent in anterior teeth than in posterior teeth. Moderate and severe fluorosis were more prevalent in posterior teeth than in anterior teeth. Conclusions: the distribution pattern of the severity of dental fluorosis suggests both prenatal and postnatal exposure to fluoride above recommended levels. This study raises the importance of the validation of dental fluorosis as a potential historical biomarker of fluoride exposure at moments that are critical for neurodevelopment.

Association of Dietary Fluoride Intake and Diet Variables with Dental Caries in Adolescents from the ELEMENT Cohort Study.

To examine the association of dietary fluoride intake, total carbohydrate consumption and other key dietary variables with dental caries experience among adolescents, a cross-sectional analysis was conducted in a sample of 402 participants from the Early Life Exposures in Mexico to Environmental Toxicants cohort. The presence and severity of dental caries were assessed using the International Caries Detection and Assessment System (ICDAS) to calculate the number of decayed, missing, and filled teeth or surfaces (D1MFT/D4MFT). The dietary intake of fluoride, energy, carbohydrates, and food groups was estimated using a validated food frequency questionnaire (FFQ). Multivariate zero-inflated negative binomial regression models and negative binomial regression models were run to estimate the association of fluoride intake (mg/day) and total carbohydrate intake (g/day) with the D1MFT/D4MFT index. We found that 80% of the adolescents experienced dental caries (D1MFT >0), with 30% presenting cavitated lesions (D4MFT >0). The mean scores for D1MFT and D4MFT were 6.2 (SD 5.3) and 0.67 (SD 1.3), respectively. The median intake of fluoride estimated by the FFQ was 0.015 mg/kg/day. This intake was statistically higher in participants with a D4MFT = 0 compared to those with a D4MFT >0 (0.90 vs. 0.82 mg/day; 0.016 vs. 0.014 mg/kg/day; p < 0.05). For D1MFT, D1MFS, D4MFT, and D4MFS scores, a higher fluoride consumption (mg/day) from foods and beverages was associated with a statistically significant reduction in the number of lesions. The reported frequency of consumption of sugary foods in a whole day was statistically higher in those with D1MFT >0 than in those with D1MFT = 0 (p < 0.05). The total carbohydrate intake (g/day) was positively associated with dental caries experience. We conclude that a higher fluoride intake through foods and beverages is associated with a lower dental caries experience among adolescents; this effect was seen even when the dietary intake of fluoride was 0.015 mg/kg/day, which is lower than the average intake recommendation. In contrast, a higher total carbohydrate intake and the frequency of intake of sugary foods were associated with a higher dental caries experience, with no apparent threshold for the effects.

Identification of proteins from human permanent erupted enamel.

Proteins from the extracellular matrix of enamel are highly specific and necessary for proper enamel formation. Most proteins are removed from the matrix by enamel proteases before complete mineralization is achieved; however, some residual protein fragments persist in the mineralized matrix of erupted enamel. So far, only amelogenin peptides obtained by traditional bottom-up proteomics have been recovered and identified in human permanent erupted enamel. In this study, we hypothesize that other enamel-specific proteins are also found in human permanent enamel, by analysing human erupted third molars. Pulverized enamel was used to extract proteins, and the protein extract was subjected directly to liquid-chromatography coupled to tandem mass spectrometry (LC-MS/MS) without a previous trypsin-digestion step. Amelogenin and non-amelogenin proteins (ameloblastin and enamelin) were succesfully identified. The sequences of the naturally occurring peptides of these proteins are reported, finding in particular that most of the peptides from the amelogenin X-isoform come from the tyrosine-rich amelogenin peptide (TRAP) and that some were identified in all specimens. In conclusion, our LC-MS/MS method without trypsin digestion increased the coverage of identification of the enamel proteome from a few amelogenin peptides to a higher number of peptides from three enamel-specific proteins.

Schoolchildren's tooth brushing characteristics and oral hygiene habits assessed with video-recorded sessions at school and a questionnaire.

Tooth brushing habits become established during the first years of childhood and last throughout lifetime. To assess tooth-brushing characteristics, the procedure was videotaped at school and a questionnaire on oral hygiene knowledge, attitudes and practices was completed. A total 146 5- to 8-year-old low-SES schoolchildren from Bogotá participated. The median total tooth brushing time was 115 sec (75% Q3-178 sec; 25% Q1-83 sec). The median time the toothbrush was in the child's mouth was 89 sec (75% Q3-145 sec; 25% Q1-65 sec). Most children brushed their maxillary (97%), mandibular (95%), anterior (96%) and posterior (81%) teeth. The surfaces most often brushed were the buccal-anterior-maxillary (96%) and mandibular (94%) surfaces. The amount of toothpaste dispensed was 2/3 of toothbrush head in 51% of children. Most children spat (93%), used the mirror (78%), and rinsed their mouth (72%). The majority (97%) was confident that the toothbrushing session was effective. The questionnaire revealed the following: none of the children brush their teeth at school; only 34% is supervised by an adult during the tooth brushing procedure, and only 30% brush twice a day. The study shows overall positive findings of tooth brushing while being observed, in terms of time and use of toothpaste. These results, together with the poor oral-health status and toothbrushing habits reported at home, highly recommend incorporating daily-supervised school-based tooth brushing sessions with fluoride toothpaste.

