Total and acid-soluble fluoride content of infant cereals, beverages and biscuits from Brazil

Evaluation of the impact of fluoride in drinking water and tea on the enamel of deciduous and permanent teeth

BACKGROUND

Systemic fluoride intake is predominantly derived from drinking water and tea. It's been noted that water and tea containing fluoride, within the boundaries set by the World Health Organization, can lessen the prevalence of dental caries. A review of the literature did not uncover any study that has examined the impact of fluoride in bottled drinking water and tea on enamel of deciduous and permanent teeth. Thus, we assessed the effects of fluoride present in seven different brands of bottled water from distinct geographical regions of Turkey, and a type of tea produced and packaged in Turkey, on the enamel of deciduous and permanent teeth.

MATERIALS AND METHODS

Fluoride analysis was performed on drinking water sourced from seven different regions of Turkey and a brand of tea brewed with these waters. The tea was harvested and packaged in Turkey. The analysis was conducted using an ion-selective electrode. In total, 112 tooth enamel samples (56 deciduous molars and 56 permanent molars) were randomly divided into eight distinct groups. These were kept in water for 15 min and tea for 15 min every day for a month. The eighth group was treated with fluoride gel prior to tea and water applications. The amount of fluoride in the tooth enamel structure was evaluated using an SEM EDX device before and after the experiment.

RESULTS

Statistically significant differences were found in fluoride content of enamel between water brands and tooth type (deciduous and permanent teeth). Fluoride levels were higher in the enamel of deciduous teeth than in permanent teeth.

CONCLUSION

Regular exposure of enamel samples to black tea and water led to an increase in fluoride levels in the enamel; thus, regular consumption of black tea and fluoride water could help reduce the prevalence of dental caries.

Estimated Dietary Fluoride Intake by 24-Month-Olds from Chocolate Bars, Cookies, Infant Cereals, and Chocolate Drinks in Brazil

The use of fluoride (F) in the prevention of dental caries is established. However, a high amount of F intake during tooth development can cause dental fluorosis The aim of this study was to analyze variations in F concentrations in chocolate bars (CB), chocolate cookies (CC), infant cereals (IC), and chocolate milk drinks (CD) to determine the daily intake of F from different sources by children at the age of risk for developing dental fluorosis. Distinct brands of CB, CC, IC, and CD were analyzed. Fluoride was separated by hexamethyldisiloxane-facilitated diffusion. Analysis was made in triplicate with an F ion-specific electrode. F ingestion (mg/kg body weight) was evaluated with the suggested consumption (0.05-0.07 mg/kg/day) for children aged 24 months (12 kg). The concentrations for all the analyzed products ranged from 0.025 to 1.827 µg/g F. The mean (range) F concentrations were CB= 0.210 ± 0.205 µg/g (0.073-0.698, n = 8), CC = 0.366 ± 0.416 µg/g (0.320-1.827, n = 9), IC = 0.422 ± 0.395 µg/g (0.073-1.061, n = 5), and CD = 0.169 ± 0.170 µg/mL (0.025-0.443, n = 12). The products that had the highest concentration in the categories CB, CC, IC, and CD, respectively, were Nescau-Ball (0.698 µg/g), Passatempo (1.827 µg/g), Milnutri (1.061 µg/g), and Toddynho (0.443 µg/mL). The consumption of only one unit of Toddynho (CD) is equivalent to more than 11% of the maximum suggested daily intake for a 24-month-old child (0.07 mg/kg body weight). When one product from each category is consumed together only once a day, this consumption is equivalent to approximately 24% of the suggested daily intake of fluoride for a 24-month-old child. The presence of high levels of fluoride in certain products suggests that they play a significant role in overall fluoride intake. It is crucial to closely monitor the fluoride content of food and drinks that are consumed by children who are at risk for dental fluorosis, and for product labels to clearly display the fluoride concentrations.

