FLUORIDE	International Society for Fluoride Research	Table of Contents 32(1) 1999

CARIES FREQUENCY IN PERMANENT TEETH BEFORE
AND AFTER DISCONTINUATION OF WATER
FLUORIDATION IN KUOPIO, FINLAND

L Seppa, S Karkkainen, H Hausen
Oulu, Finland

Abstract from Community Dentistry & Oral Epidemiology 26 (4) 256-262 1998

The piped water of Kuopio, Finland, was fluoridated in 1959. Owing to strong opposition by different civic groups, water fluoridation was stopped at the end of 1992.

Objectives: The aim of this study was to examine the consequences of the discontinuation on dental health.

Methods: In 1992 and 1995, independent random samples of all children aged 6, 9, 12 and 15 years were drawn from Kuopio and Jyvaskyla, a nearby low fluoride town whose distribution of demographic and socio-economic characteristics was fairly similar to Kuopio’s. The total number of subjects examined was 550 in 1992 and 1198 in 1995. Caries was registered clinically and radiographically by the same two calibrated dentists in both towns.

Results: In 1992, the mean DMFS values were lower in the fluoridated town for the two older age groups, the percentage differences for 12- and 15-year-olds being 37% and 29%, respectively. For the two younger age groups no meaningful differences could be found. In 1995, the only difference with possible clinical significance was found in the 15-year-olds in favor of the fluoridated town (18%). In 1995, a decline in caries was seen in the two older age groups in the nonfluoridated town. In spite of discontinued water fluoridation, no indication of an increasing trend of caries could be found in Kuopio. The mean numbers of fluoride varnish and sealant applications decreased sharply in both towns between 1992 and 1995. In spite of that caries declined. Conclusions: These findings suggest that the decline of caries has little to do with professional preventive measures performed in dental clinics.

Key words: Caries frequency, Discontinuation of water fluoridation, Finland, Need for professional fluoride applications, Water fluoridation.
Reprints: L Seppa, Univ Oulu, Inst Dent, Aapistie 3, Fin-90220 Oulu, Finland.

INFLUENCE OF CHRONIC FLUOROSIS ON
MEMBRANE LIPIDS IN RAT BRAIN

ZZ Guan, YN Wang, KQ Xiao, DY Dai, YH Chen, JL Liu, P Sindelar, G Dallner
Guiyang, Guizhou, China; Huddinge, Sweden

Abstract from Neurotoxicology & Teratology 20 (5) 537-542 1998

Brain membrane lipid in rats were analyzed after being fed either 30 or 100 ppm fluoride for 3, 5, and 7 months. The protein content of brain with fluorosis decreased, whereas the DNA content remained stable during the entire period of investigation. After 7 months of fluoride treatment, the total brain phospholipid content decreased by 10% and 20% in the 30 and 100 ppm fluoride groups, respectively. The main species of phospholipid influenced by fluorosis were phosphatidylethanolamine, phosphatidylcholine, and phosphatidylserine. The fatty acid and aldehyde compositions of individual phospholipid classes were unchanged. No modifications could be detected in the amounts of cholesterol and dolichol. After 3 months of fluoride treatment, ubiquinone contents in brain were lower; however, at 7 months they were obviously increased in both groups of fluoride treatment. The results demonstrate that the contents of phospholipid and ubiquinone are modified in brains affected by chronic fluorosis and these changes of membrane lipids could be involved in the pathogenesis of this disease.

Key words: Brain, Fatty acid, Fluorosis, Fluoride, Neutral lipid, Phospholipid.
Reprints: ZZ Guan, Guiyang Med Coll, Dept Pathol, Guiyang 550004, Guizhou, China.

