Fluoridated toothpaste: usage and ingestion of fluoride by 4- to 6-yr-old children in England

Enamel Remineralisation with a Novel Sodium Fluoride-Infused Bristle Toothbrush

This study aims to investigate whether toothbrushes with fluoride-infused bristles have any (re)mineralisation effects on bovine enamel. Bovine incisors (N = 160) were extracted, and the buccal side of the crown was cut into dimensions of ~5 mm × 5 mm with a low-speed saw. These specimens were randomly allocated into four groups: half (80 teeth) were stored in demineralising solution (DM), and the other half were stored in deionised water (DW) for 96 h. Then, they were brushed with a force of 2.0 ± 0.1 N for five min with a manual toothbrush with either fluoride-infused (TF) or regular (TR) bristles. Microhardness (Vickers), X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDS), and scanning electron microscopy (SEM) were used to investigate the surfaces of the bovine enamel specimens before and after brushing. Two-way ANOVA was used to analyse the hardness data, and the pairwise comparison method was used to analyse the Ca/P ratio, for each group at α = 0.05. The results show that brushing with either of these toothbrushes increased the Vickers microhardness on DM and DW enamel (p < 0.001), whereas hydroxyapatite was revealed in all groups by XRD. The DM samples showed a significant increase (p < 0.05) in the Ca/P ratios after brushing with TR and TF. Conversely, under DW conditions, these ratios decreased significantly after brushing. In terms of the F atomic%, TF increased significantly. SEM revealed mineral deposition in the DM groups after toothbrushing. To conclude, toothbrushing effectively induces the microhardness of sound and demineralised enamel, while fluoride-infused bristles might be able to retain fluoride on the enamel surface.

Remineralization potential of apacider mangosteen adhesive pastes on artificial carious lesions

Background/purpose

Attention to caries administration has altered toward an early finding of lesions and targeted to noninvasive management with a remineralizing agent. This study compared the remineralization potential of apacider mangosteen adhesive pastes (AMAP), 500-ppm fluoride toothpaste (FT500), and 1000-ppm fluoride toothpaste (FT1000) on artificial caries.

Materials and methods

Artificial caries were generated to enamel of eighty extracted human premolars. The specimens were allocated to four groups and subjected to pH-cycling with the application of testing agents (2 min each, for 10 days): (1) AMAP, dairy, (2) FT500, twice a day, (3) FT1000, twice a day, and (4) no treatment (NT). The surface microhardness was determined before demineralization, after demineralization, and after application of pH-cycling. The hardness, percent of hardness recovery (%HR), and percent of remineralization potential (%RP) were analyzed with ANOVA and Bonferroni's test (α = 0.05). Polarized light microscopy (PLM) was assessed for lesion depth.

Results

Significant differences in remineralization were observed upon various agents compared to NT (P < 0.05). A significant difference in remineralization was found among AMAP, FT1000, and FT500 (P < 0.05). No significant difference in %HR and %RP was observed between AMAP and FT1000 (P > 0.05). PLM signified greater decrease in depth for AMAP, compared to FT1000 and FT500, but no depth reduction for NT.

Conclusion

AMAP possesses comparable remineralization ability to FT1000. However, decreasing in depth of carious lesions was evinced with using AMAP more than FT1000 and FT500. AMAP was recommended as a potential remineralization material for handling initial caries.

Fluoride Intake and Salivary Fluoride Retention after Using High-Fluoride Toothpaste Followed by Post-Brushing Water Rinsing and Conventional (1400-1450 ppm) Fluoride Toothpastes Used without Rinsing