Fluoride Content of Ready-to-Eat Infant Foods and Drinks in Australia

The use of fluoride is effective in preventing dental caries. However, an excessive intake of fluoride leads to dental fluorosis, making it necessary to regularly monitor the fluoride intake especially for infants. There is hitherto a lack of information on fluoride content in infant foods from an Australian perspective. Therefore, this study aims to estimate the amount of fluoride content from a range of commercially available ready-to-eat (RTE) infant foods and drinks available in Australia. Based on an external calibration method, potentiometry involving a fluoride ion selective electrode and a silver|silver chloride reference electrode was conducted to analyse the fluoride content of a total of 326 solid food samples and 49 liquid food samples in this work. Our results showed an overall median (range) fluoride content of 0.16 (0.001-2.8) µg F/g of solid food samples, and 0.020 (0.002-1.2) µg F/mL of liquid food samples. In addition, ~77.5% of the liquid samples revealed a fluoride content < 0.05% µg F/mL. The highest variation of fluoride concentration (0.014-0.92 µg F/g) was found in formulas for ≥6 month-old infants. We have attributed the wide fluoride content variations in ready-to-eat infant foods and drinks to the processing steps, different ingredients and their origins, including water. In general, we found the fluoride content in most of the collected samples from Australian markets to be high and may therefore carry a risk of dental fluorosis. These results highlight the need for parents to receive appropriate information on the fluoride content of ready-to-eat infant food and drinks.

Human Health Implication of Major and Trace Elements Present in Commercial Crustaceans of a Traditional Seafood Marketing Region, Egypt

The present study focused on the distribution of some major and trace elements (S (as SO₄^2-), Na, K, B, Ca, Mg, F, Li, Al, Fe, Zn, Cu, Mn, Ni, Co, Cd, and Pb) in both flesh (Fl) and total cephalon/exoskeleton (C/E) tissues of selected crustacean species obtained from an Egyptian traditional seafood marketing region. The sequence of studied elements in (Fl) and (C/E) tissues in descending orders was S (as SO₄^2-) > Na > K > B > Mg > Ca > Li > F > Al > Zn > Fe > Cu > Pb > Ni > Mn > Co > Cd, and S (as SO₄^2-) > Na > B > K > Mg > Ca > F > Li > Al > Fe > Cu > Zn > Mn > Pb > Ni > Co > Cd, respectively. Both length-weight relationship and Fulton's condition factor showed the physical and biological statuses of the crustaceans. Ion quotient calculations of the studied tissues pointed to their importance in decreasing hypertension, preeclampsia, and heart disease. Human health risk due to the consumption of the crustacean species was determined using some guideline limits, metal pollution index (MPI), estimated daily intake (EDI), health comparison values (CVs), dietary intake (DRI-ULs), target hazard quotient (THQ), total target hazard quotient (TTHQ), and provisional tolerable weekly intake (%PTWI). MPI values of cephalon/exoskeleton tissues were greater than those of the flesh with ranges between 11.4-24.0 and 4.6-14.3, respectively. Interestingly, the calculations of TTHQ of toddler and adult were lesser than one and not expected to pose any risk concern to human from crustaceans' consumption.

Enamel Microabrasion and Dental Bleaching on Teeth Presenting Severe-pitted Enamel Fluorosis: A Case Report

The present clinical case report describes the clinical steps of enamel microabrasion associated with dental bleaching to restore severely-pitted fluorosed teeth. The process of removing the fluorotic superficial stains started by using macroabrasion with a water-cooled fine tapered 3195 FF diamond bur. Rubber dam isolation of the operative field was used to remove the remaining enamel stains and superficial irregularities with the Opalustre microabrasive compound (6.6% hydrochloric acid associated with silicon carbide particles) followed by polishing using fluoridated paste and subsequent 2% neutral fluoride gel topical application. After one month, dental bleaching was performed using 10% carbamide peroxide in custom-formed acetate trays for two hours/day for 42 days. The association of enamel microabrasion with dental bleaching was effective for reestablishing the dental esthetics of a patient with severe dental fluorosis.

