A Bayesian benchmark concentration analysis for urinary fluoride and intelligence in adults in Guizhou, China.

Environmental fluoride exposure has been linked to numerous cases of fluorosis worldwide. Previous studies have indicated that long-term exposure to fluoride can result in intellectual damage among children. However, a comprehensive health risk assessment of fluorosis-induced intellectual damage is still pending. In this research, we utilized the Bayesian Benchmark Dose Analysis System (BBMD) to investigate the dose-response relationship between urinary fluoride (U-F) concentration and Raven scores in adults from Nayong, Guizhou, China. Our research findings indecate a dose-response relationship between the concentration of U-F and intelligence scores in adults. As the benchmark response (BMR) increased, both the benchmark concentration (BMCs) and the lower bound of the credible interval (BMCLs) increased. Specifically, BMCs for the association between U-F and IQ score were determined to be 0.18 mg/L (BMCL1 = 0.08 mg/L), 0.91 mg/L (BMCL5 = 0.40 mg/L), 1.83 mg/L (BMCL10 = 0.83 mg/L) when using BMRs of 1 %, 5 %, and 10 %. These results indicate that U-F can serve as an effective biomarker for monitoring the loss of IQ in population. We propose three interim targets for public policy in preventing interllectual harm from fluoride exposure.

Analysis of indicators of caries of permanent teeth in children according to the endemic features of the Poltava region, Ukraine.

OBJECTIVE: Aim: This research is focused at analyzing the indicators and substantiating the peculiarities of caries prevention in permanent teeth in schoolchildren of Poltava region, taking into account the endemic features of the Poltava region. PATIENTS AND METHODS: Materials and Methods: A comparative study was conducted among 608 pupils of secondary schools in Kremenchuk, who consumed drinking water with fluoride concentrations in the lower limits of the norm, and 1214 pupils of secondary schools in Poltava, who consumed drinking water with fluoride concentrations in the optimal upper limits of the norm. RESULTS: Results: The rates of caries in permanent teeth in children living in a region with fluoride concentrations in drinking water in the optimal-upper normal range are several times lower than in children of the same age living in a region with fluoride concentrations in drinking water in the lower normal range, and a significant increase in the prevalence and intensity of caries is observed from 7 to 9 to 12 years of age, as teeth after eruption are most vulnerable to caries. In a region where the fluoride concentration in drinking water is in the optimal-upper range of the norm, children with early forms of fluorosis have the lowest prevalence and intensity of caries. CONCLUSION: Conclusions: Endemic features of the region directly affect the prevalence and intensity of the caries process. In regions with a fluoride concentration in drinking water within the optimal upper limits of the norm, prevention of caries in permanent teeth in children should be carried out taking into account the presence of fluorosis.

Caries prevalence and water fluoridation in Israel: a cross-sectional study.

OBJECTIVES: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5,000 individuals was fluoridated. In 2014, CWF in Israel stopped. METHOD AND MATERIALS: Data on 12-year-old children from all areas in Israel from the national cross-sectional epidemiological survey conducted in 2011 to 2012 were stratified by city water fluoridation and by city and school socioeconomic status. Two dependent variables were defined: (1) DMFT index of caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov classification of fluorosis. RESULTS: Data from 2,181 12-year-olds were analyzed. The average DMFT was 1.17 ± 1.72, and 49% were caries-free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs 0.98 in fluoridated cities) and there were more caries-free children in fluoridated cities (56.4% vs 40.6% in nonfluoridated). DMFT was higher in cities with lower socioeconomic status than high socioeconomic status (1.29 vs 1.05, respectively, P < .001) and there were fewer caries-free children in low socioeconomic status cities (44.5% vs 53.0% in high socioeconomic status cities, P < .0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in the Thylstrup-Fejerskov index), had questionable to mild fluorosis (9.3%). CONCLUSIONS: CWF is a cheap, simple method of dental health protection that reaches all socioeconomic levels, and cessation of water fluoridation reduced the health of Israel's children. CLINICAL SIGNIFICANCE: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities.

Systematic review of epidemiological and toxicological evidence on health effects of fluoride in drinking water.