This study aimed to compare the fluoride intake and salivary fluoride levels after brushing with conventional (1400-1450 ppm) fluoride toothpaste containing different fluoride agents: amine fluoride (AmF), sodium fluoride (NaF), sodium monofluorophosphate (SMFP), potassium fluoride (KF), and a high-fluoride (5000 ppm) toothpaste containing NaF. Fourteen volunteers took part in the study. They were instructed to brush and spit without rinsing after using conventional toothpaste or brush and rinse with water after using a high-fluoride toothpaste. Fluoride concentrations were determined using ion-selective fluoride (09-37 type) in the saliva samples before and after procedures. Fluoride intake was estimated based on fluoride recovered after brushing. Additionally, the amount of fluoride present in the oral fluids and lost during the rapid clearance phase after toothbrushing was calculated based on salivary fluoride levels and saliva flow immediately after brushing. Salivary fluoride after using high-fluoride toothpaste was significantly higher than those observed after conventional products. Two hours after brushing, salivary fluoride concentrations did not differ significantly from baseline values (p > 0.05) unless a high-fluoride product was used. Results indicate that by refraining from rinsing after brushing with conventional toothpaste, we cannot obtain fluoride retention in saliva as with high-fluoride toothpaste. Fluoride ingestion was higher after using a high-fluoride product.

Comparative Evaluation of Antibacterial Effect of Propolis and Aloe Vera, Xylitol, and Cpp-Acp Gels on Streptococcus mutans and Lactobacillus in Vitro

Introduction

Early childhood caries is a kind of caries occurring in deciduous teeth. Bacteria are among the main factors. Antibacterial agents such as fluoride are used in both prevention and treatment, but their application in children faces limitations such as fluorosis. Therefore, novel methods of caries prevention among the children are mainly focused on the use of fluoride-free active ingredients. In this comparative study, antibacterial effects of gels containing propolis and aloe vera, fluoride, xylitol, and CPP-ACP were investigated.

Methods

This is an in vitro study. By plate well technique, plates containing gels were created in the culture medium of Streptococcus mutans and Lactobacillus, and their antibacterial impacts were evaluated by measuring the inhibition zone after 24, 48, and 72 hours. Then, different concentrations of each gel were evaluated in the same way for the antibacterial properties. For each sample, this process was iterated 3 times, where the average was declared as the final number. The collected data were entered in SPSS 24.

Results

In both bacteria, propolis gel and aloe vera had the highest zone of inhibition, followed by fluoride and xylitol in the second and third places, respectively. Different concentrations of gels are significantly different in terms of antimicrobial effect (P value ≤ 0/05). The antimicrobial effect of propolis and aloe vera gel was kept up to the concentration of 1/16. As the bacterial and gel contact time is prolonged, the antibacterial effect of different gels increases, but the difference is not statistically significant (P value = 0.109). CPP-ACP gel had no antimicrobial effect at any concentration.

Conclusion

Propolis and aloe vera gel had a greater antimicrobial effect than other gels, where such effect was observed in low concentrations. CPP-ACP gel had no antimicrobial properties.

The occurrence, severity degree, and associated risk factors of dental fluorosis among the 12-year-old schoolchildren in Jilin, China

This study aims to describe the occurrence, severity degree, and correlated risk factors of dental fluorosis among the 12-year-old schoolchildren of Jilin, China.We conducted a cross-sectional, observational, and descriptive study among 960 12-year-old schoolchildren in Jilin. The Dean index was utilized to evaluate the severity degree of dental fluorosis. A questionnaire was sent to the guardians of children. Community fluorosis index was measured to estimate the importance of enamel fluorosis for the whole population's public health. The logistic regression analysis was also utilized to identify the correlation between fluorotic teeth and the independent variables.Nine hundred sixty children were assessed. Among them, 480 (50%) were female. 30.5% of subjects had dental fluorosis, 7.19% had very mild dental fluorosis, 10.73% experienced mild dental fluorosis, 9.58% suffered moderate dental fluorosis, and 3.02% encountered severe dental fluorosis. The overall community fluorosis index was 0.73. The results of logistic regression showed that schoolchildren who brushed teeth more frequently (OR: 2.012, 95% CI 1.767-2.342), deficiency of parental supervision (OR: 4.219, 95% CI 3.887-4.573), and lived in rural areas (OR: 2.776, 95% CI 2.163-3.489) were more correlated with enamel fluorosis. Moreover, schoolchildren whose mothers or fathers were of high education level (OR: 0.336, 95% CI 0.217-0.413 and 0.346, 95% CI 0.113-0.512) and only child (OR: 0.378, 95% CI 0.213-0.415) were protective factors for dental fluorosis.In the Jilin province of China, the risk indicators for dental fluorosis include rural areas, more frequency of brushing, low educational background of parents, and deficiency of parental supervision.

