Studies on the changes in developing enamel caused by ingestion of high levels of fluoride in the rat

Organic and inorganic content of fluorotic rat incisors measured by FTIR spectroscopy

Details on how fluoride interferes in enamel mineralization are still controversial. Therefore, this study aimed at analyzing the organic contents of fluorosis-affected teeth using Fourier Transformation Infrared spectroscopy. To this end, 10 male Wistar rats were divided into two groups: one received 45 ppm fluoride in distilled water for 60 days; the other received distilled water only. Then, the lower incisors were removed and prepared for analysis by two FTIR techniques namely, transmission and micro-ATR. For the first technique, the enamel was powdered, whereas in the second case one fluorotic incisor was cut longitudinally for micro-ATR. Using transmission and powdered samples, FTIR showed a higher C-H content in the fluorotic enamel compared with control enamel (p<0.05, n=4 in the flurotic, and n=5 in the control group). Results from the micro-ATR-FTIR spectroscopic analysis on one longitudinally cut incisor carried out at six points reveal a higher C-H bond content at the surface of the enamel, with values decreasing toward the dentine-enamel junction, and reaching the lowest values at the subsuperficial enamel. These results agree with the morphological data, which indicate that in the rat incisor the fluorotic lesion is superficial, rather than subsuperficial, as in the case of human enamel. The results also suggest that the increased C-H bond content may extend toward the more basal enamel (intraosseous), indicating that fluorotic enamel may intrinsically contain more protein. Finally, particularly when coupled to ATR, FTIR is a suitable tool to study the rat incisor enamel, which is a largely used model of normal and abnormal amelogenesis. Further studies along this line may definitely answer some questions regarding protein content in fluorotic enamel as well as their origin.

Effect of calcium, given before or after a fluoride insult, on hamster secretory amelogenesis in vitro

We tested the hypothesis that high-calcium medium given prior to or immediately after exposure to fluoride (F) reduces the negative effects of F on secretory amelogenesis. Hamster molar tooth germs were grown in organ culture in media with different calcium levels. Deposition of enamel matrix and matrix mineralization were monitored by incorporation of [3H]proline and uptake of 45Ca and acid-soluble 32PO4. Ameloblast structure and the occurrence of a fluorotic enamel matrix were examined by light and electron microscopy. A preculture of explants in high-calcium medium partially prevented the formation of fluorotic (non-mineralizing) enamel matrix, increased matrix secretion but could not prevent F-induced hypermineralization of the pre-exposure enamel. High-calcium medium, applied after F insult, accelerated the recovery of fluorotic matrix, improved ameloblast structure, enhanced amelogenin secretion, and increased enamel thickness. The data indicate that it might be the balance between the amount of mineral deposition and that of matrix secretion which is critical for the mineralization of newly secreted enamel. Exposure to F disturbs this balance by enhancing mineralization of the pre-exposure enamel, probably generating an excess of protons. High calcium may protect against F exposure by enhancing amelogenin secretion into the enamel space, thereby increasing the local buffering capacity at the mineralization front.

Fluorosis: a new model and new insights

Fluoride is an effective agent for the prevention of dental caries. However, the mechanism of how excessive fluoride exposure causes fluorosis remains uncertain. Zebrafish (Danio rerio) exhibit periodic tooth replacement throughout their lives, thereby providing continuous access to teeth at developmental stages susceptible to fluoride exposure. Zebrafish teeth do not contain true enamel, but consist of a hard enameloid surface. Therefore, we asked whether zebrafish could be used as a model organism for the study of dental fluorosis. Scanning electron microscopy of fluoride-treated teeth demonstrated that the enameloid was pitted and rough, and FTIR analysis demonstrated that the teeth also contained a significantly higher organic content when compared with untreated controls. Furthermore, we demonstrate for the first time that decreased expression of an important signaling molecule (Alk8) in tooth development may contribute to the observed fluorotic phenotype, and that increased cell apoptosis may also play a role in the mechanism of fluorosis.