Schoolchildren´s tooth brushing characteristics and oral hygiene habits assessed with video-recorded sessions at school and a questionnaire

Los hábitos de cepillado dental se establecen durante los primeros años de la infancia y duran para toda la vida. Para valorar las características del cepillado dental, se hicieron video-grabaciones del procedimiento en el colegio y se completó un cuestionario sobre conocimientos, actitudes yprácticas de la higiene oral. En total participaron 146 escolares entre los 5 y 8 años de edad, de estrato socio-económico bajo de Bogotá. Se encontró una mediana de tiempo total de cepillado de 115 segundos (75 por ciento Q3-178seg; 25 por ciento Q1-83seg) y, una mediana de tiempo de permanencia del cepillo dental en boca de 89 segundos (75 por ciento Q3-145sec; 25 por ciento Q1-65sec). Lamayoría de los niños cepilló sus dientes maxilares (97 por ciento), mandibulares (95%), anteriores (96%) y, posteriores (81%). Las superficies que cepillaron con mayor frecuencia fueron lasvestíbulo-anteriores superiores (96 por ciento) e inferiores (94 por ciento). Lacantidad de crema dental dispensada fue de 2/3 de la cabeza del cepillo en el 51 por ciento de los niños. La mayoría escupió (93 por ciento), usó el espejo (78 por ciento) y, enjuagó su boca (72 por ciento). Casi todos los niños (97 por ciento) sintieron confianza de que su sesión de cepillado fue efectiva. El cuestionario reveló que ningún niño cepilla sus dientes en el colegio; tan solo un 34 por ciento es supervisado por unadulto y, solo el 30 por ciento se cepillan dos veces al día. El estudiomuestra en general hallazgos positivos del cepillado dental cuando los niños están siendo observados, en términos de tiempo y uso de crema dental. Estos resultados, unidos al reporte de salud oral e higiene oral deficientes en casa, recomiendan de manera importante, incorporar sesiones diarias de cepi -llado dental supervisado en el colegio usando crema dental fluorada.

Schoolchildren´s tooth brushing characteristics and oral hygiene habits assessed with video-recorded sessions at school and a questionnaire

Los hábitos de cepillado dental se establecen durante los primeros años de la infancia y duran para toda la vida. Para valorar las características del cepillado dental, se hicieron video-grabaciones del procedimiento en el colegio y se completó un cuestionario sobre conocimientos, actitudes yprácticas de la higiene oral. En total participaron 146 escolares entre los 5 y 8 años de edad, de estrato socio-económico bajo de Bogotá. Se encontró una mediana de tiempo total de cepillado de 115 segundos (75 por ciento Q3-178seg; 25 por ciento Q1-83seg) y, una mediana de tiempo de permanencia del cepillo dental en boca de 89 segundos (75 por ciento Q3-145sec; 25 por ciento Q1-65sec). Lamayoría de los niños cepilló sus dientes maxilares (97 por ciento), mandibulares (95%), anteriores (96%) y, posteriores (81%). Las superficies que cepillaron con mayor frecuencia fueron lasvestíbulo-anteriores superiores (96 por ciento) e inferiores (94 por ciento). Lacantidad de crema dental dispensada fue de 2/3 de la cabeza del cepillo en el 51 por ciento de los niños. La mayoría escupió (93 por ciento), usó el espejo (78 por ciento) y, enjuagó su boca (72 por ciento). Casi todos los niños (97 por ciento) sintieron confianza de que su sesión de cepillado fue efectiva. El cuestionario reveló que ningún niño cepilla sus dientes en el colegio; tan solo un 34 por ciento es supervisado por unadulto y, solo el 30 por ciento se cepillan dos veces al día. El estudiomuestra en general hallazgos positivos del cepillado dental cuando los niños están siendo observados, en términos de tiempo y uso de crema dental. Estos resultados, unidos al reporte de salud oral e higiene oral deficientes en casa, recomiendan de manera importante, incorporar sesiones diarias de cepi -llado dental supervisado en el colegio usando crema dental fluorada.(AU)