Dental caries and associated factors among adolescents aged 12 to 15 in Jiangxi Province, China

BACKGROUND

The purpose of this survey was to examine the association of general characteristics, oral health knowledge, attitudes, behavior, and dental caries status among adolescents in Jiangxi Province and to provide a basis for future prevention of dental caries among middle school students.

METHODS

A total of 8,160 adolescents aged 12 to 15 years were invited to participate in this survey by a stratified random cluster sampling method from 30 schools in five counties in Jiangxi Province. A self-administered questionnaire was used to understand their basic characteristics, including oral health behaviors, knowledge, and attitudes. Chi-square tests were used to compare dental caries status and general characteristics. Univariate and multivariate logistic regression analyses were used to study the effects of oral health knowledge, attitudes, and behavior on dental caries.

RESULTS

The prevalence of dental caries in permanent teeth was 25.8 percent, and the mean DMFT score of 12- to 15-year-old adolescents was 0.48 ± 1.04. The prevalence in rural areas was higher than that in urban areas (P < 0.001). The prevalence was higher in girls than in boys (P < 0.001). No significant age differences were observed (P > 0.05) in the prevalence of dental caries. The multivariate logistic regression analysis indicated that the variables associated with dental caries were tooth brushing frequency, use of toothpaste, frequency of sugary milk intake, smoking, and oral health attitudes.

CONCLUSIONS

This study revealed that adolescent oral health behaviors and attitudes were associated with dental caries. It is important to implement targeted oral disease prevention and control measures among adolescents.

[Investigation of oral health knowledge, attitude, behavior of 12-15 years old children in Chongqing]

OBJECTIVE

To investigate the status of oral health knowledge, attitude, behavior of 12-15 years old children and provide a theoretical basis of prevention.

METHODS

Multi-stage stratified sampling method was used to extract four middle school students from Chongqing districts and counties (2 in the main urban area and 2 suburbs), and their oral health knowledge, attitudes and behaviors were investigated through questionnaires. All data were entered using Epidata and statistical analysis was performed using SPSS 21.0 software.

RESULTS

A total of 3 902 valid questionnaires were collected. The proportion of people who had good brushing habits was 39.7% (1 548), the average oral health knowledge accuracy rate was 58.9%, and the average oral health positive attitude was 88.6%. The number of middle school students who attended the dental experience was 54.5% (2 127), and that of the school who received oral health education was 17.5% (681). There were gender and regional differences in brushing habits.

CONCLUSIONS

The knowledge and behavior of oral health among 12-15-year-old middle school students in Chongqing need to be improved. Oral health education for middle school students should be strengthened, especially in rural and suburban areas.

Biomarkers for the Assessment of Fluoride Exposure in Children

Due to practical difficulties in quantifying fluoride exposure, the ability of various biomarkers to predict exposure has been investigated previously. However, the results are inadequate for validation of their application and usefulness. This study aimed to investigate the association between contemporary/recent biomarkers of fluoride exposure and total daily fluoride intake (TDFI) of children with large differences in fluoride exposure through drinking water. TDFI was assessed in 61 healthy 4- to 5-year-old children who provided at least 1 biomarker sample; 32 lived in a low-fluoride area (0.04 mg F/L) and 29 lived in a high-fluoride area (3.05 mg F/L). Validated questionnaires were administered to evaluate fluoride intake from diets (including water) and toothpaste ingestion. Daily urinary fluoride excretion (UFE) and fluoride concentrations in plasma, fasting whole saliva, hair, and nails (toenails/fingernails) were evaluated and related to total fluoride exposure. TDFI, UFE, and fluoride concentrations of biomarkers were statistically significantly higher in the high-fluoride area than in the low-fluoride area. There was a strong statistically significant positive correlation between TDFI and UFE (ρ = 0.756, p < 0.001); plasma fluoride concentration (ρ = 0.770, p < 0.001); and toenail fluoride concentration (ρ = 0.604, p < 0.001). The statistically significant positive correlation between TDFI and fingernail fluoride concentration (ρ = 470, p < 0.001) as well as between TDFI and fasting whole saliva fluoride concentration (ρ = 0.453, p = 0.001) was moderate, whereas it was weak between TDFI and hair fluoride concentration (ρ = 0.306, p = 0.027). In conclusion, the current study confirmed the suitability of 24-h urine samples for estimating fluoride exposure in children. The strong correlations between TDFI and fluoride in plasma and toenails also suggest these biomarkers may be considered for health risk assessments of fluoride in children who are susceptible to development of dental fluorosis.

