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Qiao Y, Cui Y, Tan Y, Zhuang C, Li X, Yong Y, Zhang X, Ren X, Cai M, Yang J, Lang Y, Wang J, Liang C, Zhang J. Fluoride induces immunotoxicity by regulating riboflavin transport and metabolism partly through IL-17A in the spleen. JOURNAL OF HAZARDOUS MATERIALS 2024; 476:135085. [PMID: 38968825 DOI: 10.1016/j.jhazmat.2024.135085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024]
Abstract
The impairment of the immune system by fluoride is a public health concern worldwide, yet the underlying mechanism is unclear. Both riboflavin and IL-17A are closely related to immune function and regulate the testicular toxicity of fluoride. However, whether riboflavin or IL-17A is involved in fluoride-induced immunotoxicity is unknown. Here, we first established a male ICR mouse model by treating mice with sodium fluoride (NaF) (100 mg/L) via the drinking water for 91 days. The results showed that fluoride increased the expression of the proinflammatory factors IL-1β and IL-17A, which led to splenic inflammation and morphological injury. Moreover, the expression levels of the riboflavin transporters SLC52A2 and SLC52A3; the transformation-related enzymes RFK and FLAD1; and the key mitochondrial functional determinants SDH, COX, and ATP in the spleen were measured via real-time PCR, Western blotting, and ELISA. The results revealed that fluoride disrupted riboflavin transport, transformation, metabolism, and mitochondrial function. Furthermore, wild-type (WT) and IL-17A knockout (IL-17A-/-) C57BL/6 J male mice of the same age were treated with NaF (24 mg/kg·bw, equivalent to 100 mg/L) and/or riboflavin sodium phosphate (5 mg/kg·bw) via gavage for 91 days. Similar parameters were evaluated as above. The results confirmed that fluoride increased riboflavin metabolism through RFK but not through FLAD1. Fluoride also affected mitochondrial function and activated neutrophils (marked with Ly6g) and macrophages (marked with CD68) in the spleen. Interestingly, IL-17A partly mediated fluoride-induced riboflavin metabolism disorder and immunotoxicity in the spleen. This work not only reveals a novel toxic mechanism for fluoride but also provides new clues for exploring the physiological function of riboflavin and for diagnosing and treating the toxic effects of fluoride in the environment.
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Affiliation(s)
- Yurou Qiao
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Yukun Cui
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Yanjia Tan
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Cuicui Zhuang
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Xiang Li
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Yufei Yong
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Xinying Zhang
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Xuting Ren
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Miaomiao Cai
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Jie Yang
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Yilin Lang
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Jundong Wang
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Chen Liang
- College of Animal Science, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China
| | - Jianhai Zhang
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu, Shanxi 030801, PR China.
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Bahekar T, Meenakshi S, Narapaka PK, Kumar N, Prakash V, Murti K. Development and Psychometric Validation of Population-Based Knowledge Attitudes and Practices-Questionnaire on Fluoride (PBKAP-QF). Biol Trace Elem Res 2024:10.1007/s12011-024-04334-x. [PMID: 39162919 DOI: 10.1007/s12011-024-04334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024]
Abstract
Fluoride exposure is a global public health concern. Understanding the knowledge, attitudes, and practices (KAP) of affected populations is essential for effective community management. This study aimed to develop and validate a KAP questionnaire to assess fluoride and its risk in general population. An extensive literature review and focus group discussions were conducted to construct the questionnaire. Content validity was assessed using the Content Validity Index (CVI) based on expert feedback. Factor analysis was performed for final tool validation, and item characteristics were analyzed using IBM SPSS v. 27 and IBM AMOS v. 26. A total of 300 responses were collected. Initially, 41 items were included in the questionnaire, which were reduced to 25 after expert review. The final version included 19 items, with an I-CVI ranging from 0.80 to 1.00, indicating no issues with item difficulty or discrimination. Cronbach's alpha ranged from 0.88 to 0.90, demonstrating good internal consistency. The Kaiser-Meyer-Olkin (KMO) value was 0.848, and Bartlett's test (χ2 = 6860.978, df = 156, p < 0.01) confirmed data suitability for factor analysis. Three constructs were extracted with factor loadings greater than 0.5. Confirmatory factor analysis demonstrated a good model fit. This study developed and validated a robust 19-item KAP questionnaire for assessing knowledge, attitudes, and practices related to fluoride exposure. The tool demonstrated excellent reliability, validity, and internal consistency, supporting its use in guiding effective community-level management and public health interventions in fluoride-endemic areas.
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Affiliation(s)
- Triveni Bahekar
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Vaishali, 844102, Bihar, India
| | - Sarasa Meenakshi
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Vaishali, 844102, Bihar, India
| | - Pavan Kumar Narapaka
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Vaishali, 844102, Bihar, India
| | - Nitesh Kumar
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Vaishali-844102, Bihar, India
| | - Ved Prakash
- Department of Endocrinology, Indira Gandhi Institute of Medical Sciences (IGIMS), Bailey Road, Sheikhpura, Patna, 800014, India.
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Vaishali, 844102, Bihar, India.
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Bloomquist TR, Spaur M, Cerna-Turoff I, Kress AM, Burjak M, Kupsco A, Casey JA, Herbstman JB, Nigra AE. Public drinking water contaminant estimates for birth cohorts in the Environmental Influences on Child Health Outcomes (ECHO) Cohort. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024:10.1038/s41370-024-00699-2. [PMID: 39098852 DOI: 10.1038/s41370-024-00699-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND The United States Environmental Protection Agency (USEPA) regulates over 80 contaminants in community water systems (CWS), including those relevant to infant health outcomes. Multi-cohort analyses of the association between measured prenatal public water contaminant concentrations and infant health outcomes are sparse in the US. OBJECTIVE Our objectives were to (1) develop Zip Code Tabulation Area (ZCTA)-level CWS contaminant concentrations for participants in the Environmental Influences on Child Health Outcomes (ECHO) Cohort and (2) evaluate regional, seasonal, and sociodemographic inequities in contaminant concentrations at the ZCTA-level. The ECHO Cohort harmonizes data from over 69 extant pregnancy and pediatric cohorts across the US. METHODS We used CWS estimates derived from the USEPA's Six-Year Review 3 (2006-2011) to develop population-weighted, average concentrations for 10 contaminants across 7640 ZCTAs relevant to the ECHO Cohort. We evaluated contaminant distributions, exceedances of regulatory thresholds, and geometric mean ratios (with corresponding percent changes) associated with ZCTA sociodemographic characteristics via spatial lag linear regression models. RESULTS We observed significant regional variability in contaminant concentrations across the US. ZCTAs were most likely to exceed the maximum contaminant level for arsenic (n = 100, 1.4%) and the health-protective threshold for total trihalomethanes (n = 3584, 64.0%). A 10% higher proportion of residents who were American Indian/Alaskan Native and Hispanic/Latino was associated with higher arsenic (11%, 95% CI: 7%, 15%; and 2%, 95% CI: 0%, 3%, respectively) and uranium (15%, 95% CI: 10%, 21%; and 9%, 95% CI: 6%, 12%, respectively) concentrations. IMPACT Nationwide epidemiologic analyses evaluating the association between US community water system contaminant concentration estimates and associated adverse birth outcomes in cohort studies are sparse because public water contaminant concentration estimates that can be readily linked to participant addresses are not available. We developed Zip Code Tabulation Area (ZCTA)-level CWS contaminant concentrations that can be linked to participants in the Environmental Influences on Child Health Outcomes (ECHO) Cohort and evaluated regional, seasonal, and sociodemographic inequities in contaminant concentrations for these ZCTAs. Future epidemiologic studies can leverage these CWS exposure estimates in the ECHO Cohort to evaluate associations with relevant infant outcomes.
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Affiliation(s)
- Tessa R Bloomquist
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Maya Spaur
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ilan Cerna-Turoff
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amii M Kress
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MA, USA
| | - Mohamad Burjak
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MA, USA
| | - Allison Kupsco
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Joan A Casey
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Anne E Nigra
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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El Messaoudi N, Franco DSP, Gubernat S, Georgin J, Şenol ZM, Ciğeroğlu Z, Allouss D, El Hajam M. Advances and future perspectives of water defluoridation by adsorption technology: A review. ENVIRONMENTAL RESEARCH 2024; 252:118857. [PMID: 38569334 DOI: 10.1016/j.envres.2024.118857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/05/2024]
Abstract
Fluoride contamination in water sources poses a significant challenge to human health and the environment. In recent years, adsorption technology has emerged as a promising approach for water defluoridation due to its efficiency and cost-effectiveness. This review article comprehensively explores the advances in water defluoridation through adsorption processes. Various adsorbents, including natural and synthetic materials, have been investigated for their efficacy in removing fluoride ions from water. The mechanisms underlying adsorption interactions are elucidated, shedding light on the factors influencing defluoridation efficiency. Moreover, the review outlines the current state of technology, highlighting successful case studies and field applications. Future perspectives in the field of water defluoridation by adsorption are discussed, emphasizing the need for sustainable and scalable solutions. The integration of novel materials, process optimization, and the development of hybrid technologies are proposed as pathways to address existing challenges and enhance the overall efficacy of water defluoridation. This comprehensive assessment of the advances and future directions in adsorption-based water defluoridation provides valuable insights for researchers, policymakers, and practitioners working towards ensuring safe and accessible drinking water for all.
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Affiliation(s)
- Noureddine El Messaoudi
- Laboratory of Applied Chemistry and Environment, Faculty of Sciences, Ibn Zohr University, Agadir, 80000, Morocco.
| | - Dison Stracke Pfingsten Franco
- Department of Civil and Environmental, Universidad de la Costa, CUC, Calle 58 # 55-66, Barranquilla, Atlántico, Colombia
| | - Sylwia Gubernat
- Inżynieria Rzeszów S.A., ul. Podkarpacka 59A, 35-082, Rzeszów, Poland
| | - Jordana Georgin
- Department of Civil and Environmental, Universidad de la Costa, CUC, Calle 58 # 55-66, Barranquilla, Atlántico, Colombia.
| | - Zeynep Mine Şenol
- Sivas Cumhuriyet University, Faculty of Health Sciences, Department of Nutrition and Diet, 58140, Sivas, Turkey
| | - Zeynep Ciğeroğlu
- Department of Chemical Engineering, Faculty of Engineering and Natural Sciences, Usak University, Usak, 64300, Turkey
| | - Dalia Allouss
- Laboratory of Materials, Catalysis & Valorization of Natural Resources, FSTM, Hassan II University, Casablanca, Morocco
| | - Maryam El Hajam
- Advanced Structures and Composites Center, University of Maine, Orono, 04469, United States
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Padilla-Reyes DA, Dueñas-Moreno J, Mahlknecht J, Mora A, Kumar M, Ornelas-Soto N, Mejía-Avendaño S, Navarro-Gómez CJ, Bhattacharya P. Arsenic and fluoride in groundwater triggering a high risk: Probabilistic results using Monte Carlo simulation and species sensitivity distribution. CHEMOSPHERE 2024; 359:142305. [PMID: 38740338 DOI: 10.1016/j.chemosphere.2024.142305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/01/2024] [Accepted: 05/09/2024] [Indexed: 05/16/2024]
Abstract
The widespread presence of arsenic (As) and fluoride (F-) in groundwater poses substantial risks to human health on a global scale. These elements have been identified as the most prevalent geogenic contaminants in groundwater in northern Mexico. Consequently, this study aimed to evaluate the human health and ecological risks associated with the content of As and F- in the Meoqui-Delicias aquifer, which is in one of Mexico's most emblematic irrigation districts. Concentrations of As and F- were measured in 38 groundwater samples using ICP-MS and ion chromatography, respectively. Overall, these elements showed a similar trend across the aquifer, revealing a positive correlation between them and pH. The concentration of As and F- in the groundwater ranged from 5.3 μg/L to 303 μg/L and from 0.5 mg/L to 8.8 mg/L, respectively. Additionally, the levels of As and F- surpassed the established national standards for safe drinking water in 92% and 97% of samples, respectively. Given that groundwater is used for both agricultural purposes and human activities, this study also assessed the associated human health and ecological risks posed by these elements using Monte Carlo simulation and Species Sensitivity Distribution. The findings disclosed a significant noncarcinogenic health risk associated with exposure to As and F-, as well as an unacceptable carcinogenic health risk to As through water consumption for both adults and children. Furthermore, a high ecological risk to aquatic species was identified for F- and high to medium risks for As in the sampling sites. Therefore, the findings in this study provide valuable information for Mexican authorities and international organizations (e.g., WHO) about the adverse effects that any exposure without treatment to groundwater from this region represents for human health.
