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Objectives: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5,000 individuals was fluoridated. In 2014, CWF in Israel stopped. Method and materials: Data on 12-year-old children from all areas in Israel from the national cross-sectional epidemiological survey conducted in 2011 to 2012 were stratified by city water fluoridation and by city and school socioeconomic status. Two dependent variables were defined: (1) DMFT index of caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov classification of fluorosis. Results: Data from 2,181 12-year-olds were analyzed. The average DMFT was 1.17 ± 1.72, and 49% were caries-free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs 0.98 in fluoridated cities) and there were more caries-free children in fluoridated cities (56.4% vs 40.6% in nonfluoridated). DMFT was higher in cities with lower socioeconomic status than high socioeconomic status (1.29 vs 1.05, respectively, P < .001) and there were fewer caries-free children in low socioeconomic status cities (44.5% vs 53.0% in high socioeconomic status cities, P < .0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in the Thylstrup-Fejerskov index), had questionable to mild fluorosis (9.3%). Conclusions: CWF is a cheap, simple method of dental health protection that reaches all socioeconomic levels, and cessation of water fluoridation reduced the health of Israel's children. Clinical significance: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities. [ABSTRACT FROM AUTHOR]

Fluoride-induced toxicity (fluorosis) poses a significant health concern globally, affecting millions of individuals. Understanding the molecular mechanisms underlying fluorosis, particularly the role of microRNAs (miRNAs), is crucial for developing effective preventive and therapeutic strategies. This review explores the pivotal role of miRNAs in the pathogenesis of fluorosis, particularly examining its impact on both hard (skeletal and dental) and soft (brain, liver, kidney, heart, and reproductive organs) tissues. Skeletal fluorosis manifests as abnormal bone mineralization and structure, while dental fluorosis affects enamel formation. In vitro and in vivo studies suggest a significant involvement of miRNAs in the progression of these conditions. For skeletal fluorosis, miR-124, miR-155, and miR-200c-3p have been identified as key regulators, while miR-296-5p and miR-214-3p are implicated in dental fluorosis. Moreover, soft tissue fluorosis encompasses a spectrum of adverse effects on various organs, including the brain, liver, kidneys, heart, and reproductive system. In soft tissues, miRNAs, such as miR-124, miR-200c-3p, miR-132, and miR-34b-5p, have been linked to cellular damage and dysfunction. Notably, miRNAs exert their effects through the modulation of critical pathways involved in fluorosis pathology, including Wnt signaling, apoptosis, cell cycle, and autophagy. Understanding the regulatory roles of miRNAs in fluorosis pathogenesis holds promise for identifying biomarkers and therapeutic targets. However, further research is needed to elucidate the molecular mechanisms underlying miRNA-mediated responses to fluoride exposure. Integration of miRNA research into fluorosis studies could facilitate the development of diagnostic tools and therapeutic interventions, thus mitigating the detrimental effects of fluorosis on both hard and soft tissues. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of soybean, selenium and spirulina on bone metabolic factors in rats with combined fluoride and aluminum poisoning.Methods:Sixty SD rats were allocated to five groups: A control group, a high-fluoride aluminum group, a high-fluoride aluminum plus soybean group, a high-fluoride aluminum plus selenium group, and a high-fluoride aluminum plus spirulina group. Serum samples were collected and radioimmunoassay (RIA) was used to measure osteocalcin (BGP), calcitonin (CT), parathyroid hormone (PHT) and insulin growth factor I (IGF-1) levels after 90 and 165 days of intervention. 1. When comparing the serum BGP level in the high-fluorine aluminum plus selenium group with the high-fluorine aluminum group, suggesting that the addition of selenium intervention was beneficial in reducing the effect of high-fluorine aluminum on bone homeostasis. 2. After 90 days and 165 days, the difference in serum CT levels between the intervention group and the control group was not statistically significant, suggesting an effect of the intervention factors.3. After 90 days of exposure, the three intervention groups had lower serum PTH levels (p < 0.00), inferring the efficacy of the interventions.4. After 90 days, serum IGF-1 levels were elevated in the Spirulina group compared with the high-fluorinated aluminum group, and the difference was statistically significant, suggesting that the addition of Spirulina intervention may counteract the inhibition of bone growth by high-fluorinated aluminum. The intervention of soybean, selenium, and spirulina can counterbalance the effects of fluoride and aluminum on bone metabolism and slow down the process of bone turnover. [ABSTRACT FROM AUTHOR]

Groundwater contains high levels of dissolved ions, which pose health risks when consumed. This study proposes biochar production for fluoride (F-) removal from aqueous solutions using sustainable materials and functionalization processes. Biochar derived from coffee grounds carbonization at 500 ℃ was functionalized with hydrogen peroxide (H2O2). Structural morphology analysis utilized SEM+EDS, BET, and BJH techniques, while XRD and FTIR analyses assessed surface chemistry. Effects of pH, dosage, and initial F- concentration on adsorption were evaluated, along with kinetics and thermodynamics.H2O2 increased acid functional groups on the surface without significantly altering surface area or pore volume. The highest adsorption capacity (0.179 mg g-1) and removal efficiency (25.5%) were at pH = 4. Kinetic studies highlighted the influence of initial F- concentration on adsorption equilibrium time and capacity. Experimental data fitting to pseudo-second-order and Elovich models suggested chemical mechanisms predominance, with intraparticle diffusion as the rate-limiting step. Adsorption isotherm fitting to Langmuir and Freundlich models indicated physical and chemical processes combination. The highest adsorption capacity was recorded at 1.46 mg g-1 at 55 ℃. Thermodynamic analysis revealed endothermic and nonspontaneous nature, potentially affecting F- affinity towards the adsorbent. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Materials and Methods Results Conclusions Clinical Significance This study aimed to evaluate, through a case report combined with in vitro study, whether a new diagnostic white tip for the transillumination technique during resin infiltration influences the procedure and degree of conversion (DC).A clinical case report demonstrated resin infiltration using the transillumination technique with a new white diagnostic tip (Radii Xpert LED diagnostic tip, SDI, Bayswater, VIC, AU) along with a light‐curing device to enhance aesthetic results. An in vitro study assessed the DC of two diagnostic white tips (Radii Xpert LED diagnostic tip [SDI, Bayswater, VIC, AU] and Valo Grand White Light Lens [Ultradent Prod., South Jordan, UT, USA]) compared to that achieved using conventional tips of both light‐curing devices. Statistical analysis was performed using two‐way ANOVA and Tukey's test (α = 0.05).The clinical case achieved complete masking of the white spot lesion. In vitro, the diagnostic white tips exhibited significantly lower DC values compared to conventional tips (p = 0.001), regardless of the light‐curing unit.The diagnostic white tip used in the transillumination technique improves resin infiltration visibility without compromising the degree of conversion.The transillumination technique with the diagnostic white tip enables monitoring of resin infiltration while maintaining effective polymerization. [ABSTRACT FROM AUTHOR]

