Associations of low level of fluoride exposure with dental fluorosis among U.S. children and adolescents, NHANES 2015–2016

Dong, Haitao; Yang, Xin; Zhang, Shixuan; Wang, Xueting; Guo, Chunhua; Zhang, Mengjie; Ma, Junxiang; Niu, Piye; Chen, Tian

doi:10.1016/j.ecoenv.2021.112439

Cited by 29 publications

(13 citation statements)

References 21 publications

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“…In American studies carried out as part of the National Health and Nutrition Examination Survey (NHANES) 2015–2016 concerning 2098 children and adolescents, the fluoride concentration in water above the level of 0.7 mg/L was 25%, but the prevalence of dental fluorosis was 70%. In this study, higher plasma fluoride concentrations were associated with higher odds of dental fluorosis in females, while this association almost disappeared in males [ 54 ]. In the presented research, we noticed the prevalence of fluorosis in females, which may suggest an influence of gender-specific hormonal and mineral metabolism.…”

Section: Discussionmentioning

confidence: 92%

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

Strużycka

Olszewska

Bogusławska-Kapała

et al. 2022

IJERPH

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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.

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Section: Discussionmentioning

confidence: 92%

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

Strużycka

Olszewska

Bogusławska-Kapała

et al. 2022

IJERPH

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“…Our findings of an association between plasma fluoride concentrations and increased WBC counts in U.S. children and adolescents suggest that ingested fluoride may be an environmental risk factor for inflammation for this population. Dental fluorosis, a biomarker for fluoride exposure, has continued to increase in the U.S. [ 37 , 38 ] suggesting increasing population based fluoride exposure. This indicates the need for additional studies to assess the effects of fluoride on markers of inflammation in adults and vulnerable human populations.…”

Section: Discussionmentioning

confidence: 99%

Fluoride exposure and blood cell markers of inflammation in children and adolescents in the United States: NHANES, 2013–2016

Besten

Wells²,

Uyghurturk

2022

Environ Health

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Background Ingestion of fluoride in drinking water has been shown to result in increased cellular markers of inflammation in rodent models. However, the approximately 5–10 × increase in water fluoride concentrations required in rat and mouse models to obtain plasma fluoride concentrations similar to those found in humans has made relevant comparisons of animal to human studies difficult to assess. As an increased white blood cell count (WBC) is a marker of inflammation in humans, we used available NHANES survey data to assess the associations between plasma fluoride levels in the U.S. and blood cell counts children and adolescents. Methods Multiple linear regressions were done to determine the association of blood cell counts and plasma fluoride in publicly available NHANES survey data from the 2013–2014 and 2015–2016 cycles. Plasma fluoride concentration measurements were available only for children aged 6 to 19, inclusive, and therefore this subpopulation was used for all analyses. Covariate predictors along with plasma fluoride were age, ethnicity, gender, and Body Mass Index (BMI). Results Plasma fluoride was significantly positively associated with water fluoride, total WBC count, segmented neutrophils, and monocytes, and negatively associated with red blood cell count when adjusted for age, gender and BMI. Conclusion Our finding that neutrophils and monocytes are associated with higher plasma fluoride in U.S. children and adolescents is consistent with animal data showing fluoride related effects of increased inflammation. These findings suggest the importance of further studies to assess potential mechanisms that are involved in absorption and filtration of ingested fluoride, particularly in tissues and organs such as the small intestine, liver and kidney.

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“…Our ndings of an association between plasma uoride concentrations and increased white blood cell counts, suggests that ingested uoride may be an environmental risk factor, which can contribute to systemic in ammation. Dental uorosis, a biomarker for uoride exposure, has continued to increase in the US (Neurath, Limeback et al 2019, Dong, Yang et al 2021, and as chronic in ammation is a signi cant risk factor for a multitude of diseases (Houser and Tansey 2017), these effects of uoride may be particularly relevant to US populations. While these uoride related effects may not be a risk factor for healthy individuals drinking uoridated water, the possible contributions of uoride ingestion to those with risk factors for in ammation, is an important consideration for further study.…”

Section: Discussionmentioning

confidence: 99%

Fluoride exposure and systemic markers of inflammation in children and adolescents in the United States: NHANES, 2013-2016

Besten

Uyghurturk

Wells

2022

Preprint

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Background: Ingestion of fluoride in drinking water has been shown to result in increased cellular markers of inflammation in rodent models. However, the approximately 10x greater fluoride concentrations in drinking water required by rat and mouse models to obtain blood fluoride concentrations similar those of found in humans, has made the relevance of these animal studies difficult to assess. Increased white blood cell count is a marker of inflammation in humans, and therefore we used available 2013-2016 NHANES survey data, which includes both blood cell counts and plasma fluoride concentrations, to explore the relationship between fluoride and inflammation in humans.OBJECTIVE: To assess associations between plasma fluoride levels and blood cell markers of inflammation in a US population. METHODS: Multiple linear regressions to determine the association of blood cell counts and plasma fluoride were done using publicly available NHANES survey data from the 2013-2014 and 2015-2016 cycles. Plasma fluoride concentrations were available for children aged 6 to 19, and therefore this subpopulation was used for all analyses. Covariate predictors along with plasma fluoride were age, gender, and Body Mass Index (BMI). RESULTS: Plasma fluoride was significantly positively associated with water fluoride, total white blood cell count, segmented neutrophils, monocytes, and negatively associated with red blood cell count when adjusted for age, gender and BMI. CONCLUSION: Our finding that neutrophils and monocytes are associated with higher plasma fluoride in US children and adolescents is consistent with animal data showing fluoride related effects in increasing inflammation. These findings suggest the importance of further studies to assess potential mechanisms for these fluoride related effects in tissues and organs, such as the small intestine, liver and kidney, that are involved in absorption and filtration of ingested fluoride.

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Associations of low level of fluoride exposure with dental fluorosis among U.S. children and adolescents, NHANES 2015–2016

Cited by 29 publications

References 21 publications

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

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

Fluoride exposure and blood cell markers of inflammation in children and adolescents in the United States: NHANES, 2013–2016

Fluoride exposure and systemic markers of inflammation in children and adolescents in the United States: NHANES, 2013-2016

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