Salt fluoridation and general health

Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods

The maintenance of oral health is a crucial aspect of general well-being; however, a significant proportion of the worldwide population experiences a range of oral diseases. Dental caries is a highly prevalent non-communicable disease globally, especially in children and adolescents. Fluoride is involved in the control of dental caries, primarily by decreasing the critical pH for dental hard tissue dissolution and decreasing enamel solubility. Due to the substantial data supporting the efficacy of fluoride in controlling dental caries, many community-level fluoridation initiatives have been devised and executed as global public health preventive interventions. These initiatives encompass the fluoridation of water, salt, and milk. Water fluoridation is considered safe and effective when fluoride levels are maintained within the recommended range (0.6 to 1.1 mg/L). Salt fluoridation has a cariostatic potential similar to that of water fluoridation, and a fluoride concentration of 250 micrograms per gram in salt is not associated with an increased risk of developing dental fluorosis. However, there is currently an effort to reduce the consumption of table salt in order to mitigate the harmful effects of excessive salt consumption. It has been hypothesized that fluoride food supplementation, such as fluoridated milk, is associated with a decrease in caries experience in permanent teeth; however, the effect is not clear in primary teeth. Public-level fluoride interventions are more cost-effective than the operative care of caries lesions and limit the burden of care. The administration of fluorides should be conducted using safe methods, limiting ingestion, and adhering to the guidelines set by international and national health agencies in each country. This is particularly important when considering children with developing dentitions. Fluoride is an important tool in the control of dental caries, but it is crucial to combine it with good oral hygiene, a healthy diet, and regular visits to a dental professional to maintain long-term oral health.

Eater-oriented knowledge framework for reducing salt and dietary sodium intake (scoping review)

Salt and dietary sodium are ubiquitously present in daily food practices and, at the same time, reducing salt intake presents an important public health issue. Given such an ambivalent position of salt in human diet, we argue that public health guidelines toward dietary sodium reduction require an eater-oriented knowledge framework. In this article we are making the first steps toward a flexible interdisciplinary database which would include nutritional, socio-economic, cultural, material, and socio-psychological determinants of salt consumption for comprehensive public health campaigns. We employ an explorative scoping review of academic articles and reports, limiting our review to the original data on salt or sodium consumption published in English or French between 2000 and 2022. We describe salt consumption as research object, identifying its representation in different research fields, data sources, methodologies, samples, and links with nutritional recommendations. We synthesize existing approaches via four eater-oriented categories: Socio-demographic and cultural descriptors of salt consumers; Knowledge, attitudes, and beliefs on nutritional norms; Salt practices associated with dietary or medical regimes; Salt materialities: interactions and contexts. In each category, we identify the dominant relational features, i.e., what kind of 'eater-salt' relation is being put forward. We thus build an interdisciplinary documentary base of dietary sodium consumption factors. We discuss the results, suggesting that comprehensive nutritional policies for global salt reduction require interdisciplinary eater-oriented data frameworks.

ESPEN micronutrient guideline

BACKGROUND

Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. Recent research has shown the importance of MNs in common pathologies, with significant deficiencies impacting the outcome.

OBJECTIVE

This guideline aims to provide information for daily clinical nutrition practice regarding assessment of MN status, monitoring, and prescription. It proposes a consensus terminology, since many words are used imprecisely, resulting in confusion. This is particularly true for the words "deficiency", "repletion", "complement", and "supplement".

METHODS

The expert group attempted to apply the 2015 standard operating procedures (SOP) for ESPEN which focuses on disease. However, this approach could not be applied due to the multiple diseases requiring clinical nutrition resulting in one text for each MN, rather than for diseases. An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL. The search focused on physiological data, historical evidence (published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations.

RESULTS

There was a limited number of interventional trials, preventing meta-analysis and leading to a low level of evidence. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90% of votes. Altogether the guideline proposes sets of recommendations for 26 MNs, resulting in 170 single recommendations. Critical MNs were identified with deficiencies being present in numerous acute and chronic diseases. Monitoring and management strategies are proposed.

CONCLUSION

This guideline should enable addressing suboptimal and deficient status of a bundle of MNs in at-risk diseases. In particular, it offers practical advice on MN provision and monitoring during nutritional support.

Dietary intake of macro- and micronutrients in Slovenian adolescents: comparison with reference values

BACKGROUND

Data on a nationally representative dietary intake in Central Europe is lacking. We investigated the diet of adolescents in Slovenia.

METHODS

Dietary habits were assessed using a food frequency questionnaire (n = 2,661), and present nutrition was assessed using a 3-day weighted dietary protocol (n = 197) for validation purposes. Dietary intake was calculated and compared with Central European [German (D), Austrian (A), and Swiss (CH); D-A-CH] recommendations and World Health Organization/Food and Agriculture Organization (WHO/FAO) recommendations.

RESULTS

Adolescents consumed exceeding reference intake values of free sugars (boys 16% of energy, girls 17%), saturated fatty acids (SFA; 13% of energy), and sodium (boys 203%, girls 210% of the WHO/FAO upper limit), but below-reference intake values of polyunsaturated fatty acids (PUFA; boys 5% of energy; girls 6%), water (boys 1,786 ml/day, girls 2,016 ml/day), and fiber density (only girls 2.8 g/MJ, p < 0.001). Among micronutrients, below-reference intakes (% of D-A-CH: boys and girls, respectively, p < 0.05) were reported for folate (64 and 69%), fluoride (28 and 31%), and calcium (91 and 97%), as well as for vitamin D (20 and 20%).

