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Wang R, Gong W, Jiang Y, Yin Q, Wang Z, Wu J, Zhang M, Li M, Liu Y, Wang J, Chen Y, Ji Y. Fluoride exposure during puberty induces testicular impairment via ER stress-triggered apoptosis in mice. Food Chem Toxicol 2024; 189:114773. [PMID: 38823497 DOI: 10.1016/j.fct.2024.114773] [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: 03/23/2024] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 06/03/2024]
Abstract
Fluoride, a ubiquitous environmental compound, carries significant health risks at excessive levels. This study investigated the reproductive toxicity of fluoride exposure during puberty in mice, focusing on its impact on testicular development, spermatogenesis, and underlying mechanisms. The results showed that fluoride exposure during puberty impaired testicular structure, induced germ cell apoptosis, and reduced sperm counts in mice. Additionally, the SOD activity and GSH content were significantly decreased, while MDA content was significantly elevated in the NaF group. Immunohistochemistry showed an increase in the number of cells positive for GRP78, a key ER stress marker. Moreover, qRT-PCR and Western blot analyses confirmed the upregulation of both Grp78 mRNA and protein expression, as well as increased mRNA expression of other ER stress-associated genes (Grp94, chop, Atf6, Atf4, and Xbp1) and enhanced protein expression of phosphorylated PERK, IRE1α, eIF2α, JNK, XBP-1, ATF-6α, ATF-4, and CHOP. In conclusion, our findings demonstrate that fluoride exposure during puberty impairs testicular structure, induces germ cell apoptosis, and reduces sperm counts in mice. ER stress may participate in testicular cell apoptosis, and contribute to the testicular damage and decreased sperm counts induced by fluoride.
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Affiliation(s)
- Rong Wang
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China; School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, China
| | - Wenjing Gong
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yumeng Jiang
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qizi Yin
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ziyue Wang
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Jie Wu
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Mingming Zhang
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Mengyuan Li
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yehao Liu
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Juan Wang
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
| | - Yuanhua Chen
- School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, China.
| | - Yanli Ji
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei Anhui, China.
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Li Y, Zhang M, Mi W, Ji L, He Q, Xie S, Xiao C, Bi Y. Spatial distribution of groundwater fluoride and arsenic and its related disease in typical drinking endemic regions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 906:167716. [PMID: 37820791 DOI: 10.1016/j.scitotenv.2023.167716] [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: 08/06/2023] [Revised: 08/22/2023] [Accepted: 10/08/2023] [Indexed: 10/13/2023]
Abstract
c exposure to geogenic fluoride and arsenic iChronic exposure to geogenic fluoride and arsenic in groundwater has a deleterious influence on the health of billions of people globally. The health status of residents impacted by connected diseases is urgently needed. A twelve-year study was carried out to identify the spatial distribution pattern of high fluoride/arsenic groundwater in an arid/semi-arid area and to estimate the population exposed to related disease. A geostatistical interpolation method and a disease inversion model were used. The results indicated that fluoride/arsenic-rich groundwater primarily accumulated in basins of Shanxi Province. Groundwater fluoride exposure provided a health concern to 3.16 million persons (9.08 % of the population), including 2.50 million children at risk of dental caries. Exposure to groundwater arsenic caused a health risk to 4.38 million inhabitants (12.58 % of total), with 1.92 million at risk of lung cancer, 1.87 million at risk of bladder cancer, and 0.29 million at risk of skin cancer, respectively. The pollution and impact of groundwater fluoride and arsenic vary greatly among residents in different environments, and accurate assessment of the affected population is of great significance for residents' health and water quality management. Our research study complements the critical data on the disease risks associated with geogenic-contaminated groundwater and provides scientific basis of water quality management for policy makers.
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Affiliation(s)
- Yuan Li
- School of Environment and Resources, Taiyuan University of Science and Technology, Taiyuan 030024, China; State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China
| | - Minghua Zhang
- School of Environment and Resources, Taiyuan University of Science and Technology, Taiyuan 030024, China
| | - Wujuan Mi
- State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China
| | - Li Ji
- School of Environment and Resources, Taiyuan University of Science and Technology, Taiyuan 030024, China
| | - Qiusheng He
- Institute of Intelligent Low Carbon and Control Technology, Taiyuan University of Science and Technology, Taiyuan 030024, China; Shanxi Polytechnic College, Taiyuan 030006, China
| | - Shulian Xie
- School of Life Science, Shanxi University, Taiyuan 030006, China
| | - Chen Xiao
- State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China
| | - Yonghong Bi
- State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China.
