A Quantitative Look at Fluorosis, Fluoride Exposure, and Intake in Children Using a Health Risk Assessment Approach

Abstract

The prevalence of dental fluorosis in the United States has increased during the last 30 years. In this study, we used a mathematical model commonly employed by the U.S. Environmental Protection Agency to estimate average daily intake of fluoride via all applicable exposure pathways contributing to fluorosis risk for infants and children living in hypothetical fluoridated and non-fluoridated communities. We also estimated hazard quotients for each exposure pathway and hazard indices for exposure conditions representative of central tendency exposure (CTE) and reasonable maximum exposure (RME) conditions. The exposure pathways considered were uptake of fluoride via fluoridated drinking water, beverages, cow’s milk, foods, and fluoride supplements for both age groups. Additionally, consumption of infant formula for infants and inadvertent swallowing of toothpaste while brushing and incidental ingestion of soil for children were also considered. The cumulative daily fluoride intake in fluoridated areas was estimated as 0.20 and 0.11 mg/kg-day for RME and CTE scenarios, respectively, for infants. On the other hand, the RME and CTE estimates for children were 0.23 and 0.06 mg/kg-day, respectively. In areas where municipal water is not fluoridated, our RME and CTE estimates for cumulative daily average intake were, respectively, 0.11 and 0.08 mg/kg-day for infants and 0.21 and 0.06 mg/kg-day for children. Our theoretical estimates are in good agreement with measurement-based estimates reported in the literature. Although CTE estimates were within the optimum range for dental caries prevention, the RME estimates were above the upper tolerable intake limit. This suggests that some children may be at risk for fluorosis.

Potential exposure and risk of fluoride intakes from tea drinks produced in Taiwan

“…Similar observations were reported in the US, Canada, Chile, and other countries (Ismail and Messer, 1996;Karthikeyan et al, 1996;Villa et al, 1998;Kumar and Swango, 1999). Erdal and Buchanan (2005) stated that some children in the US may be at risk of dental fluorosis considering multi-pathway fluoride intakes. Morgen et al (1998) reported that 69% of children 7-11 years of age examined in a suburban Boston pediatric practice were found to have dental fluorosis.…”

Toothpaste Utilization Profiles among Preschool Children

“…Fluorosis affects developing, unerupted and erupted permanent teeth of children who are below the age of six years [11], which again affects appearance of teeth and causes emotional disturbance. American Association of Poison Control Centers reported 21, 513 calls which were related to fluoride tooth patse ingestion [12].…”

The contribution of drinking water fluoride to the risk of dental fluorosis in Estonia

“…This study cannot comment on overall exposure to fluoride, although drinking water is usually the largest contributor to fluoride intake [2,12].…”