Tag Archives: dental health

Dental fluorosis prevalence high in Turkey village fluoride study

I’m somewhat surprised that this study has no control group or that the findings were not compared to a town of similar size with no fluoride. Comparing results to national statistics is not very informative. In a limited study such as this observing health effects other than dental fluorosis is unlikely.

Sezgin BI, Onur ŞG, Menteş A, Okutan AE, Haznedaroğlu E, Vieira AR. Two-fold excess of fluoride in the drinking water has no obvious health effects other than dental fluorosis. J Trace Elem Med Biol. 2018 Dec;50:216-222. doi: 10.1016/j.jtemb.2018.07.004. Epub 2018 Jul 11.

BACKGROUND: There is concern that fluorides in the drinking water is hazardous to health.

METHODS: We conducted an observational study in the village of Hanliyenice (population 280), Turkey, which has 2.5 times higher than optimal levels of fluoride in the drinking water and evaluated all children 7-13 years of age (N = 30). We collected information on dental decay, fluorosis, daily water consumption and diet, child history and her family history of cancer, cardiovascular risks/diseases, and asthma, and obtained a blood sample for extraction of genomic DNA. We genotyped ten single nucleotide polymorphisms in aquaporins.

RESULTS: As expected, a high number of children were dental caries free (19 out of 30) and had fluorosis (25 out of 30). Family history of cancer, cardiovascular events, and asthma was not different from the expected figures based on Turkey. One variant just upstream of AQP5 was associated with being fluorosis free. (G allele of AQP5 rs296763, p = 6.0E-6).

CONCLUSIONS: Exposure to levels of fluoride twice as high than the optimum in the drinking water increases the prevalence of fluorosis, dramatically decreases dental caries, and does not increase the risk of cancer, cardiovascular events, and asthma.

Ecologic study of blood lead and dental caries of limited value

Another ecologic study attempting to infer associations with very weak correlations. Would nonconsumption of food be associated with a lower prevalence of elevated dental caries?

Sanders AE, Slade GD. Blood Lead Levels and Dental Caries in U.S. Children Who Do Not Drink Tap Water. American journal of preventive medicine. 2017 Nov 18. pii: S0749-3797(17)30495-6. doi: 10.1016/j.amepre.2017.09.004.

INTRODUCTION: This study’s purpose is to determine whether nonconsumption of tap water is associated with lower prevalence of elevated blood lead levels and higher prevalence of dental caries in children and adolescents.

METHODS: Cross-sectional data from the National Health and Nutrition Examination Survey 2005-2014 recorded drinking water source (n=15,604) and blood lead levels (n=12,373) for participants aged 2-19 years, and dental caries experience for the 2011-2014 subset (n=5,677). The threshold for elevated blood lead level was ≥3 μg/dL. A binary outcome indicated presence or absence of dental caries experience. Multivariable generalized linear models estimated adjusted prevalence ratios with 95% confidence limits.

RESULTS: In analysis conducted in 2017, 15% of children and adolescents did not drink tap water, 3% had elevated blood lead levels ≥3 μg/dL, and 50% had dental caries experience. Children and adolescents who did not drink water were less likely than tap water drinkers to have an elevated blood lead level (adjusted prevalence ratios=0.62, 95% confidence limits=0.42, 0.90). Nonconsumers of tap water were more likely to have dental caries (adjusted prevalence ratios=1.13, 95% confidence limits=1.03, 1.23). Results persisted after adjustment for other covariates and using a higher threshold for elevated blood lead level.

CONCLUSIONS: In this nationally representative U.S. survey, children and adolescents who did not drink tap water had lower prevalence of elevated blood lead levels and higher prevalence of dental caries than those who drank tap water.

Early Concerns about Water Fluoridation Ignored Resulting in a Presumption of Safety

Adding fluoride to drinking water is the sacred cow for advocates within the dental community (e.g. here). Much has been written on this topic and many articles can be found on this blog and other sites. The presumption of safety was imposed and institutionalized early on. But evidence is not neutral. The assumptions of the interpreter determine what conclusions are reached based on the evidence. The historical presumption of safety (it is safe until proven that it is not) has result the same conclusion of safety by every government or association panel evaluation of fluoridation. But evidence-based hazards and risks have been completely ignored or downplayed from the beginning of the practice. Indeed, organizations simply repeat the same song typically endorsing each others endorsement. The absence of dead bodies in the street or repetitive results from ecological studies interpreted using particular statistical tests is simply not sufficient justification for continuing the practice. But it continues nevertheless…

C Carstairs Debating Water Fluoridation Before Dr. Strangelove. American Journal of Public Health. 2015;105:1559–1569. doi:10.2105/AJPH.2015.302660.

In the 1930s, scientists learned that small amounts of fluoride naturally occurring in water could protect teeth from decay, and the idea of artificially adding fluoride to public water supplies to achieve the same effect arose. In the 1940s and early 1950s, a number of studies were completed to determine whether fluoride could have harmful effects. The research suggested that the possibility of harm was small. In the early 1950s, Canadian and US medical, dental, and public health bodies all endorsed water fluoridation. I argue in this article that some early concerns about the toxicity of fluoride were put aside as evidence regarding the effectiveness and safety of water fluoridation mounted and as the opposition was taken over by people with little standing in the scientific, medical, and dental communities. The sense of optimism that infused postwar science and the desire of dentists to have a magic bullet that could wipe out tooth decay also affected the scientific debate. 

Fluoride Varnish Application

Rizzolo D, Bowser J. Update on pediatric oral healthcare.JAAPA. 2016 Aug;29(8):52-3. doi: 10.1097/01.JAA.0000484312.96684.d7.