INTRODUCTION: Fluoride is a naturally occurring substance that is also added to drinking water, dental hygiene products, and food supplements for preventing dental caries. Concerns have been raised about several other potential health risks of fluoride. OBJECTIVE: To conduct a robust synthesis of evidence regarding human health risks due to exposure to fluoride in drinking water, and to develop a point of departure (POD) for setting a health-based value (HBV) for fluoride in drinking water. METHODS: A systematic review of evidence published since recent reviews of human, animal, and in vitro data was carried out. Bradford Hill considerations were used to weigh the evidence for causality. Several key studies were considered for deriving PODs. RESULTS: The current review identified 89 human studies, 199 animal studies, and 10 major in vitro reviews. The weight of evidence on 39 health endpoints was presented. In addition to dental fluorosis, evidence was considered strong for reduction in IQ scores in children, moderate for thyroid dysfunction, weak for kidney dysfunction, and limited for sex hormone disruptions. CONCLUSION: The current review identified moderate dental fluorosis and reduction in IQ scores in children as the most relevant endpoints for establishing an HBV for fluoride in drinking water. PODs were derived for these two endpoints, although there is still some uncertainty in the causal weight of evidence for causality for reducing IQ scores in children and considerable uncertainty in the derivation of its POD. Given our evaluation of the overall weight of evidence, moderate dental fluorosis is suggested as the key endpoint until more evidence is accumulated on possible reduction of IQ scores effects. A POD of 1.56 mg fluoride/L for moderate dental fluorosis may be preferred as a starting point for setting an HBV for fluoride in drinking water to protect against moderate and severe dental fluorosis. Although outside the scope of the current review, precautionary concerns for potential neurodevelopmental cognitive effects may warrant special consideration in the derivation of the HBV for fluoride in drinking water.

Poor oral health and the risk of esophageal squamous cell carcinoma in Malawi.

Esophageal squamous cell carcinoma (ESCC) is the second most common cancer in Malawi. Risk factors for this cancer in Malawi are poorly understood. Poor oral health has previously been linked to increased ESCC risk in other high-incidence regions, including parts of Eastern and Southern Africa. We assessed the relationship between oral health and ESCC risk in a sex, age and location frequency-matched case-control study based at two hospitals in Lilongwe, Malawi from 2017 to 2020. Trained interviewers used a structured questionnaire and direct observation to collect data on demographics; behaviors; oral hygiene habits; the sum of decayed, missing or filled teeth (DMFT score); oral mucosa status; lip depigmentation and dental fluorosis via a visual scale. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI), adjusted for known and suspected ESCC risk factors. During the study period, 300 cases and 300 controls were enrolled. Subjects in the highest tertile of DMFT score (≥7) had an increased risk of ESCC with an adjusted OR of 1.96 (95% CI: 1.16-3.36) compared to those with a DMFT score of 0. Severe dental fluorosis was associated with a statistically nonsignificant increased risk of ESCC (adjusted OR = 2.24, 95% CI: 0.97-5.49) compared to individuals with no fluorosis. Associations with oral mucosa status, lip depigmentation and toothbrushing method and frequency were mostly null or uncertain. Poor oral health, indicated by a higher DMFT score, was associated with increased ESCC risk in Malawi. Dental fluorosis is another possible risk factor in this population, but further evaluation is necessary to clarify any effects of fluorosis on ESCC risk.

Effect of Long Non-coding RNA and DNA Methylation on Gene Expression in Dental Fluorosis.

