Fluoride

Material and methods and Results:

The F release of 26 brands of toothpicks and floss was followed for 24 hrs in vitro. A large variation in the release between these products was found; in general, toothpicks resulted in larger amounts of F compared with floss. The release in vivo was studied using single and multiple fluoridated toothpicks and dental floss, as well as in combination with toothbrushing or a mouthrinse with 0.2% NaF. Moreover, the administration of F by an interdental brush dipped in 0.2% NaF gel (here called the “Inter Dental Brush Gel Method”) was evaluated. Approximal saliva was collected, using paper points, before and up to 60 min after treatment. Both toothpicks and floss resulted in enhanced F concentrations in vivo. An interdental brush dipped in 0.2% NaF gel and a mouthrinse with 0.2% NaF resulted in the same F concentration as after using multiple toothpicks. All combinations of toothpicks and dental floss with F rinsing resulted in higher concentrations than after only toothbrushing or in combination with brushing. The most optimal order was to use toothpicks and dental floss after toothbrushing and before rinsing. Fifteen adults with full dentures, in which demineralised enamel and dentine specimens had been mounted, were included in an in situ experimental caries model. Toothpicks or floss, impregnated with NaF and amine fluoride (AmF), were used regularly for four weeks. All the products inhibited continuous demineralisation – dental floss somewhat more than toothpicks. A reduction in plaque micro-organisms was also found. Recommendations made by dental staff in relation to approximal cleaning aids were evaluated by a questionnaire sent to 500 dentists, 500 dental hygienists and 1000 patients in Sweden. The ability to remove approximal plaque was also evaluated in 60 regular users of approximal aids. Recommendations by dental staff are mostly given to children and adolescents in order to prevent dental caries and to older individuals to prevent gingivitis and periodontal disease. Approximal plaque appears to be more easily removed by regular users of interdental brushes compared with the use of toothpicks and dental floss.

Quarter Horses drinking water artificially fluoridated at 0.9 to 1.1 ppm over long periods of time developed dental fluorosis. Even when the horses had not been exposed to artificially fluoridated water (AFW) during formation of enamel, brown discoloration occurred and progressed. Pronounced loss of tooth-supporting alveolar bone with recession of bone and gingiva was also present as more severe signs of chronic fluorosis than enamel changes alone. The scene of these events was a lowland part of Texas just above sea level. AFW at these low concentrations can obviously induce chronic fluorosis in its own right without the support of high altitude. With a change to low fluoride (0.1 ppm) well water, a remarkable improvement was observed in the general health of the horses in a very short time. Most notably, bothersome episodes of colic promptly ceased.

“Background. In this review, the authors examine evidence regarding the effectiveness of fluoride supplements in preventing caries and their association with dental fluorosis.  Methods. Using tested search filters, the authors searched MEDLINE, the Cochrane Central Register of Controlled Trials, OVID Evidence-based Reviews and EMBASE. The authors agreed on the inclusion of 20 reports from 12 trials that met defined criteria. They also included five studies published since 1997 regarding the association between dental fluorosis and supplements.  Results. Eleven of the reports evaluated dosage schedules similar to that recommended by the American Dental Association. One potentially highly biased study of primary teeth of children during the first three years of life reported a 47.2 percent reduction in dental caries experience. Investigators in one trial involving 3- to 6-year-old children found a 43.0 percent difference, and another trial of children in this age group did not find a significant benefit. Researchers in several studies involving older children detected a significant reduction in caries increments in permanent teeth with the use of fluoride supplements. Fifteen of the studies had withdrawal rates of 30 percent or higher. All of the five included studies that evaluated the association between use of fluoride supplements and dental fluorosis found that use of the supplements increased the risk of mild-to-moderate fluorosis. Conclusions. There is weak and inconsistent evidence that the use of fluoride supplements prevents dental caries in primary teeth. There is evidence that such supplements prevent caries in permanent teeth. Mild-to-moderate dental fluorosis is a significant side effect. Clinical Implications. The current recommendations for use of fluoride supplements during the first six years of life should be re-examined.”

“Key Concepts: Researchers are intensifying their scrutiny of fluoride, which is added to most public water systems in the U.S. Some recent studies suggest that overconsumption of fluoride can raise the risks of disorders affecting teeth, bones, the brain and the thyroid gland.  A 2006 report by a committee of the National Research Council recommended that the federal government lower its current limit for fluoride in drinking water because of health risks to both children and adults.”

Perfluorinated compounds have been used for more than 50 years as process aids, surfactants, and for surface protection. This study is a comprehensive assessment of consumer exposure to perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) from a variety of environmental and product-related sources. To identify relevant pathways leading to consumer exposure to PFOS and PFOA a scenario-based approach has been applied. Scenarios represent realistic situations where age- and gender-specific exposure occurs in the everyday life of consumers. We find that North American and European consumers are likely to experience ubiquitous and long-term uptake doses of PFOS and PFOA in the range of 3 to 220 ng per kg body weight per day (ng/kg(bw)/day) and 1 to 130 ng/kg(bw)/day, respectively. The greatest portion of the chronic exposure to PFOS and PFOA is likely to result from the intake of contaminated foods, including drinking water. Consumer products cause a minor portion of the consumer exposure to PFOS and PFOA. Of these, it is mainly impregnation sprays, treated carpets in homes, and coated food contact materials that may lead to consumer exposure to PFOS and PFOA. Children tend to experience higher total uptake doses (on a body weight basis) than teenagers and adults because of higher relative uptake via food consumption and hand-to-mouth transfer of chemical from treated carpets and ingestion of dust. The uptake estimates based on scenarios are within the range of values derived from blood serum data by applying a one-compartment pharmacokinetic model.