The prevalence of osteoarthritis (OA) in Tibetans is higher than that in Han, while Tibetans have a habit of drinking brick tea with high fluoride. A cross-sectional study was conducted to explore the association between fluoride exposure in drinking brick tea and OA. All subjects were divided into four groups by the quartiles (Q) of tea fluoride (TF) and urine fluoride (UF). ROC was plotted and OR were obtained using logistic regression model. The prevalence of OA in the Q3 and Q4 group of TF were 2.2 and 2.7 times higher than in the Q1 group, and the prevalence of OA in the Q2, Q3 and Q4 group of UF were 3.2, 3.5, and 4.1 times higher than in the Q1 group. ROC analysis showed the cutoff values were 4.523 mg/day (TF) and 1.666 mg/L (UF). In conclusion, excessive fluoride in drinking brick tea could be a risk factor for developing OA. [ABSTRACT FROM AUTHOR]

Purpose: Excessive fluoride induces kidney injury by reducing the antioxidant capacity and causing oxidative stress. Our previous studies have shown that moderately forced treadmill running alleviates oxidative injury. However, the impact of voluntary wheel-running exercise on fluoride-intoxicated mice remains unclear. In this study, we investigated the effects of voluntary wheel-running exercise on oxidative stress-induced renal injury in fluoride-intoxicated mice. Methods: 80 Institute of Cancer Research (ICR) mice (half male and half female), were randomly divided into one of eight experimental groups: four receiving distilled water and the other four ingesting 100 mg/L sodium fluoride. Each group was subdivided to incorporate different exercise regimens--no wheelrunning, daytime, nighttime, and all-day wheel-running exercises. After 6 months, mice were euthanized for subsequent analyses. Results: HE staining revealed that 6 months of fluoride exposure caused structural damage in the kidneys of mice, elevated blood urea nitrogen (BUN), and uric acid (UA) levels in the serum. Levels of malondialdehyde (MDA), reactive oxygen species (ROS), hydrogen peroxide (H2O2), and catalase (CAT) enzyme activity significantly increased. In contrast, glutathione (GSH) content and total superoxide dismutase (T-SOD) and glutathione peroxidase (GSH-PX) enzyme activities obviously decreased. Interestingly, these above changes were reversed by free-wheel movement. Correlation analysis demonstrated that negative relationships exist between ROS, MDA, H2O2 levels, CAT enzyme activity, and movement distance. Additionally, T-SOD and GSH-PX enzyme activities were positively associated with exercise distance. Conclusions: Voluntary wheel-running exercise mitigated renal injury induced by sodium fluoride in mice, and the extent of renal recovery was positively correlated with the distance covered during voluntary wheel-running exercise. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions Fluoride is widely used in dentistry for its caries prevention. To reduce dental caries, the optimal fluoride concentration of public water supplies in the United States is 0.7 ppm. However, excessive systemic fluoride consumption can lead to dental/enamel fluorosis. Numerous studies have explored the effects of fluoride on enamel and enamel‐forming cells. However, research on systemic fluoride's impact on dentine is limited, particularly the effect of fluoride on the structure of the dentine–pulp complex. Therefore, this study aimed to identify how excessive fluoride affects dentine microstructure using an experimental mouse model.C57BL6/J male mice (6–9 weeks old) were randomized into four groups (Fluoride at 0, 50, 100, or 125 ppm in drinking water) (n = 4/group). Mice were provided water ad libitum for 6 weeks along with fluoride‐free food. Thereafter, mandibular incisors were analysed. Enamel phenotypes were evaluated using light microscopy and quantitative light‐induced fluorescence (QLF) to measure fluorosis levels. Dentine morphology was evaluated using micro‐CT, scanning electron microscopy (SEM), SEM–EDX (energy‐dispersive X‐ray), microhardness test and histological imaging. Data were analysed using one‐way ANOVA with Dunnett's multiple comparisons as a post hoc test and the Kruskal–Wallis test with Dunn's multiple comparisons post hoc test (p < .05).Mice treated with fluoride at 50–125 ppm developed enamel hypoplasia in their erupting incisors and micro‐CT imaging revealed that fluoride 125 ppm caused external resorption of the growing incisor. Dentine mineral density, dentine volume decreased compared with the 0 ppm control, while pulp volume increased compared with the 0 ppm control group. SEM showed wider predentine layer and abnormalities in calcified matrix vesicles derived from odontoblasts in fluoride 100 and 125 ppm groups. Vickers microhardness of dentine significantly decreased in the high‐dose group. Fluoride‐induced dentine hypoplasia in a dose‐dependent manner. Histological evaluation showed excessive fluoride 125 ppm induced micro abscess formation and inflammatory cell infiltration. Fluoride induced dentine dysplasia with a dentine microstructure resembling hypophosphatasia.High doses of systemic fluoride can cause dentine dysplasia. Both three‐dimensional and microstructural analyses showed the structural, chemical and mechanical changes in the dentine and the mineralized tissue components, along with external resorption and pulp inflammation. [ABSTRACT FROM AUTHOR]

Background: The safety of oral hygiene products is a growing concern, particularly regarding the toxicity of specific ingredients used in their formulations. The purpose of this study was to evaluate the knowledge and attitudes of dentists, physicians, pharmacists, and the general public regarding ingredients in oral hygiene products, especially fluoride. Additionally, this study aimed to identify which ingredients may exhibit potential toxicity based on historical records of any adverse effects being induced by a material/component. Methods: A self-administered questionnaire was used in an online cross-sectional observational study to collect data on sociodemographic characteristics, knowledge of fluoride in dental medicine, fluoride usage practices in oral hygiene products, opinions on ingredient toxicity in oral hygiene products, and personal experiences of adverse reactions to products and their components. The collected data underwent descriptive and regression analyses to reveal patterns and relationships within the dataset. Results: The study found a moderate overall knowledge level regarding fluoride usage in dentistry among participants (Md = 5.00, IQR 2.50–7.00). Healthcare professionals exhibited significantly higher knowledge scores compared to the general population (p ≤ 0.001), with dental professionals displaying the highest scores. Regarding concerns about the usage of fluoride, the majority of respondents (77.0%) did not express any concerns. Minor concerns included the risk of ingestion (6.0%) and dental fluorosis (4.6%). Among the other ingredients in oral hygiene products, respondents named alcohol as the most toxic ingredient (70.3%), followed by artificial colors (53.1%), artificial sweeteners (50.4%), and parabens (50.1%). It is noteworthy that the majority of participants (61.6%) stated that they had never experienced any side effects associated with the use of oral hygiene products. Conclusion: This study underscores disparities in fluoride knowledge between healthcare professionals and the general population in Croatia, with dental experts exhibiting a superior understanding. Despite lingering misconceptions about fluoride content and potential toxicity, the majority of participants acknowledge its oral health benefits and use fluoride products regularly. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to ascertain the anthropogenic effects resulting from the extraction and processing of fluorite. Specifically, it aims to analyze and quantify the relationship between fluoride content in different areas influenced by industrial production and agricultural activities, and to examine the health effects arising from chronic fluoride exposure in affected populations in China with comperison of neighborhood country Pakistan. Methods: A cross-sectional survey was conducted with 579 participants, categorized into high, moderate, and low fluoride exposure groups. Participants completed a 35-item questionnaire covering environmental, medical, and industrial dimensions. Data were analyzed using SPSS 22, employing chi-square tests to determine significant associations between fluoride exposure and health outcomes. Results: High fluoride exposure was associated with significant health issues: 70% prevalence of dental fluorosis, 65% skeletal fluorosis, and 60% cognitive impairments. The study found inconsistent implementation of emission control technologies among industrialists, with only 70% fully adopting such measures. These findings underscore the need for better regulatory compliance and public health interventions. Conclusions: The study concludes that industrial and agricultural activities substantially contribute to fluoride contamination, causing severe health problems. Effective mitigation requires stringent regulations, advanced emission control technologies, and robust public awareness campaigns. Future research should involve longitudinal studies and include more stakeholders, particularly from the agricultural sector. [ABSTRACT FROM AUTHOR]