As part of the patient-centered medical home, clinicians are being asked to apply fluoride varnish and perform oral examinations in children. This article reviews the latest national recommendations for fluoride varnish use to prevent dental caries.

Fluoride Varnish Intervention Promotes Oral Health, Qatar

Hendaus MA, Jama HA, Siddiqui FJ, Elsiddig SA, Alhammadi AH. Parental preference for fluoride varnish: a new concept in a rapidly developing nation. Patient Prefer Adherence. 2016 Jul 13;10:1227-33. doi: 10.2147/PPA.S109269.

OBJECTIVE: The objective of this study was to investigate parental preference for fluoride varnish in a country where the average percentage of dental caries in young children is up to ~73%. Consequently, the aim of this study, despite being a pilot, was to create a nationwide project in the State of Qatar to promote oral health in children.

METHODS: A cross-sectional perspective study was conducted at Hamad Medical Corporation in Qatar. Parents of children aged ≤5 years were offered an interview survey. A total of 200 questionnaires were completed (response rate =100%). The study was conducted between December 1, 2014 and March 30, 2015, and included all children aged >1 year and 90% of families were aware that dental health affects the health of the whole body. The study showed that ~70% of parents were not aware of the existence of fluoride varnish, but would allow a health provider to apply fluoride varnish. Furthermore, ~80% of parents would not stop brushing their child’s teeth and would not skip dentist appointments if varnish was to be applied. Approximately 40% of parents conveyed some concerns regarding the safety of fluoride varnish, despite being considered as a new concept. The main concern was that the child might swallow some of the fluoride. Another important concern expressed by parents was the availability of the fluoride varnish in all clinics.

CONCLUSION: The robust positive attitude of parents in this sample suggests that introducing fluoride varnish is feasible and acceptable in our community. Actions to augment fluoride varnish acceptability in the developing world, such as focusing on safety, could be important in the disseminated implementation of fluoride varnish.

Enamel Fluoride Content Associated with Fluorosis Severity

Martinez-Mier EA, Shone DB, Buckley CM, Ando M, Lippert F, Soto-Rojas AE. Relationship between enamel fluorosis severity and fluoride content. Journal of Dentistry. 2016 Jan 22. pii: S0300-5712(16)30007-0. doi: 10.1016/j.jdent.2016.01.007.

OBJECTIVES: Enamel fluorosis is a hypomineralization caused by chronic exposure to high levels of fluoride during tooth development. Previous research on the relationship between enamel fluoride content and fluorosis severity has been equivocal. The current study aimed at comparing visually and histologically assessed fluorosis severity with enamel fluoride content.

METHODS: Extracted teeth (n=112) were visually examined using the Thylstrup and Fejerskov Index for fluorosis. Eruption status of each tooth was noted. Teeth were cut into 100μm slices to assess histological changes with polarized light microscopy. Teeth were categorized as sound, mild, moderate, or severe fluorosis, visually and histologically. They were cut into squares (2×2mm) for the determination of fluoride content (microbiopsy) at depths of 30, 60 and 90μm from the external surface.

RESULTS: Erupted teeth with severe fluorosis had significantly greater mean fluoride content at 30, 60 and 90μm than sound teeth. Unerupted teeth with mild, moderate and severe fluorosis had significantly greater mean fluoride content than sound teeth at 30μm; unerupted teeth with mild and severe fluorosis had significantly greater mean fluoride content than sound teeth at 60μm, while only unerupted teeth severe fluorosis had significantly greater mean fluoride content than sound teeth at 90μm.

CONCLUSIONS: Both erupted and unerupted severely fluorosed teeth presented higher mean enamel fluoride content than sound teeth.

CLINICAL SIGNIFICANCE: Data on fluoride content in enamel will further our understanding of its biological characteristics which play a role in the management of hard tissue diseases and conditions.

Children Should Use “Pea-Sized” Amount of Dentifrice

Strittholt CA, McMillan DA, He T, Baker RA, Barker ML. A Randomized Clinical Study to Assess Ingestion of Dentifrice by Children. Regulatory toxicology and pharmacology 2015 Dec 22. pii: S0273-2300(15)30143-4. doi: 10.1016/j.yrtph.2015.12.008.

This study investigated whether there was a difference in amounts of dentifrice ingested by children based on age using pea-sized instructions. The study had a randomized, single-blinded, 3-period, crossover design modelled after Barnhart et al. (1974) with one regular-flavored and two specially-flavored dentifrices used ad libitum. Subjects were enrolled in three groups: 2-4, 5-7, and 8-12 years. They were instructed to brush at home as they would normally with each dentifrice for 3 weeks (9 weeks total). On weekly study-site visits, subjects brushed with the assigned dentifrice containing a lithium marker to measure the amount of dentifrice ingested and used. Averaging across dentifrices, amounts ingested were: 0.205g (2-4yr), 0.125g (5-7yr) and 0.135g (8-12yr), demonstrating 2-4 year-olds ingested significantly more than older children (p≤0.002). Averaging across dentifrices, amounts used were: 0.524g (2-4yr), 0.741g (5-7yr) and 0.978g (8-12yr) suggesting an age-related effect (p<0.01). Findings also showed that ingestion amount for specially-flavored dentifrices may increase relative to regular-flavored dentifrice for children 2-7 years-old. This research demonstrated that dentifrice ingestion amount decreased significantly with age while usage amount increased with age. Importantly, ingestion and usage levels in younger children reflect “pea-sized” direction and were numerically lower than historical levels reported prior to this direction.