CONCLUSIONS

The dietary habits of Slovenian adolescents are less than optimal. They are characterized by exceeding reference intake values of free sugars, salt, and SFA, and a below-reference intake of PUFA, water, and several micronutrients.

Effect of a fluoridated food item on enamel in situ

After the consumption of food items prepared with fluoridated salt elevated fluoride concentrations can be observed in saliva, whereby enamel mineralization is supposed to be positively affected. The aim of this double-blind (with respect to fluoride), placebo-controlled, randomized, cross-over study was to evaluate the effects of the consumption of either a fluoridated (effect) or a placebo food item on the mineral content of sound and pre-demineralized human enamel in situ. During both phases of the study 8 enamel specimens in each of 10 intraoral appliances were positioned, either recessed or flush with the acrylic surface. One of the flanges was brushed twice daily with fluoride-free toothpaste prior to the storage of the appliance in sucrose solution. The subjects were asked to refrain from other sources of fluorides except for the consumption of either a highly fluoride-containing (0.5 mg) or a placebo cookie (3 times daily) during the respective study phase. Mineral content and lesion depth were measured in the enamel specimens and fluoride concentrations in saliva and urine. Significantly increased urinary and salivary (immediately after food consumption) fluoride concentrations compared to baseline were observed during the effect phase. In the absence of fluorides more pronounced demineralization was observed, especially for the recessed specimens of both surface conditions. Brushing was shown to inhibit demineralization, particularly during the placebo phase. In conclusion, fluorides added to food items seem to be efficacious to inhibit enamel demineralization in plaque-covered enamel but might be less effective if oral hygiene is adequate.

Fluoride concentration in saliva after consumption of a dinner meal prepared with fluoridated salt

The aim was to determine the fluoride concentration in saliva after intake of a dinner meal prepared with fluoridated salt. The investigation had a randomized cross-over design, and 10 healthy adolescents with natural fluoride content (1.06 ppm) in their drinking water participated after informed consent. After a run-in week, the subjects were served a standardized dinner of spaghetti with minced meat sauce prepared with either fluoridated salt (test arm) or non-fluoridated salt (control arm). The fluoride concentration of the test salt was 250 ppm. Samples of stimulated whole saliva was collected at baseline, directly after eating (0 min) and then after 10, 30 and 180 min. After a 1-week wash-out period, the experimental procedure was repeated with the opposite salt. Fluoride concentration in saliva was measured with a fluoride-specific electrode and the post-ingestion levels were compared with baseline using repeated-measures ANOVA. The mean baseline concentrations were 10.9 and 8.0 microg/l in the test and control arms, respectively. Immediately after the intake, the mean fluoride values increased significantly to 81.6 microg/l in the test arm and to 31.5 microg/l in the control arm (p<0.05). The fluoride levels remained elevated (p<0.05) for 30 min after ingestion of the test meal but not following the control meal. In conclusion, consumption of a dinner meal prepared with fluoridated salt increased the salivary fluoride levels for about 30 min.

"Risk periods" associated with the development of dental fluorosis in maxillary permanent central incisors: a meta-analysis

This systematic review of the dental literature (1966-98) concerns risk periods associated with dental fluorosis in the maxillary permanent central incisors. A literature search was organized through the MedLine and the ISI databases. In addition, one unpublished paper (in manuscript) was obtained, as well as one paper published before 1966. However, out of 143 catches, only 10 studies were included in this review. The main reason for exclusions was that the data presented did not meet the criteria given for the present meta-analysis. Among the included papers, 7 pertained to subjects whose exposure to fluoride started at different ages during the enamel formation (Group 1), and 3 were based on subjects who had been exposed from birth and then experienced an abrupt reduction in daily fluoride exposure at different ages during the amelogenesis period (Group 2). The meta-analysis for Group 1 found the odds ratio (OR) for dental fluorosis in children exposed to fluoride early in life (before 2 years of age) to be 7.24 (95% CI; 4.71-11.13) as compared to children exposed later in life (after 2 years of age). The meta-analysis for the studies in Group 2 found the overall OR to be 1.88 (95% CI; 1.35-2.61) for children who had a reduction in fluoride intake after 2 years of age, as compared to individuals who experienced reduction earlier (during the first 2 years). The studies from both groups were pooled and the duration of exposure to fluoride during the first 4 years of life was the independent variable. The meta-analysis now revealed an overall OR of 5.83 (95% CI; 2.83-11.94) for long periods of fluoride exposure (>2 out of the first 4 years) versus shorter periods of exposure (<2 out of the first 4 years of life) during the enamel formation in the maxillary central incisors. Based on the findings of the meta-analysis, no specific period of enamel formation is singled out as being the most critical for the development of dental fluorosis. The duration of fluoride exposure during the amelogenesis, rather than specific risk periods, would seem to explain the development of dental fluorosis in the maxillary permanent central incisor.