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Kumah EA, Eskandari F, Azevedo LB, John S, Zohoori FV. Mapping the evidence for monitoring fluoride exposure in community prevention programmes for oral health using nail clippings and spot urine samples: a scoping review. BMC Oral Health 2022; 22:575. [PMID: 36482456 PMCID: PMC9733226 DOI: 10.1186/s12903-022-02615-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is an increased interest in identifying practical and accurate biomarkers for fluoride exposure. Due to the narrow 'dose-gap' between the benefit of caries reduction and the risk of dental fluorosis, monitoring of fluoride exposure is vital when introducing any fluoridation programme for the prevention of dental caries. This scoping review aimed to ascertain the nature and extent of the available evidence on how spot urine and nail clippings are used to measure fluoride intake/exposure, by using a unique approach of mapping the studies according to population, setting, type of study design, methodology and analytical approach in community prevention programmes. METHODS Multiple relevant databases were searched up to July 2021 for any study designs, including randomised controlled studies, quasi-experimental studies, surveys, retrospective and prospective cohort studies, case studies, phenomenological studies, and expert opinions. RESULTS The search retrieved 9,222 studies of which 155 met the inclusion criteria. A high proportion of the studies (25.2%) originated from Latin America and the Caribbean continent subregion. However, per country, China recorded the highest number, followed by India and Mexico. The majority (62.6%) employed a cross-sectional study design, and 65.8% combined participants from different age groups. Of the included studies, 82.6% used spot urine samples as a biomarker for assessing fluoride intake/exposure. Water fluoride concentration was reported in 66.5% of the studies with 46.6% of all included studies reporting a water fluoride concentration of > 1.2 mg/L. The methods used in assessing oral hygiene and dietary intake were not reported in 72.3% and 71.0% of the included studies, respectively. Only 35.5% of the included studies assessed the relationship between fluoride exposure and excretion. CONCLUSIONS This review revealed a large variability in the way in which spot urine samples and/or nail clippings are used to measure fluoride exposure in different settings and situations. Particularly, there are inconsistencies in the methodologies and the analytical approaches used in assessing fluoride exposure. Therefore, there is a need for more rigorous primary research studies using standardised approaches to determine the suitability of spot urine samples and nail clipping as biomarkers for monitoring fluoride exposure.
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Affiliation(s)
- Elizabeth Adjoa Kumah
- grid.48004.380000 0004 1936 9764Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK ,grid.26597.3f0000 0001 2325 1783School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Fatemeh Eskandari
- grid.26597.3f0000 0001 2325 1783School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Liane B. Azevedo
- grid.15751.370000 0001 0719 6059School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Sherley John
- grid.26597.3f0000 0001 2325 1783School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Fatemeh Vida Zohoori
- grid.26597.3f0000 0001 2325 1783School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Tobias G, Mordechai F, Tali C, Yaron B, Beatrice GP, Jonathan M, Harold SC. The effect of community water fluoridation cessation on children's dental health: a national experience. Isr J Health Policy Res 2022; 11:4. [PMID: 35090561 PMCID: PMC8796457 DOI: 10.1186/s13584-022-00514-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community water fluoride (CWF) is the proven cornerstone of primary dental health care promotion. In 2002 CWF was made mandatory at a national level in Israel, however a new government revoked these regulations in August 2014. "Maccabi" is the second largest national health care provider with 2.3 million members, "Maccabi-Dent", its dental branch, has 53 clinics, employing 1100 dentists. The aim of this study was to evaluate the cumulative effect on treatment rates 6 years after CWF was terminated in Israel, based on the number of dental treatments provided to children aged 3-12 years in "Maccabi-Dent" clinics. METHODS For this retrospective study, computerized dental treatment codes were collected. The "rate of treatment" was calculated by dividing the number of restorative treatments or extractions, by the number of individuals receiving treatment. The population size and the age group visiting the specific clinic were also considered. RESULTS The independent variables were fluoride concentration in drinking water, age and socioeconomic position (SEP). There was a significant increase in restorative dental treatments after 2014, (R2 = 0.0402), with approximately twice the number of treatments required in the absence of CWF. Age had a significant association (β = - 0.389, p < 0.001) as did SEP (β = 0.086, p = 0.019). CONCLUSION After CWF cessation in Israel, rates of dental treatments significantly increased. PRACTICAL IMPLICATION By examining accepted notions with up-to-date information, new confirmatory evidence helps decision makers understand the importance of adding fluoride to drinking water.