In the process of tooth development, the interaction between genetic information, epigenetic inheritance, and environment jointly affects the teeth formation. At present, the mechanism of dental fluorosis is rarely studied from transcriptomics, and there is no report on epigenetic perspective. In the study, SD rats were randomly divided into dental fluorosis group and control group fed with NaF (150 mg/L) or distilled water for 8 weeks. After 3.5 days of birth, the RNAs or DNA of rat mandibular molars were detected by RNA-seq or MethylTarget, respectively. The results demonstrated that a total of 1723 differentially expressed genes (DEGs) and 2511 differential expression lncRNAs (DE-lncRNAs) were mainly involved in the ion channels, calcium ion transport, and immunomodulatory signaling pathways. ATP2C1 and Nr1d1, which were related to Ca2+ transport, cellular calcium homeostasis, endoplasmic reticulum stress and immunity, may be the key genes in the formation of dental fluorosis. Notably, we also found that the immune response plays an important role in the formation of dental fluorosis, and a large amount of DEGs was enriched in immune regulation and NF-κB signaling pathways. Furthermore, the methylation levels of 13 sites were increased in Ago4, Atf3, Atp2c1, Dusp1, Habp4, and Mycl, while methylation levels of 5 CpG sites decreased in Ago4, Atp2c1, Habp4, and Traf6, and conformably, the expression of these genes have been significantly changed. This study comprehensively analyzed the occurrence mechanism of dental fluorosis from transcriptomics and epigenetics, so as to provide theoretical reference for further research.

The fluorosis conundrum: bridging the gap between science and public health.

Fluorosis, a chronic condition brought on by excessive fluoride ingestion which, has drawn much scientific attention and public health concern. It is a complex and multifaceted issue that affects millions of people worldwide. Despite decades of scientific research elucidating the causes, mechanisms, and prevention strategies for fluorosis, there remains a significant gap between scientific understanding and public health implementation. While the scientific community has made significant strides in understanding the etiology and prevention of fluorosis, effectively translating this knowledge into public health policies and practices remains challenging. This review explores the gap between scientific research on fluorosis and its practical implementation in public health initiatives. It suggests developing evidence-based guidelines for fluoride exposure and recommends comprehensive educational campaigns targeting the public and healthcare providers. Furthermore, it emphasizes the need for further research to fill the existing knowledge gaps and promote evidence-based decision-making. By fostering collaboration, communication, and evidence-based practices, policymakers, healthcare professionals, and the public can work together to implement preventive measures and mitigate the burden of fluorosis on affected communities. This review highlighted several vital strategies to bridge the gap between science and public health in the context of fluorosis. It emphasizes the importance of translating scientific evidence into actionable guidelines, raising public awareness about fluoride consumption, and promoting preventive measures at individual and community levels.

Prevalence and risk factors of dental fluorosis among children aged 8-12 years in Shandong province of China.

This study was to investigate the prevalence and severity of children's dental fluorosis (DF) in Shandong and identified the potential risk factors for DF. A total of 87 villages in Shandong were investigated to calculate the prevalence of DF and Community Fluorosis Index (CFI) in 2018-2019. Six hundred and seventy children were enrolled to identify the potential risk factors using univariate and multivariate logistic regressions. Goodman-Kruskal Gamma was used to explore the factors related to the severity of DF. In 87 villages, 1249 of 8700 (14.36%) children still have DF. The prevalence of DF in most villages was below 40% in 2018-2019. Water fluorine concentration when selected for the study and urinary fluorine concentration were related to the risk of DF (P < 0.001). Some eating habits, like lower frequency of eating fresh vegetables, eggs, and beans, were associated with the risk of DF (P < 0.001). The high water fluorine concentration, and lower frequency of eating fresh vegetables, eggs, and beans were also related to the severity of DF (P < 0.001). DF in children in Shandong province is still a common endemic disease. This study tries to provide a useful guide for the prevention and control of DF.

Association between polymorphism and haplotype of ATP2B1 gene and skeletal fluorosis in Han population.

To evaluate the association between ATP2B1 gene polymorphisms and skeletal fluorosis, a cross-sectional study was conducted. In China, 962 individuals were recruited, including 342 cases of skeletal fluorosis. Four TP2BA1 polymorphisms (rs2070759, rs12817819, rs17249754, and rs7136259) were analysed. The results suggested that rs17249754 and rs7136259 were associated with skeletal fluorosis. After controlling confounders, the protective effect of GG genotype in rs17249754 was apparent in individuals over 45 years old, female, with urine fluoride concentration below 1.6 mg/L, serum calcium above 2.25 mmol/L or serum phosphorus between 1.1 and 1.3. Heterozygote TC in rs7136259 increased the risk of skeletal fluorosis in subjects who are elderly, female, with urinary fluoride more than 1.6 mg/L, serum calcium more than 2.25 mmol/L and blood phosphorus between 1.1 and 1.3 mmol/L. Four loci were found to be tightly related by linkage disequilibrium analysis, and the frequency of distribution of haplotype GCGT was lower in the skeletal fluorosis group.

