Assessing Fluorosis Incidence in Areas with Low Fluoride Content in the Drinking Water, Fluorotic Enamel Architecture, and Composition Alterations

Abstract

There is currently no consensus among researchers on the optimal level of fluoride for human growth and health. As drinking water is not the sole source of fluoride for humans, and fluoride can be found in many food sources, this work aimed to determine the incidence and severity of dental fluorosis in Poland, in areas where a low fluoride content characterizes the drinking water, and to assess the impact of fluoride on the enamel composition and microstructure. The dental examination involved 696 patients (aged 15–25 years) who had since birth lived in areas where the fluoride concentration in drinking water did not exceed 0.25 mg/L. The severity of the condition was evaluated using the Dean’s Index. Both healthy teeth and teeth with varying degrees of fluorosis underwent laboratory tests designed to assess the total protein and fluoride content of the enamel. Protein amount was assessed spectrophotometrically while the level of fluoride ions was measured by DX-120 ion chromatography. The clinical study revealed 89 cases (12.8%) of dental fluorosis of varying severity. The enamel of teeth with mild and moderate fluorosis contained a significantly higher protein (p-value < 0.001 and 0.002, respectively) and fluoride level (p < 0.001) than those with no clinical signs of fluorosis. SEM images showed irregularities in the structure of the fluorotic enamel. An excessive fluoride level during amelogenesis leads to adverse changes in the chemical composition of tooth enamel and its structure. Moreover, dental fluorosis present in areas where drinking water is low in fluorides indicates a need to monitor the supply of fluoride from other possible sources, regardless of its content in the water.

Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial

“…Hydroxyapatite is a safe active ingredient ( 3 ). Fluoride, on the other hand, can cause dental fluorosis documented also in areas of low fluoride content in the drinking water ( 64 ). It is important to note that both children and adults may ingest excessive amounts of fluoride.…”

A Systematic Review on Water Fluoride Levels Causing Dental Fluorosis

“…The prevalence of dental fluorosis reported in the past five years agrees with the prevalence reported before the past five years. As shown in Tables 4 and 5, the studies included in this systematic review from the past five years were [32,[44][45][46][47][48][49][50][51][52][53][54][55][56]. In comparison, the studies included in this review before the past five years were [34][35][36][37][38][39][40][41][42][43].…”

Moderate and Severe Dental Fluorosis in the Rural Population of Anantapur, India: Change in Their Biological Susceptibility?

“…Frequently, the literature deals with the effect of fluoride toxicity in oral health considering a specific period of life; for example, if the exposition occurs during the enamel formation and mineralization process, the damage to the teeth will be more severe [ 27 , 28 ], including adverse changes in the chemical composition of tooth enamel and its structure [ 29 ]. In addition, childhood implies a natural greater risk for the toxic effects of fluorides compared to adults because children have greater metabolic rates of fluoride retention due to the natural incorporation of the fluoride to the growing skeletal and dental structures [ 30 ].…”