RISK FACTORS FOR ENAMEL FLUOROSIS IN OPTIMALLY
FLUORIDATED CHILDREN BORN AFTER THE US
MANUFACTURERS DECISION TO REDUCE THE
FLUORIDE CONCENTRATION OF INFANT FORMULA

DG Pendrys and RV Katz
Farmington, Connecticut, USA

Abstract from American Journal of Epidemiology 148 (10) 967-974 1998

This case-control study investigated risk factors for enamel fluorosis in optimally fluoridated children, born after the US infant formula industry voluntarily reduced the fluoride content of their products, Analysis was performed on 233 children, aged 10-14 years. Case-control status was determined using the Fluorosis Risk Index (FRI), Risk factor exposure was ascertained via a mailed questionnaire. Logistic regression analyses revealed a strong association between mild-to-moderate enamel fluorosis on early forming (FRI classification I) enamel surfaces and both fluoride supplement use (odds ratio (OR) = 5.95, 95% confidence interval (CI) 1.06-33.53), and early fluoride toothpaste use (OR = 6.35, 95% CI 1.21-33.40).The authors found a suggestive, but nonsignificant, association between fluorosis on these enamel surfaces and infant formula in the form of powdered concentrate (OR = 4.33, 95% CI 0.73-25.66). There was a strong association between mild-to-moderate fluorosis on later forming (FRI classification II) enamel surfaces and infant formula use in the form of powdered concentrate (OR = 10.77, 95% CI 1.89-61.25), fluoride supplement use (OR = 10.83, 95% CI 1.90-61.55), and early fluoride toothpaste use (OR = 8.37, 95% CI 1.68-41.72), No association was observed between the use of ready to feed infant formula and enamel fluorosis.

Key words: Dental fluorosis, Epidemiologic methods, Fluoride, Mottled enamel, Risk.
Reprints: DG Pendrys, Univ Connecticut, CTR Health, Sch Dent Med, Dept Behav Sci & Community Health, Farmington, CT, 06030, USA.

FLUOROSIS RISK FROM EARLY EXPOSURE
TO FLUORIDE TOOTHPASTE

AK Mascarenhas, BA Burt
Columbus, Ohio; Ann Arbor, Michigan, USA

Abstract from Community Dentistry & Oral Epidemiology 26 (4) 241-248 1998

Swallowed fluoride toothpaste in the early years of life has been postulated to be a risk factor for fluorosis, but the epidemiological evidence is weakened by the fact that most of the relevant studies were done in developed countries where an individual is exposed to multiple sources of fluoride.

Objectives: To quantify the risk of fluorosis from fluoride toothpaste in a population whose only potential source of fluoride was fluoride toothpaste.

Methods: Case-control analyses were conducted to test the hypothesis that fluoride toothpaste use before the age of 6 years increased an individual’s risk of fluorosis. Data came from a cross-sectional clinical dental examination of schoolchildren and a self-administered questionnaire to their parents. The study was conducted in Goa, India. The study group consisted of 1189 seventh grade children with a mean age of 12.2 years.

Results: The prevalence of fluorosis was 12.9% using the TF index. Results of the crude, stratified, and logistic regression analyses showed that use of fluoride toothpaste before the age of 6 years was a risk indicator for fluorosis (OR 1.83, 95% CI 1.05-3.15). Among children with fluorosis, beginning brushing before the age of 2 years increased the severity of fluorosis significantly (P<0.001). Other factors associated with the use of fluoride toothpaste, such as eating or swallowing fluoride toothpaste and higher frequency of use, did not show a statistically significant increased risk for prevalence or severity of fluorosis.

Conclusions: Fluoride toothpaste use before the age of 6 years is a risk indicator for fluorosis in this study population.

Key words: Fluoride toothpaste, Fluorosis, Goa, India, Risk indicator.
Reprints: AK Mascarenhas, 3167 Postle Hall, 305 W 12th Ave, Columbus, OH 43210, US.

A PILOT STUDY OF ESTHETIC PERCEPTIONS OF DENTAL
FLUOROSIS VS. SELECTED OTHER DENTAL CONDITIONS

CB Mcknight, SM Levy, SE Cooper, JR Jakobsen
Iowa City, IA, USA

Abstract from Journal of Dentistry for Children 65 (4) 233 ff 1998

The prevalence of fluorosis has increased over the past fifty years, and with this increase, esthetic concerns pertaining to fluorosis should also be taken into consideration. Canadian, Australian, and British studies have explored perceptions concerning enamel fluorosis, but no studies in this area have been published from the United States. In the previous studies, esthetic concerns resulting from fluorosis generally were not compared with the esthetic perceptions of other conditions such as isolated opacities, tetracycline staining, or various types of malocclusion. in the present investigation, respondents answered written questions about paired photographs, one of fluorotic teeth and the other with one of the other conditions. Results show that not only is fluorosis noticeable, but it may be more of an esthetic concern than the other conditions.