Tooth quality in dental fluorosis genetic and environmental factors

Dental fluorosis (DF) affects the appearance and structure of tooth enamel and can occur following ingestion of excess fluoride during critical periods of amelogenesis. This tooth malformation may, depending on its severity, influence enamel and dentin microhardness and dentin mineralization. Poor correlation between tooth fluoride (F) concentration and DF severity was shown in some studies, but even when a correlation was present, tooth fluoride concentration explained very little of DF severity. This fact calls into question the generally accepted hypothesis that the main factor responsible for DF severity is tooth fluoride concentration. It has been shown previously that genetic factors (susceptibility to DF) play an important role in DF severity although DF severity relates to individual susceptibility to fluoride exposure (genetics), tooth fluoride concentration relates to fluoride ingestion (environmental). The objective of this study was to investigate the correlation between tooth fluoride concentration, DF severity, and tooth mechanical and materials properties. Three strains of mice (previously shown to have different susceptibility to DF) at weaning were treated with four different levels of F in their water (0, 25, 50, and 100 ppm) for 6 weeks. Mice teeth were tested for fluoride by instrumental neutron activation analysis (INAA), DF severity determined by quantitative light-induced fluorescence [QLF], and tooth quality (enamel and dentin microhardness and dentin mineralization). Tooth fluoride concentration (environment factor) correlated positively with DF severity (QLF) (rs=0.608), fluoride treatment group (rs=0.952). However, tooth fluoride concentration correlated negatively with enamel microhardness (rs=-0.587), dentin microhardness (rs=-0.268) and dentin mineralization (rs=-0.245). Dental fluorosis (genetic factor) severity (QLF) correlated positively with fluoride treatment (rs=0.608) and tooth fluoride concentration (rs=0.583). DF severity correlated negatively with enamel microhardness (rs=-0.564) and dentin microhardness (rs=-0.356). Genetic factors (DF severity) and the environmental factor (fluoride concentration in tooth structure) have similar influence on tooth biomechanical properties, whereas only the environmental factor has an influence on tooth material property (mineralization).

Fluoride enhances intracellular degradation of amelogenins during secretory phase of amelogenesis of hamster teeth in organ culture

Amelogenins are the major protein species synthesized by secretory ameloblasts and are believed to be involved in enamel mineralization. During enamel formation, amelogenins are progressively degraded into smaller fragments by protease activity. These amelogenin fragments are removed from the enamel extracellular space, thereby enabling full mineralization of the dental enamel. Enamel from fluorotic teeth is porous and contains more proteins and less mineral than sound enamel. In this study we examined the hypothesis that fluoride (F-) is capable of inhibiting the proteolysis of amelogenins in enamel being formed in organ culture. Hamster molar tooth germs in stages of secretory amelogenesis were pulse labeled in vitro with [3H]- or [14C] proline and subsequently pulse chased. The explants were exposed to F- at different days of chase (i.e., during secretory amelogenesis early after labeling, later after labeling or at stages just beyond secretory amelogenesis). Exposure of secretory stage explants to F- enhanced the release of radiolabeled fragments when F- was applied early after labeling but progressively less if applied later. In contrast, F- had no such effect in stages beyond secretion. The enhanced release of radiolabeled fragments in secretory stages was associated with a reduction of radioactivity in the soft tissue enamel organ indicating that fragmentation of enamel matrix proteins (mainly amelogenins) occurred intracellularly. Analysis by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) demonstrated that the fluorotic enamel contained less radiolabeled parent amelogenins (M(r) 28 kD and 26 kD) but more low-molecular-mass fragments than enamel from control explants. Our data indicate that F- promotes intracellular degradation of the newly synthesized parent amelogenins during secretory stage. Our in vitro data do not support the concept that F- impairs extracellular proteolysis of amelogenins, either in the secretory phase or in the stage just beyond the secretory phase.

