Position of the American Dietetic Association: the impact of fluoride on health

Spectrophotometric Fluoride Determination Using St. John's Wort Extract as a Green Chromogenic Complexant for Al(III)

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.

Spectrophotometric determination of trace amounts of fluoride using an Al-xylenol orange complex as a colored reagent

A new spectrophotometric reagent for the determination of trace amounts of fluoride has been introduced. This method is based on the decolorization of a complex of Al(III) with xylenol orange (XO) as an ultra-sensitive colored reagent. Since the Al-XO complex plays an important role in this method, the protonation and complexation of XO with Al(III) at an ionic strength of 0.1 mol L(-1) at 25 degrees C has been studied by a spectrophotometric global analysis method. The EQUISPEC program was used to evaluate the protonation constants of XO and the stability constants of the formed complexes with Al(III). The protonation and the stability constants of the major complex species such as ML, MLH and MLH2, were determined. Finally, a spectrophotometric method for the assay of fluoride based on a decrease of the color intensity of the Al-XO complex, in an aqueous solution has been designed. The effects of some important variables on the determination of fluoride based on the proposed method were investigated. The method was applied to the determination of fluoride under the optimum conditions (pH 5.2, ionic strength 0.1 mol L(-1), 25 degrees C). The determination of fluoride in the range of 0.08-1.4 microg mL(-1) (SD = 1.2%) was successfully performed. Interferences of Fe(III) were easily eliminated by using ascorbic acid. The proposed method was applied to the determination of trace amounts of fluoride content of some real water samples.

Ossification of the transverse atlantal ligament associated with fluorosis: a report of two cases and review of the literature

STUDY DESIGN

Two cases of ossification of the transverse atlantal ligament (OTAL) are reported, and the literature is reviewed.

OBJECTIVE

To report two cases of OTAL, which share fluorosis as a possible etiologic link.

SUMMARY OF BACKGROUND DATA

OTAL, a rare phenomenon, may cause upper cervical canal stenosis and spastic quadriparesis. However, the incidence, etiology, and the best therapeutic options are currently unclear.

METHODS

Two cases are reported. Included are pertinent history, physical examination, radiographic evaluation, nonsurgical interventions, and outcomes. The available literature is also reviewed.

RESULTS

On systemic examination, these two cases were found to have ossification of many ligaments and interosseous membranes, i.e., the atlantal transverse ligament, posterior longitudinal ligament, and interosseous membranes of ribs, forearm, and leg. These findings were coupled with a history of high fluoride intake and dental fluorosis; the diagnosis of fluorosis was made. After 2 weeks of treatment with halo ring traction, and protection and stabilization with a hard cervical collar, the clinical symptoms significantly improved.

CONCLUSION

The incidence of OTAL may be not as rare as has been thought. Although the complete etiology of OTAL is not known, fluorosis may be one of the etiologic factors related to OTAL, as well as the ossification of other ligaments and interosseous membranes. Nonsurgical treatment may be safe and effective.

Sugars and dental caries

A dynamic relation exists between sugars and oral health. Diet affects the integrity of the teeth; quantity, pH, and composition of the saliva; and plaque pH. Sugars and other fermentable carbohydrates, after being hydrolyzed by salivary amylase, provide substrate for the actions of oral bacteria, which in turn lower plaque and salivary pH. The resultant action is the beginning of tooth demineralization. Consumed sugars are naturally occurring or are added. Many factors in addition to sugars affect the caries process, including the form of food or fluid, the duration of exposure, nutrient composition, sequence of eating, salivary flow, presence of buffers, and oral hygiene. Studies have confirmed the direct relation between intake of dietary sugars and dental caries across the life span. Since the introduction of fluoride, the incidence of caries worldwide has decreased, despite increases in sugars consumption. Other dietary factors (eg, the presence of buffers in dairy products; the use of sugarless chewing gum, particularly gum containing xylitol; and the consumption of sugars as part of meals rather than between meals) may reduce the risk of caries. The primary public health measures for reducing caries risk, from a nutrition perspective, are the consumption of a balanced diet and adherence to dietary guidelines and the dietary reference intakes; from a dental perspective, the primary public health measures are the use of topical fluorides and consumption of fluoridated water.

Nutrition and dental caries

Promotion of sound dietary practices is an essential component of caries management, along with fluoride exposure and oral hygiene practices. Scientific discoveries have lead to better understanding of the caries process, the ever-expanding food supply, and the interaction between the two. Fermentable carbohydrates interact dynamically with oral bacteria and saliva, and these foods will continue to be a major part of a healthful diet. Dental health professionals can serve their patients and the public by providing comprehensive oral health care and by promoting lifestyle behaviors to improve oral and general health within the time constraints of their practice. Dietary advice given should not contradict general health principles when providing practical guidance to reduce caries risk. The following principles should guide messages: * Encourage balanced diets based on moderation and variety as depicted by the Food Guide Pyramid and the Dietary Guidelines for Americans to provide a sound approach. Avoid references to "bad" foods and focus on "good" diets that include a variety of foods. * Give examples of how combining and sequencing foods can enhance mastication, saliva production, and oral clearance at each eating occasion. Combining dairy foods with sugary foods, raw foods with cooked, and protein-rich foods with acidogenic foods are all good examples. Suggest that eating and drinking be followed by cariostatic foods such as xylitol chewing gum. * Drink water to satisfy thirst and hydration needs as often as possible. Restrict consumption of sweetened beverages to meal and snack times when they can be combined with other cariostatic foods. * When a patient reports excessive dietary intake of a fermentable carbohydrate to the point of displacing other important foods in the diet, identify alternatives that will help the patient maintain or achieve a healthy body weight, oral health status, and a nutrient-dense intake.