Prevalence of Skeletal Fluorosis in Northern Tanzania: A Follow-Up Study.

OBJECTIVES: Skeletal fluorosis is a metabolic bone disease caused by excessive exposure to fluoride, predominantly through contamination of drinking water. This study aimed to identify all cases of skeletal fluorosis in Tindigani village situated in Northern Tanzania. This was done following changes in drinking water sources after a previous prevalence study in 2009 in this population. METHODS: In a door-to-door cross-sectional study of Tindigani village, a sample of residents was assessed for skeletal fluorosis and dental fluorosis. Diagnosis of skeletal fluorosis was based on pre-defined angles of deformity of the lower limbs. Dental fluorosis was diagnosed and graded using the Thylstrup and Fejerskov Index. Samples from current drinking water sources underwent fluoride analysis. RESULTS: Tindigani village had a population of 1,944 individuals. Of the 1,532 individuals who were screened, 45 had skeletal fluorosis, giving a prevalence of 3.3% (95% CI=2.4, 4.3). Dental fluorosis was present in 82.5% of those examined (95% CI=79.8, 85.3). Dental fluorosis was present in all individuals with skeletal fluorosis and at higher grades than in the rest of the population. Drinking water samples were collected from 28 sources. These included piped, surface, well, and borehole water sources. Fluoride concentrations ranged from 0.45-38.59 mg/L of fluoride. CONCLUSIONS: Skeletal fluorosis is an ongoing but preventable health problem in the current population. The delivery of sustainable low fluoride piped water to this community would be of clear health benefit. This has been addressed at a local level.

Epidemiological analysis of drinking water-type fluorosis areas and the impact of fluorosis on children's health in the past 40 years in China.

This study analyzed the effect of China's fluorosis prevention and control program, which has been in effect for more than 40 years, and the impact of fluorosis on children's health. Relevant research studies were retrieved from the following online databases from the time of their inception to May 2022: PubMed, ScienceDirect, Embase, Cochrane, China National Knowledge Infrastructure, and Wanfang. The Review Manager 5.3 software was used in statistical analyses. This article included seventy studies: Thirty-eight studies reported the effect of improving water quality and reducing fluoride content, the incidence rate of dental fluorosis in children, and the level of urinary fluoride, and thirty-two studies reported the intelligence quotient (IQ) and health status of children. Following water improvement strategies, the fluoride levels in drinking water decreased significantly; urinary fluoride levels and dental fluorosis decreased significantly in children. With regard to the effect of fluorosis on the IQ of children, the results showed that the IQ of children in areas with a high fluoride of fluorosis was lesser than that in areas with a low fluoride, and this difference was significant. Based on the prevalence of dental fluorosis and its effect on the intelligence of children, it appears that reducing fluoride levels in drinking water and monitoring water quality are important strategies for the prevention and treatment of fluorosis.

Fluoride Exposure and Skeletal Fluorosis: a Systematic Review and Dose-response Meta-analysis.

PURPOSE OF REVIEW: We performed a systematic review and meta-analysis on the relation between fluoride exposure and skeletal fluorosis (SF) using a novel statistical methodology for dose-response modeling. RECENT FINDINGS: Skeletal fluorosis, a major health issue that is endemic in some regions, affects millions of people worldwide. However, data regarding the dose-response relation between fluoride exposure and SF are limited and outdated. We included twenty-three studies in the meta-analysis. When comparing the highest versus the lowest fluoride category, the summary risk ratio (RR) for SF prevalence was 2.05 (95% CI 1.60; 2.64), with a value of 2.73 (95% CI 1.92; 3.90) for drinking water and 1.40 (95% CI 0.90; 2.17) for urinary fluoride. The RR by the risk of bias (RoB) was 2.37 (95% CI 1.56; 3.58) and 1.78 (95% CI 1.34; 2.36) for moderate and high RoB studies, respectively. The dose-response curve based on a one-stage cubic spline regression model showed an almost linear positive relation between exposure and SF occurrence starting from relatively low concentrations up to 5 mg/L and 2.5 mg/L, respectively, for water and urinary fluoride, with no substantial increase above this threshold. The RR for developing moderate-severe forms increases at 5.00 mg/L and 2.5 mg/L of water and urinary fluoride, respectively. Better-quality studies are needed to confirm these results, but greater attention should be given to water fluoride levels to prevent SF, in addition to the other potential adverse effects of fluoride exposure.