Fluoride intake and urinary fluoride excretion in 4- and 8-year-old children living in urban and rural areas of Southwest Nigeria

OBJECTIVES

To estimate and compare total daily fluoride intake (TDFI), daily urinary fluoride excretion (DUFE), daily fluoride retention (DFR), fractional urinary fluoride excretion (FUFE) and fractional fluoride retention (FFR) in 4- and 8 year-old Nigerians and explore associations between these outcomes to improve understanding of fluoride metabolism.

METHODS

Using a cross-sectional observational study, 72 four-year-olds and 72 eight-year-olds were recruited from nursery and primary schools (respectively) in lower and higher water F areas of urban and rural localities in Oyo State, southwest Nigeria. TDFI from diet and toothpaste ingestion was assessed using a validated Food Frequency Questionnaire and visual scale of toothpaste used during toothbrushing. DUFE was measured by collecting a 24-hour urine sample, FUFE estimated as the ratio between DUFE and TDFI, DFR estimated as TDFI-TDFE (where TDFE = DUFE + estimated faecal F excretion (ie TDFI × 10%), and FFR was estimated as [(TDFI-DFR)/TDFI] × 100. Data were analysed using ANOVA with post hoc tests and Student's t tests and strengths of associations between key variables measured.

RESULTS

Mean (SD) TDFI, DUFE, DFR, FUFE and FFR were 0.137 (0.169) mg/kg bw/d, 0.032 (0.027) mg/kg bw/d, 0.091 (0.147) mg/kg bw/d, 44% (44%) and 46% (44%), respectively, for 4-year-olds. Corresponding values for 8-year-olds (n = 63) were 0.106 (0.130) mg/kg bw/d, 0.022 (0.017) mg/kg bw/d, 0.073 (0.107) mg/kg bw/d, 36% (30%) and 54% (30%), respectively. Dietary contribution to TDFI was 79% and 75% (respectively), for 4- and 8-year-olds. Mean (SD) TDFI from toothpaste ingestion was 0.021 (0.013) mg/kg bw/d in 4-year-olds, 0.014 (0.010) mg/kg bw/d in 8-year-olds (P = .002) but with no differences between areas. Differences in dietary F intake determined the main differences in F exposure between areas. The positive correlation between TDFI and DUFE was weak for 4-year-olds (r = +.29) and strong for 8-year-olds (r = +.64). A strong positive correlation was observed between TDFI and DFR for both age groups: (r) = +.98 for 4-year-olds and (r) = +.99 for 8-year-olds.

CONCLUSION

Fluoride intake in these 4- and 8-year-old Nigerians was much higher than the "optimal range" of 0.05-0.07 mg/kg bw/d in rural, higher F water areas, with diet as the main contributor. F retention was similar in both age groups, with almost half of TDFI retained in the body. In terms of risk vs benefit for fluorosis and dental caries, this finding should be considered when mitigating against excessive fluoride exposure and planning F-based prevention.

Exposição a fluoreto por crianças na faixa etária crítica para fluorose dentária, residentes no semiárido brasileiro

Resumo Há uma preocupação com o aumento da prevalência de fluorose dentária, que depende da dose de fluoreto (F) a que as crianças são submetidas durante a formação dos dentes. A temperatura ambiental afeta a ingestão de água e, portanto, seria importante avaliar se as crianças que vivem em uma região de clima semiárido estão expostas a uma dose excessiva de F. Assim, o objetivo do presente estudo foi determinar a dose total de F a que as crianças são expostas durante a idade crítica para a fluorose dentária, tendo dieta (água e alimentos) e dentifrício como fontes de F, em uma região de clima semiárido no Brasil. Metodologia: foram selecionadas 26 crianças com idade de 25,2 ± 9,1 meses, residentes em Feira de Santana-BA. Foram coletadas amostras de dieta-duplicada, água, produtos de escovação e dentifrícios. A concentração de F foi determinada após o devido preparo das amostras, utilizando um eletrodo específico. Resultados: a média e o desvio padrão de dose (mg F / kg / dia) em função da dieta, dentifrício e total foram, respectivamente: 0,016 ± 0,010; 0,030 ± 0,039 e 0,047 ± 0,043. Conclusões: as crianças avaliadas, residentes em uma região de clima semiárido, não estão expostas a uma dose de risco de fluorose dentária.

