Investigation and mapping of fluoride-endemic areas and associated health risk—A case study of Agra,Uttar Pradesh,India

The present study aimed at identifying the fluoride-endemic areas in five different blocks in Agra district, Uttar Pradesh, India. A total of 365 groundwater samples from 73 villages were analyzed for establishing the concentration range of fluoride in drinking water. The fluoride level in the study area varied from 0.14 to 4.88 mg/L. Out of 73, the fluoride levels in 45 villages did not meet the permissible Word Health Organization standards. The Baroli Ahir block was found the highly fluoride-endemic area followed by Saiyan, Bichpuri, Achnera and Etmadpur. Chronic daily intake of fluoride in adults was 1.25 and 1.5 times higher than those in children and infants, respectively. The probability of dental fluorosis in infants was higher (42%) while adults were more prone to bone and skeletal fluorosis (60%). The hazard quotient analysis revealed that children were found to be at maximum risk followed by infants and adults. Sensitivity analysis revealed that the fluoride concentration is the major influencing parameter responsible for different types of fluorosis in various age groups.     

Fluoride and environmental health: a review

The relationship between environmental fluoride and human health has been studied for over 100 years by researchers from a wide variety of disciplines. Most scientists believe that small amounts of fluoride in the diet can help prevent dental caries and strengthen bones, but there are a number of adverse affects that chronic ingestion at high doses can have on human health, including dental fluorosis, skeletal fluorosis, increased rates of bone fractures, decreased birth rates, increased rates of urolithiasis (kidney stones), impaired thyroid function, and lower intelligence in children. Chronic occupational exposure to fluoride dust and gas is associated with higher rates of bladder cancer and variety of respiratory ailments. Acute fluoride toxicity and even death from the ingestion of sodium fluoride pesticides and dental products have also been reported. The distribution of fluoride in the natural environment is very uneven, largely a result of the geochemical behavior of this element. Fluorine is preferentially enriched in highly evolved magmas and hydrothermal solutions, which explains why high concentrations are often found in syenites, granitoid plutonic rocks, alkaline volcanic, and hydrothermal deposits. Fluoride can also occur in sedimentary formations that contain fluoride-bearing minerals derived from the parent rock, fluoride-rich clays, or fluorapatite. Dissolved fluoride levels are usually controlled by the solubility of fluorite (CaF₂); thus, high concentrations are often associated with soft, alkaline, and calcium-deficient waters. Although much is known about the occurrence and health effects of fluoride, problems persist in Third World countries, where populations have little choice in the source of their drinking water and food. However, even in developed nations, fluoride ingestion can exceed the recommended dose when sources other than drinking water are ignored.     

Enzymatic Activity of Glutathione S-Transferase and Dental Fluorosis Among Children Receiving Two Different Levels of Naturally Fluoridated Water

This study was conducted to measure the activity of the enzyme glutathione S-transferase (GST) in saliva and to compare the activity of this enzyme in children with and without dental fluorosis in communities with different concentrations of naturally fluoridated water. A total of 141 schoolchildren participated in this cross-sectional study. Children were selected from two communities: one with a low (0.4 ppm) and the other with a high (1.8 ppm) water fluoride concentration. Dental fluorosis was evaluated by applying the Thylstrup and Fejerskov Index (TFI) criteria. Stimulated saliva was obtained, and fluoride concentration and GST activity were measured. The GST activity was compared among children with different levels of dental fluorosis using multinomial logistic regression models and odds ratios (OR). The mean age of the children was 10.6 (±1.03) years. Approximately half of the children showed dental fluorosis (52.5 %). The average GST activity was 0.5678 (±0.1959) nmol/min/μg. A higher concentration of fluoride in the saliva was detected in children with a higher GST activity (p = 0.039). A multinomial logistic regression model used to evaluate the GST activity and the dental fluorosis score identified a strong association between TFI = 2–3 (OR = 15.44, p = 0.007) and TFI ≥ 4 (OR = 55.40, p = 0.026) and the GST activity level, compared with children showing TFI = 0–1, adjusted for age and sex. Schoolchildren with higher levels of dental fluorosis and a higher fluoride concentration in the saliva showed greater GST activity. The increased GST activity most likely was the result of the body’s need to inactivate free radicals produced by exposure to fluoride.     

The Relationship of PTH Bst BI Polymorphism, Calciotropic Hormone Levels, and Dental Fluorosis of Children in China

The aim of this study was to explore the association of parathyroid hormone (PTH) gene Bst BI polymorphism, calciotropic hormone levels, and dental fluorosis of children. A case-control study was conducted in two counties (Kaifeng and Tongxu) in Henan Province, China in 2005-2006. Two hundred and twenty-five children were recruited and divided into three groups including dental fluorosis group (DFG), non-dental fluorosis group (NDFG) from high fluoride areas, and control group (CG). Urine fluoride content was determined using fluoride ion selective electrode; PTH Bst BI were genotyped using PCR-RFLP; osteocalcin (OC) and calcitonin (CT) levels in serum were detected using radioimmunoassay. Genotype distributions were BB 85.3% (58/68), Bb 14.7% (10/68) for DFG; BB 77.6% (52/67), Bb 22.4% (15/67) for NDFG; and BB 73.3% (66/90), Bb 27.7% (24/90) for CG. No significant difference of Bst BI genotypes was observed among three groups (P > 0.05). Serum OC and urine fluoride of children were both significantly higher in DFG and NDFG than in CG (P < 0.05, respectively), while a similar situation was not observed between DFG and NDFG in high fluoride areas (P > 0.05). Serum OC level of children with BB genotype was significantly higher compared to those with Bb genotype in high fluoride areas (P < 0.05). However, no significant difference of serum CT or calcium (Ca) was observed. In conclusion, there is no correlation between dental fluorosis and PTH Bst BI polymorphism. Serum OC might be a more sensitive biomarker for detecting early stages of dental fluorosis, and further studies are needed.     