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Affiliation(s)
- Guy Tobias
- Department of Community Dentistry, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Findler Mordechai
- Dental Research Unit – Maccabi-Dent, Maccabi Healthcare Fund, Tel Aviv, Israel
| | - Chackartchi Tali
- Department of Periodontology, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Bernstein Yaron
- Dental Research Unit – Maccabi-Dent, Maccabi Healthcare Fund, Tel Aviv, Israel
| | | | - Mann Jonathan
- Dental Research Unit – Maccabi-Dent, Maccabi Healthcare Fund, Tel Aviv, Israel
| | - Sgan-Cohen Harold
- Department of Community Dentistry, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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Mohd Nor NA, Chadwick BL, Farnell DJJ, Chestnutt IG. Factors associated with dental fluorosis among Malaysian children exposed to different fluoride concentrations in the public water supply. J Public Health Dent 2021; 81:270-279. [PMID: 33634490 DOI: 10.1111/jphd.12448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 01/17/2021] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the prevalence of dental fluorosis, and factors associated with its occurrence in two cohorts of children exposed to different fluoride concentrations in the Malaysian water supply. METHODS A cross-sectional study was conducted among lifelong residents (n = 1,155) aged 9 and 12 years old living in fluoridated and nonfluoridated areas. Malaysian children aged 12 years were born when the level of fluoride in the public water supply was 0.7 ppm while those aged 9 years were born after the level was reduced to 0.5 ppm. Fluorosis was blind scored using standardized photographs of maxillary central incisors using Dean's criteria. Fluoride exposures and other factors were assessed by parental questionnaire. Data were analyzed using descriptive statistics, Chi-squared analyses, and logistic regression. RESULTS Fluorosis prevalence was lower (31.9 percent) among the younger children born after the reduction of fluoride concentration in the water, compared to a prevalence of 38.4 percent in the older cohort. Early tooth brushing practices and fluoridated toothpaste were not statistically associated with fluorosis status. However, the prevalence of fluorosis was significantly associated with parents' education level, parents' income, fluoridated water, type of infant feeding method, age breast feeding ceased, use of formula milk, duration of formula milk intake, and type of water used to reconstitute formula milk via simple logistic regression. Fluoridated water remained a significant risk factor for fluorosis in multiple logistic regression. CONCLUSIONS Fluorosis was lower among children born after the adjustment of fluoride concentration in the water. Fluoridated water remained as a strong risk factor for fluorosis after downward adjustment of its fluoride concentration.
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Affiliation(s)
- Nor Azlida Mohd Nor
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Barbara L Chadwick
- Department of Applied Clinical Research and Dental Public Health, Cardiff University School of Dentistry, Cardiff, UK
| | - Damian J J Farnell
- Department of Applied Clinical Research and Dental Public Health, Cardiff University School of Dentistry, Cardiff, UK
| | - Ivor G Chestnutt
- Department of Applied Clinical Research and Dental Public Health, Cardiff University School of Dentistry, Cardiff, UK
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James P, Harding M, Beecher T, Browne D, Cronin M, Guiney H, O'Mullane D, Whelton H. Impact of Reducing Water Fluoride on Dental Caries and Fluorosis. J Dent Res 2020; 100:507-514. [PMID: 33345672 DOI: 10.1177/0022034520978777] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Guidance intended to reduce fluoride toothpaste ingestion in early childhood was introduced in Ireland in 2002. In 2007, water fluoride concentration was adjusted from 0.8-1.0 to 0.6-0.8 ppm. The objective of this study was to determine the difference in caries and fluorosis levels following introduction of these 2 policy measures. A before-and-after study compared caries and fluorosis in random samples of 8-y-olds in Dublin (n = 707) and Cork-Kerry (n = 1148) in 2017 with 8-y-olds in Dublin (n = 679) and Cork-Kerry (n = 565) in 2002. Dentinal caries experience (primary teeth, d3vcmft(cde)) and fluorosis (permanent teeth, Dean's index of very mild or higher) were clinically measured. Lifetime exposure to community water fluoridation (CWF) was classified as "full CWF"/"no CWF." Effect of examination year on caries prevalence and severity and fluorosis prevalence was assessed using multivariate regression adjusting for other explanatory variables. There was little change in commencement of fluoride toothpaste use at ≤24 mo following introduction of toothbrushing guidance. Among children with full CWF, there was no statistically significant difference in caries prevalence or severity between 2017 and 2002. In 2017, caries prevalence was 55% in Dublin (full CWF) and 56% in Cork-Kerry (full CWF), and mean d3vcmft(cde) among children with caries was 3.4 and 3.7, respectively. Caries severity was less in 2017 (mean 4.2) than 2002 (mean 4.9) among children with no CWF (P = 0.039). The difference in caries severity between children with full CWF and no CWF was less in 2017 than in 2002 (interaction P = 0.013), suggesting a reduced benefit for CWF in 2017. In 2017, fluorosis prevalence was 18% in Dublin (full CWF) and 12% in Cork-Kerry (full CWF). Fluorosis was predominantly "very mild" with no statistically significant difference between 2017 and 2002. CWF at 0.6 to 0.8 ppm is an effective caries-preventive measure. Results suggested low uptake of toothbrushing guidance, a reduced caries-preventive effect for CWF in primary teeth, and no reduction in fluorosis following introduction of the policy measures.