Understanding Optimum Fluoride Intake from Population-Level Evidence

Policy on fluoride intake involves balancing caries against dental fluorosis in populations. The origin of this balance lies with Dean’s research on fluoride concentration in water supplies, caries, and fluorosis. Dean identified cut points in the Index of Dental Fluorosis of 0.4 and 0.6 as critical. These equate to 1.3 and 1.6 mg fluoride (F)/L. However, 1.0 mg F/L, initially called a permissible level, was adopted for fluoridation programs. McClure, in 1943, derived an “optimum” fluoride intake based on this permissible concentration. It was not until 1944 that Dean referred to this concentration as the “optimal” concentration. These were critical steps that have informed health authorities through to today. Several countries have derived toxicological estimates of an adequate and an upper level of intake of fluoride as an important nutrient. The US Institute of Medicine (IOM) in 1997 estimated an Adequate Intake (AI) of 0.05 mg F/kg bodyweight (bw)/d and a Tolerable Upper Intake Level (UL) of 0.10 mg F/kg bw/d. These have been widely promulgated. However, a conundrum has existed with estimates of actual fluoride intake that exceed the UL without the expected adverse fluorosis effects being observed. Both the AI and UL need review. Fluoride intake at an individual level should be interpreted to inform more nuanced guidelines for individual behavior. An “optimum” intake should be based on community perceptions of caries and fluorosis, while the ultimate test for fluoride intake is monitoring caries and fluorosis in populations.

Prevalence and extent of enamel defects in the permanent teeth of 8-year-old Nigerian children

OBJECTIVES

Enamel formation is a vulnerable developmental process, susceptible to environmental influences such as excessive systemic fluoride (F) exposure and infant/childhood disease. This study determined prevalence and extent of developmental enamel defects (DDE) and dental fluorosis in 8-year-old Nigerians and explored associations with key predictors.

METHODS

A sample of 322 healthy 8-year-olds (155 males, 167 females) from primary schools in lower and higher water F areas of (i) rural and (ii) urban parts of Oyo State in south-west Nigeria (n = 4 areas) (in which the mean (SD) F concentration of community water supplies ranged from 0.07 (0.02) to 2.13 (0.64) mg F/L) were dentally examined using modified DDE (mDDE) and Thylstrup and Fejerskov (TF) indices. Drinking waters, cooking waters and toothpaste samples were analysed for F concentration using a F ion-selective electrode (F-ISE). Information on infant/childhood diseases, infant feeding and tooth cleaning practices was obtained from parents/legal guardians. Data were analysed using ANOVA, chi-square tests, Spearman correlation and binary logistic regression as appropriate.

RESULTS

Mean (SD) F concentration of actual drinking and actual cooking waters consumed by participants was 0.25 (0.20) and 0.24 (0.14) mg F/L respectively in the urban higher F area; 1.11 (1.00) and 1.16 (1.02) mg F/L, respectively in the rural higher F area (P < .05). Overall, mouth prevalence of DDE in the permanent dentition was 61.2% with a mean (SD) of 2.4 (2.2) index teeth affected. Dental fluorosis mouth prevalence was 29.8% with a mean of 2.1 (3.7) teeth affected. Prevalence and extent of DDE and dental fluorosis were greater in higher F than lower water F areas (P < .001). A weak positive correlation was seen between extent of dental fluorosis and drinking water F concentration (ρ = 0.28). The absence of infant/childhood disease was associated with a lower risk of DDE being present (P = .001), with an odds ratio of 0.43 (95% CI = 0.26, 0.71). Gender was a statistically significant (P = .014) predictor for dental fluorosis with females having a higher risk OR 1.94 (95% CI = 1.14, 3.28) of dental fluorosis than males.