Esthetic recovery of teeth presenting fluorotic enamel stains using enamel microabrasion and home-monitored dental bleaching

This clinical report describes the enamel microabrasion technique for removing maxillary and mandibular hard fluorotic enamel stains followed by home-monitored home dental bleaching. The removal of fluorotic enamel stains utilized macroabrasion with a water-cooled, fine-tapered 3195 FF diamond bur followed microabrasion with the application of Prema Compound (Premier Dental Products Co, Norristown, PA, USA). Home-monitored dental bleaching was performed 14 days after enamel microabrasion using a 10% carbamide peroxide gel for 2 h/day. The wearing time of the acetate tray/dental bleaching was quantified by a microsensor from TheraMon microelectronic system (Sales Agency Gschladt, Hargelsberg, Austria) that was completely embedded in the acetate trays. The teeth were bleached effectively during 23 days. The mean wearing time of the acetate trays/dental bleaching product was 1.54 h/day, for the upper and lower arches. The patient reported satisfaction with the treatment. The association of enamel microabrasion and home dental bleaching was an excellent clinical treatment for teeth affected with enamel fluorosis.

Comparison of fluoride effects on germination and growth of Zea mays, Glycine max and Sorghum vulgare

BACKGROUND

Fluorosis is a disease caused by over-exposure to fluoride (F). Argentina's rural lands have higher fluorine content than urban lands. Evidence confirms that plants grown in fluoridated areas could have higher F content. We compared F uptake and growth of crops grown in different F concentrations. The effect of 0-8 ppm F concentrations on maize, soybeans and sorghum germination and growth was compared. After 6 days seeding, the germination was determined, the roots and aerial parts lengths were measured, and vigor index was calculated. F content was measured in each part of the plants. Controls with equal concentrations of NaCl were carried out.

RESULTS

Significant decrease in roots and aerial parts lengths, and in vigor index of maize and soybeans plants was observed with F concentrations greater than 2 ppm. This was not observed in sorghum seedlings. Also, the amount of F in all crops augmented as F increases, being higher in roots and ungerminated seeds. Sorghum was the crop with the highest F content.

CONCLUSION

Fluoride decreased the germination and growth of maize and soybeans and therefore could influence on their production. Conversely, sorghum seems to be resistant to the action of F. © 2015 Society of Chemical Industry.

Fluoride Induces a Volume Reduction in CA1 Hippocampal Slices Via MAP Kinase Pathway Through Volume Regulated Anion Channels

Regulation of cell volume is an important aspect of cellular homeostasis during neural activity. This volume regulation is thought to be mediated by activation of specific transporters, aquaporin, and volume regulated anion channels (VRAC). In cultured astrocytes, it was reported that swelling-induced mitogen-activated protein (MAP) kinase activation is required to open VRAC, which are thought to be important in regulatory volume decrease and in the response of CNS to trauma and excitotoxicity. It has been also described that sodium fluoride (NaF), a recognized G-protein activator and protein phosphatase inhibitor, leads to a significant MAP kinase activation in endothelial cells. However, NaF's effect in volume regulation in the brain is not known yet. Here, we investigated the mechanism of NaF-induced volume change in rat and mouse hippocampal slices using intrinsic optical signal (IOS) recording, in which we measured relative changes in intracellular and extracellular volume as changes in light transmittance through brain slices. We found that NaF (1~5 mM) application induced a reduction in light transmittance (decreased volume) in CA1 hippocampus, which was completely reversed by MAP kinase inhibitor U0126 (10 µM). We also observed that NaF-induced volume reduction was blocked by anion channel blockers, suggesting that NaF-induced volume reduction could be mediated by VRAC. Overall, our results propose a novel molecular mechanism of NaF-induced volume reduction via MAP kinase signaling pathway by activation of VRAC.

Fluoride intake from food items in 2- to 6-year-old Brazilian children living in a non-fluoridated area using a semiquantitative food frequency questionnaire

BACKGROUND

Estimating fluoride intake (FI) using the 'duplicate plate' method is difficult and can raise ethical dilemmas.

AIM

To apply a semiquantitative food frequency questionnaire (FFQ) to 2- to 6-year-old Brazilian children in a non-fluoridated area (i) to estimate their FI and (ii) to provide additional validity to the questionnaire by comparing the results obtained with those found previously in a fluoridated municipality.

