Determination of fluorides in pharmaceutical products for oral hygiene

Comparative Perceptions of Fluoride Toxicity in Oral Hygiene Products: Insights from the General Population and Healthcare Professionals

BACKGROUND

The safety of oral hygiene products is a growing concern, particularly regarding the toxicity of specific ingredients used in their formulations. The purpose of this study was to evaluate the knowledge and attitudes of dentists, physicians, pharmacists, and the general public regarding ingredients in oral hygiene products, especially fluoride. Additionally, this study aimed to identify which ingredients may exhibit potential toxicity based on historical records of any adverse effects being induced by a material/component.

METHODS

A self-administered questionnaire was used in an online cross-sectional observational study to collect data on sociodemographic characteristics, knowledge of fluoride in dental medicine, fluoride usage practices in oral hygiene products, opinions on ingredient toxicity in oral hygiene products, and personal experiences of adverse reactions to products and their components. The collected data underwent descriptive and regression analyses to reveal patterns and relationships within the dataset.

RESULTS

The study found a moderate overall knowledge level regarding fluoride usage in dentistry among participants (Md = 5.00, IQR 2.50-7.00). Healthcare professionals exhibited significantly higher knowledge scores compared to the general population (p ≤ 0.001), with dental professionals displaying the highest scores. Regarding concerns about the usage of fluoride, the majority of respondents (77.0%) did not express any concerns. Minor concerns included the risk of ingestion (6.0%) and dental fluorosis (4.6%). Among the other ingredients in oral hygiene products, respondents named alcohol as the most toxic ingredient (70.3%), followed by artificial colors (53.1%), artificial sweeteners (50.4%), and parabens (50.1%). It is noteworthy that the majority of participants (61.6%) stated that they had never experienced any side effects associated with the use of oral hygiene products.

CONCLUSION

This study underscores disparities in fluoride knowledge between healthcare professionals and the general population in Croatia, with dental experts exhibiting a superior understanding. Despite lingering misconceptions about fluoride content and potential toxicity, the majority of participants acknowledge its oral health benefits and use fluoride products regularly.

Fluoride, pH Value, and Titratable Acidity of Commercially Available Mouthwashes

AIM

The primary objective of this work was to assess total soluble fluoride (TSF), pH values, and titratable acidity (TA) of various mouthwashes "in vitro," and the second was to compare fluoride content on labels with measured TSF.

METHODS

Commercial mouthwashes were collected and analysed. Company, type, manufacturer data, and active ingredients (essential oils [EO], cetylpyridinium chloride [CPC], chlorhexidine [CHX], and fluoride) were described. TSF, pH, and TA capacity were measured. Descriptive quantitative analysis were performed per mouthwash.

RESULTS

In total, 54 mouthwashes from 20 brands were included. These included mouthwashes with the active ingredients EO (n = 11), CPC (n = 17), CHX (n = 18), and fluoride (n = 32); 27 mouthwashes with more than 1 of these active ingredients; and 4 with none of the above-mentioned ingredients. Fluoride was present in different formulations; most contained sodium fluoride (NaF), and a few had sodium monofluorophosphate and amine fluoride + NaF. The pH values of all evaluated mouthwashes ranged from 4.1 to 7.9. Twenty mouthwashes presented pHs below 5.5, of which 10 contained fluoride. TA ranged from 0 to 48. According to the manufacturer data, mouthwashes with fluoride had concentrations from 217 to 450 ppm, with 90% in the range from 217 to 254 ppm. Laboratory data revealed that TSF ranged from 229 to 500 ppm, with 90% in the range from 229 to 337 ppm. A statistically significant difference was observed between measured TSF and the labelled fluoride content on the packaging of the fluoride mouthwashes (mean difference, 43.92 ± 34.34; P < .001). Most of these mouthwashes contained at least the amount of fluoride as mentioned on the packaging (93%).

CONCLUSION

The pH values and TA of commercially available mouthwashes showed a large variation. TSF levels of the fluoride mouthwashes were found to be at least the amount of fluoride as labelled. Dental care professionals should be aware of the pH, TA, fluoride content, and other active ingredients of different mouthwashes to better understand their potential impact on oral health.

Ingredients in Commercially Available Mouthwashes

OBJECTIVES

Mouthwashes, a cornerstone of oral and dental hygiene, play a pivotal role in combating the formation of dental plaque, a leading cause of periodontal disease and dental caries. This study aimed to review the composition of mouthwashes found on retail shelves in Turkey and evaluate their prevalence and side effects, if any.

METHODS

The mouthwashes examined were sourced from the 5 largest chain stores in each district of Istanbul. A comprehensive list of the constituents was meticulously recorded. The research was supported by an extensive compilation of references from scholarly databases such as Google Scholar, PubMed, and ScienceDirect. Through rigorous analysis, the relative proportions of mouthwash ingredients and components were determined.

RESULTS

A total of 45 distinctive variations of mouthwashes, representing 17 prominent brands, were identified. Amongst the 116 ingredients discovered, 70 were evaluated for potential adverse effects and undesirable side effects. The aroma of the mouthwash (n = 45; 100%), as welll as their sodium fluoride (n = 28; 62.22%), sodium saccharin (n = 29; 64.44%), sorbitol (n = 21; 46.6%), and propylene glycol (n = 28; 62.22%) content were the main undesireable features.

CONCLUSIONS

The limited array of mouthwashes found on store shelves poses a concern for both oral and public health. Furthermore, the intricate composition of these products, consisting of numerous ingredients with the potential for adverse effects, warrants serious attention. Both clinicians and patients should acknowledge the importance and unwarranted side effects of the compnents of the mouthwashes.