CONCLUSIONS

In these Nigerian 8-year-olds (n = 322), mouth prevalence of DDE was 61.2% (mean (SD) teeth affected = 2.4 (2.2)), and a key positive predictor was a history of infant/childhood disease. With 29.8% of these children exhibiting dental fluorosis (mean (SD) teeth affected = 2.1(3.7)), drinking water F concentration was identified as a positive predictor, along with gender, with females more at risk of dental fluorosis than males.

Vigilância epidemiológica da fluorose dentária em município de clima tropical com água de abastecimento público fluoretada

Resumo O objetivo deste estudo foi avaliar a prevalência e a severidade de fluorose dentária em escolares de 11 a 14 anos de idade em Teresina (PI) Brasil, município de clima tropical com água de abastecimento público fluoretada. Estudo do tipo observacional transversal no qual foram avaliadas 571 crianças distribuídas nas redes pública e particular de ensino. A coleta de dados foi realizada nas unidades escolares, após recolhimento do Termo de Consentimento Livre e Esclarecido (TCLE) e questionário respondido pelos pais referentes às condições socioeconômicas e demográficas e aos hábitos de higiene bucal. O exame dentário foi realizado por um cirurgião-dentista calibrado. O índice aplicado foi o Thylstrup e Fejerskov (TF). A prevalência de fluorose foi de 77,9%, e apenas 12,5% das crianças acometidas apresentaram TF ≥ 3, grau com comprometimento estético. Os pré-molares foram os dentes mais afetados pela fluorose. Dentre os escolares com maior severidade de fluorose, 98,6% dos pertenciam à classe social mais baixa (>B2), 91,5% nasceram e sempre moraram em Teresina, 94,4% consumiam água de abastecimento fluoretada, 76% usaram dentifrício infantil e 64% as mães relataram que engoliam dentifrício. A prevalência de fluorose foi elevada, mas com baixa severidade, em indivíduos expostos à fluoretação desde o nascimento.

Total Fluoride Intake by Children from a Tropical Brazilian City

The main sources of fluoride intake by children are fluoridated water and toothpaste. Little has been studied regarding fluoride intake from these sources in regions with tropical climates and high temperatures throughout the year. This study aimed to determine the amount of fluoride ingested from diet and tooth brushing by children who live in a city with a tropical climate. Sixty-seven children from Teresina, Piauí, Brazil, took part in this study. The city's water supply was optimally fluoridated. The duplicate-diet method was used to determine the fluoride intake from diet. The intake of fluoride from dentifrice was determined by subtracting the amount of fluoride placed on the toothbrush and that recovered after brushing. The concentration of fluoride was measured using an ion-specific electrode and is expressed as milligrams/kilogram of body weight/day. The mean (±SD) total amount was 0.071 ± 0.036 mg F/kg body weight/day, and the relative contributions of diet and toothpaste were 0.025 ± 0.010 and 0.046 ± 0.035, respectively. The factors associated with fluoride intake from toothpaste were: use of children's toothpaste (p = 0.003), use of large amounts of toothpaste (p < 0.001), and a high frequency of tooth brushing (p = 0.003). Sixty-four percent of children had an intake of less than 0.07 mg F/kg body weight/day, which is considered the upper limit for an aesthetically tolerable fluorosis risk. The results suggest that the amount of fluoride ingested by most children who live in a Brazilian city with a tropical climate is considered safe in terms of the risk of dental fluorosis.