An interventional clinical trial investigating the effects of Spirulina platensis on dental fluorosis and antioxidant system in lambs reared in endemic areas.

This study aimed to evaluate the protective effect of Spirulina platensis primary against dental fluorosis and secondary against oxidative stress in lambs reared in endemic fluorosis areas. Forty-eight lambs aged 5 months were divided into four equal groups (each one including 6 males and 6 females). Groups I and II served as controls belonging respectively to fluorosis-free (Settat) and endemic fluorosis (El Fokra) areas, while the other two Groups III and IV (belonging to El Fokra) received respectively a fixed daily intake of 250 and 500 mg/kg bodyweight (BW) of Spirulina platensis. The experiment was carried out for 13 months until the adult incisors appeared for all animals. According to the Dean's Fluorosis Index (DFI), 500 mg/kg BW/day of Spirulina platensis (Group IV) protected against dental fluorosis. Moreover, in both male and female lambs, this dose significantly (p < 0.0001) reduced the plasmatic levels of fluoride, proteins, GSH, and MDA compared to the Group II. Furthermore, enzymatic activities of catalase and SOD increased significantly (p < 0.0001) in male and female lambs of the Group IV as compared to Group II. In conclusion, our findings support the potential use of Spirulina platensis as a valuable solution for addressing fluorosis in sheep, warranting further clinical trials.

[Spatial correlation between the prevalence of dental fluorosis and the chemical elemental composition of drinking water sources in a typical coal-fired pollution fluorosis area].

Objective: To investigate the spatial distribution characteristics and correlation between the prevalence of dental fluorosis and the chemical elemental composition of drinking water sources in coal-fired fluorosis areas. Methods: Based on the survey data on the prevalence of dental fluorosis at CDC in Guizhou Province in 2022, 274 original surface drinking water sources were collected in typical coal-fired fluorosis areas, and fluoride (F), calcium (Ca), magnesium (Mg), aluminum (Al), titanium (Ti), chromium (Cr), manganese (Mn), iron (Fe), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), molybdenum (Mo), cadmium (Cd), barium (Ba), lead (Pb) 17 elements; apply Moran's I index, Getis-Ord Gi* hotspot analysis of the global spatial autocorrelation of chemical elements in drinking water and the degree of aggregation of each element on the local area, and correlation analysis with the prevalence of dental fluorosis in the region. Results: Except for Cu, Zn, and Cd, global spatial autocorrelation Moran's I was negative, and all other elements were positive. F, Ca, Al, Ti, As, Mo, Cd, and Cu elements showed high values of aggregation in the southeastern low-altitude area; Mg, Ba, Pb, Cr, Mn, and Fe elements were mainly aggregated in the central altitude terrain transition area, Zn and Se elements in water sources are significantly positively correlated with the prevalence of dental fluorosis (P<0.05). In contrast, F, Mg, Al, Ti, As, Mo, Cd, Ba, and Pb elements negatively correlate (P<0.05). Elements in the central region were high-high aggregation, as a hot spot aggregation area with high disease incidence, while F, Al, Mn, Mo, Cd, and Ba elements in the western region were low-low aggregation, as a cold spot aggregation area with a low incidence of fluorosis. Conclusions: The risk of population fluoride exposure in surface drinking water sources is shallow. However, the chemical element content of drinking water sources in coal-fired polluted endemic fluorosis areas has prominent spatial geographical distribution characteristics. There is a significant spatial aggregation effect with the prevalence of dental fluorosis, which may play a synergistic or antagonistic effect on the occurrence and prevalence of dental fluorosis.

Community Water Fluoridation Levels To Promote Effectiveness and Safety in Oral Health - United States, 2016-2021.