Effects of fluoride on rat dental enamel matrix proteinases

Enamel fluorosis is characterised by increased porosity and a delay in the removal of enamel matrix proteins as the enamel matures. Amelogenin is the primary matrix protein in secretory-stage dental enamel. As enamel matures, amelogenins are hydrolysed by a number of enamel proteinases, including matrix metalloproteinase-20 (MMP-20 or enamelysin) and serine proteinase. Here, the effect of ingested fluoride on the relative activity of proteinases in the enamel matrix and the specific effect of fluoride on MMP-20 activity were examined. Proteinase activity relative to total enamel matrix protein was measured by fluorescence assay of enamel matrix dissected from rats given 0, 50, or 100 parts per 10(6) fluoride in their drinking water. To determine the specific effect of fluoride on the activity of MMP-20, the hydrolysis of a full-length recombinant human amelogenin by recombinant MMP-20 (rMMP-20) in the presence of 0, 2, 5, 10 or 100 microM fluoride was compared by sodium dodecyl sulphate (SDS)-polyacrylamide gel electrophoresis (PAGE). In addition, a fluorescent peptide assay was developed to quantify enzyme activity against the tyrosine-rich amelogenin peptide cleavage site. In the late maturation stage, total proteinase activity per unit protein was lower in the fluoride-exposed rats than in the control rats. This in vivo finding indicates that fluoride ingestion can alter the relative amount of active proteinase in mature enamel. Hydrolysis of amelogenin at neutral pH by rMMP-20 was reduced in the presence of 100 microM F. In the peptide assay, rMMP-20 activity was significantly reduced by concentrations of fluoride as low as 2 microM at pH 6, with no significant effect at pH 7.2. These in vitro assays show that micromolar concentrations of fluoride can alter metalloproteinase activity, particularly when the pH is reduced to 6.0. These studies suggest that the effects of fluoride on enamel matrix proteinase secretion or activity could be involved in the aetiology of fluorosis in enamel and other mineralising tissues.

Clinical diagnosis of enamel defects: pitfalls and practical guidelines

Changes in enamel during its development are permanently recorded, and commonly present as either demarcated opacity, diffuse opacity, or enamel hypoplasia. Developmental enamel defects may provide clues regarding their aetiology, and this may have application in clinical dentistry, dental epidemiology and anthropology. However, the usefulness of these applications may be hampered by many pitfalls encountered in the detection and diagnosis of developmental enamel defects. The defects may be masked by saliva, dental plaque, and incorrect lighting. In addition, confounding effects of post-eruptive changes such as dental caries, attrition, and traumatic loss of tooth structure may impair the detection of developmental enamel defects. The non-specificity of appearance of enamel defects may make aetiologic diagnosis of enamel hypoplasia difficult. Furthermore, difficulty is often encountered in the relative timing of events in enamel hypoplasia, due to limited data on the chronology of development of the human dentition. In this review, pitfalls in the clinical assessment of enamel defects are discussed, and guidelines to overcome some of these difficulties are presented.

The protein composition of normal and developmentally defective enamel

The development of human enamel involves a complex series of events including the secretion and degradation of a unique extracellular matrix. Ameloblasts progress through a succession of cellular phenotypes executing specialized secretory and regulatory functions. When performing optimally, ameloblasts produce a highly structured and mineralized tissue. Given the elaborate developmental events required for normal enamel formation, it is not surprising that a variety of enamel malformations arise from defects in matrix synthesis, secretion and extracellular processing. Normal matrix secretion and post-secretory processing by ameloblasts can be affected by a variety of hereditary and environmental conditions. These disturbances can result in an abnormal amount and/or composition of matrix proteins, and subsequently, an altered enamel structure and/or mineral content. For example, abnormal matrix removal during enamel maturation apparently contributes to hypomineralization associated with dental fluorosis. Incomplete matrix removal can also occur in several different forms of the hereditary condition amelogenesis imperfects. Specific types of this condition can have retention of substantial enamel protein (e.g. 5% by weight) that is, at least in part, composed of amelogenin and/or its breakdown products. Characterization of the enamel proteins in teeth affected by developmental disturbances can provide insight into the pathogenesis and normal formation of this highly specialized tissue.

Protein characterization of fluorosed human enamel

Despite extensive investigation, the development mechanism or mechanisms resulting in dental fluorosis are unknown. Several hypotheses suggest abnormal matrix synthesis, secretion, and delayed and/or defective matrix degradation with retention of enamel protein. The purpose of this study was to characterize the protein composition of fluorosed human enamel. Nine permanent moderately fluorosed (developed in a 3.2 ppm H2O area) and ten permanent normal control teeth (from individuals with < 0.2 ppm F in their drinking water) were evaluated. The enamel fluoride concentration, protein content, and amino acid composition were determined for each tooth. The enamel proteins were further characterized by gel electrophoresis and by Western blot analysis by means of polyclonal antibodies raised against recombinant amelogenin protein. Fluorotic enamel had significantly elevated (p = 0.0001) F levels compared with normal enamel (mean [F-] fluorosed = 431 ppm; mean [F-] control = 62 ppm). While there was a significantly greater protein content by weight in fluorosed enamel compared with normal enamel (mean fluorosed = 0.27%; mean control = 0.11%), the amino acid profiles were similar for fluorosed and normal enamel. Gel electrophoresis showed fluorosed enamel to have a greater diversity of primarily low-molecular-weight proteins compared with normal enamel. Western blot analysis did not indicate retention of amelogenin in either fluorosed or normal enamel. This investigation showed that the protein content of fluorosed enamel was greater than that of normal enamel; however, the amino acid compositions were similar for fluorosed and normal enamel. Furthermore, there does not appear to be retention of significant amounts of amelogenin in fully mature, moderately fluorosed human enamel. Although delayed removal of the enamel matrix proteins may play a role in the hypomineralization defects seen in fluorosed enamel, the majority of these proteins are absent in the mature tissue of these moderately fluorosed teeth.