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Affiliation(s)
- Diego A Padilla-Reyes
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Campus Monterrey, Monterrey, 64849, Nuevo Leon, Mexico
| | - Jaime Dueñas-Moreno
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Campus Monterrey, Monterrey, 64849, Nuevo Leon, Mexico
| | - Jürgen Mahlknecht
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Campus Monterrey, Monterrey, 64849, Nuevo Leon, Mexico.
| | - Abrahan Mora
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Campus Monterrey, Monterrey, 64849, Nuevo Leon, Mexico
| | - Manish Kumar
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Campus Monterrey, Monterrey, 64849, Nuevo Leon, Mexico; Sustainability Cluster, School of Advanced Engineering, UPES, Dehradun, Uttarakhand, 248007, India
| | - Nancy Ornelas-Soto
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Campus Monterrey, Monterrey, 64849, Nuevo Leon, Mexico
| | - Sandra Mejía-Avendaño
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Campus Monterrey, Monterrey, 64849, Nuevo Leon, Mexico
| | - Carmen J Navarro-Gómez
- Faculty of Engineering, Autonomous University of Chihuahua, Circuito Universitario, 31109, Campus Uach II, Chihuahua, Chih, C.P. 31125, Mexico
| | - Prosun Bhattacharya
- KTH-International Groundwater Arsenic Research Group, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 10B, SE-114 28, Stockholm, Sweden
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Lee WS, Kim JH, Han B, Lee GC, Jung HR, Shin YJ, Ha EK, Lee E, Lee S, Han MY. Association of fluoride exposure with disease burden and neurodevelopment outcomes in children in South Korea. World J Pediatr 2024:10.1007/s12519-024-00820-3. [PMID: 38937407 DOI: 10.1007/s12519-024-00820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 05/22/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Community water fluoridation is an effective public health strategy for preventing dental caries, yet. Concerns exist about potential health problems. This study explores associations between tap water fluoride levels and pediatric disease burden, as well as neurodevelopmental outcomes at 6 years of age. METHODS This nationwide population-based cohort study included children born in Korean cities with and without tap water fluoridation projects, between 2006 and 2012, aiming for a fluoride concentration of 0.8 ± 0.2 mg/L in treated tap water. Data from the National Health Insurance Service were used, spanning from birth to 2018. The relationship between exposure to fluoridated tap water and incidence of 16 childhood diseases that were previously identified as potentially linked to fluoride exposure were examined. Additionally, we evaluated the neurodevelopmental outcomes across various domains, including gross motor, fine motor, cognition, language, social skills, and self-help functions. These assessments were performed using data from a comprehensive national health screening program for children aged six years. RESULTS A fluoride-unexposed group included 22,881 children, whereas a fluoride-exposed group comprised 29,991 children (52% males). Children in the fluoride-exposed group had a decreased risk of dental caries and bone fractures [hazard ratio (95% confidence interval, CI), 0.76 (0.63-0.93) and 0.89 (0.82-0.93), respectively] and increased risk of hepatic failures [1.85, (1.14-2.98)] compared to those in the unexposed group. Additionally, the risk ratio of abnormal neurodevelopmental screening outcomes increased by 9%, but this was statistically uncertain (95% CI, 0.95-1.26). CONCLUSIONS Fluoridated tap water was associated with an increased risk of hepatic failure but a decreased risk of bone fractures in children. The association between fluoridated tap water and neurodevelopmental screening outcomes at 6 years remains unclear, highlighting the need for further studies to clarify this association.
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Affiliation(s)
- Won Seok Lee
- Department of Pediatrics, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Republic of Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Boeun Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
- Multi-Omics Research Center, CHA Future Medicine Research Institute, Seongnam, Republic of Korea
| | - Gi Chun Lee
- Department of Computer Science and Engineering, Konkuk University, Seoul, Republic of Korea
| | - Hye Ri Jung
- School of Medicine, CHA University, Pocheon, Republic of Korea
| | - Ye Jin Shin
- School of Medicine, CHA University, Pocheon, Republic of Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea.
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Jin T, Huang T, Zhang T, Li Q, Yan C, Wang Q, Chen X, Zhou J, Sun Y, Bo W, Luo Z, Li H, An Y. A Bayesian benchmark concentration analysis for urinary fluoride and intelligence in adults in Guizhou, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 925:171326. [PMID: 38460703 DOI: 10.1016/j.scitotenv.2024.171326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
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.
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Affiliation(s)
- Tingxu Jin
- Department of Toxicology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, Jiangsu, China; School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China.
| | - Tongtong Huang
- Department of Toxicology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, Jiangsu, China
| | - Tianxue Zhang
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China
| | - Quan Li
- Center for Disease Control and Prevention, Nayong County, 553300 Bijie City, Guizhou Province, China
| | - Cheng Yan
- School of Environmental Studies, China University of Geosciences, Wuhan 430074, China; Hubei Key Laboratory of Environmental Water Science in the Yangtze River Basin, China University of Geosciences, Wuhan 430074, China
| | - Qian Wang
- Center for Disease Control and Prevention, Nayong County, 553300 Bijie City, Guizhou Province, China
| | - Xiufang Chen
- Center for Disease Control and Prevention, Nayong County, 553300 Bijie City, Guizhou Province, China
| | - Jing Zhou
- Center for Disease Control and Prevention, Nayong County, 553300 Bijie City, Guizhou Province, China
| | - Yitong Sun
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China
| | - Wenqing Bo
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China
| | - Ziqi Luo
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China
| | - Haodong Li
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China
| | - Yan An
- Department of Toxicology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou 215123, Jiangsu, China.
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Goin DE, Padula AM, Woodruff TJ, Sherris A, Charbonneau K, Morello-Frosch R. Water Fluoridation and Birth Outcomes in California. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:57004. [PMID: 38752991 PMCID: PMC11098007 DOI: 10.1289/ehp13732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND There is a lack of research on the relationship between water fluoridation and pregnancy outcomes. OBJECTIVES We assessed whether hypothetical interventions to reduce fluoride levels would improve birth outcomes in California. METHODS We linked California birth records from 2000 to 2018 to annual average fluoride levels by community water system. Fluoride levels were collected from consumer confidence reports using publicly available data and public record requests. We estimated the effects of a hypothetical intervention reducing water fluoride levels to 0.7 ppm (the current level recommended by the US Department of Health and Human Services) and 0.5 ppm (below the current recommendation) on birth weight, birth-weight-for-gestational age z-scores, gestational age, preterm birth, small-for-gestational age, large-for-gestational age, and macrosomia using linear regression with natural cubic splines and G-computation. Inference was calculated using a clustered bootstrap with Wald-type confidence intervals. We evaluated race/ethnicity, health insurance type, fetal sex, and arsenic levels as potential effect modifiers. RESULTS Fluoride levels ranged from 0 to 2.5 ppm , with a median of 0.51 ppm . There was a small negative association on birth weight with the hypothetical intervention to reduce fluoride levels to 0.7 ppm [- 2.2 g ; 95% confidence interval (CI): - 4.4 , 0.0] and to 0.5 ppm (- 5.8 g ; 95% CI: - 10.0 , - 1.6 ). There were small negative associations with birth-weight-for-gestational-age z-scores for both hypothetical interventions (0.7 ppm : - 0.004 ; 95% CI: - 0.007 , 0.000 and 0.5 ppm : - 0.006 ; 95% CI: - 0.013 , 0.000). We also observed small negative associations for risk of large-for-gestational age for both the hypothetical interventions to 0.7 ppm [risk difference ( RD ) = - 0.001 ; 95% CI: - 0.002 , 0.000 and 0.5 ppm (- 0.001 ; 95% CI: - 0.003 , 0.000)]. We did not observe any associations with preterm birth or with being small for gestational age for either hypothetical intervention. We did not observe any associations with risk of preterm birth or small-for-gestational age for either hypothetical intervention. CONCLUSION We estimated that a reduction in water fluoride levels would modestly decrease birth weight and birth-weight-for-gestational-age z-scores in California. https://doi.org/10.1289/EHP13732.
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Affiliation(s)
- Dana E. Goin
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Amy M. Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Tracey J. Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Allison Sherris
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Palo Alto, California, USA
| | - Kiley Charbonneau
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy, and Management, University of California, Berkeley, Berkeley, California, USA
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
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9
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Malin AJ, Eckel SP, Hu H, Martinez-Mier EA, Hernandez-Castro I, Yang T, Farzan SF, Habre R, Breton CV, Bastain TM. Maternal Urinary Fluoride and Child Neurobehavior at Age 36 Months. JAMA Netw Open 2024; 7:e2411987. [PMID: 38767917 PMCID: PMC11107298 DOI: 10.1001/jamanetworkopen.2024.11987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/18/2024] [Indexed: 05/22/2024] Open
Abstract
Importance Recent studies in Canadian and Mexican populations suggest an association of higher prenatal fluoride exposure with poorer neurobehavioral development, but whether this association holds for US-based populations is unknown. Objective To examine associations of third trimester maternal urinary fluoride (MUF) with child neurobehavior at age 3 years in the US. Design, Setting, and Participants This prospective cohort study utilized urine samples archived from 2017 to 2020 and neurobehavioral data assessed from 2020 to 2023 from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort, which consisted of predominately Hispanic women residing in Los Angeles, California. Cohort eligibility criteria at recruitment included being 18 years of age or older, less than 30 weeks' gestation, and a fluent English or Spanish speaker. Exclusion criteria included having a disability preventing participation or provision of informed consent, being HIV positive or incarcerated, and having a multiple gestation pregnancy. There were 263 mother-child pairs who completed the 3-year study visit. In this analysis, women who reported prenatal smoking were excluded. Data analysis was conducted from October 2022 to March 2024. Exposure Specific gravity-adjusted MUF (MUFSG), a biomarker of prenatal fluoride exposure. Main Outcomes and Measures Neurobehavior was quantified using the Preschool Child Behavior Checklist (CBCL), which included composite scores for Total Problems, Internalizing Problems, and Externalizing Problems. CBCL composite T scores range from 28 to 100. T scores from 60 to 63 are in the borderline clinical range, whereas scores above 63 are in the clinical range. Linear and logistic regression models adjusted for covariates were conducted. Results A total of 229 mother-child pairs (mean [SD] maternal age, 29.45 [5.67] years; 116 female children [50.7%] and 113 male children [49.3%]) who had MUFSG measured were included in the study. Median (IQR) MUFSG was 0.76 (0.51-1.19) mg/L, and 32 participants (14.0%) had a Total Problems T score in the borderline clinical or clinical range. A 1-IQR (0.68 mg/L) increase in MUFSG was associated with nearly double the odds of the Total Problems T score being in the borderline clinical or clinical range (odds ratio, 1.83; 95% CI, 1.17-2.86; P = .008), as well as with a 2.29-point increase in T score for the Internalizing Problems composite (B = 2.29; 95% CI, 0.47-4.11; P = .01) and a 2.14-point increase in T score for the Total Problems composite (B = 2.14; 95% CI, 0.29-3.98; P = .02). Conclusions and Relevance In this prospective cohort study of mother-child pairs in Los Angeles, California, prenatal fluoride exposure was associated with increased neurobehavioral problems. These findings suggest that there may be a need to establish recommendations for limiting fluoride exposure during the prenatal period.
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Affiliation(s)
- Ashley J. Malin
- Department of Epidemiology, College of Public Health and Health Professions University of Florida, Gainesville
- College of Medicine, University of Florida, Gainesville
| | - Sandrah P. Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles
| | - Howard Hu
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles
| | - E. Angeles Martinez-Mier
- Department of Dental Public Health and Dental Informatics, School of Dentistry, Indiana University, Indianapolis
| | - Ixel Hernandez-Castro
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles
| | - Tingyu Yang
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles
| | - Shohreh F. Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles
| | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles
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10
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Singh V, Suresh LT, Sutter JP, Bar AK. Selective fluoride sensing by a novel series of lanthanide-based one-dimensional coordination polymers through intramolecular proton transfer. Dalton Trans 2024; 53:7436-7449. [PMID: 38592674 DOI: 10.1039/d4dt00598h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
A novel series of one-dimensional coordination polymers (CPs) is achieved via a facile one-pot synthesis strategy employing the nitrate salts of trivalent lanthanides, a pentadentate chelating ligand, and triphenylphosphine oxide at a controlled stoichiometry under ambient conditions. All the CPs are characterized comprehensively using spectroscopic, X-ray crystallographic and magnetometric studies. The CPs are found to be thermally stable up to a significantly high temperature and resistant to water for an indefinite time. They are photoactive and exhibit selective fluoride ion (F-) sensing with excellent efficiency both colorimetrically and fluorimetrically in the solid-state as well as in solution. The presence of F- concomitantly sensitizes the photoluminescence enhancement and visual decolourization of the CPs in solution owing to the ground-state intra-molecular proton transfer. The photophysical response of the CPs to F- in solution was found to be instantaneous (<30 s). The sensitivity of detection is observed to be significantly high over a wide range of F- concentrations, covering the beneficial and detrimental domains of F- concentrations in drinking water. The limit of detection (LoD) under ambient conditions was found to be in the micromolar (μM) range-the best being 0.22 μM found using UV-vis spectrometry and 7.5 μM using fluorimetry. In comparison, the USEPA standard cut-off for the upper limit of F- concentration in drinking water is 211 μM, and the LoD of measuring F- concentration using the USEPA standard method using a fluoride-selective electrode is 26.3 μM. The CPs display markedly high selectivity toward F- with negligible-to-no interference from the commonly abundant ions (Cl-, Br-, I-, CH3CO2-, CO32-, SO42-, HPO42-, NH4+, Na+, K+, Mg2+, and Ca2+) in terms of UV-vis spectral change. Moreover, they also exhibit solid-state IR-spectrometric sensitivity towards F- under ambient conditions.
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Affiliation(s)
- Vaibhav Singh
- Department of Chemistry, Indian Institute of Science Education and Research Tirupati, Tirupati - 517507, Andhra Pradesh, India.
| | - Lakshmi Thachanadan Suresh
- Department of Chemistry, Indian Institute of Science Education and Research Tirupati, Tirupati - 517507, Andhra Pradesh, India.
| | - Jean-Pascal Sutter
- Laboratoire de Chimie de Coordination du CNRS (LCC-CNRS), Université de Toulouse, CNRS, Toulouse, France.
| | - Arun Kumar Bar
- Department of Chemistry, Indian Institute of Science Education and Research Tirupati, Tirupati - 517507, Andhra Pradesh, India.
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11
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Lee JN, Hill CM, Chi DL. Using Policy Briefs to Communicate Dental Research Findings to Policymakers. JDR Clin Trans Res 2024; 9:150-159. [PMID: 37317831 DOI: 10.1177/23800844231171831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES New scientific knowledge is not always available to decision makers. Policy briefs are a way that dental researchers can communicate research findings to policymakers. This study compares usefulness of 2 types of policy briefs about sugar-sweetened beverage (SSB) intake and tooth decay. METHODS We developed 2 policy brief types (data focused and narrative focused) and emailed a randomly assigned policy brief to 825 policymakers and staff from 3 levels of government (city, county, and state) in Washington State. Participants completed a 22-item online questionnaire. There were 4 study outcomes: whether the brief was understandable, whether the brief was credible, likelihood of use, and likelihood to be shared (each measured on a 5-point Likert-like scale). The t test was used to evaluate whether outcomes differed by policy brief type and government level (α = 0.05). RESULTS There were 108 respondents (adjusted response rate 14.6%). About 41.6% of participants were in city government, 26.9% were in county government, and 29.6% were in state government. Participants reported that both data- and narrative-focused briefs were understandable (mean rating [MR] and standard deviation [SD]: 4.15 ± 0.68 and 4.09 ± 0.81, respectively; P = 0.65) and credible (MR and SD: 4.13 ± 0.70 and 4.09 ± 0.70, respectively; P = 0.74), but they were not likely to use (MR and SD: 2.71 ± 1.15 and 2.55 ± 1.28, respectively; P = 0.51) or share it (MR and SD: 2.62 ± 1.04 and 2.66 ± 1.30, respectively; P = 0.87). The likelihood of sharing briefs differed significantly by level of government (P = 0.017). Participants at the state level were more likely to share information from the briefs (mean rating and SD: 3.10 ± 0.80) than city- and county-level participants (MR and SD: 2.62 ± 1.27, and 2.24 ± 1.21, respectively). CONCLUSION Both data- and narrative-focused policy briefs may be a useful way to communicate dental research findings to policymakers, but additional steps are needed to ensure that briefs are used and shared. KNOWLEDGE TRANSFER STATEMENT Researchers should disseminate their research findings to maximize scientific impact. Our study findings indicate that policy briefs may be a useful way to communicate dental research findings to policymakers, but additional research is needed on the best ways to disseminate findings.
