Fluoride intake from fluids and urinary fluoride excretion by young children in Kuwait: a non-fluoridated community

Factors influencing the spatial distribution and individual variation in urinary fluoride levels in Tibet, China

Nowadays, fluorosis is the most prevalent endemic disease in Tibet and one of the most concerned public health problems in China; urinary fluoride is a common diagnostic indicator of endemic fluorosis. However, the spatial distribution and influencing factors of urinary fluoride content in Tibet remain unclear. This study aims to bridge this gap by geographically weighted regression (GWR), analyses of variance (ANOVAs), Geodetector, and stepwise multiple linear regression (MLR). To achieve this goal, this study first investigated fluoride levels in the fasting urine among 637 Tibetan residents from 73 counties in Tibet, the urinary fluoride level was chosen as an indicator of fluorosis, which can reflect the health impairment. Then we identified the potential factors that could influence the spatial distribution and individual variation of urinary fluoride levels from physical environmental and socioeconomic perspective, respectively. The results showed that urinary fluoride levels in Tibet were slightly exceeding the average value for adult urinary fluoride in China, and that residents with high urinary fluoride were mainly found in the west and east; those with low urinary fluoride were mainly found in the central-southern regions. And the urinary fluoride levels had a significantly positive correlation with water fluoride and a significantly negative correlation with average annual temperature. Urinary fluoride levels increased until age 60 and followed an inverted "U"-shaped trajectory according to annual household income (80,000 renminbi (RMB) was the inflection point); pastoralists had greater exposure to fluoride than farmers. Furthermore, the Geodetector and MLR showed that the urinary fluoride level was influenced by both physical environmental and socioeconomic factors. The socioeconomic factors such as age, annual household income and occupation had a greater impact than the physical environment on urinary fluoride concentration. These findings can provide scientific basis for preventing and controlling endemic fluorosis in the Tibetan Plateau and adjacent areas.

Urinary minerals excretion among primary schoolchildren in Dubai-United Arab Emirates

Introduction

Urinary excretion of calcium (Ca), magnesium (Mg), phosphorus (P), iodine and fluoride is used to assess their statuses and/or the existence of metabolic abnormalities. In the United Arab Emirates (UAE), the urinary concentration of these minerals among children have not been documented.

Materials and methods

A cross-sectional study, including 593 subjects (232 boys and 361 girls), was conducted among healthy 6 to 11-year-old Emirati children living in Dubai. Non-fasting morning urine samples and anthropometrical measurements were collected and analyzed. Results were expressed as per mg of creatinine (Cr).

Results

On average, estimated Cr excretion was 17.88±3.12 mg/kg/d. Mean urinary Ca/Cr, Mg/Cr and P/Cr excretions were 0.08±0.07 mg/mg, 0.09±0.04 mg/mg, and 0.57±0.26 mg/mg respectively. Urinary excretion of Ca, Mg and P were found to decrease as age increased. Urinary excretion and predicted intake of fluoride were lower than 0.05 mg/kg body weight per day. Surprisingly, more than 50% of the children were found to have urinary iodine excretion level above adequate.

Conclusion

The Emirati schoolchildren had comparable levels of urinary Ca, Mg and P excretion to other countries. The 95% percentile allows the use of the current data as a reference value for the detection of mineral abnormalities. Fluoride excretion implies that Emirati children are at low risk of fluorosis. The level of urinary iodine excretion is slightly higher than recommended and requires close monitoring of the process of salt iodization to avoid the harmful impact of iodine overconsumption.

Influence of Fluoridated Groundwater and 1,100 Ppm Fluoride Dentifrice on Biomarkers of Exposure to Fluoride

Abstract This research aimed to determine the influence of fluoridated groundwater and 1,100 ppm fluoride dentifrice on biomarkers of exposure to fluoride in preschoolers. A cross-sectional study was performed on thirty preschoolers recruited from naturally fluoridated and non-fluoridated areas (n=15). Total Daily Fluoride Intake (TDFI) from diet and dentifrice, and Daily Urinary Fluoride Excretion (DUFE) was measured over 24 h. Nails samples were collected twice during 30 days. Fluoride analyses were performed using a fluoride-ion-specific electrode. Data were evaluated using the Student and paired t-test, Pearson correlation analysis, multiple linear regression analysis (α≤0.05). Fluoridated groundwater and dentifrice were the dominant sources (r2 > 0.83) of TDFI in children from a naturally fluoridated and a non-fluoridated area, respectively. A positive correlation between TDFI and DUFE (r=0.50), and between [F] in fingernails and toenails (r=0.60) were found in children from a naturally fluoridated area. The [F] in nails of finger and toe were not correlated to TDFI. The consumption of fluoridated groundwater influenced the fluoride concentration in urine. In addition, the use of 1,100 ppm fluoride dentifrice did not influence the fluoride concentration in urine and fingernails.