Drinking water fluoridated at the level recommended by the U.S. Public Health Service (USPHS) reduces dental caries (cavities) by approximately 25% in children and adults (1). USPHS recommends fluoride levels to achieve oral health benefits and minimize risks associated with excess fluoride exposure. To provide the benefits of community water fluoridation, water systems should target a level of 0.7 mg/L and maintain levels ≥0.6 mg/L (2). The Environmental Protection Agency (EPA) sets a safety standard at 2.0 mg/L to prevent mild or moderate dental fluorosis, a condition that causes changes in the appearance of tooth enamel caused by hypermineralization resulting from excess fluoride intake during tooth-forming years (i.e., before age 8 years). During 2016-2021, fluoride measurements for 16.3% of population-weighted monthly fluoride measurements (person-months) reported by community water systems to CDC's Water Fluoridation Reporting System (WFRS) were <0.6 mg/L; only 0.01% of person-months exceeded 2.0 mg/L. More than 80% of population-weighted fluoride measurements from community water systems reporting to WFRS were above 0.6 mg/L. Although 0.7 mg/L is the recommended optimal level, ≥0.6 mg/L is still effective for the prevention of caries. A total of 4,080 community water systems safely fluoridated water 99.99% of the time with levels below the secondary safety standard of 2.0 mg/L. Water systems are encouraged to work with their state programs to report their fluoride data into WFRS and meet USPHS recommendations to provide the full benefit of fluoridation for caries prevention.

A National Study Exploring the Association Between Fluoride Levels and Dental Fluorosis.

Importance: While the effects of fluoride on health have been widely researched, fewer high-quality studies examine the association of fluoride levels in water and dental fluorosis. Objective: To investigate the association between fluoride exposure from drinking water and dental fluorosis. Design, Setting, and Participants: This cross-sectional study used the 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey (NHANES) data (January 1, 2013, through December 31, 2016). NHANES uses a complex sampling technique to develop nationally representative sample estimates of the US population that consists of interviews and physical assessments. Children and adolescents aged 6 to 15 years were included because NHANES contains their data for all 3 forms of fluoride measures: plasma fluoride levels, water levels of fluoride, and dietary fluoride supplementation. Data were analyzed from January 1 to April 30, 2023. Exposures: Water and plasma fluoride levels were measured by laboratory personnel. Dietary fluoride supplement data were self-reported. Main Outcomes and Measures: The Dean's Fluorosis Index was used to evaluate fluorosis status for each tooth. The dental fluorosis severity value was based on the second most affected tooth. Independent variables included plasma and water fluoride concentrations and dietary fluoride supplementation. An independent samples t test was used to compare fluoride exposures between groups, and Pearson correlation assessed the association between plasma and water fluoride levels. To assess whether fluoride exposures were associated with dental fluorosis, logistic regression analyses were conducted. Results: There were 1543 participants in the 2013-2014 NHANES cycle (weighted proportion male, 51.9%; mean [SD] age, 11.0 [2.7] years) and 1452 in the 2015-2016 cycle (weighted proportion male, 52.6%; mean [SD] age, 11.1 [2.8] years). A weighted 87.3% exhibited some degree of fluorosis in the 2013-2014 cycle and 68.2% in the 2015-2016 cycle. Higher fluoride levels in water and plasma were significantly associated with higher odds of dental fluorosis (adjusted odds ratios, 2.378 [95% CI, 2.372-2.383] in the 2013-2014 cycle and 1.568 [95% CI, 1.564-1.571] in the 2015-2016 cycle). Conclusions and Relevance: The findings of this cross-sectional study suggest that exposure to higher concentrations of fluoride in water and having higher plasma levels of fluoride were associated with a greater risk of dental fluorosis. Further research can help policy makers develop policies that balance substantial caries prevention with the risk of dental fluorosis.

