Dental Fluorosis according to Birth Cohort and Fluoride Markers in an Endemic Region of Colombia

Abstract

Objectives. To analyze changes in the dental fluorosis (DF) incidence according to a birth cohort and explore current exposure to DF in a case series. Methods. Repeated cross-sectional study of two periods: 2015 and 2018. Two standardized examiners registered DF using the Thylstrup-Fejerskov index in permanent teeth of children aged 7–18 years. Period and birth cohort frequencies were estimated by a generalized linear model, binomial family, and logarithmic link function. Period estimates are presented as prevalence ratios (PR) and birth cohort estimates as cumulative incidence ratios (RR); 95% confidence intervals and P values are reported. In a subsample of 37 volunteers (12.29 ± 2.63 years), the fluoride (F) concentration in toenails was measured using the HMDS diffusion method and an ion-specific electrode. Other samples from the local environment such as food, soil, and coal were also collected. Results. In 274 children, we found that nonsignificant increases between periods (PR = 1.17; 95% CI: 0.89–1.55) were not explained by birth cohort effects. A total of 37.8% of the subsample had a toenail F concentration ≥2 μg F/g. The salty snacks and seasoning had the highest F concentrations among local environmental samples. Conclusion. In this population with a high DF frequency according to birth cohort and the evaluated period, the study of soil, coal, and food samples indicated a continued F exposure. F concentration found in the toenails shows a moderate F exposure; nearly a third of the children and adolescents exceeded the adopted threshold of 2 μg F/g. It is important to monitor and explore changes in exposure in highly affected population.

Distribution of Dental Fluorosis in the Southern Zone of Ecuador: An Epidemiological Study

“…This study, whose objective was to investigate the prevalence of DF and its severity, is the first carried out in the southern region of the country, in provinces with different climatic and altitude characteristics such as Azuay, Cañar and Morona Santiago, which are apparently non-fluoridated areas, so the data obtained can serve as a starting point for future research. The results show a high prevalence of DF in the three provinces evaluated, with no significant differences between them ( p > 0.05), coinciding with previous studies carried out in some Latin American cities [ 31 , 35 , 36 , 37 , 38 , 39 ] and in Ecuador [ 30 , 40 , 41 , 42 ] ( Figure 2 ). The fluoride incorporated into the organism from water sources, processed or not processed food, or by accidental ingestion, through the consumption of toothpaste, constitutes the main source for pathologies at the dental enamel level [ 43 ], with an effect variable according to the period of contact of the mineral with the tooth in its formation stage [ 44 ].…”

“…The evaluation of the presence of pathology requires a careful protocol and the use of one of the two systems or indices to measure the severity of the pathology, the Dean index [ 36 ] or the Thylstrup and Fejeskov index (tfi) [ 45 ], whose use is validated and considered reliable in the analysis of DF, with slight differences between them limited to the analysis protocol [ 46 , 47 ]. For that reason, the use of the Dean index was required in this study, because it was considered comparable to previous studies carried out in similar Ecuadorian populations, which evidenced the high presence of mild fluorosis in the evaluated population [ 40 ], related to the consumption of food, water, tooth brushing, pharmacies’ use [ 30 ], triggering enamel defect [ 48 ] and demineralization processes associated with dental cavities when the DF increase [ 49 ].…”

Estimated Dietary Fluoride Intake by 24-Month-Olds from Chocolate Bars, Cookies, Infant Cereals, and Chocolate Drinks in Brazil

“…Although evidence on the dental effects of topical F is widely accepted, the risk-benefit ratio of systemic exposure to F ingestion is a complex scenario, as excessive intake during tooth development can increase the risk of DF [ 34 ]. Several studies have reported an increase in the occurrence of this dental condition in both primary [ 7 , 8 , 13 ] and permanent dentitions [ 9 , 10 , 14 , 35 ]. Studies on the timing of F intake and fluorosis have focused on the most aesthetically important teeth, the maxillary central incisors [ 10 , 11 , 12 , 36 , 37 ].…”

“…However, for the maxillary central incisors that are of greatest cosmetic importance, the critical period of susceptibility to DF comprises the first 3 years of life [ 12 ]. Recent studies have shown an increase in the prevalence of DF, both in the primary [ 7 , 8 , 13 ] and in the permanent [ 9 , 10 , 14 ] dentitions. Therefore, it is extremely important to assess children’s sources of F intake individually, as total F intake impacts the development of DF [ 5 , 15 , 16 ].…”

Advances in epidemiological status and pathogenesis of dental fluorosis

“…In terms of the living environment, there is an increase in the prevalence of people who is in the plateau. These people have the habit of drinking brick tea and using coal or wood containing fluoride to make food, which leads to the spread of fluoride from the fuel into the air and its absorption by the human respiratory tract (Saldarriaga et al, 2021a). In areas with high fluoride contents in rock or soil, fluoride leaching can occur, resulting in groundwater pollution.…”