Key words: Esthetic concerns, Fluorosis, Trends.
Reprints: CB Mcknight, Univ Iowa, Coll Dent, Dept Prevent & Community Dent, Iowa City, IA 52242 USA.

SKELETAL FLUOROSIS DUE TO EXCESSIVE CONSUMPTION OF FLUORIDE-RICH BOTTLED WATER IN A PATIENT WITH MODERATELY SEVERE RENAL FAILURE [French]

AM Avimadje, J Jeannou, S Mammou, P Goupille, JP Valat
Tours, France

Abstract from Semaine des Hopitaux 74 (23-26) 986-989 1998

A 71-year-old man with moderately severe renal failure who had been drinking two liters per day of a fluoride-rich bottled water (Vichy Saint-Yorre) for the last seven years developed arthralgia with radiological evidence of hyperostosis. Fluoride levels were elevated in the-serum and urine. These criteria establish the diagnosis in 97% of cases of skeletal fluorosis, although the definitive test is determination of the level of fluoride in bone. The causes of fluoride intoxication are reviewed, and their clinical, laboratory test, and radiological features are discussed.

Key words: Fluorine/poisoning, Kidney failure chronic, Mineral waters.
Reprints: AM Avimadje, Chu, Hop Trousseau, Serv Rhumatol, F-37044 Tours, France.

DEVELOPMENTAL ENAMEL DEFECTS IN CHILDREN
WITH DIFFERENT FLUORIDE SUPPLEMENTATION:
A FOLLOW-UP STUDY

KA Hiller, G Wilfart, G Schmalz
Regensburg and Berlin, Germany

Abstract from Caries Research 32 (6) 405-411 1998

The intake of fluorides with water, food, dental fluoride preparations, or in particular fluoride supplements, such as NaF tablets, may lead to dental fluorosis. In the present study conducted in a nonfluoridated area in Germany, developmental enamel defects were examined using the Modified Developmental Defects of Enamel Index (Mod DDE Index), which subdivides enamel defects into the categories demarcated (Mod DDE score 1) and diffuse (Mod DDE score 2) opacities and hypoplasia (Mod DDE score 3). 158 children, between 8.5 and 10 years old, were assigned to three examination groups, defined by three different fluoride tablet programs. The children in all three examination groups, F-1, F-2, and F-3, had received 0.25 mg F^–/day up to the age of 2 years, F-1 and F-3 from birth on, F-2 beginning with the 7th month of life. F-1 and F-2 received 0.5 mg F^–/day during the 3rd and 0.75 mg F^–/day during the 4th and 5th year of life. For F-3, beginning with the 3rd year of life, no further recommendations were made. 158 sociodemographically matched children living in a neighboring town served as controls and did not take part in any structured fluoride supplementation program. The proportions of children with Mod DDE scores 1, 2, or 3 at least in one index tooth were significantly higher in the examination groups (40%) than in the control group (20%). Also, the proportions of children with Mod DDE score 2 at least in one index tooth were significantly higher in the examination groups (18%) than in the control group (8%). The proportions of children with Mod DDE score 1 at least in one index tooth were 25% in the examination groups and 17% in the control group. No Mod DDE score 3 was found. Not more than 5% of the children in each group had 50% of their teeth with Mod DDE score I, 2, or 3. The proportions of teeth per child with Mod DDE score 2 were significantly higher in the examination group than in the control group. While uncontrolled variables cannot be excluded, the observed differences between the experimental and control groups may be attributed to the ingestion of fluoride tablets in the experimental group.

Key words: Cariostatic agents, Dental fluorosis, Epidemiology, Follow-up studies, Fluoridation, Fluorides, Fluoride supplementation, Mod DDE index, Mottled enamel.
Reprints: KA Hiller, Univ Regensburg, Dept Operat Dent & Periodontol, Franz Josef Str Allee 11, D-93042 Regensburg, Germany.