Fluoride Exposure Effects and Dental Fluorosis in Children in Mexico City

BACKGROUND The objective of the present study was to determine the prevalence and severity of dental fluorosis and to evaluate exposure to fluoridated products in students in the southwest part of the Federal District (Mexico City). MATERIAL AND METHODS Students between 10 and 12 years of age who were born and raised in the study zone were evaluated. The level of dental fluorosis was determined using the modified Dean index (DI) using criteria recommended by the World Health Organization (WHO). A bivariate analysis was performed with the χ2 test, and odds ratios (OR) and 95% confidence intervals (CI) are presented. Logistic regression was performed to evaluate the association between dental fluorosis and the independent variables. RESULTS A total of 239 students were evaluated. Their mean age was 11±0.82 years, and there were 122 (51%) males. Overall, dental fluorosis was found in 59% of participants; 29.3% had very mild fluorosis, 20.9% had mild fluorosis, 6.7% had moderate fluorosis, and 2.1% had severe fluorosis. The mean fluorosis score was 0.887±0.956. In the final logistic regression model, dental fluorosis was significantly associated with frequency of brushing (OR: 0.444; 95% CI: 0.297-0.666) and with the absence of parental supervision (OR: 0.636; 95% CI: 0.525-0.771). CONCLUSIONS The association found with frequency of brushing and lack of parental supervision may be contributing to the prevalence and severity of dental fluorosis.

Fluoride toothpaste efficacy and safety in children younger than 6 years: a systematic review

BACKGROUND

The authors conducted a systematic review to assess the efficacy and safety of fluoride toothpaste use in children younger than 6 years.

METHODS

The authors defined research questions to formulate a search strategy. They screened studies, extracted data and assessed risk of bias systematically. They conducted meta-analyses to determine the effects of brushing with fluoride toothpaste.

RESULTS

Use of fluoride toothpaste brushing had a statistically significant effect on mean decayed, missing and filled primary tooth surfaces and decayed, missing and filled primary teeth for populations at high risk of developing caries (standard mean difference [95 percent confidence interval {CI}], -0.25 [-0.36 to -0.14] and -0.19 [-0.32 to -0.06], respectively). The effects of using different fluoride concentration toothpastes on caries varied. Study findings showed either a decrease in the odds of having fluorosis (odds ratio [OR] [95 percent CI] = 0.66 [0.48-0.90]) when the use of fluoride toothpaste was initiated after 24 months or no statistically significant difference (OR [95 percent CI] = 0.92 [0.71-1.18]). Beginning use after 12 or 14 months of age decreased the risk of fluorosis (OR = 0.70 [0.57-0.88]).

CONCLUSIONS

Limited scientific evidence demonstrates that for children younger than 6 years, fluoride toothpaste use is effective in caries control. Ingesting pea-sized amounts or more can lead to mild fluorosis. Practical Implications. To minimize the risk of fluorosis in children while maximizing the caries-prevention benefit for all age groups, the appropriate amount of fluoride toothpaste should be used by all children regardless of age. Dentists should counsel caregivers by using oral description, visual aids and actual demonstration to help ensure that the appropriate amount of toothpaste is used.

Oral health status and oral health knowledge, attitudes and behavior among rural children in Shaanxi, western China: a cross-sectional survey

BACKGROUND

The current oral health status and possible dental risk factors among children in rural Shaanxi Province, western China are unreported. This study aimed to describe the oral health status and to analyze the possible risk factors for the oral health status in this population.

METHODS

A multi-stage cluster sampling method was used to survey 12- to 15-year-olds and 4- to 6-year-olds in villages in Shaanxi Province. The structured questionnaires were provided to the 12- to 15-year-olds and to the caregivers of the 4- to 6-year-olds to collect information on the subjects' oral health knowledge, attitudes and behavior. A clinical examination was performed to assess dental caries and gingival bleeding (only 12- to 15-year-olds). SPSS 17.0 statistical software was used to analyze the data.

RESULTS

The decayed, missing, filled teeth (DMFT) index scores of 12- to 15-year-olds and 4-to 6-year-olds averaged 0.45 and 3.05, respectively. The caries prevalence was 23.9% in 12- to 15-year-olds and 67% in 4-to 6-year-olds. Additionally, 45.2% of the 12- to 15-year-olds had gingival bleeding and 62.8% had calculus. The oral health knowledge of the subjects was generally poor, whereas they held very positive attitudes toward oral health. A low number of participants reported that they brushed their teeth at least twice daily. Moreover, a statistically significant relationship was found between oral health knowledge scores, tooth brushing frequency and DMFT scores as well as gingival bleeding in the 12- to 15-year-olds. Frequency of sweets consumption was strongly related to dmft scores in the 4- to 6-year-olds.

