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

Toothpaste ingestion-evaluating the problem and ensuring safety: systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the ingestion of toothpaste and its sequelae. The study adhered to the PRISMA guidelines and was registered in the PROSPERO database. A comprehensive search strategy was conducted across multiple databases, resulting in the inclusion of 18 relevant publications. Eligible studies encompassed various designs and included both children and adults as the study population. Data extraction was carried out systematically, and relevant information on study characteristics, interventions, and outcomes were collected. The assessment of bias was performed using the Joanna Briggs Institute's Critical Appraisal Tools showing variations of bias among the included studies. The overall risk of systemic toxicity was found to be low, and no severe or life-threatening events were reported in the included studies. Furthermore, some toothpaste formulations containing higher concentrations of fluoride were associated with an increased risk of dental fluorosis. These findings have several implications for practice and policy. Healthcare providers and dental professionals should emphasize the importance of promoting safe toothpaste use, especially in vulnerable populations such as young children who are more prone to accidental ingestion. Public health campaigns and educational initiatives should aim to raise awareness about appropriate toothpaste usage and the potential risks. In addition, toothpaste manufacturers and regulatory bodies should consider revising guidelines and regulations to ensure the safety of oral care products, including the appropriate concentration of active ingredients. Future research should focus on investigating the long-term effects of toothpaste ingestion, exploring potential interactions between different active ingredients, and evaluating the efficacy of current preventive measures.

A Systematic Review and Meta-Analysis of the Relationship Between the Severity of Dental Fluorosis and Fluoride Biomarkers in Endemic Areas

The intake of high concentrations of fluoride, mainly through drinking water, diet and fluoridated dentifrices, produces fluorosis, which in its early stages is manifested as dental fluorosis (DF). To recognize exposure to fluoride in endemic areas and to evaluate the risk of developing health impairment, the WHO has established several biomarkers that are used to determine systemic fluorine (F^-) exposure. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the relationship between the severity of DF and fluoride biomarkers in endemic areas. The protocol of this study was previously registered as CRD42021244974. A digital search was carried out in PubMed/Medline, SpringerLink, Scopus, Cochrane and Google Scholar by employing the keywords "urine", "nails", "hair", "plasma", "saliva" and "dental fluorosis" for the original studies with content associated with F^- for the biomarkers and DF. The mean difference was established as the effect measure for the meta-analysis. Seven studies fulfilled the eligibility criteria, among which five assessed urine and two employed nails as fluoride biomarkers. A positive significant difference was found between the biomarkers and the severity of DF (0.27, p < 0.001) and individually for each biomarker (urine: 0.14, p = 0.001; nails: 0.88, p < 0.05). The F^- concentration in urine and nails is correlated with the severity of DF, with the most evident differences between healthy individuals and those with mild severity. Both biomarkers are adequate to assess this relationship in endemic areas of fluoride and DF.

The Safety of Fluoride Compounds and Their Effect on the Human Body-A Narrative Review

Fluoride is one of the elements commonly present in the human environment. Due to its characteristics, it is very widely used in medicine, dentistry, industry or agriculture. On the other hand, its universality possesses a real threat to the human body in the form of acute and chronic poisoning. The aim of this paper is to characterize the properties of fluoride and its effects on the human body, as well as the sources of its occurrence. Particular emphasis is placed on the safety of its use and optimal dosage intake, which prevents accumulation and reduces its potential side effects. The positive effect of proper fluoride supply is widely described. In order to avoid overdose, it is best to consult a specialist to properly select the dosage.

Hydrogeochemical characterisation and health hazards of fluoride enriched groundwater in diverse aquifer types

High concentration of fluoride (up to 20.9 mg/L) in groundwater with significant variation (p = 5.9E-128) among samples was reported from Birbhum district, an acknowledged fluoride endemic region in India. The groundwater samples (N = 368) were grouped based on their hydrochemical properties and aquifer geology for hydro-geochemical characterization. Friedman's test showed p < 0.0001 confidence level which indicates that fluoride concentration among geological groups and water groups are independent. Bland-Altman plot was used to study the inter-relationships among the groups through bias value (∂) and limit of agreement (LoA). Among the geological groups, laterites and granite-gneiss groups exhibited statistically significantly difference in fluoride geochemistry; whereas the younger and older alluvium groups displayed similar characteristics. The fluoride concentration was found to be in the order Lateritic > Granite-gneiss > Older alluvium ≥ Younger alluvium. Dissolution of minerals (such as fluorite, biotite) in laterite sheeted basalt, and granite-gneiss is the main source of groundwater fluoride in the region. Fluoride concentration is also influenced by depth of water table. Hydrochemical study indicated that fluoride concentration was higher in Na-HCO₃ than in Ca-SO₄ and Ca-HCO₃ type of groundwater. The fluoride concentration were positively correlated with Na⁺ and pH and negatively correlated with the Ca²⁺ and Mg²⁺ signifying linkage with halite dissolution and calcite, dolomite precipitation. Geostatistical mapping of WQI through empirical bayesian kriging (EBK) with respect to regional optimal guideline value (0.73 mg/L) classified that groundwater in some parts of the district are unfit for drinking purpose. Health survey (N = 1767) based on Dean's criteria for dental fluorosis indicated presence of slight to moderate dental hazard. Besides, providing baseline data for management of groundwater quality in the study area, the study demonstrated the applicability of Bland-Altman analysis and empirical bayesian kriging (EBK) in delineation and interpolation of fluoride contaminated region.