Ameloblast cycling patterns as measured by fluorochrome infiltration of rat incisor enamel

Rapid modulation of maturation ameloblasts between smooth-ended and ruffle-ended forms may play an important part in the development of normal dental enamel. Previous studies of modulation rates relied upon measurements of stained or fluorescing bands on the enamel surface of whole incisors along with separate histological sections for cell-band dimensions. The present study utilized direct measurement of maturation-ameloblast bands and fluorescing regions of underlying enamel in the same histological sections, which increased the accuracy and ease with which modulation rates could be determined. Rats were injected with calcein at various times before killing and preparation of survey midsagittal sections of the lower incisors. The lengths of bands of smooth-ended ameloblasts and underlying fluorescing regions of enamel were measured throughout the maturation zone. Modulation rates were found to range from 238 microns/h (early maturation) to 91 microns/h (late maturation). Calcein diffused into enamel to varying degrees depending upon the location within the maturation stage. This new approach of direct measurement greatly facilitates the investigation of ameloblast modulation and provides additional insights into progressive structural changes in enamel during maturation.

Dental fluorosis: its use as a biomarker

Several epidemiological studies, beginning with those of Dean and co-workers in the 1940's, clearly demonstrate the relationship between dental fluorosis in humans and the level of fluoride in water supplies. These studies and others have shown that, in a population, there is a direct relationship among the degree of enamel fluorosis, plasma and bone fluoride levels, and the concentration of fluoride in drinking water. However, dental fluorosis is a reflection of fluoride exposure only during the time of enamel formation, somewhat limiting its use as a biomarker. In addition, the degree of fluorosis is dependent not only on the total fluoride dose, but also on the timing and duration of fluoride exposure. At the level of an individual response to fluoride exposure, factors such as body weight, activity level, nutritional factors, and the rate of skeletal growth and remodeling are also important. These variables, along with an individual variability in response to similar doses of fluoride, indicate that enamel fluorosis cannot be used as a biological marker of the level of fluoride exposure for an individual.

Dental tissue effects of fluoride

It is now well-established that a linear relationship exists between fluoride dose and enamel fluorosis in human populations. With increasing severity, the subsurface enamel all along the tooth becomes increasingly porous (hypomineralized), and the lesion extends toward the inner enamel. In dentin, hypomineralization results in an enhancement of the incremental lines. After eruption, the more severe forms are subject to extensive mechanical breakdown of the surface. The continuum of fluoride-induced changes can best be classified by the TF index, which reflects, on an ordinal scale, the histopathological features and increases in enamel fluoride concentrations. Human and animal studies have shown that it is possible to develop dental fluorosis by exposure during enamel maturation alone. It is less apparent whether an effect of fluoride on the stage of enamel matrix secretion, alone, is able to produce changes in enamel similar to those described as dental fluorosis in man. The clinical concept of post-eruptive maturation of erupting sound human enamel, resulting in fluoride uptake, most likely reflects subclinical caries. Incorporation of fluoride into enamel is principally possible only as a result of concomitant enamel dissolution (caries lesion development). At higher fluoride concentrations, calcium-fluoride-like material may form, although the formation, identification, and dissolution of this compound are far from resolved. It is concluded that dental fluorosis is a sensitive way of recording past fluoride exposure because, so far, no other agent or condition in man is known to create changes within the dentition similar to those induced by fluoride. Since the predominant cariostatic effect of fluoride is not due to its uptake by the enamel during tooth development, it is possible to obtain extensive caries reductions without a concomitant risk of dental fluorosis.