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Affiliation(s)
- P James
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - M Harding
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland.,Cork Kerry Community Healthcare Area, Health Services Executive, Dental Clinic, St. Finbarr's Hospital, Cork, Ireland
| | - T Beecher
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - D Browne
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland.,Cork Kerry Community Healthcare Area, Health Services Executive, Dental Clinic, St. Finbarr's Hospital, Cork, Ireland
| | - M Cronin
- Department of Statistics, School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - H Guiney
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - D O'Mullane
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - H Whelton
- College of Medicine and Health, University College Cork, Erinville, Cork, Ireland
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Bai R, Huang Y, Wang F, Guo J. Associations of fluoride exposure with sex steroid hormones among U.S. children and adolescents, NHANES 2013-2016. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 260:114003. [PMID: 31995781 DOI: 10.1016/j.envpol.2020.114003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 05/23/2023]
Abstract
Fluoride mediated disruption of sex steroid hormones has been demonstrated in animals. However, evidence from humans was limited and contradictory, especially for children and adolescents. Based on data of the National Health and Nutrition Survey (NHANES) 2013-2016, a total of 3392 subjects aged 6-19 years were analyzed in this cross-sectional study. Both plasma and water fluoride levels were quantified electrometrically using the ion-specific electrode. Sex steroid hormones of total testosterone, estradiol and sex hormone-binding globulin (SHBG) were tested in serum. Percent changes and 95% confidence intervals (CIs) in sex steroid hormones associated with tertiles of fluoride levels (setting the first as reference) were estimated using adjusted linear regression models by stratification of gender and age. Compared with subjects at the first tertile of plasma fluoride, percent changes (95% CIs) in testosterone were -8.08% (-17.36%, 2.25%) and -21.65% (-30.44%, -11.75%) for the second and third tertiles, respectively (P trend <0.001). Male adolescents at the third tertile of plasma fluoride had decreased levels of testosterone (percent change = -21.09%, 95% CIs = -36.61% to -1.77%). Similar inverse associations were also found when investigating the relationships between plasma fluoride and estradiol. Besides, the data indicated decreased levels of SHBG associated with water and plasma fluoride among the male adolescents (percent change of the third tertile = -9.39%, 95% CIs = -17.25% to -0.78%) and female children (percent change of the second tertile = -10.78%, 95% CIs = -17.55% to -3.45%), respectively. The data indicated gender- and age-specific inverse associations of fluoride in plasma and water with sex steroid hormones of total testosterone, estradiol and SHBG in U.S. children and adolescents. Prospective cohort studies are warranted to confirm the causality.
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Affiliation(s)
- Rongpan Bai
- Institute of Environmental Health, Department of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Huang
- Key Laboratory of Reproductive Genetics (Ministry of Education), and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Wang
- Department of Obstetrics and Gynecology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Guo
- Institute of Environmental Health, Department of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
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Abstract
Since the classical epidemiological studies by Dean, it has been known that there should be an optimum level of exposure to fluoride that would be able to provide the maximum protection against caries, with minimum dental fluorosis. The "optimal" daily intake of fluoride for children (0.05-0.07 mg per kilogram bodyweight) that is still accepted worldwide was empirically determined. In the present review, we discuss the appropriateness of the current guidance for fluoride intake, in light of the windows of susceptibility to caries and fluorosis, the modern trends of fluoride intake from multiple sources, individual variations in fluoride metabolism, and recent epidemiological data. The main conclusion is that it is very difficult to think about a strict recommendation for an "optimal" range of fluoride intake at the individual level in light of existing knowledge of 1) the mechanisms of action of fluoride to control caries, 2) the mechanisms involved in dental fluorosis development, 3) the distinct factors that interfere in the metabolism of fluoride, and 4) the windows of susceptibility to both dental caries and fluorosis development. An "optimal" range of fluoride intake is, however, desirable at the population level to guide programs of community fluoridation, but further research is necessary to provide additional support for future decisions on guidance in this area. This list includes the effect of factors affecting fluoride metabolism, clinical trials on the effectiveness of low-fluoride dentifrices to prevent caries in the primary dentition, and validation of biomarkers of exposure to fluoride.