URINARY FLUORIDE LEVELS AND PREVALENCE OF DENTAL
FLUOROSIS IN THREE BRAZILIAN CITIES WITH DIFFERENT
FLUORIDE CONCENTRATIONS IN THE DRINKING WATER

SD Heintze, JRD Bastos, R Bastos
Bauru, Brazil

Abstract from Community Dentistry & Oral Epidemiology 26 (5) 316-323 1998

Urine samples from three daytime periods were collected from 545 5-50-year-old residents of three different Brazilian cities: Garca had fluoridated drinking water since 1973, Bauru since 1975 and Itapolis was not fluoridated. Dental fluorosis was examined in 985 5-24-year-olds using the Thylstrup-Fejerskov index (TF). The subjects were asked to estimate their daily intake of liquids and frequency of beverage consumption. The analysis of 94 water samples showed high variations in the fluoride content of the drinking water. The mean fluoride concentration of the water samples in Garca was 0.9 mg/L (range 0.75-1.2), in Bauru 0.64 mg/L (range 0.01-1.3), and in Itapolis 0.02 mg/L. Mean urinary fluoride concentration was 1.31 mg/L (s 0.61) in Garca, 0.88 mg/L (s 0.49) in Bauru, and 0.39 mg/L (s 0.21) in Itapolis. Self-reported daily liquid intake was not related to urinary fluoride concentration. The mean prevalence of fluorosis was 13.3% in Garca, 6.8% in Bauu, and 1.7% in Itapolis, with mainly categories TF 1 and TF 2 being recorded. Subjects with dental fluorosis tended to show a higher mean urinary fluoride concentration but the difference was not statistically significant. The study showed that fluoride exposure measured by urinary fluoride excretion was within the range expected for the level of fluoride concentration in the drinking water. However, enamel fluorosis tended to be markedly lower than expected. This study revealed that fluoride levels in the two cities with fluoridated drinking water were variable. To optimise anticaries benefits and minimise the risk of fluorosis greater control of the fluoride dosing of the drinking water is required.

Key words: Brazil, Fluorosis, Urinary fluoride concentration, Water fluoridation.
Reprints: JRD Bastos, Univ Sao Paulo, Bauru Dent Sch, Dept Social Dent, Al Dr Octavio P Brisolla 9-75, Br-17043101 Bauru, Sp, Brazil.

DENTAL FLUOROSIS IN CHILEAN CHILDREN:
EVALUATION OF RISK FACTORS

AE Villa, S Guerrero, G Icaza, J Villalobos, M Anabalon
Santiago, Chile

Abstract from Community Dentistry & Oral Epidemiology 26 (5) 310-315 1998

The purpose of this case-control study was to determine the association between very-mild-to-moderate enamel fluorosis and exposure during early childhood to fluoridated water, mainly through ingestion of powdered milk. Analysis was performed on 136 residents of the optimally fluoridated community of San Felipe in the Chilean Fifth Region, who were categorised into one of three groups according to their age when water fluoridation was introduced in 1986: Group I was born after 1986; Group II was 16-24 months old in 1986; and Group III was >24 months of age. The case and control subjects were selected on the basis of a clinical examination given in July 1996. Dean’s scoring system was used to determine fluorosis status. Risk factor exposure was ascertained by a questionnaire used in interviews with mothers of participating children. Logistic regression analysis, after adjustment for confounding variables, revealed that very-mild-to-moderate enamel fluorosis of permanent central maxillary incisors (CMI) was strongly associated both with the age of the subjects when water fluoridation began and with breast-feeding duration for children belonging to Group I. Subjects in Group I were 20.44 times more likely (95% CI: 5.00-93.48) to develop CMI fluorosis than children who were older than 24 months (Group III) when fluoridation began. Subjects who were between 16 and 24 months old when water fluoridation began were 4.15 times more likely (95% CI: 1.05-16.43) to have CMI fluorosis than children older than 24 months. An inverse association was found with breastfeeding duration (OR=0.86, 95% CI: 0.75-0.98) among Group I subjects but not in Groups II and III. Results obtained suggest that the current fluoride concentration in drinking water may be contributing to fluorosis. Further studies will be necessary to determine the relative competing risks of dental fluorosis and dental caries in Chilean children in order to establish the most appropriate water fluoridation level in Chile.