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Affiliation(s)
- J N Lee
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - C M Hill
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - D L Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
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12
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Pontigo-Loyola AP, Mendoza-Rodriguez M, de la Rosa-Santillana R, Rivera-Pacheco MG, Islas-Granillo H, Casanova-Rosado JF, Márquez-Corona MDL, Navarrete-Hernández JDJ, Medina-Solís CE, Manton DJ. Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods. Pediatr Rep 2024; 16:243-253. [PMID: 38651460 PMCID: PMC11036215 DOI: 10.3390/pediatric16020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
The maintenance of oral health is a crucial aspect of general well-being; however, a significant proportion of the worldwide population experiences a range of oral diseases. Dental caries is a highly prevalent non-communicable disease globally, especially in children and adolescents. Fluoride is involved in the control of dental caries, primarily by decreasing the critical pH for dental hard tissue dissolution and decreasing enamel solubility. Due to the substantial data supporting the efficacy of fluoride in controlling dental caries, many community-level fluoridation initiatives have been devised and executed as global public health preventive interventions. These initiatives encompass the fluoridation of water, salt, and milk. Water fluoridation is considered safe and effective when fluoride levels are maintained within the recommended range (0.6 to 1.1 mg/L). Salt fluoridation has a cariostatic potential similar to that of water fluoridation, and a fluoride concentration of 250 micrograms per gram in salt is not associated with an increased risk of developing dental fluorosis. However, there is currently an effort to reduce the consumption of table salt in order to mitigate the harmful effects of excessive salt consumption. It has been hypothesized that fluoride food supplementation, such as fluoridated milk, is associated with a decrease in caries experience in permanent teeth; however, the effect is not clear in primary teeth. Public-level fluoride interventions are more cost-effective than the operative care of caries lesions and limit the burden of care. The administration of fluorides should be conducted using safe methods, limiting ingestion, and adhering to the guidelines set by international and national health agencies in each country. This is particularly important when considering children with developing dentitions. Fluoride is an important tool in the control of dental caries, but it is crucial to combine it with good oral hygiene, a healthy diet, and regular visits to a dental professional to maintain long-term oral health.
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Affiliation(s)
- América Patricia Pontigo-Loyola
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Martha Mendoza-Rodriguez
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Rubén de la Rosa-Santillana
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Maria Gracia Rivera-Pacheco
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
- Department of Cariology, Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Horacio Islas-Granillo
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | | | - María de Lourdes Márquez-Corona
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - José de Jesús Navarrete-Hernández
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Carlo Eduardo Medina-Solís
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
- Advanced Studies and Research Center in Dentistry “Dr. Keisaburo Miyata” of Faculty of Dentistry, Autonomous University of the State of Mexico, Toluca 50130, Mexico
| | - David J. Manton
- Department of Cariology, Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
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13
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Sanders AE, Divaris K, Godebo TR, Slade GD. Effect of bottled fluoridated water to prevent dental caries in primary teeth: study protocol for a phase 2 parallel-group 3.5-year randomized controlled clinical trial (waterBEST). Trials 2024; 25:167. [PMID: 38443989 PMCID: PMC10913546 DOI: 10.1186/s13063-024-08000-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Fluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles. METHODS waterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo-controlled, parallel-group trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first 4 years of life. Two hundred children living in eastern North Carolina, USA, and aged 2-6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child's home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children's water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child's fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit. DISCUSSION waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has the potential to prevent early childhood caries in a large segment of the US population that currently does not benefit from fluoridated public water. TRIAL REGISTRATION ClinicalTrials.gov NCT04893681. Registered on March 2022. Last update posted on 10 October 2023. https://clinicaltrials.gov/study/NCT04893681?cond=Dental%20Caries%20in%20Children&term=fluoride&locStr=North%20Carolina,%20USA&country=United%20States&state=North%20Carolina&distance=50&rank=1.
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Affiliation(s)
- Anne E Sanders
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kimon Divaris
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tewodros R Godebo
- Department of Environmental Health Sciences, Tulane University, New Orleans, LA, USA
| | - Gary D Slade
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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14
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Sanders AE, Godebo TR, Divaris K, Slade GD. Effect of bottled fluoridated water to prevent dental caries in primary teeth: study protocol for a phase 2 parallel group 3.5-year randomized controlled clinical trial (waterBEST). RESEARCH SQUARE 2024:rs.3.rs-3632524. [PMID: 38410455 PMCID: PMC10896389 DOI: 10.21203/rs.3.rs-3632524/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background Fluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles. Methods waterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo controlled, parallel group, trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first four years of life. Two hundred children living in eastern North Carolina, USA, and aged 2-6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child's home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children's water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child's fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit. Discussion waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has potential to prevent early childhood caries in a large segment of the U.S. population that currently does not benefit from fluoridated public water.
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Affiliation(s)
- Anne E Sanders
- UNC-Chapel Hill: The University of North Carolina at Chapel Hill
| | | | - Kimon Divaris
- UNC-Chapel Hill: The University of North Carolina at Chapel Hill
| | - Gary D Slade
- UNC-Chapel Hill: The University of North Carolina at Chapel Hill
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15
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Zheng FM, Yan IG, Sun IG, Duangthip D, Lo ECM, Chu CH. Early Childhood Caries and Dental Public Health Programmes in Hong Kong. Int Dent J 2024; 74:35-41. [PMID: 37839956 PMCID: PMC10829355 DOI: 10.1016/j.identj.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 10/17/2023] Open
Abstract
The objective of this study was to investigate the relationship amongst early childhood caries (ECC), economic development, and dental public health programmes in Hong Kong. We searched exhaustively qualitative and quantitative data on the oral health policy, dental service, public health strategies of caries control and epidemiologic surveys on ECC. We then performed meta-regression to explore the impact of the Human Development Index (HDI), gross domestic product (GDP) growth, water fluoridation, oral health promotion, dental school establishment, free education, and dental workforce on ECC prevalence in 5-year-olds. We found that the first government oral health survey was conducted in 1960, when Hong Kong experienced significant growth, as the HDI indicated. The survey revealed that 97% of 6- to 8-year-old children experienced ECC. Water fluoridation was implemented in 1961 at 0.7 ppm (0.9 ppm in winter) to prevent caries. The government offered free 9-year education in 1978. In 1981, the government established a dental school to improve a low dentist-to-population ratio of 1:9000. The ECC prevalence amongst 5- to 6- year-old children was reduced from 84% in 1968 to 63% in 1986. The Department of Health created an oral health education division in 1989. The ECC prevalence for 5-year-old children was further reduced to 44% in 1997. The ECC prevalence amongst 5-year-old children was stabilised at 51% both in 2001 and 2011. However in 2021, the prevalence of untreated ECC increased to 57% during the outbreak of COVID-19. Meta-regression analysis showed that ECC prevalence was not linked to GDP growth but decreased with improvements in HDI, the provision of 9-year free education, the establishment of a dental school, fluoridation of water supply, and implementation of territory-wide oral health promotion. In conclusion, better education, living conditions, and dental public health programmes have improved children's oral health in Hong Kong.
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Affiliation(s)
| | - Iliana Gehui Yan
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Ivy Guofang Sun
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | | | | | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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16
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Kumar S, Chhabra V, Mehra M, K S, Kumar B H, Shenoy S, Swamy RS, Murti K, Pai KSR, Kumar N. The fluorosis conundrum: bridging the gap between science and public health. Toxicol Mech Methods 2024; 34:214-235. [PMID: 37921264 DOI: 10.1080/15376516.2023.2268722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
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.
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Affiliation(s)
- Sachindra Kumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Vishal Chhabra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Hajipur, India
| | - Manmeet Mehra
- Department of Pharmacology, Guru Nanak Dev University, Amritsar, India
| | - Saranya K
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, India
| | - Harish Kumar B
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Smita Shenoy
- Department of Pharmacology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Ravindra Shantakumar Swamy
- Division of Anatomy, Department of Basic Medical Sciences (DBMS), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, India
| | - K Sreedhara Ranganath Pai
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Nitesh Kumar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Hajipur, India
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Sudradjat H, Meyer F, Fandrich P, Schulze Zur Wiesche E, Limeback H, Enax J. Doses of fluoride toothpaste for children up to 24 months. BDJ Open 2024; 10:7. [PMID: 38296947 PMCID: PMC10831090 DOI: 10.1038/s41405-024-00187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024] Open
Abstract
AIM The aim of this study was to test the dose of fluoride toothpaste by parents for their children aged up to 24 months. METHODS Parents who use fluoride toothpastes for their children were asked to dose two commercially available toothpastes (A and B) with 1000 ppm fluoride each for their children as they would normally do at home. The toothpaste amounts were weighed, and as reference, the weight of an 'optimal' grain of rice-size amount of each toothpaste was used. RESULTS 61 parents dosed a mean of 0.263 ± 0.172 g toothpaste A and 0.281 ± 0.145 g toothpaste B. The parents' mean doses were 5.9 times higher for toothpaste A and 7.2 times higher for toothpaste B than an 'optimal' grain of rice-size amount (the reference dose as recommended). The difference between parent's and reference dose was statistically significant (p < 0.001). Moreover, 39.3% of parents were not aware about conditions of use and warnings that have to be printed on the package of fluoride toothpastes. CONCLUSION In this study, parents significantly overdosed the toothpaste for their children. To avoid fluoride intake from toothpaste, parents can choose fluoride-free alternatives for the oral care of their infants and toddlers.
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Affiliation(s)
- Henny Sudradjat
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
- Private dental practice, Braunschweig, Germany
| | - Frederic Meyer
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
| | - Pascal Fandrich
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
| | - Erik Schulze Zur Wiesche
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
| | - Hardy Limeback
- Faculty of Dentistry, University of Toronto, Toronto, ON, M5G 1G6, Canada
| | - Joachim Enax
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany.
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India Aldana S, Colicino E, Cantoral Preciado A, Tolentino M, Baccarelli AA, Wright RO, Téllez Rojo MM, Valvi D. Longitudinal associations between early-life fluoride exposures and cardiometabolic outcomes in school-aged children. ENVIRONMENT INTERNATIONAL 2024; 183:108375. [PMID: 38128386 PMCID: PMC10842303 DOI: 10.1016/j.envint.2023.108375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND/AIM Fluoride is a natural mineral present in food, water, and dental products, constituting ubiquitous long-term exposure in early childhood and across the lifespan. Experimental evidence shows fluoride-induced lipid disturbances with potential implications for cardiometabolic health. However, epidemiological studies are scarce. For the first time, we evaluated associations between repeated fluoride measures and cardiometabolic outcomes in children. METHODS We studied ∼ 500 Mexican children from the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) cohort with measurements on urinary fluoride at age 4, and dietary fluoride at ages 4, 6, and 8 years approximately. We used covariate-adjusted linear mixed-effects and linear regression models to assess fluoride associations with multiple cardiometabolic outcomes (ages 4-8): lipids (total cholesterol, HDL, LDL, and triglycerides), glucose, HbA1c, adipokines (leptin and adiponectin), body fat, and age- and sex-specific z-scores of body mass index (zBMI), waist circumference, and blood pressure. RESULTS Dietary fluoride intake at age 4 was associated with annual increases in triglycerides [β per-fluoride-doubling = 2.02 (95 % CI: 0.37, 3.69)], cholesterol [β = 1.46 (95 % CI: 0.52, 2.39)], HDL [β = 0.39 (95 % CI: 0.02, 0.76)], LDL [β = 0.87 (95 % CI: 0.02, 1.71)], and HbA1c [β = 0.76 (95 % CI: 0.28, 1.24)], and decreased leptin [β = -3.58 (95 % CI: -6.34, -0.75)] between the ages 4 and 8. In cross-sectional analyses at age 8, higher tertiles of fluoride exposure were associated with increases in zBMI, triglycerides, glucose, and leptin (p-tertile trend < 0.05). Stronger associations were observed in boys at year 8 and in girls prior to year 8 (p-sex interaction < 0.05). Fewer but consistent associations were observed for urinary fluoride at age 4, indicating increased annual changes in HDL and HbA1c with higher fluoride levels. CONCLUSION Dietary fluoride exposures in early- and mid-childhood were associated with adverse cardiometabolic outcomes in school-aged children. Further research is needed to elucidate whether these associations persist at later ages.