BACKGROUND: Micro-abrasion, at-home whitening combined with infiltration resin have a good effect on dental fluorosis, but the effect of this method on micro-cracks in dental fluorosis is still unclear. OBJECTIVE: To explore the effect of micro-abrasion, at-home whitening combined with infiltration resin on micro-cracked dental fluorosis. METHODS: (1) Clinical research: A total of 23 patients with micro-cracked dental fluorosis, including 255 micro-cracked dental fluorosis, were selected from July 2020 to March 2021 in the Department of Prosthodontics, Stomatology Hospital, Tianjin Medical University. All of them received combined treatment of tooth micro-abrasion, at-home whitening and infiltration resin. The tooth color, tooth sensitivity, and tooth pain threshold were compared before treatment and 1 week and 1 month after treatment. (2) In vitro experiment: 60 teeth with fluorosis with at least one crack on the tooth surface were collected and randomly divided into three groups for treatment. The control group was treated without any treatment. The whitening group was treated with micro-abrasion and at-home whitening, and the combined group was treated with micro-abrasion, at-home whitening, and infiltration resin, with 20 teeth in each group. The microhardness of the three groups of teeth samples after treatment was measured. RESULTS AND CONCLUSION: (1) Clinical study: 6 months after treatment, among 255 teeth with micro-cracked dental fluorosis, whitening treatment for 207 teeth was significantly effective and whitening treatment for 48 teeth was effective, and the overall treatment efficiency was 100%. With the extension of treatment time, the proportion of moderate and severe dental sensitivity showed a decreasing trend. At 6 months after treatment, 255 teeth with dental fluorosis had no severe sensitivity, 15 with moderate sensitivity, 125 with mild sensitivity, and 115 with no sensitivity, and the difference was significant compared with the sensitivity before treatment (P < 0.05). There was no significant difference in the threshold of tooth pain before treatment and 1 week and 6 months after treatment (P > 0.05). (2) In vitro experiment: The tooth microhardness of the whitening group was lower than that of the control group and the combined group (P < 0.05), but there was no significant difference between the control group and the combined group (P > 0.05). (3) The results show that the methods of micro-abrasion, at-home whitening combined with infiltration resin have good clinical efficacy in the treatment of micro-cracked dental fluorosis. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between the frequency and severity of dental fluorosis and Molar Incisor Hypomineralization (MIH) in 8-12-year-old schoolchildren living in an area with a high concentration of fluoride in the drinking water. Methods: The present cross‑sectional study was conducted on Mexican children (n = 573) selected from one community presenting a drinking water fluoride concentration of 1.39 ppm/F. The prevalence of dental fluorosis was ascertained using the Thylstrup and Fejerskov Index (TFI). The presence and severity of MIH was evaluated using the European Academy of Pediatric Dentistry (EAPD) criteria. A multinomial regression model was used to estimate the odds ratio (OR) and the 95% confidence intervals (CI), using the severity of MIH as the result. Results: The prevalence of MIH was 37.7% and, by severity, was 16.1% mild, 14.3% moderate, and 7.3% severe. The prevalence of dental fluorosis in permanent dentition was 70.9% (TFI ≥1) and, by severity, was 29.2% (TFI = 0), 45.6% (TFI 1–3) and 25.3% (TFI ≥4), while 54.5% of subjects were found to have poor oral hygiene. Schoolchildren with fluorosis (TFI ≥4) were 49% less likely [OR = 0.51; p = 0.025] to present mild MIH than children with fluorosis (TFI <4). Similarly, children with fluorosis (TFI ≥4) were 53% [OR = 0.47; p = 0.019] and 62% [OR = 0.38; p = 0.036] less likely to present moderate and severe MIH than children with fluorosis (TFI <4). Conclusion: An inverse relationship between the presence of fluorosis and MIH was found. The results obtained by the present study may contribute to both the early identification of disorders affecting the enamel and the creation and implementation of long-term oral health prevention, promotion, and intervention programs in the affected population. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the levels of fluoride in drinking water and its health impact in Semema, Tigray, Ethiopia. Water samples were collected in February, March and April from three potential spring water sources, namely May Atkaru, May Sensela and May Liham. Each sample was analyzed for a variety of physicochemical parameters including fluoride using standard APHA procedures through double beam UV–Visible spectrophotometer, atomic absorption spectrophotometer and titrimetric methods. All the measured physicochemical parameters except hardness (345.78–368.35 mg/L) and alkalinity (231.3–354.6 mg/L) were recorded below the WHO permissible limit set for drinking water. The amount of fluoride in May Atkaru (4.00 mg/L) and May Sensela (3.89 mg/L) was significantly greater than the WHO permissible limit set for drinking water, 1.5 mg/L. Moreover, HQ . 1 from May Atkaru and May Sensela revealed the possibility of dental and skeletal fluorosis over extended exposure to fluoride irrespective of age and sex variations. This confirmed people in the area with mottled teeth are vulnerable to the excessive consumption of fluoride, which poses health risks. Therefore, it needs immediate interventions to minimize the debilitating effect of fluoride in drinking water by creating awareness among the community and policymakers to introduce low-cost defluoridation methods. [ABSTRACT FROM AUTHOR]

Excessive fluoride ingestion during tooth development can cause dental fluorosis. Previously, we reported that fluoride activates histone acetyltransferase (HAT) to acetylate p53, promoting fluoride toxicity in mouse ameloblast-like LS8 cells. However, the roles of HAT and histone acetylation status in fluoride-mediated gene expression remain unidentified. Here, we demonstrate that fluoride-mediated histone modification causes gene expression alterations in LS8 cells. LS8 cells were treated with or without fluoride followed by ChIP-Seq analysis of H3K27ac. Genes were identified by differential H3K27ac peaks within ±1 kb from transcription start sites. The levels of mRNA of identified genes were assessed using rea-time PCR (qPCR). Fluoride increased H3K27ac peaks associated with Bax, p21, and Mdm2 genes and upregulated their mRNA levels. Fluoride decreased H3K27ac peaks and p53, Bad, and Bcl2 had suppressed transcription. HAT inhibitors (Anacardic acid or MG149) suppressed fluoride-induced mRNA of p21 and Mdm2, while fluoride and the histone deacetylase (HDAC) inhibitor sodium butyrate increased Bad and Bcl2 expression above that of fluoride treatment alone. To our knowledge, this is the first study that demonstrates epigenetic regulation via fluoride treatment via H3 acetylation. Further investigation is required to elucidate epigenetic mechanisms of fluoride toxicity in enamel development. [ABSTRACT FROM AUTHOR]