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Affiliation(s)
- M A R Buzalaf
- 1 Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Brazil
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9
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Patel M. Dental caries vaccine: are we there yet? Lett Appl Microbiol 2019; 70:2-12. [PMID: 31518435 DOI: 10.1111/lam.13218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 12/21/2022]
Abstract
Dental caries, caused by Streptococcus mutans, is a common infection. Caries vaccine has been under investigation for the last 40 years. Many in vitro and in vivo studies and some human clinical trials have determined many pertinent aspects regarding vaccine development. The virulence determinants of Strep. mutans, such as Ag I/II, responsible for adherence to surfaces, glucosyltransferase, responsible for the production of glucan, and the glucan-binding protein, responsible for the attachment of glucan to surfaces, have been known to elicit an antigen-specific immune response. It is also known that more than one antigen or a functional part of the genome responsible for these virulence determinants provide a better host response compared with the monogenic vaccine or complete genome of a specific antigen. To enhance the host response, the use of adjuvants has been studied and the routes of antigen administration have been investigated. In recent years, some promising vaccines such as pGJA-P/VAX, LT derivative/Pi39-512 , KFD2-rPAc and SBR/GBR-CMV-nirB have been developed and tested in animals. New virulence targets need to be explored. Multicentre collaborative studies and human clinical trials are required and some interest from funders and public health experts should be generated to overcome this hurdle. SIGNIFICANCE AND IMPACT OF THE STUDY: Dental caries is an irreversible, multifactorial opportunistic infection. The treatment is costly, making it a public health problem. Despite many years of promising laboratory research, animal studies and clinical trials, there is no commercially available vaccine today. The research objectives have become more refined from lessons learnt over the years. Multigenic DNA/recombinant vaccines, using the best proved adjuvants with a delivery system for the nasal or sublingual route, should be developed and researched with multicentre collaborative efforts. In addition, new vaccine targets can be identified. To overcome the economic hurdle, funders and public health interest should be stimulated.
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Affiliation(s)
- M Patel
- Department of Oral Biological Sciences, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Whelton H, Spencer A, Do L, Rugg-Gunn A. Fluoride Revolution and Dental Caries: Evolution of Policies for Global Use. J Dent Res 2019; 98:837-846. [DOI: 10.1177/0022034519843495] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Epidemiological studies over 70 y ago provided the basis for the use of fluoride in caries prevention. They revealed the clear relation between water fluoride concentration, and therefore fluoride exposure, and prevalence and severity of dental fluorosis and dental caries. After successful trials, programs for water fluoridation were introduced, and industry developed effective fluoride-containing toothpastes and other fluoride vehicles. Reductions in caries experience were recorded in many countries, attributable to the widespread use of fluoride. This is a considerable success story; oral health for many was radically improved. While previously, water had been the only significant source of fluoride, now there are many, and this led to an increase in the occurrence of dental fluorosis. Risks identified for dental fluorosis were ingestion of fluoride-containing toothpaste, water fluoridation, fluoride tablets (which were sometimes ingested in areas with water fluoridation), and infant formula feeds. Policies were introduced to reduce excessive fluoride exposure during the period of tooth development, and these were successful in reducing dental fluorosis without compromising caries prevention. There is now a much better understanding of the public perception of dental fluorosis, with mild fluorosis being of no aesthetic concern. The advantages of water fluoridation are that it provides substantial lifelong caries prevention, is economic, and reduces health inequalities: it reaches a substantial number of people worldwide. Fluoride-containing toothpastes are by far the most important way of delivering the beneficial effect of fluoride worldwide. The preventive effects of conjoint exposure (e.g., use of fluoride toothpaste in a fluoridated area) are additive. The World Health Organization has informed member states of the benefits of the appropriate use of fluoride. Many countries have policies to maximize the benefits of fluoride, but many have yet to do so.
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Affiliation(s)
- H.P. Whelton
- Oral Health Services Research Centre and College of Medicine and Health, University College Cork, Cork, Ireland
| | - A.J. Spencer
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | - L.G. Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
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