DESIGN

The FFQ was administered to parents of 398 children residing in a non-fluoridated community. Constituents of the diet were divided into solids, water and other beverages and their fluoride content was analysed with the electrode. Data were analysed using unpaired t-test.

RESULTS

The mean (±SD) FIs from solids, water and other beverages were 0.009 ± 0.004, 0.001 ± 0.001 and 0.007 ± 0.007 mg F/kg body weight/day, respectively, totalling 0.017 ± 0.009 mg F/kg body weight/day. Total FI from food/beverage items ingested in the non-fluoridated area was significantly lower than that observed in a study previously conducted in a fluoridated area (P < 0.0001).

CONCLUSIONS

This result reinforces the use of the FFQ as a promising alternative to duplicate diet in order to estimate FI in children in this age range, with potential application in broad epidemiological surveys.

Factors affecting the bioaccessibility of fluoride from seafood products

Fluoride is considered important for health because of its beneficial effect on the prevention of dental caries and on bone development in the child population. However, excessive intake has negative effects. The main pathway for exposure is oral, through consumption of drinking water, and some food products. Therefore its bioaccessibility (quantity of the element solubilized during the digestive process) is a parameter to be considered when estimating the risk/benefit associated with this element. The aim of the present study was to evaluate the influence of the digestion phase, gastrointestinal digestion factors (pH, pepsin and bile salt concentrations) and the presence of cations on the bioaccessibility of fluoride from seafood products. The results show that the solubilization of fluoride takes place entirely during the gastric phase. Its bioaccessibility is strongly influenced by conditions that favor the formation of insoluble complexes of fluoride with other elements present in the matrix. The factors that are most influential in reducing its bioaccessibility are the increase in pH in the gastric phase, the presence of cations, especially in the intestinal phase, and a low concentration of bile salts.

The analog of Ginkgo biloba extract 761 is a protective factor of cognitive impairment induced by chronic fluorosis

Ginkgo biloba extract EGb761 is widely used to treat patients with learning and memory impairment in Alzheimer's disease and Parkinson's disease in China. However, it is not yet clear whether the analog of EGb761 (EGb) has a protective effect on the learning and memory damage induced by chronic fluorosis. In this study, 30 Wistar rats were randomly divided into three groups: a control group, a sodium fluoride (NaF) + EGb group, and a NaF group. The rats were administered 0.5 ml water containing NaF (100 mg/l) and EGb (120 mg/kg) per day via gavage. After 3 months, the rats' capacity for learning and memory was tested using a Y-maze. Damage to hippocampal neurons was evaluated by histological examination of the CA3 area. Superoxide dismutase (SOD) activity and the levels of glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) were measured. Furthermore, the expression levels of Bcl-2 and Bax and the levels of cleaved Caspase3 in the hippocampus were evaluated by RT-PCR and Western blotting. The results showed that EGb could improve learning and memory abilities, enhance the activities of SOD and GSH-Px, attenuate the level of MDA, upregulate the ratio of Bcl-2/Bax, and downregulate the level of cleaved Caspase3.

Fluoride ingestion from food items and dentifrice in 2-6-year-old Brazilian children living in a fluoridated area using a semiquantitative food frequency questionnaire

OBJECTIVES

The aim of this study was to evaluate the fluoride intake of 2-6-year-old Brazilian children using a semiquantitative food frequency questionnaire (FFQ) which also estimated fluoride intake from dentifrice.

METHODS

The FFQ was previously validated through application to 78 2-6-year-old Brazilian children and then administered to 379 children residing in an optimally fluoridated community in Brazil (Bauru, State of São Paulo). The FFQ was applied to the parents and used to estimate the food intake of the children. The constituents of the diet were divided into solids, water and other beverages. The fluoride content of the diet items was analyzed with the fluoride electrode. The questionnaire also estimated fluoride intake from dentifrice.

RESULTS

The average (+/-SD) fluoride intake from solids, water, other beverages and dentifrice was 0.008 +/- 0.005; 0.011 +/- 0.004; 0.009 +/- 0.014 and 0.036 +/- 0.028 mg F/kg body weight/day, respectively, totalizing 0.064 +/- 0.035 mg F/kg body weight/day. The dentifrice and the diet contributed with 56.3% and 43.7% of the daily fluoride intake, respectively. Among the children evaluated, 31.2% are estimated to have risk to develop dental fluorosis (intake>0.07 mg F/kg body weight/day).