Knowledge, Attitude, and Barriers to Fluoride Application as a Preventive Measure among Oral Health Care Providers

Objective

To investigate the knowledge, attitude, and possible barriers to fluoride application among oral health-care providers in Kuwait.

Methods

A validated self-administered questionnaire was distributed to a random sample of 291 dentists. The questionnaire included four categories: dentists' characteristics, knowledge of and attitude towards fluoride application, factors influencing decision-making on prescription of fluoride, and the clinician's perception of own knowledge. Means, group differences, and logistic regression were calculated.

Results

262 completed the questionnaire (response rate of 90%). Half of the participants (49%) reported that water fluoridation is the best method for caries prevention in children. Majority of the participants (80%) acknowledged that topical fluoride prevents dental caries, but only 40% frequently use it in their practices. Fear of overdose was a concern in 57% of the participants. About 31% believed that caries is a multifactorial disease and cannot be prevented. In addition, 32% of the dentists who thought caries is multifactorial and cannot be prevented stated that restorations take precedence over preventive therapy.

Conclusion

Despite the participants being in favor of topical fluoride application and believing in its effectiveness, certain barriers were apparent such as knowledge deficiencies, products labelling flaw, and lack of participation in effective continuing educational activities.

Water and Beverage Consumption among Children Aged 4-13 Years in Lebanon: Findings from a National Cross-Sectional Study

This study evaluates total water intake (TWI) from plain water, beverages and foods among Lebanese children and compares TWI to dietary reference intakes (DRIs). In a national cross-sectional survey, data on demographic, socioeconomic, anthropometric, and physical activity characteristics were obtained from 4 to 13-year-old children (n = 752). Food and beverage consumption patterns were assessed using a validated food-frequency questionnaire. TWI was estimated at 1651 mL/day, with beverages contributing 72% of the TWI compared to 28% from foods. Beverages with the highest contribution to TWI included plain water, fruit juice and soda. A significantly higher proportion of 9–13-year-old children failed to meet the DRIs compared to 4–8 years old (92%–98% vs. 74%). Gender differentials were observed with a significantly higher proportion of boys meeting the DRIs compared to girls. The water to energy ratio ranged between 0.84 and 0.87, which fell short of meeting the desirable recommendations. In addition, children from higher socioeconomic status had higher intakes of water from milk and bottled water, coupled with lower water intakes from sodas. The study findings show an alarming high proportion of Lebanese children failing to meet TWI recommendations, and call for culture-specific interventions to instill healthy fluid consumption patterns early in life.

Lebanese children are iodine deficient and urinary sodium and fluoride excretion are weak positive predictors of urinary iodine

PURPOSE

To assess iodine and fluoride status among Lebanese children.

METHODS

A nationally representative cross-sectional study of 6- to 10-year-old schoolchildren was conducted using multistage cluster sampling. Spot urine samples were collected from 1403 children, and urinary iodine, fluoride, creatinine and sodium levels were measured. Salt samples from markets (n = 30) were tested for iodine concentration by titration.

RESULTS

Median urinary iodine concentration was 66.0 µg/l, indicating mild deficiency, and almost 75 % of Lebanese children had a urinary iodine concentration (UIC) <100 µg/l. UIC was higher among children from private schools and in areas of higher socioeconomic status. Most salt samples were fortified at levels far below the legislated requirement, and 56 % of samples contained less than 15 ppm iodine. Fluoride-to-creatinine ratio (F/Cr) was 0.250 (0.159-0.448) mg/g. There were weak positive correlations between UIC and urinary sodium (r ² = 0.039, P value <0.001) and UIC and urinary fluoride (r ² = 0.009, P value <0.001).

CONCLUSIONS

Lebanese elementary school children are iodine deficient due to inadequately iodized salt. The weak correlation between UIC and urinary sodium suggests most dietary iodine does not come from iodized salt. The poor correlation between UIC and urinary fluoride suggests that fluoride intake is not affecting iodine metabolism. Efforts are needed in Lebanon to improve industry compliance with salt fortification through improved monitoring and enforcement of legislation.