Fluorine substituents have become a widespread and important drug component, their introduction facilitated by the development of safe and selective fluorinating agents. Organofluorine affects nearly all physical and adsorption, distribution, metabolism, and excretion properties of a lead compound. Its inductive effects are relatively well understood, enhancing bioavailability, for example, by reducing the basicity of neighboring amines. In contrast, exploration of the specific influence of carbon-fluorine single bonds on docking interactions, whether through direct contact with the protein or through stereoelectronic effects on molecular conformation of the drug, has only recently begun. Here, we review experimental progress in this vein and add complementary analysis based on comprehensive searches in the Cambridge Structural Database and the Protein Data Bank.

OBJECTIVES:
The purpose of this article was to review the fluoride release and recharge capabilities, and antibacterial properties, of fluoride-releasing dental restoratives, and discuss the current status concerning the prevention or inhibition of caries development and progression.

METHODS:
Information from original scientific full papers or reviews listed in PubMed (search term: fluoride release AND (restorative OR glass-ionomer OR compomer OR polyacid-modified composite resin OR composite OR amalgam)), published from 1980 to 2004, was included in the review. Papers dealing with endodontic or orthodontic topics were not taken into consideration. Clinical studies concerning secondary caries development were only included when performed in split-mouth design with an observation period of at least three years.

RESULTS:
Fluoride-containing dental materials show clear differences in the fluoride release and uptake characteristics. Short- and long-term fluoride releases from restoratives are related to their matrices, setting mechanisms and fluoride content and depend on several environmental conditions. Fluoride-releasing materials may act as a fluoride reservoir and may increase the fluoride level in saliva, plaque and dental hard tissues. However, clinical studies exhibited conflicting data as to whether or not these materials significantly prevent or inhibit secondary caries and affect the growth of caries-associated bacteria compared to non-fluoridated restoratives.

SIGNIFICANCE:
Fluoride release and uptake characteristics depend on the matrices, fillers and fluoride content as well as on the setting mechanisms and environmental conditions of the restoratives. Fluoride-releasing materials, predominantly glass-ionomers and compomers, did show cariostatic properties and may affect bacterial metabolism under simulated cariogenic conditions in vitro. However, it is not proven by prospective clinical studies whether the incidence of secondary caries can be significantly reduced by the fluoride release of restorative materials.

“Thank you for this opportunity to address the committee. I understand that your plans to fluoridate are already in place. I wish to simply inform you of some the implications of those plans.”

“Fluoride is widely believed to be a useful chemical substance for preventing dental caries. However, the mechanism underlying crystal perforation in the tooth enamel and the effect of fluoride on hard tissues are unclear. To clarify the mechanism of the biological action of fluoride in the mineralization process, we examined the hard tissues of rats having received water containing a relatively low fluoride level. Electron microscopy revealed that fluoride ions could interrupt the crystal nucleation process, resulting in crystal perforation in the developing tooth enamel and the presence of amorphous minerals in bone crystals. Furthermore, the results of enzymatic analyses indicated that fluoride directly interfered with the synthesis of carbonic anhydrase by the enamel-forming cells, rather than being directly involved in the crystal formation. From the results, we would like to provide a possible mechanism of crystal perforation in the enamel induced by fluoride intake. Also, we would like to suggest that regardless of its amount, fluoride intake has harmful effects on both tooth and bone formation. “

“Silicofluorides (SiFs), fluosilicic acid (FSA) and sodium fluosilicate (NaFSA), are used to fluoridate over 90% of US fluoridated municipal water supplies. Living in communities with silicofluoride treated water (SiFW) is associated with two neurotoxic effects: (1) Prevalence of children with elevated blood lead (PbB > 10 ?g/dL) is about double that in non-fluoridated communities (Risk Ratio 2, ?2p < 0.01). SiFW is associated with serious corrosion of lead-bearing brass plumbing, producing elevated water lead (PbW) at the faucet. New data refute the long-prevailing belief that PbW contributes little to children’s blood lead (PbB), it is likely to contribute 50% or more. (2) SiFW has been shown to interfere with cholinergic function. Unlike the fully ionized state of fluoride (F-) in water treated with sodium fluoride (NaFW), the SiF anion, [SiF6]2- in SiFW releases F- in a complicated dissociation process. Small amounts of incompletely dissociated [SiF6]2- or low molecular weight (LMW) silicic acid (SA) oligomers may remain in SiFW. A German PhD study found that SiFW is a more powerful inhibitor of acetylcholinesterase (AChE) than NaFW. It is proposed here that SiFW induces protein mis-folding via a mechanism that would affect polypeptides in general, and explain dental fluorosis, a tooth enamel defect that is not merely “cosmetic” but a “canary in the mine” foretelling other adverse, albeit subtle, health and behavioral effects. Efforts to refute evidence of such effects are analyzed and rebutted. In 1999 and 2000, senior EPA personnel admitted they knew of no health effects studies of SiFs. In 2002 SiFs were nominated for NTP animal testing. In 2006 an NRC Fluoride Study Committee recommended such studies. It is not known at this writing whether any had begun. “