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Affiliation(s)
- Sandra India Aldana
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Maricruz Tolentino
- Department of Nutrition, National Institute of Perinatology, Mexico City, Mexico
| | - Andrea A Baccarelli
- Departments of Environmental Health Sciences and Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martha María Téllez Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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19
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Hefferon R, Goin DE, Sarnat JA, Nigra AE. Regional and racial/ethnic inequalities in public drinking water fluoride concentrations across the US. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:68-76. [PMID: 37391608 PMCID: PMC10756931 DOI: 10.1038/s41370-023-00570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Although the US Centers for Disease Control and Prevention (CDC) considers fluoridation of community water systems (CWSs) to be a major public health achievement responsible for reducing dental disease, recent epidemiologic evidence suggests that chronic exposure to population-relevant levels of fluoride may also be associated with adverse child neurodevelopmental outcomes. To our knowledge, a nationally representative database of CWS fluoride concentration estimates that can be readily linked to US epidemiologic cohorts for further study is not publicly available. Our objectives were to evaluate broad regional and sociodemographic inequalities in CWS fluoride concentrations across the US, and to determine if county-level racial/ethnic composition was associated with county-level CWS fluoride. METHODS We generated CWS-level (N = 32,495) and population weighted county-level (N = 2152) fluoride concentration estimates using over 250,000 routine compliance monitoring records collected from the US Environmental Protection Agency's (EPA) Third Six Year Review (2006-2011). We compared CWS-level fluoride distributions across subgroups including region, population size served, and county sociodemographic characteristics. In county-level spatial error models, we also evaluated geometric mean ratios (GMRs) of CWS fluoride per 10% higher proportion of residents belonging to a given racial/ethnic subgroup. RESULTS 4.5% of CWSs (serving >2.9 million residents) reported mean 2006-2011 fluoride concentrations ≥1500 µg/L (the World Health Organization's guideline for drinking water quality). Arithmetic mean, 90th, and 95th percentile contaminant concentrations were greatest in CWSs reliant on groundwater, located in the Southwest and Eastern Midwest, and serving Semi-Urban, Hispanic communities. In fully adjusted spatial error models, the GMR (95% CI) of CWS fluoride per a 10% higher proportion of county residents that were Hispanic/Latino was 1.16 (1.10, 1.23). IMPACT STATEMENT We find that over 2.9 million US residents are served by public water systems with average fluoride concentrations exceeding the World Health Organization's guidance limit. We also find significant inequalities in community water system fluoride concentration estimates (2006-2011) across the US, especially for Hispanic/Latino communities who also experience elevated arsenic and uranium in regulated public drinking water systems. Our fluoride estimates can be leveraged in future epidemiologic studies to assess the potential association between chronic fluoride exposure and related adverse outcomes.
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Affiliation(s)
- Rose Hefferon
- Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Dana E Goin
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Jeremy A Sarnat
- Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Anne E Nigra
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
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20
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Gamar Elanbya MO, Ramadan AM. Fluoride levels in Almadinah Almunawwarah bottled water. J Taibah Univ Med Sci 2023; 18:1500-1506. [PMID: 38162876 PMCID: PMC10757310 DOI: 10.1016/j.jtumed.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/12/2023] [Accepted: 06/09/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives This research aimed to determine the fluoride levels in commercially available bottled waters and assess the accuracy of the fluoride levels labels on the bottles. Methods We obtained the labels from 28 water bottles from markets in Almadinah Almunawwarah. Water samples were diluted with an equal volume of total ionic strength adjustment buffer at the General Administration for Water Services. The electrode potential of each sample was then directly compared to standard fluoride solutions. For each sample, two readings were taken, and the average was recorded. Fluoride-ion levels were determined using a fluoride-ion-selective electrode and a digital readout ion meter. Results On average, the mean fluoride levels in the labelled bottles were 0.94 ± 0.14 PPM. The level of the actual fluoride content was 1.13 ± 0.31 PPM. Inconsistencies between the brand labels and true levels of fluoride were detected. Only one brand of bottled water was comparable in terms of the fluoride levels on the labels and the analysed fluoride levels. Only 85.71% of the brands tested had fluoride levels within the permissible fluoride range (0.6-1.5 PPM), 10.71% had fluoride levels above the permissible fluoride range, and 3.57% had fluoride levels below the permissible fluoride range. Conclusions In the KSA, most brands of bottled waters had fluoride levels above the ideal levels that are vital to the prevention of dental caries. There were differences in the fluoride levels recorded on the labels and the true levels determined in the laboratory. Fluoride levels must be accurately reported if we are to achieve necessary aesthetic and cosmetic benefits. Bottled water must meet critical quality standards to avoid the negative consequences of higher fluoride levels. Dentists and parents should be aware of this discrepancy.
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Affiliation(s)
- May O. Gamar Elanbya
- Department of Preventive Dental Sciences, Taibah University, Almadinah Almunawwarah, KSA
| | - AbdelRahman M. Ramadan
- Programme Director of Periodontology for Saudi Commission for Health Specialist at Ibn Sina National College for Medical Sciences, Jeddah, KSA
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21
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Veneri F, Iamandii I, Vinceti M, Birnbaum LS, Generali L, Consolo U, Filippini T. Fluoride Exposure and Skeletal Fluorosis: a Systematic Review and Dose-response Meta-analysis. Curr Environ Health Rep 2023; 10:417-441. [PMID: 37861949 DOI: 10.1007/s40572-023-00412-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
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.
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Affiliation(s)
- Federica Veneri
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), Unit of Dentistry & Oral-Maxillo-Facial Surgery - University of Modena and Reggio Emilia, 41124, Modena, Italy
- PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences - University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Inga Iamandii
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, Medical School - University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, Medical School - University of Modena and Reggio Emilia, 41124, Modena, Italy.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02215, USA.
| | - Linda S Birnbaum
- Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA
| | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), Unit of Dentistry & Oral-Maxillo-Facial Surgery - University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), Unit of Dentistry & Oral-Maxillo-Facial Surgery - University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, Medical School - University of Modena and Reggio Emilia, 41124, Modena, Italy
- School of Public Health, University of California Berkeley, Berkeley, CA, 94720, USA
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22
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Wang L, Zhang Y, Wang L, Cheng Y, Yuan D, Zhai J, Xie X. Near-Infrared Fluoride Sensing Nano-Optodes and Distance-Based Hydrogels Containing Aluminum-Phthalocyanine. ACS Sens 2023; 8:4384-4390. [PMID: 37963263 DOI: 10.1021/acssensors.3c01848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Fluoride ions are highly relevant in environmental and biological sciences, and there is a very limited number of established fluoride chemical sensors. Previous fluoride-selective optodes were demonstrated with metal-porphyrin as the ionophore and required a chromoionophore for optical signal transduction. We demonstrate here novel optical fluoride sensing with nano-optodes containing an aluminum-phthalocyanine complex (AlClPc) as the single active sensing component, simplifying the conventional ion-selective optodes approach. The fluoride nano-optodes were interrogated in the absorbance and fluorescence modes in the near-infrared region, with absorption around 725 nm and emission peaks at 720 and 800 nm, respectively. The nano-optodes exhibited a lower detection limit around 0.1 μM and good selectivity over a range of common anions including ClO4-, Cl-, Br-, I-, SO42-, NO3-, and AcO-. Furthermore, the nano-optodes were physically entrapped in agarose hydrogels to allow distance-based point-of-care testing (POCT) applications. The 3D networks of the agarose hydrogel were able to filter off large particulates in the samples without stopping fluoride ions to reach the nano-optodes. The fluoride concentrations in real samples including river water, mineral water, and groundwater were successfully determined with the distance-based sensing hydrogel, and the results agreed well with those from commercial fluoride electrodes. Therefore, the results in this work lay the groundwork for the optical detection of fluoride in environmental samples without very sophisticated sample manipulation.
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Affiliation(s)
- Lanfei Wang
- Department of Chemistry, Southern University of Science and Technology, Shenzhen 518055, China
| | - Ye Zhang
- Laboratory of Functionalized Molecular Solids, Ministry of Education, Anhui Province Key Laboratory of Biomedical Materials and Chemical Measurement, College of Chemistry and Materials Science, Anhui Normal University, Wuhu 241002, P. R. China
| | - Liyuan Wang
- Laboratory of Functionalized Molecular Solids, Ministry of Education, Anhui Province Key Laboratory of Biomedical Materials and Chemical Measurement, College of Chemistry and Materials Science, Anhui Normal University, Wuhu 241002, P. R. China
| | - Yu Cheng
- Department of Chemistry, Southern University of Science and Technology, Shenzhen 518055, China
| | - Dajing Yuan
- Laboratory of Functionalized Molecular Solids, Ministry of Education, Anhui Province Key Laboratory of Biomedical Materials and Chemical Measurement, College of Chemistry and Materials Science, Anhui Normal University, Wuhu 241002, P. R. China
| | - Jingying Zhai
- Academy for Advanced Interdisciplinary Studies, Southern University of Science and Technology, Shenzhen 518055, China
| | - Xiaojiang Xie
- Department of Chemistry, Southern University of Science and Technology, Shenzhen 518055, China
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23
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Hung M, Mohajeri A, Chiang J, Park J, Bautista B, Hardy C, Lipsky MS. Community Water Fluoridation in Focus: A Comprehensive Look at Fluoridation Levels across America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7100. [PMID: 38063530 PMCID: PMC10706776 DOI: 10.3390/ijerph20237100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
Objective: This study reports on the number and percentage of community water systems (CWSs) meeting fluoride concentration standards set by the U.S. Department of Health and Human Services (DHHS). The study also explored changes in the population exposed to optimally fluoridated water in these systems between 2006 and 2020. Methods: This study analyzed U.S. Centers for Disease Control and Prevention data from 2006 to 2020, tabulating state-specific CWS fluoridation rates, ranking them, and calculating the percent change. Results: In 2020, 72.7% of the US population received CWS water, with 62.9% of those individuals served by a CWS system meeting DHHS fluoridation standards. This compares to 69.2% receiving CWS water in 2006 and 74.6% in 2012. The overall change in those receiving fluoridated water was 1.4%, from 61.5% in 2006 to 62.9% in 2020. State-specific percentages ranged from 8.5% in Hawaii to 100% in Washington DC in 2020 (median: 76.4%). Conclusions: Although endorsed by the American Dental Association, the percentage of individuals receiving fluoridated water did not increase substantially from 2006 to 2020, indicating that there has not been much progress toward meeting the Healthy People 2030 goal that 77.1% of Americans receive water with enough fluoride to prevent tooth decay.
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Affiliation(s)
- Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
- College of Social Work, University of Utah, Salt Lake City, UT 84112, USA
- Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA
| | - Amir Mohajeri
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Jody Chiang
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Jungweon Park
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- College of Dentistry, Ohio State University, Columbus, OH 43210, USA
| | - Beatrice Bautista
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Chase Hardy
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- College of Dentistry, University of Texas Health Sciences, San Antonio, TX 78253, USA
| | - Martin S. Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- Institute on Aging, Portland State University, Portland, OR 97201, USA
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24
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Senevirathna L, Ratnayake HE, Jayasinghe N, Gao J, Zhou X, Nanayakkara S. Water fluoridation in Australia: A systematic review. ENVIRONMENTAL RESEARCH 2023; 237:116915. [PMID: 37598841 DOI: 10.1016/j.envres.2023.116915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
Water fluoridation is considered a safe and effective public health strategy to improve oral health. This review aimed to systematically summarize the available evidence of water fluoridation in Australia, focusing on the history, health impacts, cost effectiveness, challenges, and limitations. A systematic search was conducted on the Ovid Medline, Web of Science, Scopus, ProQuest Central, Cinahl, and Informit databases to identify literature on water fluoridation in Australia. A grey literature search and backward snowballing were used to capture additional literature. Primary studies, reviews, letters, and opinion papers were included in the quantitative analysis and summarized based on the year of publication and geographical location. The data were extracted from primary studies and summarized under three subheadings: history, community health impacts and the limitations and challenges. Water fluoridation in Australia was first implemented in 1953 in Tasmania. Most states and territories in Australia embraced water fluoridation by 1977 and currently, 89% of the Australian population has access to fluoridated drinking water. Studies report that water fluoridation has reduced dental caries by 26-44% in children, teenagers, and adults, benefiting everyone regardless of age, income, or access to dental care. It has been recognized as a cost-effective intervention to prevent dental caries, especially in rural and low-income areas. Water fluoridation as a public health measure has faced challenges, including political and public opposition, implementation and maintenance costs, access and equity, communication and education, and ethical concerns. Variations in research activities on water fluoridation across Australian states and territories over the last seven decades can be due to several factors, including the time of implementation, funding, and support. Ongoing monitoring and research to review and update optimal fluoride levels in drinking water in Australia is warranted to ensure sustainable benefits on oral health while preventing any adverse impacts.
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Affiliation(s)
- Lalantha Senevirathna
- CSU Engineering, School of Computing, Mathematics and Engineering, Charles Sturt University, Bathurst, Australia; Gulbali Institute for Agriculture, Water and Environment, Charles Sturt University, Albury, Australia
| | | | - Nadeeka Jayasinghe
- CSU Engineering, School of Computing, Mathematics and Engineering, Charles Sturt University, Bathurst, Australia
| | - Jinlong Gao
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute of Dental Research, Westmead Centre for Oral health, Westmead Hospital, Westmead, Australia
| | - Xiaoyan Zhou
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute of Dental Research, Westmead Centre for Oral health, Westmead Hospital, Westmead, Australia
| | - Shanika Nanayakkara
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute of Dental Research, Westmead Centre for Oral health, Westmead Hospital, Westmead, Australia.
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25
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Godebo TR, Jeuland M, Tekle-Haimanot R, Alemayehu B, Shankar A, Wolfe A, Phan N. Association between fluoride exposure in drinking water and cognitive deficits in children: A pilot study. Neurotoxicol Teratol 2023; 100:107293. [PMID: 37690675 DOI: 10.1016/j.ntt.2023.107293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
Fluoride (F) exposure in drinking water may lead to reduced cognitive function among children; however, findings largely remain inconclusive. In this pilot study, we examined associations between a range of chronic F exposures (low to high: 0.4 to 15.5 mg/L) in drinking water and cognition in school-aged children (5-14 years, n = 74) in rural Ethiopia. Fluoride exposure was determined from samples of community-based drinking water wells and urine. Cognitive performance was measured using: 1) assessments of ability to draw familiar objects (donkey, house, and person), and 2) a validated Cambridge Neuropsychological Test Automated Battery's (CANTAB) Paired Associate Learning (PAL), which examines memory and new learning and is closely associated with hippocampus function of the brain. Associations between F and cognitive outcomes were evaluated using regression analysis, adjusting for demographic, health status, and other covariates. The median (range) of water and urine F levels was 7.6 (0.4-15.5 mg/L) and 6.3 (0.5-15.7 mg/L), respectively; these measures were strongly correlated (r = 0.74), indicating that water is the primary source of F exposure. Fluoride in drinking water was negatively associated with cognitive function, measured by both drawing and CANTAB test performance. Inverse relationships were also found between F and drawing objects task scores, after adjusting for covariates (p < 0.05). Further analysis using CANTAB PAL tasks in the children confirmed that F level in drinking water was positively associated with the number of errors made by children (p < 0.01), also after adjusting for covariates (p < 0.05). This association between water F and total errors made became markedly stronger as PAL task difficulty increased. Fluoride exposure was also inversely associated with other PAL tasksthe number of patterns reached, first attempt memory score and mean errors to success. These findings provide supportive evidence that high F exposures may be associated with cognitive deficits in children. Additional well-designed studies are critically needed to establish the neurotoxicity of F in children and adults exposed to both low levels known to protect dental caries, as well as excess F levels in drinking water.