CONCLUSIONS

The dentifrice was the main source of fluoride intake by the children evaluated. However, the fluoride concentration in food items also significantly contributed to the daily ingestion by 2-6-year-old children. The questionnaire used seems to be a promising alternative to duplicate diet to estimate the fluoride intake at this age range and may have potential to be used in broad epidemiological surveys.

Dietary Fluoride Intake by Children Receiving Different Sources of Systemic Fluoride

There has been no comparison of fluoride (F) intake by pre-school children receiving more traditional sources of systemic F. The aim of this study was to estimate the dietary F intake by children receiving F from artificially fluoridated water (AFW-Brazil, 0.6–0.8 mg F/L), naturally fluoridated water (NFW-Brazil, 0.6–0.9 mg F/L), fluoridated salt (FS-Peru, 180–200 mg F/Kg), and fluoridated milk (FM-Peru, 0.25 mg F). Children (n = 21–26) aged 4–6 yrs old participated in each community. A non-fluoridated community (NoF) was evaluated as the control population. Dietary F intake was monitored by the “duplicate plate” method, with different constituents (water, other beverages, and solids). F was analyzed with an ion-selective electrode. Data were tested by Kruskall-Wallis and Dunn’s tests (p < 0.05). Mean (± SD) F intake (mg/Kg b.w./day) was 0.04 ± 0.01b, 0.06 ± 0.02a,b, 0.05 ± 0.02a,b, 0.06 ± 0.01a, and 0.01 ± 0.00c for AFW/NFW/FS/FM/NoF, respectively. The main dietary contributors for AFW/NFW and FS/FM/NoF were water and solids, respectively. The results indicate that the dietary F intake must be considered before a systemic method of fluoridation is implemented.

Fluoride concentrations in industrialized beverages consumed by children in the city of Bauru, Brazil

The increasing consumption of juices, soft drinks and teas among children has increased significantly fluoride ingestion at the age range of risk for development of dental fluorosis.

OBJECTIVE

The purpose of this study was to evaluate fluoride concentrations in some brands of industrialized beverages consumed by children in the city of Bauru, SP, Brazil.

MATERIAL AND METHODS

98 brands of beverages were analyzed, divided into 3 lots, comprising 36, 32 and 30 brands, respectively, for the first, second and third lots. Fluoride concentrations were determined by HMDS-facilitated diffusion, using a fluoride ion-specific electrode (Orion 9409).

RESULTS

Fluoride concentrations ranged between 0.04 and 1.76 microg F/mL. It was observed a wide variation in fluoride concentrations among the different brands, as well as the different lots of the same brand. There was no information on fluoride concentrations on the labels of any product.

CONCLUSIONS

Some of the products analyzed could contribute significantly to the total fluoride intake and, thus, be important risk factors for development of dental fluorosis, which indicates the need of controlling the production of these beverages with respect to fluoride concentration.

Determination of exposure and probable ingestion of fluoride through tea, toothpaste, tobacco and pan masala

Levels of water soluble and acid soluble fluoride in tea, toothpaste, tobacco and pan masala (mouth freshener) were estimated. These items are, generally, ignored while calculating the total dietary intake of fluoride. Tea, toothpaste, tobacco, pan masala (with tobacco and without tobacco) frequently expose human body to 3.88-137.09, 53.5-338.5, 28.0-113.0, 16.5-306.5 and 23.5-185.0 microg of fluoride per gram of these items, respectively. An effort was also made to quantify, on the basis of available studies, the probable human ingestion of fluoride through these substances. Increased leaching of fluoride from some of these substances has been observed in acidic conditions in the present study. The results can be extrapolated to acidic conditions of human stomach.