Potentiometric Determination of Free Fluoride Content in Wines from Dalmatia Region (Croatia)—A Comparative Study of Direct Potentiometry and Standard Addition Method

The aim of this study was to investigate 30 different types of Dalmatian wines as a potential source of fluoride. A fluoride ion selective electrode was used to measure the fluoride concentration in each sample. The direct potentiometric method and the standard addition method were evaluated, the latter being suggested as more accurate and precise. Measurements were performed in two buffers, acetate buffer and total ionic strength adjustment buffer (TISAB), to compare their influence on fluoride determination. The obtained results show that TISAB is a better choice than acetate buffer as a medium for fluoride determination. According to the proposed method, mass concentrations of fluoride of 0.19 and 0.18 mg/L were found in the studied red and white wines, with standard deviations of 0.04 and 0.03 mg/L, respectively. All determined fluorine levels in the tested wines were within the recommended limits and do not pose a risk to human health. No significant difference was found between the fluorine content in white and red wines, but there was a difference depending on the place of origin of the wine. The measured pH values for all the wines studied (except one sample) are very similar and show no significant correlation with the fluoride content.

Use of zinc oxide nanoparticles for detection of fluoride in toothpaste gel

This study aimed to investigate the metal-binding effect of fluoride, contained in different commercial toothpaste gels; the study aimed to determine if the toothpastes contained excessive concentrations of fluoride, which result in white spot lesions. A spectrophotometric method that used spectrophotometric reagents, including zinc oxide nanoparticles and iron chloride, was used to determine fluoride distribution; the analysis was based on the selective attack of fluoride ions on metals. Fluoride concentrations between 0 and 1450 ppm were analyzed. Although the iron-fluoride complex was a more sensitive reagent, the zinc-fluoride complex could serve as a suitable alternative to it for fluoride analysis, partly because the method was less time consuming and more stable. The detection and quantification limits obtained from the linear calibration curves of the zinc-fluoride complexes, in deionized water, were 0.191:1 and 0.579:1 w/w ZnO, respectively. A model calibration curve was suggested to detect the unknown products of fluoride degradation. Dentists could use a fluoride treatment similar to the protocol used in this study, to prevent potential enamel demineralization, and exclude physical cavity preparation and restoration.

Masking Ability of Various Metal Complexing Ligands at 1.0 mM Concentrations on the Potentiometric Determination of Fluoride in Aqueous Samples

Fluoride is a common anion present in natural waters. Among many analytical methods used for the quantification of fluoride in natural waters, potentiometric analysis is one of the most widely used methods because of minimum interferences from other ions commonly present in natural waters. The potentiometric analysis requires the use of ionic strength adjusting buffer abbreviated as TISAB to obtain accurate and reproducible data. In most of the reported literature, higher concentrations of strong metal chelating ligands are used as masking agents generally in the concentration range of 1.0 to 0.01 M. In the present study, effectiveness of the masking agents, phosphate, citrate, CDTA ((1,2-cyclohexylenedinitrilo)tetraacetic acid), EDTA (ethylenediaminetetraacetic acid) HE-EDTA ((hydroxyethyl)ethylenediaminetriacetic acid)), triethanolamine, and tartaric acid at 1.0 mM in TISAB solutions was investigated. The experimental data were compared with a commercially available WTW 140100 TISAB solution as the reference buffer. According to the experimental data, the reference buffer always produced the highest fluoride concentrations and the measured fluoride concentrations were in the range of 0.611 to 1.956 mg/L. Out of all the masking agents investigated, only CDTA performed marginally well and approximately a quarter of the samples produced statistically comparable data to the reference buffer. All the other masking agents produced significantly low concentrations compared to the reference buffer. The most probable reasons for the underestimation of fluoride concentrations could be shorter decomplexing time and lower masking agent concentrations.

Effect of hesperidin on fluoride-induced neurobehavioral and biochemical changes in rats

Fluoride is the second largest contaminant of drinking water. Fluoride toxicity is a major concern in the endemic areas where a high amount of fluoride is present in ground water. Oxidative stress has been proposed to be one of the mechanisms of fluoride-induced toxicity. Antioxidant-rich food has been found to alleviate fluoride-induced toxicity. Therefore, in this study, we have examined the effect of hesperidin on fluoride-induced neurobehavioral changes in rats. In the current study, male Sprague-Dawley rats were exposed to sodium fluoride through drinking water (120 ppm). Hesperidin (200 mg kg^-1  d^-1 ; per os) was administered either alone or in combination with fluoride-containing drinking water. Bisphinol A diglycidyl ether (BADGE) was used as peroxisome proliferator-activated receptor-γ (PPAR-γ) antagonist and was administered (10 mg kg^-1  d^-1 ; intraperitoneal injection) with/without hesperidin along with fluoride-containing drinking water. The behavioral changes in the animals were assessed by analyzing rotarod test, novel object recognition test, and forced swim test (FST). After 8 weeks, animals were killed to isolate blood and brain for monitoring biochemical changes. The 8-week exposure of fluoride resulted in motor impairment as observed with reduced fall time in rotarod test, memory impairment as observed with reduced preference index in novel object recognition test, and depression-like behavior as observed with reduced mobility index in the FST. Treatment with hesperidin improved neurobehavioral impairment along with restoration in brain biochemical changes (ie, acetylcholinesterase activity and antioxidant and oxidative stress parameters). The protective effect of hesperidin was reversed by coadministration of BADGE. The neuroprotective effect of hesperidin appears to be contributed through PPAR-γ receptor.

Recent Developments in Methods of Analysis for Fluoride Determination

This review covers current analytical techniques, instruments, and methodologies used in the analysis of fluoride in various matrices. Our comprehensive literature search showed that there is no recently published review article about analytical methodologies for fluoride. In this review, we explore chromatographic, spectroscopic, and electrochemical innovations appearing in the recent literature.