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Affiliation(s)
- Tewodros Rango Godebo
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
| | - Marc Jeuland
- Sanford School of Public Policy and Duke Global Health Institute, Duke University, Durham, NC, 27708, USA
| | - Redda Tekle-Haimanot
- Addis Ababa University, School of Medicine, Department of Neurology, Addis Ababa, Ethiopia
| | - Biniyam Alemayehu
- Addis Ababa University, School of Medicine, Department of Neurology, Addis Ababa, Ethiopia
| | - Arti Shankar
- Department of Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Amy Wolfe
- University of Kentucky, Kentucky Geological Survey, Lexington, KY, 40506, USA
| | - Nati Phan
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
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Kumar J, Crall JJ, Holt K. Oral Health of Women and Children: Progress, Challenges, and Priorities. Matern Child Health J 2023; 27:1930-1942. [PMID: 37477726 PMCID: PMC10564662 DOI: 10.1007/s10995-023-03757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Tooth decay remains the most prevalent chronic disease in children and adults, even though it is largely preventable. Studies show that mothers' oral and overall health is linked to children's oral health and pregnancy outcomes. This paper examines achievements during the last 20 years, assesses current challenges, and discusses future priorities. ORAL HEALTH STATUS Data show a modest improvement in children's oral health during the last 20 years; however, tooth decay still affects more than half of adolescents. According to national survey data, about 26% of working-age adults had untreated tooth decay. Overall, significant oral health disparities by race/ethnicity and income persist. DENTAL SERVICE UTILIZATION The annual dental visit rate for children in the 2015 Medical Expenditure Panel Survey was 48%. Among children enrolled in Medicaid, dental visit rates increased from 18% in 1993 to nearly 50% in 2018. About 46% of women are estimated to receive teeth cleaning during pregnancy. Over the years, race or ethnicity and income-level differences in dental visits observed in the early 2000s have narrowed substantially in children but not among pregnant women. DISCUSSION Many effective interventions are available at the community and individual levels but are underutilized. Lack of integration of oral health into the overall health care system and programs, community conditions, poverty, and limited health literacy make it difficult for families to engage in healthy habits, use preventive interventions, and access treatment promptly. CONCLUSION To further improve oral health, policy and system reforms are needed to address the factors mentioned above. Therefore, we urge the federal Maternal and Child Health Bureau to take steps to convene a workshop to develop a framework for future actions.
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Affiliation(s)
- Jayanth Kumar
- Department of Public Health, MS 7208, 1616 Capitol Avenue, Sacramento, CA 95814 USA
| | | | - Katrina Holt
- Department of Pediatrics, National Maternal and Child Oral Health Resource Center, Georgetown University, 37th and O Streets, N.W, Washington, DC 20057 USA
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Meng X, Wang J, Liu Y, Li M, Guan Z, Sowanoua A, Yang D, Pei J, Gao Y. Relatively low fluoride in drinking water increases risk of knee osteoarthritis (KOA): a population-based cross-sectional study in China. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:8735-8747. [PMID: 37715839 DOI: 10.1007/s10653-023-01742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/21/2023] [Indexed: 09/18/2023]
Abstract
Previous studies indicate that fluoride in drinking water has a toxic effect on cartilage and skeleton, which triggers osteoarthritis (OA) of which the most frequent is knee OA (KOA). A cross-sectional study was conducted to assess the association between fluoride exposure and KOA among 1128 subjects. Water fluoride (WF) and urinary fluoride (UF) were chosen as external exposure (internal exposure) of fluoride. Logistic regression analysis showed that an increased fluoride exposure was a risk factor for KOA (WF: OR = 1.318, 95% CI 1.162-1.495, p < 0.001; UF: OR = 1.210, 95% CI 1.119-1.310, p < 0.001). After adjusting for covariates, the risk of KOA in the 4th quartile (Q) of WF was twice that of the 1st Q (OR = 2.079, 95% CI 1.448-2.986, p < 0.001). The risks of KOA in the 2nd Q, 3rd Q and 4th Q of UF were 1.6, 1.5, and 2.9 times higher than in the 1stQ (OR = 1.597, 95% CI 1.066-2.393, p = 0.023; OR = 1.560, 95% CI 1.043-2.333, p = 0.030; OR = 2.897, 95% CI 1.957-4.288, p < 0.001). The population aged < 60 exposed to the 4th Q of WF (or UF) had a higher risk than the population exposed to the 1st Q of WF (or UF) (ORWF = 1.958, 95% CI 1.249-3.070, p = 0.003; ORUF = 2.923, 95% CI 1.814-4.711, p < 0.001). With increasing UF by Q, the male had a risk of KOA. In conclusion, excessive fluoride dose in drinking water could increase the risk of KOA. Especially, the population with aged < 60, male and obesity more likely to having KOA when they exposed to same higher fluoride.
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Affiliation(s)
- Xinyue Meng
- Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang Province, China
| | - Jian Wang
- Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang Province, China
| | - Yang Liu
- Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang Province, China
| | - Mang Li
- Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang Province, China
| | - Zhizhong Guan
- Department of Pathology and Key Lab of Endemic and Ethnic Diseases, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Alphonse Sowanoua
- Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang Province, China
| | - Dan Yang
- Chongqing Blood Center, Jiulongpo, 400015, Chongqing, China.
- , Chongqing, China.
| | - Junrui Pei
- Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang Province, China.
| | - Yanhui Gao
- Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang Province, China.
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Malin AJ, Hu H, Martínez-Mier EA, Eckel SP, Farzan SF, Howe CG, Funk W, Meeker JD, Habre R, Bastain TM, Breton CV. Urinary fluoride levels and metal co-exposures among pregnant women in Los Angeles, California. Environ Health 2023; 22:74. [PMID: 37880740 PMCID: PMC10601173 DOI: 10.1186/s12940-023-01026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Fluoride is ubiquitous in the United States (US); however, data on biomarkers and patterns of fluoride exposure among US pregnant women are scarce. We examined specific gravity adjusted maternal urinary fluoride (MUFsg) in relation to sociodemographic variables and metal co-exposures among pregnant women in Los Angeles, California. METHODS Participants were from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) cohort. There were 293 and 490 women with MUFsg measured during first and third trimesters, respectively. An intra-class correlation coefficient examined consistency of MUFsg between trimesters. Kruskal-Wallis and Mann-Whitney U tests examined associations of MUFsg with sociodemographic variables. Covariate adjusted linear regression examined associations of MUFsg with blood metals and specific gravity adjusted urine metals among a subsample of participants within and between trimesters. A False Discovery Rate (FDR) correction accounted for multiple comparisons. RESULTS Median (IQR) MUFsg was 0.65 (0.5) mg/L and 0.8 (0.59) mg/L, during trimesters one and three respectively. During both trimesters, MUFsg was higher among older participants, those with higher income, and White, non-Hispanic participants than Hispanic participants. MUFsg was also higher for White, non-Hispanic participants than for Black, non-Hispanic participants in trimester three, and for those with graduate training in trimester one. MUFsg was negatively associated with blood mercury in trimester one and positively associated with blood lead in trimester three. MUFsg was positively associated with various urinary metals, including antimony, barium, cadmium, cobalt, copper, lead, nickel, tin, and zinc in trimesters one and/or three. CONCLUSIONS MUFsg levels observed were comparable to those found in pregnant women in Mexico and Canada that have been associated with poorer neurodevelopmental outcomes. Lower urinary fluoride levels among Hispanic and non-Hispanic Black participants in MADRES compared to non-Hispanic White participants may reflect lower tap water consumption or lower fluoride exposure from other sources. Additional research is needed to examine whether MUFsg levels observed among pregnant women in the US are associated with neurodevelopmental outcomes.
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Affiliation(s)
- Ashley J Malin
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, 32603, USA.
| | - Howard Hu
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 1845 N Soto Street, Los Angeles, CA, 90089-9239, USA
| | - E Angeles Martínez-Mier
- Department of Cariology, Operative Dentistry and Dental Public Health, School of Dentistry, Indiana University, 1121 W. Michigan St., Indianapolis, IN, 46202-2876, USA
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 1845 N Soto Street, Los Angeles, CA, 90089-9239, USA
| | - Shohreh F Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 1845 N Soto Street, Los Angeles, CA, 90089-9239, USA
| | - Caitlin G Howe
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Williamson Translational Research Building, 7th Floor, Lebanon, NH, 03756, USA
| | - William Funk
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr Ste 1400, Chicago, IL, 60611, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, 1420 Washington Hts, Ann Arbor, MI, 48109, USA
| | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 1845 N Soto Street, Los Angeles, CA, 90089-9239, USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 1845 N Soto Street, Los Angeles, CA, 90089-9239, USA
| | - Carrie V Breton
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 1845 N Soto Street, Los Angeles, CA, 90089-9239, USA
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Hung M, Mohajeri A, Vu T, Moparthi H, Lipsky MS. Association between fluoride exposure and blood pressure. J Public Health Res 2023; 12:22799036231204323. [PMID: 37822995 PMCID: PMC10563487 DOI: 10.1177/22799036231204323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/22/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives This study investigated whether fluoride was associated with an increased prevalence of high blood pressure (BP) among adolescents in the United States. Methods The study sample consisted of 2015-2016 National Health and Nutrition Examination Survey participants aged 13-17 years. Independent-samples t-tests, Chi-square tests, and regression models were used to analyze the data. Results A total of 814 participants met the study criteria. The findings showed that the proportion of patients with high levels of water or plasma fluoride in the high BP group was higher than that in the normal BP group. However, after adjusting for sociodemographic covariates, neither water nor plasma fluoride levels were significantly associated with a high BP. Conclusions This study did not find an association between either water or plasma fluoride levels and high BP. Further study is needed to exclude a dose dependent effect at higher levels of fluoride.
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Affiliation(s)
- Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
- Division of Public Health, University of Utah, Salt Lake City, UT, USA
- Veteran Affairs Salt Lake City Health Care, Salt Lake City, UT, USA
| | - Amir Mohajeri
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
| | - Teresa Vu
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
| | - Hyma Moparthi
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
| | - Martin S Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
- Institute on Aging, Portland State University, Portland, OR, USA
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Camayo JS, Gutierrez-Ilave M, Cardenas-Silva W, Mallma-Medina A, Calderon KLM, Espinoza-Carhuancho F, Mayta-Tovalino F. A Bibliometric Study of Trends, Indicators, and Characteristics in the Global Scientific Production on Fluorosis. J Contemp Dent Pract 2023; 24:743-749. [PMID: 38152906 DOI: 10.5005/jp-journals-10024-3579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
AIM To perform an analysis of the trends, indicators, and characteristics of the world scientific production on fluorosis, and to evaluate its impact on scientific research in this field. MATERIALS AND METHODS A descriptive, cross-sectional study was conducted with a bibliometric approach of the worldwide scientific production on fluorosis published during the years 2018-2023. All metadata were extracted from the Scopus database. The articles were exported in .csv format to SciVal (Elsevier). Of the collected articles, 69 were original, 17 were reviews, 2 were conference papers, 6 were book chapters, among others. RESULTS It was found that among the journals with the highest number of articles were Biological Trace Element, Caries Research, Children, Fluoride, and Indian Journal of Forensics. In addition, the highest percentage of authors have published between 1 and 2 articles, with a smaller proportion having 3-4 publications. Among the journals with the highest number of articles are Biological Trace Element, Caries Research, Children, Fluoride, and Indian Journal of Forensics. The Universidade de São Paulo has the most publications, although it is also one of those with the lowest citation-weighted impact in relation to the global average (FWCI: 0.9). CONCLUSION The collaboration map shows a wide international cooperation network, with an active participation of Brazil among Latin American countries. Scientific production in fluorosis has a negative trend from 2018 to 2023 and is mainly concentrated in high-impact scientific journals. CLINICAL SIGNIFICANCE The study shows a wide network of international cooperation on fluorosis, so the results provide important information to guide future clinically focused research on fluorosis and its impact on public health.
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Affiliation(s)
| | - Margot Gutierrez-Ilave
- Department of Academic, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - William Cardenas-Silva
- Department of Academic, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Adrian Mallma-Medina
- Department of Academic, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Fran Espinoza-Carhuancho
- Grupo de Bibliometría, Evaluación de evidencia y Revisiones Sistemáticas (BEERS), Human Medicine Career, Universidad Cientifica del Sur, Lima, Peru
| | - Frank Mayta-Tovalino
- Department of Academic, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru; Grupo de Bibliometría, Evaluación de evidencia y Revisiones Sistemáticas (BEERS), Human Medicine Career, Universidad Cientifica del Sur, Lima, Peru, Phone: +511214-2500, e-mail:
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Lindsay SE, Smith S, Yang S, Yoo J. Community Water Fluoridation and Rate of Pediatric Fractures. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202310000-00001. [PMID: 37796978 PMCID: PMC10558222 DOI: 10.5435/jaaosglobal-d-22-00221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The effect of community water fluoridation on bone fragility and fracture has been inconclusive in the literature. The null hypothesis of this study was that no association was observed between water fluoride level and risk of fracture in children. METHODS Community fluoridation data were obtained from the Centers for Disease Control and Prevention while data on fracture rates were obtained from the PearlDiver database. The rate of fracture type for each state was then compared with state-level fluoridation data using Pearson correlation coefficients and Wilcoxon rank-sum tests. RESULTS Positive correlations were found between the percentage of state water fluoridation and fracture rates for both bone forearm fracture (BBFFx) and femur fracture. Fluoride levels had positive correlations with fracture rates for all fracture types. Increased fracture rates were found between states in the highest quartiles of percentage of state water fluoridation and fluoride water levels for supracondylar humerus fracture and BBFFx. CONCLUSIONS A higher level of water fluoridation was associated with higher rates of supracondylar humerus fracture and BBFFx in children aged 4 to 10 years. These findings do not imply causality, but they suggest that additional investigation into the effect of fluoride on pediatric bone health may be indicated.