Key words: Appearance, Chilean children, Critical period, Dental fluorosis, Permanent teeth, Prevalence, Risk factors, Water.
Reprints: AE Villa, Inta Inst, Nutr & Food Technol, Casilla 138-11, Santiago, Chile.

ESTIMATION OF OPTIMAL CONCENTRATION OF FLUORIDE IN
DRINKING WATER UNDER CONDITIONS PREVAILING IN CHILE

AE Villa, S Guerrero, J Villalobos
Santiago, Chile

Abstract from Community Dentistry & Oral Epidemiology 26 (4) 249-255 1998

The purpose of this comparative study of caries and dental fluorosis experience in Chilean children was to estimate the optimal range of fluoride concentration in tap water under conditions currently prevailing in Chile. The sample included 2431 schoolchildren 7, 12 and 15 years old, life-long residents of five communities with fluoride concentrations in their tap water in the range 0.07-1.1 mg/L. The study population received an oral clinical examination including caries experience and an enamel fluorosis evaluation of the permanent dentition (Dean’s scoring system). For 15-year-old children, the DMFT index changed from 5.06 to 2.60, and for 12-year-olds it changed from 3.10 to 1.36 when fluoride water concentration changed from 0.07 to 1.10 mg/L. For 7-year-old children the dmft index correspondingly changed from 3.67 to 1.59. The relationship between DMFT for 12-year-olds and water fluoride concentration was best fitted by a logarithmic function (r(2)=0.98). The Community Fluorosis Index (CFI) was used to assess enamel fluorosis in the study population, and it showed a linear relationship (r(2)=0.983) with increasing fluoride concentration of water for the 12-year-old group. Results obtained suggest that under current Chilean conditions, the optimal range of fluoride concentration in potable water should lie in the 0.5-0.6 mg/L range.

Key words: Caries experience, Chilean children, Dental-caries, Fluorosis, Prevalence.
Reprints: Villa AE, Inta, Inst Nutr & Food Technol, Casilla 138-11, Santiago, Chile.

FLUOROSIS IN SOME TRIBAL VILLAGES OF
UDAIPUR DISTRICT (RAJASTHAN)

SL Choubisa
Dungarpur, India

Abstract from Journal of Environmental Biology 19 (4) 341-352 1998

Chronic fluoride intoxication (fluorosis) was observed in villagers and their domestic animals (cattle, buffaloes, sheep and goats) from ten villages of the Udaipur district of Rajasthan where drinking waters contained 0.3 to 7.0 mg/L fluoride. The prevalence of dental fluorosis and skeletal fluorosis in villagers was relatively higher than that observed in the animals. At 5.8 mg/L mean fluoride concentration, 88.7% of children (<18 years) and 100% of adults were found to be affected with dental fluorosis. The highest prevalence (42.2%) of skeletal fluorosis was observed at 5.8 mg F/L (mean). Males showed relatively a higher prevalence of skeletal fluorosis. In general, the prevalence and severeness of skeletal fluorosis increased with increasing of fluoride concentration and with age. None of fluorotic subjects revealed evidence of genu-valgum syndrome and goitre (hyperthyroidism).

Among mature animals, buffaloes were found to have a higher prevalence and greater severity of dental and skeletal fluorosis when compared with cattle. The prevalence of dental fluorosis was higher in calves of both type of animals than in adults. Sheep and goats examined at the same time were found to be free of fluorosis. Radiological findings and deformities in fluorotic subjects as well as fluorosis in relation to fluoride concentrations, age and sex are also discussed.

Key words: Dairy-cows, Domestic animals, Fluoride, Fluorosis, Rajastan, Tribal villages, Udaipur district, Villagers.
Reprints: SL Choubisa, Ml Sukhadia Univ, Sbp Govt Coll, Pg Dept Zool, Dungarpur 314001, India.