Fluoride (iF) is an inorganic element commonly present in groundwater in central Mexico and is considered a health risk when it exceeds the Mexican drinking water standard of 1.5 mg/L. Prolonged exposure to iF can cause various adverse health effects, such as dental fluorosis and neurological effects, particularly in children. A rapid and cost-effective strategy to identify possible areas where the resident population may be at risk of exposure to this contaminant is the health risk estimation methodology of the Pan American Health Organization (PAHO). The aim of this study was to estimate the environmental risk of iF exposure in residents of Jerez, Zacatecas, Mexico, and subsequently construct risk maps to identify areas of the city where there is a higher risk of exposure. Fifty-five tap water samples were collected from households to determine iF concentrations using the ion-selective electrode method. Based on these environmental values, the hazard quotient (HQ) was estimated following the health risk estimation methodology. Subsequently, risk maps were generated from these values to visualize the spatial distribution of high-risk areas within the city. The iF concentrations in tap water ranged from 1.3 to 7.3 mg/L (ppm), with only one sample below the standard of 1.5 mg/L. We estimated HQ values ranging from 0.63 to 3.73. Exposure to iF in tap water is a health problem that must be addressed, necessitating risk communication actions that enable the population to safeguard its health through simple measures, thereby avoiding future health costs. [ABSTRACT FROM AUTHOR]

Fluoride (F) is widely distributed in the environment and poses serious health risks to humans and animals. Although a good body of literature demonstrates a close relationship between F content and renal system performance, there is no satisfactory information on the involved intracellular routes. Hence, this study used histopathology and mitochondrial fission to explore fluorine-induced nephrotoxicity further. For this purpose, mice were exposed to the F ion (0, 25, 50, 100 mg/L) for 90 days. The effects of different F levels on renal pathomorphology and ion metabolism were assessed using hematoxylin and eosin (H&E), periodic acid-Schiff stain (PAS), periodic acid-silver methenamine (PASM), Prussian blue (PB), and alkaline phosphatase (ALP) staining. The results showed that F could lead to glomerular atrophy, tubular degeneration, and vacuolization. Meanwhile, F also could increase glomerular and tubular glycoproteins; made thickening of the renal capsule membrane and thickening of the tubular basement membrane; led to the accumulation of iron ions in the tubules; and increased in glomerular alp and decreased tubular alp. Concomitantly, IHC results showed that F significantly upregulated the expression levels of mitochondrial fission-related proteins, including mitochondrial fission factor (Mff), fission 1 (Fis1), and mitochondrial dynamics proteins of 49 kDa (MiD49) and 51 kDa (MiD51), ultimately caused apoptosis. To sum up, excessive fluorine has a strong nephrotoxicity effect, disrupting the balance of mitochondrial fission and fusion, interfering with the process of mitochondrial fission, and then causing damage to renal tissue structure and apoptosis. [ABSTRACT FROM AUTHOR]

This document provides a review of fluoride mitigation, specifically focusing on the global and Indian scenarios. It explains that fluoride is naturally present in water and air, with varying concentrations in water. In India, the fluoride content in drinking water ranges from 1.0 to 48.0 mg/L, exceeding the World Health Organisation's upper limit of 1.5 mg/L. The article highlights that approximately 100 million people worldwide suffer from fluorosis, with 11.7 million people at risk in India. It discusses various initiatives taken by the government, state governments, and the private sector to mitigate fluorosis, including the use of defluoridation units and water treatment plants. The document also provides information on different methods used for mitigating fluorosis, such as the conversion of wells, construction of sand wells, rainwater harvesting, and the use of defluoridation kits. It emphasizes the role of dentists in educating patients and promoting safe drinking water practices. The document concludes by suggesting the need for further pilot studies and full-scale projects to strengthen fluorosis mitigation efforts. [Extracted from the article]

This study aimed to evaluate dental adhesives containing different concentrations of zinc oxide nanoparticles (ZnO‐NPs) for their use in the treatment of dental fluorosis, observe the interaction of the adhesive on healthy enamel surfaces and with mild and moderate fluorosis, measure the adhesive strength and fluorosis, and determine the phosphorus (P) and calcium (Ca) content on these surfaces, as a reference for the potential use of this adhesive with ZnO‐NPs for dental fluorosis treatment.Transmission electron microscopy (TEM) and field emission scanning electron microscopy (FESEM) were used to characterise the ZnO‐NPs and analyse the weight percentages of P and Ca in the enamel using X‐ray energy dispersive spectroscopy (EDS) and the adhesive strength using a universal mechanical testing machine.FESEM characterisation revealed that the ZnO‐NPs were less than 100 nm in size, with quasi‐spherical and hexagonal prism shapes. The synthesis of the ZnO‐NPs was confirmed by TEM, revealing their hexagonal crystalline structure. The adhesive strength by the universal mechanical testing machine showed that the adhesive with a 3% wt. concentration of ZnO‐NPs was better in the three groups of teeth, showing higher adhesive strength in teeth with mild (15.15 MPa) and moderate (12.76 MPa) fluorosis surfaces, and was even higher than that in healthy teeth (9.65 MPa).EDS analysis showed that teeth with mild and moderate fluorosis had the highest weight percentages of P and Ca, but there were no statistically significant differences compared to healthy teeth and teeth treated with adhesives.Lay description: This study focused on testing a new dental adhesive containing small particles called ZnO nanoparticles (ZnO‐NPs). This study aimed to demonstrate whether this adhesive with ZnO‐NPs could be useful for treating dental fluorosis by improving its adhesion to teeth.One of the first objectives was to determine whether the dental adhesive could adhere better to teeth affected by mild or moderate fluorosis than to healthy teeth by measuring whether the levels of two important elements for healthy teeth, calcium (Ca) and phosphorus (P), were affected by the adhesive.The size and shape of the small particles and teeth with mild or moderate fluorosis were observed using scanning electron microscopy. The nanoparticles were small (< 100 nm) and had specific quasi‐spherical and hexagonal prismatic shapes. More damage to the enamel was observed in teeth with mild or moderate fluorosis than in healthy teeth.The adhesive strength test demonstrated that the dental adhesive with 3% ZnO‐NPs had the best adhesion on all healthy conditions of teeth. It was particularly effective in teeth with mild or moderate fluorosis.Finally, the evaluation of the levels of P and Ca on the enamel showed that teeth with fluorosis had higher levels of these elements, but using the dental adhesive with ZnO‐NPs did not change the levels of these elements significantly because the adhesive avoided greater detachment because of greater adhesion to these surfaces.In conclusion, adding these small particles to dental adhesives could be an option for treating teeth affected by fluorosis. It stuck well and did not affect the levels of the important elements in the teeth. [ABSTRACT FROM AUTHOR]

India has been dealing with fluoride contamination of groundwater for the past few decades. Long-term exposure of fluoride can cause skeletal and dental fluorosis. Therefore, an in-depth exploration of fluoride concentrations in different parts of India is desirable. This work employs machine learning algorithms to analyze the fluoride concentrations in five major affected Indian states (Andhra Pradesh, Rajasthan, Tamil Nadu, Telangana and West Bengal). A correlation matrix was used to identify appropriate predictor variables for fluoride prediction. The various algorithms used for predictions included K-nearest neighbor (KNN), logistic regression (LR), random forest (RF), support vector classifier (SVC), Gaussian NB, MLP classifier, decision tree classifier, gradient boosting classifier, voting classifier soft and voting classifier hard. The performance of these models is assessed over accuracy, precision, recall and error rate and receiver operating curve. As the dataset was skewed, the performance of models was evaluated before and after resampling. Analysis of results indicates that the RF model is the best model for predicting fluoride contamination in groundwater in Indian states. [ABSTRACT FROM AUTHOR]

