Dose‐response relationship between water fluoride levels and the category of questionable dental fluorosis

Myers, Howard M.

doi:10.1111/j.1600-0528.1983.tb01366.x

Cited by 14 publications

(5 citation statements)

References 14 publications

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“…Angmar-Mansson and co-workers (75) postulated that temporary peak values rather than elevated fasting values are responsible for the occurrence of enamel fluorosis and that the peak values must approach about 10 mmol to alter enamel formation by the ameloblasts. However, Myers (76) noted that the distinct pattern of increasing prevalence of fluorosis with increasing levels of fluoride in the water is not compatible with the concept of a threshold level for the action of fluoride ion on the enamel organ (76). The effects of fluoride ingestion appear to be cumulative during tooth formation (1,2,27,36,69,77).…”

Section: Exposure To Fluoride -Timing Duration and Dosementioning

confidence: 99%

Biological mechanisms of dental fluorosis relevant to the use of fluoride supplements

DenBesten

1999

Comm Dent Oral Epid

122

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Fluorosis occurs when fluoride interacts with mineralizing tissues, causing alterations in the mineralization process. In dental enamel, fluorosis causes subsurface hypomineralizations or porosity, which extend toward the dentinal-enamel junction as severity increases. This subsurface porosity is most likely caused by a delay in the hydrolysis and removal of enamel proteins, particularly amelogenins, as the enamel matures. This delay could be due to the direct effect of fluoride on the ameloblasts or to an interaction of fluoride with the proteins or proteinases in the mineralizing matrix. The specific mechanisms by which fluoride causes the changes leading to enamel fluorosis are not well defined; though the early-maturation stage of enamel formation appears to be particularly sensitive to fluoride exposure. The development of fluorosis is highly dependent on the dose, duration, and timing of fluoride exposure. The risk of enamel fluorosis is lowest when exposure takes place only during the secretory stage, but highest when exposure occurs in both secretory and maturation stages. The incidence of dental fluorosis is best correlated with the total cumulative fluoride exposure to the developing dentition. Fluoride supplements can contribute to the total fluoride exposure of children, and if the total fluoride exposure to the developing teeth is excessive, fluorosis will result.

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Section: Exposure To Fluoride -Timing Duration and Dosementioning

confidence: 99%

Biological mechanisms of dental fluorosis relevant to the use of fluoride supplements

DenBesten

1999

Comm Dent Oral Epid

122

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“…These conditions include calcium deficiency, disorders in acidbase balance, disruptions of urinary flow and renal handling of fluoride, and the nature of the diet . Further evidence of considerable variation among individuals is that the epidemiological evidence is not consistent with the concept of a consistent threshold level for fluorosis (Myers, 1983).…”

mentioning

confidence: 96%

The Changing Patterns of Systemic Fluoride Intake

1992

J Dent Res

303

246

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Fluorosis prevalence has increased in North America since the 1930's-1940's. It may also have increased since 1970, though the evidence for that is less clear. Continued monitoring will help determine whether increased fluorosis prevalence in children in the United States is a cohort effect from the 1970's. This review considers the evidence for an increase in fluoride ingestion from all sources since the 1970's. If an increase has occurred, the most likely sources are fluoride dietary supplements, inadvertent swallowing of fluoride toothpastes, and increased fluoride in food and beverages. For adults, there is no evidence from dietary surveys to show that fluoride intake has increased over the last generation. Dietary surveys for children aged six months to two years are similarly inconclusive, though the great variation in fluoride content of various infant foods might be obscuring real effects. The data on fluoride intake by children from food and beverages, infant foods included, are not strong enough to conclude that an increase in fluoride ingestion has occurred since the 1970's. However, the suggested upper limit of fluoride intake is substantially being reached in many children by ingestion of fluoride from food and drink (0.2-0.3 mg per day) and from fluoride toothpaste (0.2-0.3 mg per day). Two public health issues that arise from this review are: (a) the need for a downward revision in the schedule for fluoride supplementation, and (b) education on the potential for high fluoride concentration of soft drinks and processed fruit juices.

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“…It would appear that defining a case on the basis of having a tooth scored as questionable or higher is justified from a biological perspective, even though examiner reliability may become a more prominent factor in the variation of estimates. Meyers (17) has suggested that there is a dose-response relationship between the prevalence of the questionable category of fluorosis and fluoride, indicating the lack of a threshold level for dental fluorosis. While questions related to the prevalence and severity of fluorosis in those drinking water containing fluoride above optimal levels are important, they are considered outside the scope of this review.…”

mentioning

confidence: 99%

The Prevalence and Severity of Enamel Fluorosis in North American Children

1999

J Public Health Dent

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The question considered in this review is the extent to which changes in the prevalence or severity of enamel fluorosis have occurred over the last half-century. Emphasis is given to a review of those studies in which subjects are drinking water that is fluoride deficient and those in which subjects are drinking optimally fluoridated water, either adjusted or natural. Trends in fluorosis were examined using two definitions of fluorosis (definite and any signs) and three types of comparisons--comparisons of pooled estimates from all available studies that include data from different communities and time periods, comparisons of estimates from the same communities at different times, and comparisons of estimates from selected studies in the early years of fluorosis research with results of the US National Fluorosis Survey done by the National Institute of Dental Research. A clear increase in fluorosis among populations drinking community water that contains less than 0.3 ppm fluoride was found. Results of the comparisons using studies with Dean's Index pooled at different time points, comparisons in the same communities over time, and comparisons of prevalence found in selected communities before fluoride was widely available with the National Fluorosis Survey all support this conclusion. An increase in the prevalence of fluorosis in those drinking optimally fluoridated water likely has occurred as well; however, evidence for such a trend is not as clear as for fluoride deficient communities because of mixed results depending on the type of comparison. The majority of fluorosis cases continue to be mild and seem of little esthetic consequence for most of the public or dental profession. But a few cases of more severe fluorosis can be found now in some communities. Because the prevalence of fluorosis is now higher than 50 years ago, we can conclude that fluoride availability to the developing enamel during critical periods when enamel is at risk of fluorosis has increased in North American children.

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Dose‐response relationship between water fluoride levels and the category of questionable dental fluorosis

Cited by 14 publications

References 14 publications

Biological mechanisms of dental fluorosis relevant to the use of fluoride supplements

Biological mechanisms of dental fluorosis relevant to the use of fluoride supplements

The Changing Patterns of Systemic Fluoride Intake

The Prevalence and Severity of Enamel Fluorosis in North American Children

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