Low-to-moderate fluoride exposure, relative mitochondrial DNA levels, and dental fluorosis in Chinese children

BACKGROUND

The alteration of mitochondrial DNA (mtDNA) content contributes to many diseases, however, little is known about its effect on the prevalence of dental fluorosis (DF).

OBJECTIVES

We conducted a cross-sectional study to investigate the association of low-to-moderate fluoride exposure with relative mtDNA levels in relation to DF in children.

METHODS

We recruited 616 resident children, aged 7-13 years, randomly from low-to-moderate fluoride areas in Tianjin, China. We measured the fluoride concentrations in drinking water and urine using the national standardized ion selective electrode method, and determined the relative levels of mtDNA using a quantitative real-time polymerase chain reaction assay. The association among fluoride exposure, relative mtDNA levels, and the prevalence of DF were examined using multivariable linear and logistic regression models. We also performed stratified and mediation analyses.

RESULTS

The relative mtDNA levels of participants in the DF group were significantly lower than in the non-DF group (0.95 ± 0.44 vs. 1.12 ± 0.45, P < 0.001). In the adjusted models, we found that a 1 mg/L increment in water fluoride concentration was associated with a 0.10-unit decrease in circulating relative mtDNA levels (95% CI: -0.14, -0.06) and a 2.85-fold increase (95% CI: 2.01, 3.92) in moderate DF prevalence. A 1 mg/L increment in urinary fluoride level was associated with a 0.12-unit decrease in circulating relative mtDNA levels (95% CI: -0.14, -0.09) and a 1.85-fold increase (95% CI: 1.39, 2.39) in moderate DF prevalence. Stratified analysis indicated a weaker positive association of DF prevalence with fluoride exposure, while a stronger inverse relationship with relative mtDNA levels in boys than in girls. Assuming causality, we estimated that circulating mtDNA levels mediated 13.0% (95% CI: 5.2, 28.7%) and 9.6% (95% CI: 4.7, 18.5%) of the estimated effect of a 1 mg/L increment in water fluoride and urinary fluoride on prevalence of moderate DF, respectively.

CONCLUSIONS

Gender potentially modifies the associations of DF prevalence with relative mtDNA levels and low-to-moderate fluoride exposure. The reduced circulating mtDNA levels may partly mediate the elevated prevalence of moderate DF in children under such exposure.

Long term spatial-temporal dynamics of fluoride in sources of drinking water and associated health risks in a semiarid region of Northern China

There is a concern about the increasing prevalence of health problems related to the ingestion of fluoride (F^-) in the developing world. Drinking water is one important source of F^-, and the concentration of F^- needs to be known to ensure the safety of drinking water. In this study, F^- levels in drinking water were investigated across Taiyuan in Shanxi Province, China. Spatial-temporal distribution characteristics and potential associated health risks were analyzed using GIS. We collected 485 samples from shallow wells without any defluoridation treatments between 2008 and 2016. After analyzing the samples of F^- content we found that mean F^- levels of urban areas (0.61 ± 0.39 mg L^-1), suburban areas (0.70 ± 0.87 mg L^-1) and for all of Taiyuan city (0.63 ± 0.56 mg L^-1) were in optimum range based on the recommendation by USEPA. However, individual locations within industrial areas (e.g. Gujiao District) had higher F^- levels (1.06 mg L^-1). A concerning result showed that 12.37% of tested locations had F^- concentrations larger than 1.0 mg L^-1. We calculated F^- Health Risk Indices (HRIs_F) and found that highest were associated with suburban areas, especially in the year 2009 and 2010. However, from 2008 to 2016, overall F^- levels and HRIs_F of the sampled groundwater in Taiyuan City showed a decreasing trend. HRIs_F in suburban areas was higher than urban areas, possible due to the heavily prevalent coal mining industry in those areas. Specific policies should be formulated to address HRIs_F.

Factors associated with dental fluorosis in three zones of Ecuador

Background

To determine the prevalence of dental fluorosis in 10-12 year-old school children, in three provinces of the inter-andean Region of Ecuador: Imbabura, Pichincha and Chimborazo, as well as the relationship between certain factors, considering that the latest studies go back to the year 2009.

Material and Methods

A cross-sectional and observational study was proposed. A sample of 599 was calculated at 95% of confidence considering population projections for children between 10 and 12 old of three zones of Ecuador. However, 608 school children, who had the acceptance and informed consent of their parents to participate, completed a survey about factors associated with dental fluorosis. Once the survey was completed, the vestibular surfaces of the upper and lower anterior teeth of the infant were photographed, following standardized distance and light procedures. Three evaluators, trained in the detection of fluorosis using the Thylstrup and Fejerskov index, analyzed the photographs. The Stata 13.0 software was used for the statistical analysis, with a level of significance of 5% and with a confidence interval of 95%. To relate the risk factor of fluorosis, a multinomial logistic model was used.

Results

The prevalence of dental fluorosis was of 89.96%, with a greater presence of grade 2 TF. A positive statistical relationship and statistical significance was detected between dental fluorosis and consumption of bottled beverages. Also the amount of toothpaste used and its ingestion during brushing (p = 0.000) were analyzed.

Conclusions

The populations evaluated, that are related to the consumption of bottled beverages and involuntary toothpaste ingestion, and have a high prevalence of a mild level of fluorosis. Key words:Fluorosis, dental, risk factors, epidemiology.