To investigate the relationship between fluoride exposure and Osteochondroma (OC) prevalence, a cross-sectional study was conducted in drinking water endemic fluorosis areas of Heilongjiang Province, China. Our study first reported that the prevalence of OC was 2.3% in drinking water endemic fluorosis areas of Heilongjiang Province, China, and no difference in gender. Logistic regression analysis found that compared to 1st quartile participants, the prevalence of OC was 73% lower in the 2nd quartile participants of WF (Water fluoride), and 3.4 times higher among the 2nd quartile UF (Urinary fluoride) participants. Our study suggests that 0.259–0.420 mg/L of WF may be considered an appropriate level for reducing OC prevalence, while UF (≥0.750 mg/L) could slightly increase the prevalence of OC. In summary, the link between fluoride and OC prevalence is complicated and needs to be further investigated in a cohort population. [ABSTRACT FROM AUTHOR]

Objective: To assess the evidence presented in a set of articles that use the Canadian Maternal–Infant Research on Environmental Chemicals (MIREC) study database to claim that community water fluoridation (CWF) is associated with harm to foetal and infant cognitive development. Methods: Critical appraisal of measurements and processes in the MIREC database, and articles derived therefrom. MIREC's cohort is approximately 2000 pregnant women recruited in 10 centres across Canada, 2008–2011, leading to measuring 512 children aged 3–6 years in six cities. Fluoride exposure was measured by city fluoridation status, self‐reports and maternal spot urine samples. Intelligence Quotient (IQ) was measured using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI‐III) by different assessors in each city. Results: MIREC's fluoride and IQ measurements are invalid and therefore cannot support the claim that CWF is associated with IQ decline in children. Conclusions: The MIREC fluoride‐IQ articles' results should be considered unacceptable for legal and policy purposes; other water fluoridation studies and systematic reviews show no effect of fluoridation on cognition. [ABSTRACT FROM AUTHOR]

The article assesses the fluoride concentration of the groundwater in the Charkhi Dadri and Baund Kalan districts in Haryana, India. The study compares the fluoride concentrations in villages and towns in Charkhi Dadri and Baund Kalan. It evaluates skeletal and dental fluorosis and identified the origins of fluoride in groundwater including the abundance of fluoride-bearing minerals in the host rock, chemical interactions and their interaction with water.

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Dental fluorosis is a subsurface hypomineralization condition, characterized by yellow to dark brown stains, with or without enamel porosity and pitting. Due to aesthetic concerns, children with discolored anterior teeth often experience negative impacts on their psychological, emotional, and social development. Treatment options include porcelain laminates or veneers, direct resin restorations, and crowns. However, these methods are invasive and require significant enamel reduction, making them unsuitable for children due to their enlarged pulp chambers. Microabrasion is the least invasive and safest treatment for children with fluorosis. This technique involves using a combination of 37% phosphoric acid gel with extra fine grain pumice, 18% hydrochloric acid in pumice, or 6.6% and 10% hydrochloric acid with silica carbide particles. The mixture is applied with a slowly rotating rubber cup to the areas of discoloration or white opacities. An additional benefit of microabrasion is that it leaves the enamel surface highly polished, reducing the growth of cariogenic bacteria and increasing resistance to demineralization. This case report describes two instances of dental fluorosis treated with microabrasion using different acidic compounds in two pediatric patients, resulting in clinically acceptable and aesthetically pleasing outcomes. [ABSTRACT FROM AUTHOR]

Background: Numerous approaches have been adopted to evaluate limited freshwater resources and the associated health hazards due to excessive amounts of fluoride in drinking water. The study aims to assess the degree and severity of dental and skeletal fluorosis and examine the broader effects of fluorosis on human health and society in the Manbhum-Singhbhum Plateau region, India. Methods: The Community Fluorosis Index (CFI) and Dean's Index have been used to measure the magnitude and severity of dental and skeletal fluorosis. Questionnaire surveys, Focus Group Discussions (FGDs), and appropriate statistical methods have been applied to identify the social impacts. Risk-prone zones have been identified through overlay analysis using geoinformatics. Results: About 54.60% of people in 67 villages of this part of the Manbhum-Singhbhum Plateau are affected in varying degrees of fluorosis ranging from very mild to mild, moderate, and severe dental fluorosis. Among these 67 villages, Janra (Manbazar I) and Hijla (Barabazar) have the most severely affected people. School dropout (n = 426), social isolation (n = 149), remarriage (n = 21), and physically disabled (n = 75) have also been reported. The study shows that about 414.29 km2 of the Manbhum-Singhbhum Plateau comes under the high-risk-prone category. Conclusions: The societal and environmental awareness of the fluorosis-affected individuals is almost absent in this region. Economic hardships, lack of education, inadequate health care facilities, water scarcity, and lack of awareness increase the magnitude of health hazards and societal vulnerability of the people in this region, who are largely dependent on natural resources. [ABSTRACT FROM AUTHOR]

Purpose: Fluoride is a naturally occurring water contaminant. Prolonged exposure to this element has been shown to have adverse effects on different tissues, as demonstrated by numerous experimental and epidemiological studies. Additionally, fluoride can cross the placental barrier and is present in breast milk, leading to prenatal exposure in areas with endemic fluorosis. The aim of this study is to examine the impact of chronic fluoride exposure during various developmental stages on dental health and growth in male Wistar rats. Methods: Adult Wistar rats were randomly assigned to fluoride exposure groups (10, 100, and 150 ppm F-) and a control group. The animals began treatment 14 days prior to mating. The litters were weaned at 21 days of age, and the males continued the same exposure concentration until they were 90 days old. Likewise, the same concentrations were used in male Wistar rats that were 21 days old until they reached 90 days of age. Food and water consumption, as well as body weight records, were kept weekly throughout the experiment. At the end of the treatment, dental evaluations were performed, and blood samples were taken to determine serum fluoride concentrations. Results: The litters of the fluoride-treated groups showed a decrease in the number of live births and a lower weight at weaning. The offspring of the highest fluoride group exposed (150 ppm F-) had a significant reduction in both water and food consumption, while body weight gain was lower in all treated groups compared to the control group. All groups exposed to fluoride exhibited an increase in serum fluoride levels, as well as moderate to severe lesions in the incisors in a concentration-dependent manner. However, the group that was exposed to 100 ppm F- after weaning showed a lower total weight gain, a higher score on the dental evaluation scale, and a higher serum concentration of F- compared to the animals that were exposed to the same concentration since gestation. Conclusions: This study presents evidence of the negative impact of high concentrations of F- on adult individuals, including reproductive and developmental effects in those exposed during gestation and continuing chronic consumption into adulthood. Furthermore, the study highlights that the effects of chronic F- exposure vary depending on the developmental stage of the individual at the time of exposure. [ABSTRACT FROM AUTHOR]