CONCLUSION

The oral health status, oral health knowledge and behaviors among village children in Shaanxi Province are poor. Oral health education to improve oral health knowledge and to increase the frequency of tooth brushing should be undertaken in the rural schools in western China.

In vitro assessment of a toothpaste range specifically designed for children

OBJECTIVE

To evaluate the ability of a range of low abrasivity experimental toothpastes designed for use by children at different stages of their development (typically ages 0-2 years, 3-5 years and 6+ years) to promote fluoride uptake and remineralisation of artificial caries lesions.

METHODS

pH cycling study: demineralised human permanent enamel specimens were subjected to a daily pH cycling regime consisting of four 1-minute treatments with toothpaste slurries, a 4-hour acid challenge and remineralisation in pooled whole human saliva. Surface microhardness (SMH) was measured at baseline, 10 days and 20 days, and the fluoride content determined at 20 days. Enamel Fluoride Uptake (EFU): these studies were based on Method #40 described in the US Food and Drug Administration (FDA) testing procedures. Abrasivity: relative enamel abrasivity (REA) and relative dentine abrasivity (RDA) were measured using the Hefferren abrasivity test. Bioavailable fluoride: the bioavailable fluoride was determined for all experimental toothpastes from slurries of one part toothpaste plus 10 parts deionised water.

RESULTS

Enamel remineralisation measured by changes in SMH correlated with enamel fluoride content. A statistically significant fluoride dose response was observed for all toothpastes tested across all age groups (P < 0.05). The fluoride content of specimens in the pH cycling model correlated with the EFU testing results. The enamel and dentine abrasivities were low and the level of bioavailable fluoride was high for all experimental toothpastes.

CONCLUSION

A series of low abrasivity experimental toothpastes were developed which were effective at promoting fluoride uptake and remineralisation of artificial caries lesions.

Estimated fluoride doses from toothpastes should be based on total soluble fluoride

The fluoride dose ingested by young children may be overestimated if based on levels of total fluoride (TF) rather than levels of bioavailable fluoride (total soluble fluoride—TSF) in toothpaste. The aim of the present study was to compare doses of fluoride intake based on TF and TSF. Fluoride intake in 158 Brazilian children aged three and four years was determined after tooth brushing with their usual toothpaste (either family toothpaste (n = 80) or children’s toothpaste (n = 78)). The estimated dose (mg F/day/Kg of body weight) of TF or TSF ingested was calculated from the chemical analysis of the toothpastes. Although the ingested dose of TF from the family toothpastes was higher than that from the children’s toothpastes (0.074 ± 0.007 and 0.039 ± 0.003 mg F/day/Kg, respectively; p < 0.05), no difference between types of toothpaste was found regarding the ingested dose based on TSF (0.039 ± 0.005 and 0.039 ± 0.005 mg F/day/Kg, respectively; p > 0.05). The fluoride dose ingested by children from toothpastes may be overestimated if based on the TF of the product. This finding suggests that the ingested dose should be calculated based on TSF. Dose of TSF ingested by children is similar whether family or children’s toothpaste is used.

Drinking water fluoride levels for a city in northern Mexico (durango) determined using a direct electrochemical method and their potential effects on oral health

Fluoride is ingested primarily through consuming drinking water. When drinking water contains fluoride concentrations>0.7 parts per million (ppm), consuming such water can be toxic to the human body; this toxicity is called "fluorosis." Therefore, it is critical to determine the fluoride concentrations in drinking water. The objective of this study was to determine the fluoride concentration in the drinking water of the city of Durango. The wells that supply the drinking water distribution system for the city of Durango were studied. One hundred eighty-nine (189) water samples were analyzed, and the fluoride concentration in each sample was quantified as established by the law NMX-AA-077-SCFI-2001. The fluoride concentrations in such samples varied between 2.22 and 7.23 ppm with a 4.313±1.318 ppm mean concentration. The highest values were observed in the northern area of the city, with a 5.001±2.669 ppm mean value. The samples produced values that exceeded the national standard for fluoride in drinking water. Chronic exposure to fluoride at such concentrations produces harmful health effects, the first sign of which is dental fluorosis. Therefore, it is essential that the government authorities implement water defluoridation programs and take preventative measures to reduce the ingestion of this toxic halogen.