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Affiliation(s)
| | - Spencer Smith
- From the Oregon Health & Science University, Portland, OR
| | - Scott Yang
- From the Oregon Health & Science University, Portland, OR
| | - Jung Yoo
- From the Oregon Health & Science University, Portland, OR
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Melough M, Sathyanarayana S, Zohoori F, Gustafsson H, Sullivan E, Chi D, Levy S, McKinney C. Impact of Fluoride on Associations between Free Sugars Intake and Dental Caries in US Children. JDR Clin Trans Res 2023; 8:215-223. [PMID: 35446163 PMCID: PMC10404899 DOI: 10.1177/23800844221093038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Dental caries is the most prevalent chronic disease in US children, with the highest burden among Black and Hispanic youth. Sugars are a primary risk factor, but few studies have specifically measured intakes of free sugars and related this to dental caries or explored the extent to which water fluoride mitigates the cariogenicity of free sugars. Furthermore, the cariogenicity of certain free sugars sources, such as extruded fruit and vegetable products, is unclear. METHODS Using cross-sectional data on 4,906 children aged 2 to 19 y in the US National Health and Nutrition Examination Survey 2013-2016, we examined associations of free sugars intake with counts of decayed or filled primary tooth surfaces (dfs) and decayed, missing, or filled permanent surfaces (DMFS) in negative binomial regressions. Stratified models examined these associations in children with home water fluoride above or below the Centers for Disease Control and Prevention (CDC)-recommended level of 0.7 ppm. RESULTS Free sugars accounted for 16.4% of energy, primarily contributed by added sugars. In adjusted models, a doubling in the percentage of energy from free sugars was associated with 22% (95% confidence interval [CI], 1%-47%) greater dfs among children aged 2 to 8. A doubling in energy from added sugars was associated with 20% (95% CI, 1%-42%) greater dfs and 10% (95% CI, 2%-20%) greater DMFS in children aged 6 to 19 y. Beverages were the most important source of added sugars associated with increased caries. Other free sugars were not associated with dfs or DMFS. Associations between free sugars and caries were diminished among children with home water fluoride of 0.7 ppm or greater. CONCLUSIONS Free sugars intake, especially in the form of added sugars and specifically in sweetened beverages, was associated with higher dental caries. Water fluoride exposures modify these associations, reducing caries risk in the primary dentition of children whose home water meets recommended fluoride levels. KNOWLEDGE TRANSFER STATEMENT Intake of free sugars, especially in the form of added sugars and specifically in beverages, was associated with higher dental caries in US children in this study. Water fluoride exposure at CDC-recommended levels protected against caries, especially in the primary dentition. These findings suggest that household water fluoridation at CDC-recommended levels protects against the cariogenic potential of free and added sugars during childhood.
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Affiliation(s)
- M.M. Melough
- Department of Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, USA
| | - S. Sathyanarayana
- Department of Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, USA
- Departments of Pediatrics and Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - F.V. Zohoori
- Centre for Public Health Research, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - H.C. Gustafsson
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - E.L. Sullivan
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - D.L. Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - S.M. Levy
- Department of Preventive & Community Dentistry, College of Dentistry, and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - C.M. McKinney
- Department of Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
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Lamloum D, Arghittu A, Ferrara P, Castiglia P, Dettori M, Gaeta M, Odone A, Campus G. A Systematic Review of Clinical Practice Guidelines for Caries Prevention following the AGREE II Checklist. Healthcare (Basel) 2023; 11:1895. [PMID: 37444729 DOI: 10.3390/healthcare11131895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/07/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Untreated oral diseases are detrimental to overall well-being and quality of life and are in close relationship with social and economic consequences. The presence of strong evidence for caries primary and secondary prevention is a compulsory tool for the development of clinical practice guidelines (CPGs). This paper was aimed to assess systematically the importance of clinical practice guidelines in caries prevention management considering both the adult and pediatric populations and evaluate them using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Checklist. Records were extracted from EMBASE, SCOPUS, PubMed/Medline and seven other relevant guideline databases between 6 January and 14 February 2023. Two reviewers independently conducted the appraisal using the web-based platform My AGREE PLUS. Twenty-one guidelines/papers met the inclusion criteria and were reviewed. Eight CPGs included both primary and secondary prevention interventions, whereas thirteen presented a single preventive model. Overall, 12 guidelines were published in the USA. The mean AGREE II scores ranged from 35.4% to 84.3%. Of the total twenty-one included guidelines, twelve were classified as "Recommended", ranging from 56.3% to 84.3%, the others were described as "Recommended with modification", ranging from 35.4% to 68.9%. From the AGREE II analysis carried out, the CPGs included in this survey adopted a punctual methodological rigor but lacked applicative power. The present survey showed that the public, as the primary beneficiary, played a limited role in the development of the twenty-one CPGs. Hence, methodological improvement can better support high-quality CPG development in the future.
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Affiliation(s)
- Demetrio Lamloum
- Department of Restorative, Pediatric and Preventive Dentistry, University of Bern, 3012 Bern, Switzerland
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Antonella Arghittu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Pietro Ferrara
- Center for Public Health Research, University of Milan-Bicocca, 20126 Monza, Italy
- IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Paolo Castiglia
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Marco Dettori
- Department of Restorative, Pediatric and Preventive Dentistry, University of Bern, 3012 Bern, Switzerland
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Guglielmo Campus
- Department of Restorative, Pediatric and Preventive Dentistry, University of Bern, 3012 Bern, Switzerland
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Department of Cariology, Saveetha Dental College and Hospitals, Chennai 600077, India
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Zhang S, Zheng Y, Du H, Zhang W, Li H, Ou Y, Xu F, Lin J, Fu H, Ni X, Chang LJ, Shu G. The Pathophysiological Changes and Clinical Effects of Tetramethylpyrazine in ICR Mice with Fluoride-Induced Hepatopathy. Molecules 2023; 28:4849. [PMID: 37375405 DOI: 10.3390/molecules28124849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/04/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The excessive intake of fluoride, one of the trace elements required to maintain health, leads to liver injury. Tetramethylpyrazine (TMP) is a kind of traditional Chinese medicine monomer with a good antioxidant and hepatoprotective function. The aim of this study was to investigate the effect of TMP on liver injury induced by acute fluorosis. A total of 60 1-month-old male ICR mice were selected. All mice were randomly divided into five groups: a control (K) group, a model (F) group, a low-dose (LT) group, a medium-dose (MT) group, and a high-dose (HT) group. The control and model groups were given distilled water, while 40 mg/kg (LT), 80 mg/kg (MT), or 160 mg/kg (HT) of TMP was fed by gavage for two weeks, with a maximum gavage volume for the mice of 0.2 mL/10 g/d. Except for the control group, all groups were given fluoride (35 mg/kg) by an intraperitoneal injection on the last day of the experiment. The results of this study showed that, compared with the model group, TMP alleviated the pathological changes in the liver induced by the fluoride and improved the ultrastructure of liver cells; TMP significantly decreased the levels of ALT, AST, and MDA (p < 0.05) and increased the levels of T-AOC, T-SOD, and GSH (p < 0.05). The results of mRNA detection showed that TMP significantly increased the mRNA expression levels of Nrf2, HO-1, CAT, GSH-Px, and SOD in the liver compared with the model group (p < 0.05). In conclusion, TMP can inhibit oxidative stress by activating the Nrf2 pathway and alleviate the liver injury induced by fluoride.
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Affiliation(s)
- Shuai Zhang
- Department of Basic Veterinary Medicine, Sichuan Agricultural University, Chengdu 611100, China
| | - Yilei Zheng
- Center for Veterinary Sciences, Zhejiang University, Hangzhou 310030, China
| | - Hong Du
- Department of Basic Veterinary Medicine, Sichuan Agricultural University, Chengdu 611100, China
| | - Wei Zhang
- Department of Basic Veterinary Medicine, Sichuan Agricultural University, Chengdu 611100, China
| | - Haohuan Li
- Department of Basic Veterinary Medicine, Sichuan Agricultural University, Chengdu 611100, China
| | - Yangping Ou
- Department of Basic Veterinary Medicine, Sichuan Agricultural University, Chengdu 611100, China
| | - Funeng Xu
- Department of Basic Veterinary Medicine, Sichuan Agricultural University, Chengdu 611100, China
| | - Juchun Lin
- Department of Basic Veterinary Medicine, Sichuan Agricultural University, Chengdu 611100, China
| | - Hualin Fu
- Department of Basic Veterinary Medicine, Sichuan Agricultural University, Chengdu 611100, China
| | - Xueqing Ni
- Animal Microecology Institute, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu 611130, China
| | - Li-Jen Chang
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA
| | - Gang Shu
- Department of Basic Veterinary Medicine, Sichuan Agricultural University, Chengdu 611100, China
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Oni O, Ibiyemi O. FLUORIDE CONTENT OF COMMERCIALLY PACKAGED SACHET WATER IN IBARAPA LAND, SOUTHWEST, NIGERIA. Ann Ib Postgrad Med 2023; 21:30-34. [PMID: 37528819 PMCID: PMC10388419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Background Fluoride concentration (F conc) in water is a major determinant for the occurrence of dental caries and dental fluorosis. In most homes of rural communities, especially in developing countries, there is a major reliance on sachet water as an alternate low-cost drinking water. This study aims to determine the fluoride concentrations of common commercially packaged sachet water in Ibarapa land, Southwestern, Nigeria. Methods An observational study was conducted using convenience sampling of all commercially packaged sachet water for drinking in Ibarapa land, Southwestern, Nigeria. Thirteen samples of sachet water were obtained from Ayete (2), Igboora (6) and Lanlate (5). F conc of the sachet water was determined in triplicate using the Fluoride Ion-Selective Electrode by direct analysis. Temperature and pH of water were also measured. Results were analysed using SPSS version 23. Results The F conc, temperature and pH range were 0.03 mgF/l - 2 mgF/l, 26.4°C - 27.2°C and 6.90 - 8.19 respectively. The minimum F conc in all samples was 0.03ppm at pH 6.90 while maximum was 2ppm at pH 7.78. F conc in 2 (15.4%), 8 (61.5%) and 3 (23.1%) water samples were 0.5-0.6 mgF/l, <0.5 mgF/ l and >0.6 mgF/l respectively. No sachet water had fluoride levels printed on their labels. Conclusion F conc of the sachet water varied, with the majority of samples having low concentrations. Attention needs to be paid to both low levels and high levels of fluoride in drinking water to ensure safety and protective benefit.
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Affiliation(s)
- O.O. Oni
- Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Nigeria
| | - O. Ibiyemi
- Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Hung M, Hon ES, Mohajeri A, Moparthi H, Vu T, Jeon J, Lipsky MS. A National Study Exploring the Association Between Fluoride Levels and Dental Fluorosis. JAMA Netw Open 2023; 6:e2318406. [PMID: 37351888 PMCID: PMC10290240 DOI: 10.1001/jamanetworkopen.2023.18406] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/30/2023] [Indexed: 06/24/2023] Open
Abstract
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.
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Affiliation(s)
- Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
- Division of Public Health, University of Utah, Salt Lake City
- College of Social Work, University of Utah, Salt Lake City
- College of Education, University of Utah, Salt Lake City
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Eric S. Hon
- Department of Economics, University of Chicago, Chicago, Illinois
| | - Amir Mohajeri
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
| | - Hyma Moparthi
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
| | - Teresa Vu
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
| | - Jason Jeon
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
| | - Martin S. Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
- Portland State University Institute on Aging, Portland, Oregon
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Guo M, Afrim FK, Li Z, Li N, Fu X, Ding L, Feng Z, Yang S, Huang H, Yu F, Zhou G, Ba Y. Association between fluoride exposure and blood pressure in children and adolescents aged 6 to19 years in the United States: NHANES, 2013-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:541-551. [PMID: 35168424 DOI: 10.1080/09603123.2022.2040449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
To examine the association between fluoride exposure and childhood blood pressure (BP), we used data involving 3260 subjects participating in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016. Both plasma and water fluoride concentrations were measured using the ion-specific electrode. Outcome variables were systolic blood pressure (SBP) and diastolic blood pressure (DBP). For a 1-mg/L increase in water fluoride concentration, the participants' SBP decreased by 0.473 mm Hg (95% CI: -0.860, -0.087). Specifically, inverse associations were found between water fluoride and SBP in girls (β= -0.423, 95% CI: -0.886, -0.021), adolescents (β= -0.623, 95% CI: -0.975, -0.272), and non-Hispanic whites (β= -0.694, 95% CI: -1.237, -0.151). Also, every 1-μmol/L increase in plasma fluoride concentration was associated with a 1.183 mm Hg decrease in SBP among other races (95% CI: -2.258, -0.108). This study suggested that fluoride exposure may affect childhood blood pressure.