Purpose: To assess the knowledge of parents/guardians of children considered within the risk range for the development of dental fluorosis on the preventive and adverse effects of fluoride, as well as the relationship with variables related to the use of fluoridated toothpaste by their children. Methods: Interviews (n=398; convenience sample) were conducted at three vaccination centers in the city of Araçatuba (Brazil), using a structured questionnaire comprising items related to the interviewees' education, child’s age and gender, data on brushing habits and use of fluoridated dentifrice, and questions on preventive and adverse effects of fluoride. The amount of toothpaste used was estimated by showing 7 identical toothbrushes with varying amounts of biscuit-simulating toothpaste (previously determined by dentifrice weighing using a precision scale). Data were submitted to Mann Whitney’s, Kruskal Wallis’ and Dunn's tests, and Spearman's correlation coefficient (p<0.05). Results: The interviewees’ schooling was directly related to their knowledge of preventive and adverse effects of fluoride (p<0.05), and inversely related to the amount of dentifrice used by the child (p<0.001). Also, the child's age was inversely related to dentifrice ingestion (during toothbrushing and from the tube) (p<0.001). The type of dentifrice was also influenced by the child's age and the interviewee's schooling (p<0.05). Conclusions: It was concluded that educational strategies targeted at parents/guardians of children are needed to achieve the greatest preventive effect of fluoridated dentifrices with the lowest possible side effects. [ABSTRACT FROM AUTHOR]

This study investigates the fluoride concentration in drinking water across 84 villages in the Rewari Block of Rewari District, Haryana, India, a region with significant agricultural activity and semi-arid climate. Fluoride, a persistent pollutant, is naturally present in the Earth's crust and can accumulate in groundwater, particularly in regions with fluoride-bearing minerals. The study utilized the ion-selective electrode (ISE) method to measure fluoride levels in groundwater samples, finding concentrations ranging from 0.3 to 1.3 mg/L, which is within the permissible limit set by the World Health Organization (WHO). However, 21 villages reported levels exceeding the recommended 1.0 mg/L limit. The higher fluoride concentrations in some areas are attributed to geological factors, such as the presence of fluoride-rich rocks, deeper water tables, and specific climatic conditions. These findings highlight the need for targeted interventions by government and non-governmental organizations (NGOs) to mitigate the health risks associated with fluoride contamination in drinking water, particularly in rural and semi-arid regions dependent on groundwater sources. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the impact of case-based learning (CBL) versus lecture-based learning (LBL) on dental students' clinical decision-making regarding DF severity using Visual Analog Scale (VAS) scoring. Methods: Eighty first-year graduate dental students were randomly assigned to either the CBL (n = 38) or LBL (n = 42) groups. Both groups received instruction on DF diagnosis, with CBL involving small group sessions analyzing real cases and LBL involving traditional lectures. Effectiveness was assessed by presenting 32 dental fluorosis cases with Thylstrup-Fejerskov Index (TSIF) scores ranging from 0 to 7 through slide presentations to both groups for VAS assessment. Five evaluators of each group randomly selected were asked to repeat the rating 2 weeks later. Statistical analysis included two-way ANOVA for group and gender differences, intra-class correlation coefficient (ICC) for reliability, and Spearman correlation coefficients for validity. Results: Variations in VAS scores were observed between CBL and LBL groups, with no significant gender impact. Excellent inter- and intra-evaluator agreement was found for VAS scoring in both groups, indicating its reliability. Validation against established indices (such as DI and TSIF) demonstrated strong correlations, with CBL students exhibiting higher correlations. Conclusions: CBL enhances students' clinical decision-making and proficiency in DF diagnosis, as evidenced by more consistent and accurate VAS scoring compared to LBL. These findings highlight the importance of innovative educational strategies in dental curricula, with implications for improving training quality and clinical outcomes. Trial registration: The study was registered at the Clinical Research Center, Hospital of Stomatology, Wuhan University (Registration code: HGGC-036). [ABSTRACT FROM AUTHOR]

Purpose: Excessive fluoride ingestion induces dental fluorosis that is generated by oxidative stress-mediated apoptosis. Oppositely, regular exercise has been shown to ameliorate oxidative damages and alleviate cell apoptosis in various diseases. However, little attention is paid to the effect of exercise on dental fluorosis. Thus, we employed the exercise regime including forced treadmill running (FTR) in fluorosis mice to explore the effect. Methods: Briefly, three-week-old Institute of Cancer Research (ICR) mice drinking water contained 100 mg/L sodium fluoride (NaF) and 0 mg/L NaF were compulsively submitted to treadmill running for 12 months. Results: Results showed that 12 months of fluoride exposure markedly elevated the incisors fluorine concentrations. FTR restrained the elevation of cross-linked C-terminal telopetide of type I collagen (CTX-I) concentration in urine from mice after 12 months of fluoride exposure. The slightly reduced contents of reactive oxygen species (ROS), malondialdehyde (MDA) and observably enhanced activities of catalase (CAT), glutathione peroxidase (GSH-Px), total superoxide dismutase (T-SOD) and total antioxidant capacity (T-AOC) were found in the incisors of fluoride-toxic mice subjected to FTR. Furthermore, FTR restrained fluoride-caused ameloblasts apoptosis induced by MDA in incisors through reducing the mRNA expressions of p38 mitogen-activated protein kinase (p38MAPK), c-Jun N-terminal kinase (JNK), IkappaB kinase-beta (IKK-β), Caspase3 and enhancing the mRNA expression of B-cell lymphoma 2 (Bcl-2), superoxide dismutase 1 (SOD1). Conclusions: Above results suggested that regular exercise may be a convenient therapy for dental fluorosis. [ABSTRACT FROM AUTHOR]

Fluoride is an essential element in preventing tooth decay, but excessive consumption can be harmful to health. There are various sources of fluoride exposure, including oral intake from water, tea, dates, toothpaste, and green vegetables; however, the extent of exposure varies among different groups in the population. Therefore, it is crucial to monitor the consumption of these sources to avoid the risk of excessive fluoride intake. Our study, analyzing 33 varieties of root, fruit, tuber, and leaf vegetables produced in the Rabat-Salé-Kenitra region of Morocco, should be aiming to understand fluoride accumulation in vegetables, classify different varieties based on their fluoride content, and assess the risks associated with high fluoride exposure through vegetable consumption. The results revealed fluoride levels ranging from 2.3 to 36.2 mg/kg for leaves of consumable plants, 0.17 to 13.2 mg/kg for leafy vegetables, 0 to 5.19 mg/kg for fruit vegetables, 1.45 to 3.66 mg/kg for tuber vegetables, 1.62 to 8.33 mg/kg for bulb vegetables, and 0.85 to 3.40 mg/kg for root vegetables. This study emphasizes the significance of understanding fluoride concentrations in vegetables. It suggests classifying different varieties based on their fluoride content to prevent the risks associated with excessive fluoride exposure from consuming these vegetables. High fluoride exposure through vegetables can result in various health problems, including dental, skeletal, and other types of fluorosis. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluated human health risks of fluoride contamination in groundwater samples to understand its suitability for drinking purpose using Mashihal village, Raichur District in India. Topics include categories of fluorosis such as skeletal fluorosis, non-skeletal fluorosis , and muscular fluorosis, health effects of fluoride on local community as age wise in Mashihal village, and association between age and skeletal fluorosis on local community.