Fluorosis dental en adolescentes de instituciones educativas de Lima, Perú / Dental fluorosis in adolescents from Educational Institutions in Lima, Peru

Introducción: La fluorosis dental es una patología endémica causada por la ingestión excesiva de fluoruros que pueden producir una alteración durante el desarrollo del esmalte, y es considerado un importante problema de salud pública porque afecta la salud bucal y sistémica de la población. Objetivo: Este estudio tuvo como idea principal determinar la frecuencia y los niveles de fluorosis dental en escolares de 12 a 15 años pertenecientes a dos instituciones educativas de Lima - Perú. Método: Se realizó un estudio descriptivo de tipo transversal, la muestra estuvo conformada por 252 estudiantes, entre 12 y 15 años de dos centros educativos de Lima. El muestreo fue por selección sistemática de elementos muestrales. La fluorosis dental se evalúo mediante el Índice de Dean. Para determinar la frecuencia y los niveles de fluorosis dental, se realizó un examen clínico bucal y se desarrolló un cuestionario validado previamente. Resultados: La frecuencia de fluorosis dental fue de 44,8% (n=113) afectando más a los varones en un 27,39% (n=69) y a los adolescentes de 13 años (15,1%). En relación con los niveles de fluorosis, predominó el tipo "muy leve" (34,9%). También se encontró una asociación entre la presencia y el nivel de fluorosis con el número de aplicaciones de flúor (p<0,05). Además, se dijo que el índice comunitario de fluorosis de Dean fue de 0,43. Conclusiones: En la población escolar evaluada, la frecuencia de fluorosis fue de 44,8% y el nivel predominante de fluorosis fue muy leve. Además, el índice comunitario fue de 0,43, el cual mostró un nivel límite de importancia para la salud pública. Por lo que se puede considerar que el número de aplicaciones tópicas de flúor recibido por la población sin una planificación adecuada se podría convertir en un factor de riesgo para causar fluorosis dental.

Introduction: Dental fluorosis is an endemic pathology caused by the excessive ingestion of fluorides that can produce an alteration during the development of the enamel and is considered an important public health problema because it affects the oral and systemic health of the population. Objective: The objective of this study was to determine the frequency and levels of dental fluorosis in school children between 12 and 15 years of age belonging to two educational institutions in Lima, Peru. Method: A descriptive cross-sectional study was carried out, the sample consisted of 252 students between 12 and 15 years of age from two educational centers in Lima. Sampling was by systematic selection of sample elements. Dental fluorosis was evaluated using the Dean Index. To determine the frequency and levels of dental fluorosis a clinical oral examination was carried out and a previously validated questionnaire was developed. Results: The frequency of dental fluorosis was 44.8% (n=113) affecting more males by 27.39% (n=69) and adolescents aged 13 years (15.1%). In relation to the levels of fluorosis, the "very mild" type predominated (34.9%). An association was also found between the presence and level of fluorosis with the number of fluoride applications (p<0.05). In addition, Dean's community fluorosis index was reported to be 0.43. Conclusions: In the school population evaluated, the frequency of fluorosis was 44.8% and the predominant level of fluorosis was very mild. In addition, the community index was 0.43, which indicated a borderline level of public health importance. Therefore, it can be considered that the number of topical fluoride applications received by the population without adequate planning could become a risk factor for causing dental fluorosis.

The Protective Effect of Breastfeeding on Dental Fluorosis Among Children in Rural Fluoride-Endemic Areas.

Background: Living in fluoride-endemic areas and the inevitable use of groundwater for consumption have imposed children at high risk of dental fluorosis. To mitigate exposure to excessive fluoride at age of developing dentition, breastfeeding might serve as a natural public health intervention against dental fluorosis in that socially disadvantaged context. Objective: This study aimed to evaluate the preventive effect of breastfeeding against dental fluorosis in children living in fluoride-endemic areas in Nakhon Pathom Province, Thailand. Evaluation of the association through several epidemiological models depicted by a directed acyclic graph (DAG) was undertaken. Methods: A case-control study of 127 cases of dental fluorosis and 85 controls was conducted. Independent factor of breastfeeding, along with other past exposure variables, were traced backwardly since infancy by caregiver history taking. Fluoride concentrations in groundwater utilized for household supply matching to residence and number of years by age of each child were collected from 2008 to 2015. Multivariable Poisson regression with robust standard errors was sequentially executed to estimate prevalence ratio (PR) according to models in DAG. Results: Breastfeeding was significantly higher (95.3%) among controls compared to cases (84.2%), p = 0.014. Contrastingly, prevalence of using toothpaste larger than pea-sized and having fluoride ≥1.5 ppm in household water supply was higher among cases. Univariable and subsequent five multivariable regression models according to DAG consistently unveiled significant protective effect of breastfeeding on dental fluorosis with PR ranging from 0.66 to 0.75. Conclusions: Breastfeeding for at least 6 months had preventive effect against dental fluorosis among children living in fluoride-endemic areas.