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Affiliation(s)
- Meng Guo
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Francis-Kojo Afrim
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhiyuan Li
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Na Li
- Dietary Center, Zhengzhou Health Vocational College, Zhengzhou, Henan, China
| | - Xiaoli Fu
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Limin Ding
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zichen Feng
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Shuo Yang
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Hui Huang
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Fangfang Yu
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Guoyu Zhou
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yue Ba
- Department of Environmental Health & Environment and Health Innovation Team, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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Seay BA, Dasu K, MacGregor IC, Austin MP, Krile RT, Frank AJ, Fenton GA, Heiss DR, Williamson RJ, Buehler S. Per- and polyfluoroalkyl substances fate and transport at a wastewater treatment plant with a collocated sewage sludge incinerator. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 874:162357. [PMID: 36858229 DOI: 10.1016/j.scitotenv.2023.162357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
This study aims to understand the fate and transport of per- and polyfluoroalkyl substances (PFAS) and inorganic fluoride (IF) at an undisclosed municipal wastewater treatment plant (WWTP) operating a sewage sludge incinerator (SSI). A robust statistical analysis characterized concentrations and mass flows at all WWTP and SSI primary influents/effluents, including thermal-treatment derived airborne emissions. WWTP-level net mass flows (NMFs) of total PFAS were not statistically different from zero. SSI-level NMFs indicate that PFAS, and specifically perfluoroalkyl acids (PFAAs), are being broken down. The NMF of perfluoroalkyl sulfonic acids (PFSAs; -274 ± 34 mg/day) was statistically significant. The observed breakdown primarily occurred in the sewage sludge. However, the total PFAS destruction and removal efficiency of 51 % indicates the SSI may inadequately remove PFAS. The statistically significant IF source (NMF = 16 ± 4.2 kg/day) compared to the sink of PFAS as fluoride (NMF = -0.00036 kg/day) suggests that other fluorine-containing substances are breaking down in the SSI. WWTP PFAS mass discharges were primarily to the aquatic environment (>99 %), with <0.5 % emitted to the atmosphere/landfill. Emission rates for formerly phased-out PFOS and PFOA were compared to previously reported levels. Given the environmental persistence of these compounds, the observed decreases in PFOS and PFOA discharge rates from prior reports implies regional/local differences in emissions or possibly their accumulation elsewhere. PFAS were observed in stack gas emissions, but modestly contributed to NMFs and showed negligible contribution to ambient air concentrations observed downwind.
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Affiliation(s)
- Brannon A Seay
- Battelle Memorial Institute, 505 King Ave, Columbus, OH 43201, United States.
| | - Kavitha Dasu
- Battelle Memorial Institute, 505 King Ave, Columbus, OH 43201, United States
| | - Ian C MacGregor
- Battelle Memorial Institute, 505 King Ave, Columbus, OH 43201, United States
| | - Matthew P Austin
- Battelle Memorial Institute, 505 King Ave, Columbus, OH 43201, United States
| | - Robert T Krile
- Battelle Memorial Institute, 505 King Ave, Columbus, OH 43201, United States
| | - Aaron J Frank
- Battelle Memorial Institute, 505 King Ave, Columbus, OH 43201, United States
| | - George A Fenton
- Battelle Memorial Institute, 505 King Ave, Columbus, OH 43201, United States
| | - Derik R Heiss
- Battelle Memorial Institute, 505 King Ave, Columbus, OH 43201, United States
| | - Rhett J Williamson
- Battelle Memorial Institute, 505 King Ave, Columbus, OH 43201, United States
| | - Stephanie Buehler
- Battelle Memorial Institute, 505 King Ave, Columbus, OH 43201, United States
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Kumar JV, Moss ME, Liu H, Fisher-Owens S. Association between low fluoride exposure and children's intelligence: a meta-analysis relevant to community water fluoridation. Public Health 2023; 219:73-84. [PMID: 37120936 DOI: 10.1016/j.puhe.2023.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Previous meta-analyses have mainly focused on studies conducted in endemic fluorosis areas with relatively high fluoride concentrations. These are impoverished rural communities in China, India, and Iran, and the findings cannot be generalised to developed countries. Therefore, we investigated the association between fluoride concentrations relevant to community water fluoridation and children's cognition measured with IQ scores by synthesising effect sizes reported in observational studies. METHODS A previous meta-analysis and the National Toxicology Program database that included a search of multiple databases and the authors' search of PubMed, Google Scholar, and Mendeley provided the data. Cross-sectional and cohort studies examining the association between fluoride and children's cognition and intelligence scores were selected. Two reviewers abstracted data using standard procedures. We performed three meta-analyses to synthesise the effects using the random effects models. RESULTS Eight studies of standardized mean difference in IQ scores from non-endemic fluorosis areas found no statistically significant difference between recommended and lower levels of fluoride (standardized mean difference = 0.07; 95% confidence interval: -0.02, 0.17; I2 = 0%), and no significant fluctuation in IQ scores across the differences in fluoride concentrations by non-linear modeling with restricted cubic spline (P = 0.21). Meta-analyses of children's and maternal spot urinary fluoride associated pooled regression coefficients (Betachildren = 0.16; 95% confidence interval: -0.40, 0.73; P = 0.57; I2 = 0%, Betamaternal = -0.92; 95% CI: -3.29, 1.46; P = 0.45; I2 = 72%) were not statistically significant. Further regression analysis by standardizing absolute mean IQ scores from lower fluoride areas did not show a relationship between F concentration and IQ scores (Model Likelihood-ratio test: P-value = 0.34.) CONCLUSIONS: These meta-analyses show that fluoride exposure relevant to community water fluoridation is not associated with lower IQ scores in children. However, the reported association observed at higher fluoride levels in endemic areas requires further investigation.
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Affiliation(s)
- Jayanth V Kumar
- California Department of Public Health, MS 7208, 1616 Capitol Ave, Sacramento, CA 95814, USA.
| | - Mark E Moss
- ECU School of Dental Medicine, 1851 MacGregor Downs Road - MS 701, East Carolina University, Greenville, NC 27834-4354, USA
| | - Honghu Liu
- Public and Population Health, School of Dentistry, Department of Medicine, University of California, Los Angeles (UCLA), CA 90095, USA
| | - Susan Fisher-Owens
- School of Medicine and School of Dentistry, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
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40
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Bradley PM, Kolpin DW, Thompson DA, Romanok KM, Smalling KL, Breitmeyer SE, Cardon MC, Cwiertny DM, Evans N, Field RW, Focazio MJ, Beane Freeman LE, Givens CE, Gray JL, Hager GL, Hladik ML, Hofmann JN, Jones RR, Kanagy LK, Lane RF, McCleskey RB, Medgyesi D, Medlock-Kakaley EK, Meppelink SM, Meyer MT, Stavreva DA, Ward MH. Juxtaposition of intensive agriculture, vulnerable aquifers, and mixed chemical/microbial exposures in private-well tapwater in northeast Iowa. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 868:161672. [PMID: 36657670 PMCID: PMC9976626 DOI: 10.1016/j.scitotenv.2023.161672] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
In the United States and globally, contaminant exposure in unregulated private-well point-of-use tapwater (TW) is a recognized public-health data gap and an obstacle to both risk-management and homeowner decision making. To help address the lack of data on broad contaminant exposures in private-well TW from hydrologically-vulnerable (alluvial, karst) aquifers in agriculturally-intensive landscapes, samples were collected in 2018-2019 from 47 northeast Iowa farms and analyzed for 35 inorganics, 437 unique organics, 5 in vitro bioassays, and 11 microbial assays. Twenty-six inorganics and 51 organics, dominated by pesticides and related transformation products (35 herbicide-, 5 insecticide-, and 2 fungicide-related), were observed in TW. Heterotrophic bacteria detections were near ubiquitous (94 % of the samples), with detection of total coliform bacteria in 28 % of the samples and growth on at least one putative-pathogen selective media across all TW samples. Health-based hazard index screening levels were exceeded frequently in private-well TW and attributed primarily to inorganics (nitrate, uranium). Results support incorporation of residential treatment systems to protect against contaminant exposure and the need for increased monitoring of rural private-well homes. Continued assessment of unmonitored and unregulated private-supply TW is needed to model contaminant exposures and human-health risks.
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Affiliation(s)
| | | | | | | | | | | | - Mary C Cardon
- U.S. Environmental Protection Agency, Durham, NC, USA
| | | | - Nicola Evans
- U.S. Environmental Protection Agency, Durham, NC, USA
| | | | | | | | | | | | | | | | | | - Rena R Jones
- National Cancer Institute/NIH, Rockville, MD, USA
| | | | | | | | | | | | | | | | | | - Mary H Ward
- National Cancer Institute/NIH, Rockville, MD, USA
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41
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Veneri F, Vinceti M, Generali L, Giannone ME, Mazzoleni E, Birnbaum LS, Consolo U, Filippini T. Fluoride exposure and cognitive neurodevelopment: Systematic review and dose-response meta-analysis. ENVIRONMENTAL RESEARCH 2023; 221:115239. [PMID: 36639015 DOI: 10.1016/j.envres.2023.115239] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
Many uncertainties still surround the possible harmful effect of fluoride exposure on cognitive neurodevelopment in children. The aim of this systematic review and meta-analysis was to characterize this relation through a dose-response approach, by comparing the intelligence quotient (IQ) scores in the highest versus the lowest fluoride exposure category with a random-effects model, within a one-stage dose-response meta-analysis based on a cubic spline random-effects model. Out of 1996 potentially relevant literature records, 33 studies were eligible for this review, 30 of which were also suitable for meta-analysis. The summary mean difference of IQ score, comparing highest versus lowest fluoride categories and considering all types of exposure, was -4.68 (95% confidence interval-CI -6.45; -2.92), with a value of -5.60 (95% CI -7.76; -3.44) for drinking water fluoride and -3.84 (95% CI -7.93; 0.24) for urinary fluoride. Dose-response analysis showed a substantially linear IQ decrease for increasing water fluoride above 1 mg/L, with -3.05 (95% CI -4.06; -2.04) IQ points per 1 mg/L up to 2 mg/L, becoming steeper above such level. A weaker and substantially linear decrease of -2.15 (95% CI -4.48; 0.18) IQ points with increasing urinary fluoride emerged above 0.28 mg/L (approximately reflecting a water fluoride content of 0.7 mg/L). The inverse association between fluoride exposure and IQ was particularly strong in the studies at high risk of bias, while no adverse effect emerged in the only study judged at low risk of bias. Overall, most studies suggested an adverse effect of fluoride exposure on children's IQ, starting at low levels of exposure. However, a major role of residual confounding could not be ruled out, thus indicating the need of additional prospective studies at low risk of bias to conclusively assess the relation between fluoride exposure and cognitive neurodevelopment.
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Affiliation(s)
- Federica Veneri
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), Unit of Dentistry & Oral-Maxillo-Facial Surgery - University of Modena and Reggio Emilia, Modena, Italy; PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences - University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, Medical School - University of Modena and Reggio Emilia, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), Unit of Dentistry & Oral-Maxillo-Facial Surgery - University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Edvige Giannone
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, Medical School - University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Mazzoleni
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, Medical School - University of Modena and Reggio Emilia, Modena, Italy
| | - Linda S Birnbaum
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), Unit of Dentistry & Oral-Maxillo-Facial Surgery - University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, Medical School - University of Modena and Reggio Emilia, Modena, Italy; School of Public Health, University of California Berkeley, Berkeley, CA, USA
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A Scoping Review of Iodine and Fluoride in Pregnancy in Relation to Maternal Thyroid Function and Offspring Neurodevelopment. Adv Nutr 2023; 14:317-338. [PMID: 36796438 DOI: 10.1016/j.advnut.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 02/04/2023] Open
Abstract
Iodine (I), an essential nutrient, is important for thyroid function and therefore growth and development. Fluoride (F), also an essential nutrient, strengthens bones and teeth, and prevents childhood dental caries. Both severe and mild-to-moderate I deficiency and high F exposure during development are associated to decreased intelligence quotient with recent reports associating high levels of F exposure during pregnancy and infancy to low intelligence quotient. Both F and I are halogens, and it has been suggested that F may interfere with the role of I in thyroid function. We provide a scoping review of the literature on I and F exposure dur pregnancy and their individual effects on thyroid function and offspring neurodevelopment. We first discuss I intake and status in pregnancy and the relationship to thyroid function and offspring neurodevelopment. We follow with the F in pregnancy and offspring neurodevelopment. We then review the interaction between I and F on thyroid function. We searched for, and found only one study that assessed both I and F in pregnancy. We conclude more studies are needed.
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Bhagavatula P, Comnick CL, Warren JJ, Levy SM. Patterns of fluoride intake from 6 to 17 years of age: The Iowa Fluoride Study. J Public Health Dent 2023; 83:18-25. [PMID: 36251680 PMCID: PMC10006287 DOI: 10.1111/jphd.12542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/17/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This article reports on estimated daily fluoride intake from water, other beverages and selected foods, dentifrice, and dietary fluoride supplements by both individual sources, and all sources combined, among 787 children participating in the Iowa Fluoride Study (IFS) from 6 to 17 years of age. METHODS Total daily fluoride intake (mg F) and fluoride intake per kilogram bodyweight (mg F/kg bw) were estimated using responses to questionnaires sent every 3-6 months. Dietary assessments included frequencies and amounts of beverage intake for the previous week from water, milk, ready-to-drink beverages, beverages made by adding water to concentrate or powder, and selected foods with substantial water content. Descriptive statistics and bivariate and multivariable analyses with linear mixed models were used to assess associations with each of mg F and mg F/kg bw. RESULTS Mean combined dietary fluoride (mg F) from all sources examined in the study increased slightly with age, whereas the fluoride intake per kg bw decreased with age. Age, sex, and socioeconomic status were significantly associated with fluoride intake (mg F and mg F/kg bw). Each year increase in age was associated with a 0.02-mg increase in fluoride consumption, on average, after adjusting for the effects of covariates. CONCLUSIONS Daily mean fluoride intakes from single and combined sources were relatively stable, while the intake of fluoride per kg bw decreased from 6 to 17 years of age. Fluoridated water was the major source of ingested fluoride, contributing over 50% of total daily intake at all ages.
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Affiliation(s)
| | | | - John J Warren
- College of Dentistry, University of Iowa, Iowa City, Iowa, USA
| | - Steven M Levy
- College of Dentistry, University of Iowa, Iowa City, Iowa, USA
- College of Public Health, University of Iowa, Iowa CIty, Iowa, USA
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Sawangjang B, Takizawa S. Re-evaluating fluoride intake from food and drinking water: Effect of boiling and fluoride adsorption on food. JOURNAL OF HAZARDOUS MATERIALS 2023; 443:130162. [PMID: 36257112 DOI: 10.1016/j.jhazmat.2022.130162] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/01/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
Although drinking water is the main source of fluoride intake, recent studies reported that fluoride intake from foods could also be high, depending on cooking methods. In this study, we quantified the fluoride accumulation in foods soaked or boiled in fluoride-containing water and assessed the fluoride intake in different age groups from food and drinking water. We observed that, in the case of rice soaked in fluoride-containing water, more fluoride was accumulated in the rice than previously estimated. Fluoride interferes with the iodine staining process of rice, indicating fluoride adsorption. Fluoride accumulation in rice and vegetables increased when the soaking temperature was raised to 100 °C due to the gelatinization of rice grains and softening of vegetables. Ingesting foods boiled in fluoride-containing water increased the fluoride intake per body weight of infants more significantly than that in children and adults due to their low body weight. These results indicate that soaking and boiling foods in fluoride-containing water significantly increases fluoride intake compared to previous estimations. Therefore, it is necessary to re-evaluate the fluoride intake from food and drinking water considering the methods used for cooking food in each country and region.