Background: There is no consensus on which molar incisor hypomineralization (MIH) indices are more suitable for epidemiological surveys. Aim: To compare the operational aspects and diagnostic ability of the MIH index (simplified/MIH_s and extended/MIH_e) with the MIH‐Severity Scoring System (MIH‐SSS) in classifying and diagnosing MIH. Design: This cross‐sectional study assessed the indices in a homogeneous group of 680 6‐ to 10‐year‐old schoolchildren in Bauru, Brazil, who had at least one first permanent molar, ensuring consistent conditions. Followed by toothbrushing, the children seated on school chairs were examined by the two calibrated researchers under artificial lighting, using mouth mirror and WHO probe, and chronometer recording the duration of examinations. Results: The prevalence of MIH was 24.7%. The most common characteristic of MIH was demarcated opacity, with a prevalence of 81.7% and 85.45% according to the MIH_s and the MIH‐SSS, respectively. A positive association was observed among the MIH_s, the MIH_e, and the MIH‐SSS (chi‐squared test; p <.01). The MIH‐SSS demonstrated a shorter average application time than both versions of the MIH index (ANOVA/Tukey; p <.05). Additionally, fluorosis was found to be the most prevalent among other developmental defects of enamel, with a prevalence of 38.38%. Conclusion: All systems effectively diagnosed MIH and its characteristics. [ABSTRACT FROM AUTHOR]

For children living in the urban slums of Nairobi (Kenya), primary health conditions are not guaranteed, and oral diseases add further concern at social and institutional levels beyond the general poverty conditions. This study aims at determining the factors that influence the oral health status of children living in Nairobi slums. A cross-sectional study on school-aged subjects was conducted in June 2022 in three urban slum areas of Nairobi through a pediatric dental screening. The PI (Plaque Index), CPITN (Community Periodontal Index of Treatment Needs), and dmft (decayed, missing, and filled teeth index—deciduous) were considered as primary outcomes of dental health. Multivariate statistical analysis, based on ordinal and zero-inflated negative binomial regression models, was conducted to identify determinants of the oral outcomes in a wide set of potential predictors. A sample of 359 children aged 2–17 was examined. The PI was significantly associated with age, the type of bite, and the use of a toothbrush. The CPITN is influenced by different types of malocclusions, abnormal frenulum, dental trauma, and fluorosis. Dietary habits were found to significantly impact the susceptibility to dental caries. Fluorosis and a dental visit in the last year were highlighted as risk and protective factors, respectively, against higher rates of caries. The oral health features of children living in Nairobi slums are differently affected by socio-demographic conditions, dietary habits, dental characteristics, and oral care practices. [ABSTRACT FROM AUTHOR]

Jalili syndrome (JS) (MIM#217080) is a rare autosomal recessive disorder with oculo‐dental malformations. The clinical phenotype is characterized by the presence of Cone‐Rod Dystrophy (CRD) and Amelogenesis Imperfecta (AI). Genetic mechanism entails a mutation in the CNNM4, a metal transporter gene located on Chromosome 2q11.2. A high fluoride concentration in groundwater has also been identified as an epigenetic factor in this syndrome. JS draws the attention of dentists due to its distinct oral manifestations. To the best of our knowledge, this is the first genetically confirmed pediatric case report from the Indian subcontinent emphasizing the clinical and radiographic features of this condition and its management in a 6‐year‐old child. [ABSTRACT FROM AUTHOR]

A 60-year-old woman from Cuddalore presented with restricted neck movements, progressive difficulty in walking, and lower limb weakness, leading to bed confinement. Clinical examination revealed spastic paraparesis, brisk reflexes, and sensory deficits below the hips. Laboratory investigations indicated renal insufficiency and elevated urine fluoride levels. Imaging demonstrated calcifications of sacroiliac, sacrospinous ligaments, interosseous membrane, and posterior longitudinal ligament, with osteosclerosis and osteoporosis. Differential diagnoses included Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis. However, the unique pattern of ligament calcification and elevated fluoride levels supported a diagnosis of fluorosis. This case underscores the importance of considering fluorosis in patients from endemic areas with spastic paraparesis and characteristic radiological findings. Posterior decompression via laminectomy was performed, emphasizing the need for awareness of fluorosis as a potential cause of cervical compressive myelopathy.

Excess fluoride in drinking water causes both dental and skeletal fluorosis among other problems. As such there is need to develop affordable and easily accessible techniques for fluoride removal from drinking water. This work assessed surface modified diatomite mixed with brick for fluoride removal. Diatomite samples were modified using aluminium hydroxide and the mixture was optimized for fluoride removal through response surface methodology (RSM) using the Box-Wilson central composite design. Batch experiments showed that, individually, a 28 g/L dose of the surface modified diatomite sufficiently removed fluoride to the acceptable level of 1.5 mg/L from an initial concentration of 10 mg/L fluoride while a 300 g/L dose of brick powder was required to remove an equal amount of fluoride in the same water samples. RSM optimization showed that a mixture of surface modified diatomite and brick in the mass ratio 1.8:17.8 grams per milligram of fluoride in water can be used to remove fluoride in water to an acceptable level. Adsorption of fluoride by surface modified diatomite fit better into the Freundlich adsorption isotherm (R$ ^2 $ = 0.9753) compared to the Langmuir (R$ ^2 $ = 0.8954), while adsorption by brick better fit the Langmuir adsorption mechanism (R$ ^2 $ = 0.9804) in comparison to the Freundlich adsorption (R$ ^2 $ = 0.9372). Kinetic studies revealed that chemisorption was the main mechanism for both surface modified diatomite and brick adsorbents. Conclusively, an optimal mixture of surface modified diatomite and brick can be successfully used for fluoride removal in areas for which water has high fluoride contamination.