Relationship between daily fluoride intake from diet and the use of dentifrice and human plasma fluoride concentrations

The literature contains reports of the relationship between the fluoride concentrations in drinking water and human plasma. None of these studies, however, documented individual levels of daily fluoride intake, which can vary considerably among individuals served by the same water supply. Furthermore, while water can be an important source of fluoride, other sources, especially fluoridated dentifrices, also contribute substantially. This 2-day study with five 25-35-year-old subjects in each of three communities (Bauru, 0.6-0.8 ppm F; Domelia, 0.7 ppm F; Floresta, 0.3 ppm F) determined plasma fluoride concentrations and fluoride intake from diet and the use of dentifrice which, together, approximate total daily fluoride intake. The purposes were to determine: (1) the extent to which plasma fluoride concentrations approached levels known to affect the quality and quantity of bone; (2) the relationship between fluoride intake and plasma concentrations. Plasma was collected at 4-h intervals starting at 0800 h and ending at 2000 h each day. Average fluoride intakes from diet and the use of dentifrice in the three communities ranged from 0.16 to 0.82 mg/day and from 0.29 to 3.16 mg/day, respectively. The overall average plasma concentrations in the three communities were 0.44, 0.45 and 0.54 micromol/l (P<0.005). They were directly related to intake from the use of dentifrice (P=0.030) and to total intake (P=0.033), but were not related to dietary intake (P=0.176). In conclusion, despite fluoride intake from various sources, the plasma fluoride concentrations of the study subjects remained at levels far below those associated with effects on bone production.

Availability of fluoride from meals given to kindergarten children in Brazil

OBJECTIVES

The aim of this study was to evaluate the amount of fluoride supplied daily in the meals given in 44 public kindergarten schools in Bauru, Brazil. In addition, the fluoride concentration of water supplies and its impact on the amount of fluoride found in the meal samples were also investigated.

METHODS

Meal samples and water were collected during 2 weeks (10 working days) in public kindergarten schools. Samples of meals were homogenized with known volumes of deionized water. Fluoride present in meal samples was analyzed with the ion-specific electrode (Orion 9609), after hexamethyldisilazane-facilitated diffusion. Fluoride in water samples was analyzed with the same electrode, after buffering with TISAB II. All the analyses were made in duplicate.

RESULTS

Fluoride analyzed (mean+/-SD) was 0.50+/-0.20 microg/ml, ranging from nondetectable to 1.42 microg/ml for water samples (n=424) and 0.067+/-0.059 mg, ranging from 0.007 to 0.580 mg for meal samples (n=431). A weak but significant correlation was observed between the amount of fluoride in meals and fluoride concentration in water supplies (r=0.139, P=0.0042).

CONCLUSIONS

Despite the seemingly small role played by school meals in the total daily fluoride intake, they can contribute to the total fluoride intake of children on a chronic basis, when in association with other fluoride products. Additionally, the impact of fluoridated public water supply on the final fluoride concentration of the school meals analyzed may be regarded as low.

Enamel fluorosis prevalence after a 7-year interruption in water fluoridation in Jaú, São Paulo, Brazil

OBJECTIVES

This paper analyzes the impact of a 7-year interruption in water fluoridation on the prevalence of enamel fluorosis in Jaú, state of São Paulo, Brazil.

METHODS

Fluorosis prevalence (TF index) was evaluated in permanent maxillary central incisors of children (9-14 years old) that were 36 (n=81; cohort -36), 27 (n=81; cohort -27), and 18 months old (+/-1 month; n=89; cohort -18) in October 1991, when the breakstarted, and 18months old(+/-1 month;n=70; cohort 18) after that date. Children brushed their teeth prior to examination, which was conducted under natural light by three calibrated examiners (agreement 87.8-93.8%, kappa 0.72-0.85).

RESULTS

The fluorosis prevalence (TF> or =1) was 7.41 percent, 3.70 percent, 7.87 percent, and 18.57 percent, respectively, for cohorts -36, -27, -18, and 18. The difference between cohort 18 and the other groups was statistically significant (Kruskall-Wallis test, P=.05).

CONCLUSIONS

These results suggest that the fluoridated water is not an important risk factor for enamel fluorosis, since the prevalence of enamel fluorosis was low in the cohorts -36, -27, and -18 when fluoridated water was used.