Effects of chronic fluoride exposure on morphometric parameters defining the stages of amelogenesis and ameloblast modulation in rat incisors

The response of ameloblasts to long-term (6 weeks) exposure to 100 ppm fluoride was examined in continuously erupting mandibular incisors of female Sprague-Dawley rats as compared to control rats receiving a similar diet (Teklad L-356) but no sodium fluoride in their drinking water. After treatment, animals from both groups were perfused intravascularly with glutaraldehyde, and the incisors were removed and processed for light microscope morphometric analyses directly from 1 microns thick Epon sections. Other animals were injected intravenously with calcein (green fluorescence) followed 4 hours later by xylenol orange (red fluorescence) in order to reveal smooth-ended ameloblast modulation bands and thereby allow quantification of parameters related to the creation and movement of modulation waves within the maturation zone of these teeth. The results indicated that rat incisors expressed four major changes in normal amelogenesis which could be attributed to the chronic fluoride treatment. First, ameloblasts produced a thinner than normal enamel layer by the time they completed the secretory stage and entered the maturation stage of amelogenesis. Second, enamel organ cells within the maturation zone, especially those from the papillary layer, were shorter in height than normal. Third, ameloblasts related to maturing enamel in areas where it was partially soluble and/or fully soluble in EDTA modulated at a rate that was much slower than normal. In some locations ameloblasts remained ruffle-ended for as much as 30% longer than normal per cycle. This upset the usual pattern such that fewer total modulation cycles were completed per unit time by these ameloblasts. Fourth, enamel proteins were lost from the maturing enamel layer at a rate that was about 40% slower than normal. The data suggested that ameloblasts detected the delay in the extracellular breakdown and/or loss of enamel proteins and they responded by remaining ruffle-ended for longer intervals than usual (positive feedback).

The presence and possible functions of the matrix metalloproteinase collagenase activator protein in developing enamel matrix

The developing enamel matrix contains mostly amelogenins, which are hydrophobic proline-rich proteins. During amelogenesis, the amelogenins are presumably hydrolysed and removed from the enamel. Recently a number of metalloproteinases that may be important in amelogenesis have been identified in zymograms of the developing enamel matrix. In the present study an antibody specific for the matrix metalloproteinase collagenase activator protein (CAP) was characterized and used to identify this metalloproteinase in enamel. Immunoblotting showed that the CAP proteinase was present in the enamel matrix. Immunohistochemistry confirmed that the proteinase is localized in the enamel matrix, most specifically along the dentino-enamel junction. Purified CAP was found to hydrolyse amelogenin protein. Possible functions of the proteinase in the enamel matrix are discussed.

Separation by polyacrylamide gel electrophoresis of multiple proteases in rat and bovine enamel

At least seven protein bands of protease activity were found in rat secretory enamel and six bands in bovine secretory enamel. The bovine proteases had molecular weights similar to those found in rat enamel. Two bands were found to be active in gels containing enamel proteins. All proteases were acid-resistant and calcium-dependent. In vitro digestion of secretory enamel resulted in a changing profile of proteases. Rat maturation enamel contained a 23,000 and a 33,000 molecular-weight protease which were not present in the secretory enamel. The 33,000 molecular weight protease was also active against enamel proteins. Thus multiple proteases are present in rat and bovine secretory enamel and in rat maturation enamel; some of these may be important in hydrolysis of enamel proteins.

A comparative study of disturbed mineralization of rat incisor enamel induced by strontium and fluoride administration

The disturbed pattern of mineralization of developing enamel of the rat incisor after the oral administration of SrCl2 and NaF was investigated in an attempt to disclose possible mechanisms which might not be readily detectable under normal conditions, but which may control the progressive mineralization of developing enamel, especially during the maturation stage. Undemineralized ground sections of upper incisors were examined by contact microradiography, tetracycline labeling, and electron microprobe analysis. It was clear that Sr and F disturb the pattern of mineralization during the maturation stage in a characteristic fashion. Sr inhibits the early stage of maturation in which mineralization progresses from the surface toward the middle layer, whereas F accelerates the same stage prominently. At the late stage of maturation, the pattern of hypomineralization is different in the enamel of Sr- and F-treated rats. Mineralization in the inner and innermost layers of the Sr-treated rats and that in the outer layer of the F-treated rats ceases earlier than that in the controls, although the enamel is still hypomineralized.

At the latest stage of maturation, Fe penetrates more deeply into the hypomineralized enamel of the Sr- and F-treated rats, because of the higher porosity of the matrix.

These results suggest that the maturation stage is not a simple, continuous process, but rather is composed of substages (phases) which have different control mechanisms and in which mineralization progresses in different modes and rates.