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Affiliation(s)
- Benyapa Sawangjang
- Department of Urban Engineering, Graduate School of Engineering, The University of Tokyo, Japan 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan.
| | - Satoshi Takizawa
- Department of Urban Engineering, Graduate School of Engineering, The University of Tokyo, Japan 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan.
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45
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Woolf AD, Stierman BD, Barnett ED, Byron LG. Drinking Water From Private Wells and Risks to Children. Pediatrics 2023; 151:190542. [PMID: 36995188 DOI: 10.1542/peds.2022-060645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 02/04/2023] Open
Abstract
Drinking water for approximately 23 million US households is obtained from private wells. These wells can become contaminated by pollutant chemicals or pathogenic organisms, leading to significant illness. Although the US Environmental Protection Agency and all states offer guidance for construction, maintenance, and testing of private wells, most states only regulate the construction of new private water wells. With a few exceptions, there is little regulation after construction. Well owners are responsible for their own wells. Children may also drink well water at child care or when traveling. Illness resulting from children’s ingestion of contaminated water can be severe. This report reviews relevant aspects of groundwater and wells; describes the common chemical and microbiologic contaminants; gives an algorithm with recommendations for inspection, testing, and remediation for wells providing drinking water for children; and provides references and Internet resources for more information.
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Affiliation(s)
- Alan D Woolf
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bryan D Stierman
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth D Barnett
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Lori G Byron
- Indian Health Service (retired), SCL Health, Billings, Montana
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46
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Woolf AD, Stierman BD, Barnett ED, Byron LG. Drinking Water From Private Wells and Risks to Children. Pediatrics 2023; 151:190540. [PMID: 36995187 DOI: 10.1542/peds.2022-060644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/31/2023] Open
Abstract
Drinking water for >23 million US households is obtained from private wells. These wells can become contaminated by chemicals, naturally occurring toxic substances, or pathogenic organisms that can cause illness in children. Although the US Environmental Protection Agency and most states offer some guidance for the construction, maintenance, and testing of private wells, most states only regulate the construction of new private water wells. With few exceptions, well owners are responsible for their own wells after the initial construction. Children may also drink well water at childcare or when traveling. This policy statement provides recommendations for the inspection, testing, and remediation of private wells to provide safe drinking water for children.
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Affiliation(s)
- Alan D Woolf
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bryan D Stierman
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth D Barnett
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Lori G Byron
- Indian Health Service (retired), SCL Health, Billings, Montana
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47
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Berger V, Green Buzhor M, Evstafeva D, Mügeli L, Leroux JC. 3D printing of a controlled urea delivery device for the prevention of tooth decay. Int J Pharm 2023; 631:122528. [PMID: 36563799 DOI: 10.1016/j.ijpharm.2022.122528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Dental caries is one of the most widespread chronic infectious diseases in the world. It is mainly caused by the production of acid in the biofilm from the bacterial metabolism of carbohydrates. Nowadays, the prevention of caries is mainly based on the use of topical formulations containing fluoride. However, effective fluoride supplementation may not be sufficient in high-risk individuals, leading to the exploration of alternative strategies such as the neutralization of acid in the oral cavity. Urea is hydrolyzed into ammonia by oral bacteria, leading to a local alkalization that may counteract tooth decay. Herein, we report the fabrication of 3D printed personalized dental trays with a local and prolonged release of urea. Composite filaments with tunable urea release kinetics were produced by hot melt extrusion of poly(ε-caprolactone) and poly(vinyl alcohol) or poly(ethylene glycol) blends mixed with urea. The filaments were further used to 3D print by fused deposition modeling objects capable of releasing urea in a sustained and spatially controlled manner. In vitro studies performed in the presence of Streptococcus salivarius demonstrated the ability of urea released from a 3D printed model toothguards to reduce the pH drop induced by carbohydrates. This study showed the potential of urea-loaded devices to reduce cariogenic acidification of the environment surrounding the enamel by delivering urea directly to the tooth surface.
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Affiliation(s)
- Valentine Berger
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093 Zurich, Switzerland
| | - Marina Green Buzhor
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093 Zurich, Switzerland
| | - Diana Evstafeva
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093 Zurich, Switzerland
| | - Lena Mügeli
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093 Zurich, Switzerland
| | - Jean-Christophe Leroux
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093 Zurich, Switzerland.
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48
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Bradley PM, Romanok KM, Smalling KL, Focazio MJ, Evans N, Fitzpatrick SC, Givens CE, Gordon SE, Gray JL, Green EM, Griffin DW, Hladik ML, Kanagy LK, Lisle JT, Loftin KA, Blaine McCleskey R, Medlock-Kakaley EK, Navas-Acien A, Roth DA, South P, Weis CP. Bottled water contaminant exposures and potential human effects. ENVIRONMENT INTERNATIONAL 2023; 171:107701. [PMID: 36542998 PMCID: PMC10123854 DOI: 10.1016/j.envint.2022.107701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/03/2022] [Accepted: 12/14/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Bottled water (BW) consumption in the United States and globally has increased amidst heightened concern about environmental contaminant exposures and health risks in drinking water supplies, despite a paucity of directly comparable, environmentally-relevant contaminant exposure data for BW. This study provides insight into exposures and cumulative risks to human health from inorganic/organic/microbial contaminants in BW. METHODS BW from 30 total domestic US (23) and imported (7) sources, including purified tapwater (7) and spring water (23), were analyzed for 3 field parameters, 53 inorganics, 465 organics, 14 microbial metrics, and in vitro estrogen receptor (ER) bioactivity. Health-benchmark-weighted cumulative hazard indices and ratios of organic-contaminant in vitro exposure-activity cutoffs were assessed for detected regulated and unregulated inorganic and organic contaminants. RESULTS 48 inorganics and 45 organics were detected in sampled BW. No enforceable chemical quality standards were exceeded, but several inorganic and organic contaminants with maximum contaminant level goal(s) (MCLG) of zero (no known safe level of exposure to vulnerable sub-populations) were detected. Among these, arsenic, lead, and uranium were detected in 67 %, 17 %, and 57 % of BW, respectively, almost exclusively in spring-sourced samples not treated by advanced filtration. Organic MCLG exceedances included frequent detections of disinfection byproducts (DBP) in tapwater-sourced BW and sporadic detections of DBP and volatile organic chemicals in BW sourced from tapwater and springs. Precautionary health-based screening levels were exceeded frequently and attributed primarily to DBP in tapwater-sourced BW and co-occurring inorganic and organic contaminants in spring-sourced BW. CONCLUSION The results indicate that simultaneous exposures to multiple drinking-water contaminants of potential human-health concern are common in BW. Improved understandings of human exposures based on more environmentally realistic and directly comparable point-of-use exposure characterizations, like this BW study, are essential to public health because drinking water is a biological necessity and, consequently, a high-vulnerability vector for human contaminant exposures.
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Affiliation(s)
| | | | | | | | - Nicola Evans
- U.S. Environmental Protection Agency, Durham, NC, USA
| | | | | | | | | | - Emily M Green
- U.S. Environmental Protection Agency, Durham, NC, USA
| | | | | | | | - John T Lisle
- U.S. Geological Survey, Saint Petersburg, Florida, USA
| | | | | | | | | | | | - Paul South
- U.S. Food and Drug Administration, College Park, Maryland, USA
| | - Christopher P Weis
- National Institute of Environmental Health Sciences/NIH, Bethesda, MD, USA
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49
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Abdel Fattah MA, Barghouth MH, Wassel MO, Deraz OH, Khalil AE, Sarsik HM, Mohsen AMA, Qenawy AS, Abou El Fadl RK. Epidemiology of dental caries in permanent dentition: evidence from a population-based survey in Egypt. BMC Public Health 2022; 22:2438. [PMID: 36575430 PMCID: PMC9794108 DOI: 10.1186/s12889-022-14844-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In recognition of the risk factors common between oral diseases and various chronic conditions and the intersection between oral health and some sustainable development goals, the current cross-sectional study was designed to quantify the burden of dental caries and identify factors associated with its occurrence in permanent teeth. METHODS Using data from Egypt's population-based survey (2013-2014), two individual-level outcomes; past caries experience (DMFT > 0) and presence of untreated carious lesions (DT > 0) were assessed using the WHO basic methods for oral health surveys. Information on potential explanatory variables including sociodemographic characteristics, exposure to fluoridated water, dental attendance, and dental anxiety was gathered using a structured questionnaire. Stratified multistage cluster random sampling was used to recruit survey participants. Multivariable logistic regression was performed to identify significant potential risk factors for caries in the permanent dentition of Egyptians. FINDINGS A total of 9,457 participants were included of which 70.3% had at least one untreated carious lesion. After adjusting for all covariates, analphabetic Egyptians were found to have significantly higher odds of caries experience in permanent dentition DMFT > 0 (OR 1.54, 95% CI [1.20-1.98]), DT > 0 (OR 1.62, 95% CI [1.32-2.00]). Males, however, had significantly lower caries risk DMFT > 0 (OR 0.75, 95% CI [0.67-0.85]), DT > 0 (OR 0.81, 95% CI [0.73-0.89]) when compared to females. Regarding age, mean DMFT scores were significantly lower in age groups (6-15 years) (OR 0.03, 95% CI [0.014; 0.082]), (16- 20 years) (OR 0.09, 95% CI [0.037; 0.23]), and (21-35 years) (OR 0.22, 95% CI [0.09; 0.53]) than among people ≥ 60 years. CONCLUSION Addressing individual-level caries risk factors should be complemented by addressing upstream factors to reduce burden of untreated dental caries among Egyptians.
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Affiliation(s)
| | - Muhammad Helmi Barghouth
- grid.7269.a0000 0004 0621 1570Faculty of Dentistry, Ain Shams University, Organization of African Unity st. Abbasia, 11566 Cairo, Egypt
| | - Mariem Osama Wassel
- grid.7269.a0000 0004 0621 1570Faculty of Dentistry, Ain Shams University, Organization of African Unity st. Abbasia, 11566 Cairo, Egypt
| | - Omar Hassan Deraz
- Integrative Epidemiology of Cardiovascular Disease, Université de Paris, INSERM U970, 56 Rue Leblanc, 75015 Paris, France
| | - Ahmed Essam Khalil
- grid.440862.c0000 0004 0377 5514British University in Egypt, Suez Desert Road El Sherouk City, Cairo, 11837 Egypt
| | - Hazem Magdy Sarsik
- grid.412258.80000 0000 9477 7793Faculty of Dentistry, Tanta University, Tanta Qism 2, Tanta, Gharbia Governorate, Cairo, 6624033 Egypt
| | | | - Amr Shaaban Qenawy
- grid.415762.3Ministry of Health and Population, 3 Magles El Shaab Street, Cairo, Egypt
| | - Reham Khaled Abou El Fadl
- grid.7269.a0000 0004 0621 1570Faculty of Dentistry, Ain Shams University, Organization of African Unity st. Abbasia, 11566 Cairo, Egypt
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50
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Yardımcı B, Üzer A, Apak R. Spectrophotometric Fluoride Determination Using St. John's Wort Extract as a Green Chromogenic Complexant for Al(III). ACS OMEGA 2022; 7:45432-45442. [PMID: 36530298 PMCID: PMC9753515 DOI: 10.1021/acsomega.2c06048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/10/2022] [Indexed: 06/17/2023]
Abstract
In this study, we applied an innovative approach of green analytical chemistry to develop a novel and eco-friendly chromogenic agent for fluoride determination by making use of the nontoxic Al(III)-flavonoid complex in a natural extract from St. John's wort plant. The initial intensely yellow-colored Al(III)-flavonoid complex formed in the plant extract was converted to a colorless AlF6 3- complex with increasing amounts of fluoride, and color bleaching of the Al-flavonoid chromophore (measured as absorbance decrement) was proportional to fluoride concentration. The developed method gave a linear response within the F- concentration range of 0.11-1.32 mM with the LOD and LOQ values of 0.026 mM (0.5 mg L-1) and 0.079 mM (1.5 mg L-1), respectively. The LOD value for fluoride was below the WHO-permissible limit (1.5 mg L-1) and the US-EPA-enforceable limit (4 mg L-1) in water. The possible interference effects of common anions (Cl-, Br-, I-, NO3 -, HCO3 -, SO4 2-, and PO4 3-) and cations (K+, NH4 +, Ag+, Ca2+, Mg2+, Mn2+, Fe2+, and Fe3+) were investigated; the observed interferences from Fe2+, Fe3+, and PO4 3- were easily eliminated by masking iron with the necessary amount of Na2EDTA without affecting the blank absorbance of the Al(III)-flavonoid complex, precipitating phosphate with Ag(I) salt, and partly neutralizing alkaline water samples to pH 4 with acetic acid. The developed method was applied to real water samples and also validated against a reference spectroscopic method at the 95% confidence level.
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Affiliation(s)
- Batuhan Yardımcı
- Science
and Technology Application and Research Center (ARTMER), Zonguldak Bülent Ecevit University, Kozlu, 67600 Zonguldak, Turkey
| | - Ayşem Üzer
- Department
of Chemistry, Faculty of Engineering, Istanbul
University-Cerrahpaşa, Avcilar, 34320 Istanbul, Turkey
| | - Reşat Apak
- Department
of Chemistry, Faculty of Engineering, Istanbul
University-Cerrahpaşa, Avcilar, 34320 Istanbul, Turkey
- Turkish
Academy of Sciences (TUBA), Bayraktar Neighborhood, Vedat Dalokay St. No. 112, Çankaya, 06690 Ankara, Turkey
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