A Bibliometric Analysis of the Top 100 Most-Cited Papers Concerning Dental Fluorosis.

A high number of citations can indicate the potential of any specific paper to influence other research and generate changes in clinical practice. Analyzing the most-cited papers in a certain scientific field may assist researchers to identify the influential papers as well their main characteristics. The present study aimed to analyze the 100 most-cited papers concerning dental fluorosis (DF) through a bibliometric review. A search was performed in the Web of Science Core Collection (WoS-CC) database in November 2021. The papers were displayed in descending order according to the number of citations in WoS-CC. Two independent researchers performed the selection. Scopus and Google Scholar were used to compare the number of citations with WoS-CC. The following data were extracted from the papers: title, authors, number and density of citations, institution, country, continent, year of publication, journal title, keywords, study design, and theme. Collaborative networks were generated using the VOSviewer software. The top 100 most-cited papers were published between 1974 and 2014 and were cited 6,717 times (ranging from 35 to 417). Community Dentistry and Oral Epidemiology (24%), Journal of Dental Research (21%), Journal of Public Health Dentistry (17%), and Caries Research (13%) published the most papers. Observational studies (60%) and literature reviews (19%) were the most common study designs. The main topics were epidemiology (44%) and fluoride intake (32%). The countries with the highest number of papers were the USA (44%), Canada (10%), and Brazil (9%). The University of Iowa (USA) had the most papers (12%). Levy SM was the author with the highest number of papers (12%). The 100 most-cited papers on DF were mainly observational studies focused on epidemiology and originated in North America. There were few interventional studies and systematic reviews among the most-cited papers concerning this topic.

A community-based study of dental fluorosis in rural children (6-12 years) from an aspirational district in Karnataka, India.

Objectives: The present study was planned to estimate the prevalence of dental fluorosis in 6-12 years of children and its association with various drinking water sources, water, and urine fluoride levels among the subset of children under the umbrella of a larger study to address iodine deficiency disorders and iron deficiency anemia in 17 villages of Manvi and Devadurga talukas of Raichur district of Karnataka. Methods: Analysis of subset of data and urine samples of children under the umbrella of a larger cross-sectional community-based study was conducted in 17 villages of Manvi and Devadurga taluks of Raichur district. House to house survey was carried out to collect data using a semi-structured questionnaire in ODK software. Demographic details, source of drinking water, clinical assessment of dental fluorosis, and height and weight measurements were performed by trained staff. Urine and water samples were collected for fluoride level estimation. The overall prevalence of dental fluorosis and its severity-wise prevalence were estimated. Association between dental fluorosis and age, gender, type of diet, source of drinking water, height for age, BMI for age, water fluoride level, and urine fluoride level were carried out using logistic regression analysis. Results: The prevalence of dental fluorosis was 46.0%. Mild, moderate, and severe dental fluorosis was found in 37.9, 7.8, and 0.3% of children. With the increasing age of participants, the odds of dental fluorosis were found to increase by 2-4 folds. The odds of having dental fluorosis were significantly increased with increasing water fluoride levels of 3 to 5 ppm [AOR = 3.147 (1.585-6.248); P = 0.001] in comparison with water fluoride levels of < 1 ppm. The similar trend was found with urine fluoride level > 4 ppm [AOR = 3.607 (1.861-6.990); P < 0.001]. As compared to river water, other sources of drinking water were significantly associated with higher odds of dental fluorosis. Conclusions: Prevalence of dental fluorosis was high in 6 to 12 years due to overexposure of fluoride from drinking water. High water and urine fluoride levels in children indicate the chronic exposure to fluoride and suggest that the population is at high risk of developing chronic fluorosis.