Background: Dental fluorosis (DF) is caused by excessive exposure to fluoride during odontogenesis and leads to various changes in the development of tooth enamel. Some regions in Mexico are considered endemic fluorosis zones due to the high fluoride content in drinking water. The objective of this study was to perform a systematic review and meta-analysis to identify the association between the concentration of fluoride in drinking water and the severity of dental fluorosis in northern and western Mexico. Methods: This protocol was registered in the PROSPERO database (ID: CRD42023401519). The search for information was carried out in the PubMed/Medline, Scopus, SpringerLink, and Google Scholar databases between January 2015 and October 2023. The overall relative risk was calculated using the inverse of variance approach with the random effects method. The RoB 2.0 tool was used to construct risk plots. Results: Eleven articles were analyzed qualitatively, and most of the included studies presented at least one level of DF severity; six articles were analyzed quantitatively, dividing them into two regions. In North region it was observed a higher prevalence of severe TF cases, corresponding to ≥ TF 5 category (4.78) [3.55, 6.42]. In the West region, most of the included studies presented a higher prevalence of less severe cases, corresponding to ≤ TF 4, in comparison with the North region (0.01) [0.00, 0.52], interpreted as a protective effect. Conclusion: The concentrations of fluorides in drinking water are reportedly high in these regions and are directly related to the severity of dental fluorosis experienced by the inhabitants. In the Northern region exists a major concentration of fluoride in drinking water compared with the Western region as well as a prevalence of higher severity cases of dental fluorosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Fluorosis is a disorder of enamel development caused by long-term intake of large amounts of fluoride during enamel development. OBJECTIVE: To further explore the molecular mechanism of dental fluorosis formation by screening the differentially expressed genes associated with calcium homeostasis in ameloblasts by transcriptome sequencing technology. METHODS: LS8 cells were treated with 0, 0.4, 0.8, 1.6, 3.2 and 6.4 mmol/L sodium fluoride (NaF) for 24, 48 and 72 hours to observe the effects of different concentrations of NaF on the morphology, cell activity and intracellular Ca2+ concentration of LS8 cells. The differentially expressed genes were screened by transcriptome sequencing and validated. RESULTS AND CONCLUSION: After 24 hours of treatment, the cells treated with 0, 0.4, and 0.8 mmol/L NaF were in good growth condition, with increased cell number and clear cell outline. When the NaF concentration was ≥ 1.6 mmol/L, the cells were gradually shrunken and became smaller and the number of cells decreased with the increase of NaF concentration. After 48 and 72 hours of treatment, the number of cells increased in the 0, 0.4 mmol/L NaF groups, while gradually decreased in the 0.8, 1.6, 3.2 mmol/L NaF groups, with rounded and smaller cell morphology. The cells in the 6.4 mmol/L NaF group were shrunken, rounded and suspended in the medium, with almost no adherent cells. When treated with the same concentration of NaF, LS8 cells were in optimal growth after 24 hours of treatment. Results from cell counting kit-8 assay showed that when treated with the same concentration of NaF, the cell activity decreased with the increase of treatment time; when the treatment time was the same, the cell activity decreased with the increase of NaF concentration. After 24 hours of treatment, the intracellular Ca2+ concentration increased with the increase of NaF concentration. Transcriptome sequencing analysis identified genes involved in the regulation of cellular calcium homeostasis: Hsp90b1, Canx, Calr, and Hspa5 that were significantly upregulated (P < 0.05) and Cacna1a that was significantly downregulated (P < 0.05). To conclude, the inhibitory effect of NaF on LS8 cell proliferation may be related to the abnormal increase in intracellular Ca2+ concentration, and the mechanism may be caused by the upregulation of the expression of protein processing and synthesis pathways Hsp90b1, Canx, Calr, and Hspa5 and the downregulation of the expression of calcium signaling pathway Cacna1a. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: In low- and middle-income countries, oral health is frequently marginalized due to limited dental care access. This cross-sectional study assesses the outcomes of dental outreach camps in Zanzibar, Tanzania, organized in 2019 and 2023, to understand their impact on addressing local oral health needs over a four-year span. Methods: The study involved a thorough examination and analysis of clinical dental health data from both outreach camps. In 2019, 224 patients were examined, and in 2023, the number increased to 354. The assessment covered various dental health parameters, including dental caries, DMFT/dmft indices, enamel fluorosis, dental trauma, oral mucosa lesions, and non-carious tooth surface loss. Results: The analysis demonstrated a significant reduction in dental caries among adolescents and teens, decreasing from 62.5% in 2019 to 35.59% in 2023 (p < 0.0001). Similarly, the prevalence of teeth missing due to caries showed marked reductions from 40.2% to 9.04% in adolescents and teens (p < 0.0001) and from 25.89% to 11.86% among preschool and school-aged children (p = 0.004). Moreover, a significant change was observed in the Basic Erosive Wear Examination (BEWE) scores, with cases showing no erosive tooth wear (BEWE = 0) decreasing from 49.1% to 33.3% (p = 0.016), and cases with initial loss of enamel surface texture (BEWE = 1) increasing from 47.3% to 61% (p = 0.044). Conclusions: The outreach camps conducted in 2019 and 2023 showed tangible improvements in certain dental health metrics, particularly a reduction in dental caries and missing teeth due to caries among adolescents and teens. However, the uptick in non-carious tooth surface loss points to emerging dental health concerns. These results underline the importance of sustained and targeted dental health interventions to improve oral health outcomes in underserved communities such as Zanzibar. [ABSTRACT FROM AUTHOR]

This study focuses on identifying fluoride (F‒) concentrations and its health risk assessment (HRA) in drinking water sources in south-eastern Türkiye. Groundwater quality was assessed using some graphical approaches such as Schoeller and Piper diagrams and GIS mapping. Average daily exposure dosages through oral and dermal contact exposure routes were considered to determine the potential health risk of F‒ in groundwater. Groundwater samples were taken from 53 points in spring, summer, autumn, and winter seasons. The results showed that the average annual F‒ concentrations in water resources in the study area were 0.26‒3.62 mg/L. According to the HRA results, the highest F‒ health risk in this region was observed in children, followed by teenagers and adults. This study indicated that there is a strong relationship between the high health risk (4.28 > 3.5) in children and dental fluorosis caused by high F‒ concentration in groundwater. [ABSTRACT FROM AUTHOR]

Skeletal fluorosis is rare and occurs secondary to chronic high amounts of fluoride consumption, manifesting as diffuse osteosclerosis, skeletal pain, connective tissue calcification, and increased fracture risk. Methoxyflurane is a volatile, fluorinated hydrocarbon-inhaled analgesic, and the maximum recommended dose is 15 mL (99.9 % w/w) per wk. A rodent study found increased skeletal fluoride after methoxyflurane exposure. However, skeletal fluorosis secondary to methoxyflurane use in humans has rarely been reported. We present the case of a 47-yr-old female with diffuse osteosclerosis secondary to fluorosis from methoxyflurane use for chronic pain, presenting with 3 yr of generalized bony pain and multiple fragility fractures. Lumbar spine BMD was elevated. CT and radiographs demonstrated new-onset marked diffuse osteosclerosis, with calcification of interosseous membranes and ligaments, and a bone scan demonstrated a grossly increased uptake throughout the skeleton. Biochemistry revealed an elevated alkaline phosphatase and bone turnover markers, mild secondary hyperparathyroidism with vitamin D deficiency, and mild renal impairment. Zoledronic acid, prescribed for presumed Paget's disease, severely exacerbated bony pain. Urinary fluoride was elevated (7.3 mg/L; reference range < 3.0 mg/L) and the patient revealed using methoxyflurane 9 mL per wk for 8 yr for chronic pain. A decalcified bone biopsy revealed haphazardly arranged cement lines and osteocytes lacunae and canaliculi, which was consistent with an osteosclerotic process. Focal subtle basophilic stippling around osteocyte lacunae was suggestive of fluorosis. Although fluorosis is not a histological diagnosis, the presence of compatible histology features was supportive of the diagnosis in this case with clinical–radiological–pathological correlation. Skeletal fluorosis should be considered as a cause of acquired diffuse osteosclerosis. Methoxyflurane should not be recommended for chronic pain. The risk of repeated low-dose exposure to fluoride from methoxyflurane use as analgesia may be greater than expected, and the maximum recommended dose for methoxyflurane may require re-evaluation to minimize skeletal complications. Abbreviated abstract Skeletal fluorosis is rare and occurs secondary to chronic high amounts of fluoride consumption, manifesting as diffuse osteosclerosis, skeletal pain, connective tissue calcification, and increased fracture risk. We present the case of a 47-yr-old female with skeletal fluorosis secondary to long-term methoxyflurane for chronic pain. The risk of repeated low-dose exposure to fluoride from methoxyflurane use for analgesia may be greater than expected, and the maximum recommended dose for methoxyflurane may require re-evaluation to minimize skeletal complications. [ABSTRACT FROM AUTHOR]