CHRONIC GYPSUM FERTILISER INGESTION AS A SIGNIFICANT
CONTRIBUTOR TO A MULTIFACTORIAL CATTLE MORTALITY

CA Bourke, SJ Ottaway
Orange NSW Australia

Abstract from Australian Veterinary Journal 76 (8) 565-569 1998

Objective. To assess the validity of claims that heavy metal contamination from an open-cut mine caused the death of 226 cattle on a nearby farm over a period of 18 months, and to investigate other possible contributing factors. Procedure A retrospective assessment of previous investigations combined with additional chemical analyses. Results Extensive chemical analyses produced no evidence of heavy metal contamination associated with the mine. Analysis of bones indicated exposure to fluoride in greater than normal amounts. The main source of fluoride seems to have been gypsum that was included in a feed supplement and also ingested from fertiliser dumps on paddocks. The gypsum itself may have contributed significantly to the ill health. Other factors probably affected some classes of animals, notably the young calves.

Conclusions. What originally seemed to be a disease problem of single aetiology probably was an expression of interacting multifactorial causes. This investigation has high lighted the potential toxicity of gypsum to livestock and the need for further studies to establish its basis.

Key words: Cattle, Toxicosis, Gypsum.
Reprints: CA Bourke, New S Wales Agr & Fisheries, Orange Agr Inst. Forest Rd Orange NSW 2800 Australia.

BOTTLED DRINKS AS ADDITIONAL SOURCE OF
FLUORIDE EXPOSITION [Spanish]

JP Loyolarodriguez, AJ Pozosguillen, JC Hernandezguerrero
San Luis Potosi, and Mexico City, Mexico

Abstract from Salud Publica de Mexico 40 (5) 438-441 1998

Objective. To evaluate and to report the concentration of fluoride in soft drinks and juices consumed in San Luis Potosi, S.L.P., Mexico, and its implications as a risk factor for developing dental fluorosis. Material and methods. The contents of some products from 2 main national companies and 2 other local companies were studied. The samples were collected from 1O different batches in the case of the soft drinks, and from 5 batches in the case of the juices, with 3 samples per batch, during 3 months. The ion selective electrode method was used to determine the concentration of fluoride. Results. Soft drinks from 2 main national companies showed high fluoride concentrations that were statistically significant between groups (p < 0.05). Fluoride levels of products from local and national companies also showed differences that were statistically significant between groups (p < 0.05). All natural juices tested showed high fluoride concentrations.

Conclusions. Most soft drinks and juices consumed in SLP had high fluoride levels above Mexican regulations (0.7 ppm) and could be a substantial risk factor for developing dental fluorosis.

Key words: Bottled drinks, Dental fluorosis, Fluoride, Mexico.
Reprints: JP Loyolarodriguez, Univ Autonoma San Luis Potosi, Fac Estomatol, Ctr Invest Estomatol, San Luis Potosi, Mexico.

SERUM AND URINE FLUORIDE CONCENTRATION:
RELATIONSHIPS TO AGE, SEX AND RENAL FUNCTION
IN A NON-FLUORIDATED POPULATION

M Torra, M Rodamilans, J Corbella
Barcelona, Spain

Abstract from Science of the Total Environment 220 (1) 81-85 1998

Serum and urine fluoride levels were determined in 250 healthy subjects (15-90 years, 122 men and 128 women) residing in Catalonia, Spain, and in 150 patients (20-81 years, 84 men and 66 women) with chronic renal failure undergoing regular dialysis treatment, living in the same geographical area, to determine normal range and to investigate its relationships to age, sex and renal function. Serum and urine fluoride were determined by a fluoride ion specific electrode system. Mean (±S.D.) serum fluoride concentration was 17.5 ± 9.5 µg/l, ranging from 1 to 47 µg/l, in the control group and 58 ± 31 µg/l, ranging from 28 to 185 µg/l, in renal patients. Urine fluoride concentration in the healthy group was 671 ± 373 µg/24 h, ranging from 156 to 1900 µg/24 h. Fluoride status in the patient group was significantly greater than the control group. There was significant correlation between serum fluoride and age. No sex related difference was found.

Key words: Age, Fluoride, Renal patients, Ion specific electrode system.
Reprints: M Torra, Univ Barcelona, Hosp Clin & Prov, Villarroel 170, Barcelona 08036, Spain.

FLUORIDE 32 (1)  1999 pp 33-42	International Society for Fluoride Research
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