Paleopathology of skeletal fluorosis

Skeletal fluorosis is one of a range of conditions causing excessive ossification and joint ankylosis in skeletons. It is rarely considered, however, in differential diagnoses of palaeopathological lesions. This paper considers the identification of skeletal fluorosis in a skeletal sample from the island of Bahrain, Arabian Gulf, dating to ca. 250 BC–AD 250. Approximately 4% of 255 adult skeletons in the sample have hyperostosic lesions resulting in joint ankylosis primarily of the lumbar vertebrae, as well as the major joints. These lesions most frequently occur among males in the 50+ age group. Chemical analysis on a small series of bone and dental samples confirmed the presence of high levels of fluoride, while staining of the teeth is evidence of dental fluorosis. The level of dental fluorosis is comparable with a naturally occurring fluoride level in water of between 1–2 ppm. The prevalence of hyperostosic lesions, however, appears higher than expected, and two possible reasons are suggested: confusion between a diagnosis of diffuse idiopathic skeletal hyperostosis and skeletal fluorosis on partial or less severely affected skeletons; and the presence of predisposing factors for skeletal fluorosis on the island in the past. Am J Phys Anthropol 109:465–483, 1999. © 1999 Wiley-Liss, Inc.     

Epidemiological,Clinical, and Biochemical Study of Endemic Dental and Skeletal Fluorosis in Punjab

The incidence of dental fluorosis in 46,000 children in the Punjab was assessed and compared with the fluoride content of their water supplies. Ten villages were selected for more detailed studies of skeletal as well as dental fluorosis.Factors other than the fluoride contect of the drinking water which were found to influence the incidence and the severity of fluorosis were the chemical composition of the water and in particular its calcium content; the duration of exposure; sex and occupation; nutritional status; and climatic and geological variations. The role of fluoride-containing foodstuffs has yet to be assessed.     

Gastrointestinal Absorption and Renal Excretion of Fluoride After Ingestion of a High-Fluoride Dentifrice

This study aimed to evaluate the gastrointestinal absorption and renal excretion of fluoride after the ingestion of high-fluoride dentifrice. Twelve volunteers participated in this in vivo, crossover, and blinded study. In three experimental phases, the volunteers were randomly assigned to one of three treatment groups, who ingested either the following: distilled and deionized water (control), conventional dentifrice (1100 μg/g), or high-fluoride dentifrice (5000 μg/g). Both dentifrices contained fluoride in the form of NaF/SiO₂. To determine the rate of fluoride absorption, non-stimulated saliva was collected for up to 120 min after ingestion and the area under the curve of the salivary fluoride concentration was plotted as a function of time and the maximum concentration determined. All urine produced during the 24 h before and after ingestion was collected, and urinary excretion was calculated from the difference between the urinary fluoride concentrations in the two periods. A specific ion electrode coupled to an ion analyzer was used to measure fluoride concentrations. Statistical analysis was performed by ANOVA followed by Tukey’s test with p set at 5%. All measured parameters were highest after the ingestion of the dentifrice with 5000 μg/g (p < 0.001), confirming that this has an increased level of bioavailable fluoride compared with the conventional dentifrice. The high-fluoride dentifrice increases the concentration of salivary fluoride, which may explain its greater anticaries effect. However, it poses a potential risk of causing dental fluorosis and so should not be used by children.

     

The Health of Native Americans: Towards a Biocultural Epidemiology and Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives

The Health of Native Americans: Towards a Biocultural Epidemiology. T. Kue Young. New York: Oxford University Press, 1994 (cloth), ix + 275 pp.
Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives. James B. Waldram, D. Ann Herring, and T. Kue Young. Toronto: University of Toronto Press, 1995 (cloth and paper), xii + 334 pp.     

Influence of coffee on fluoride metabolism in rats

Concomitant intragastric administration of sodium fluoride and coffee resulted in a significantly higher (P less than 0.01) plasma fluoride level than intake of the same amount of fluoride with water. The same result was obtained when coffee was substituted with an equivalent amount of caffeine. Comparison of plasma fluoride levels by total area under the curve of plasma fluoride concentration versus time indicated an almost 2-fold difference. Although the mechanism(s) is not known, it appears that caffeine is responsible for the present observation. This finding could help explain the variations in the incidence of dental fluorosis among people living in optimally fluoridated communities.     

Fluoride intake and utilization by Hungarian children: associations and interrelationships

Selected interactions were examined between F, Al, Ca and Mg intakes and their manifestations in dental health parameters and biological samples relating to Hungarian children. The prevalence (DMFT, DMFS) and severity (SR) of caries were inversely related to the F concentration of household water and to the amount of F ingested from foods, beverages and tap or well water. Dental fluorosis and the F content of enamel, plaque, saliva, urine, nails and hair were directly related to the F content of water and to dietary F intake. The high significance levels and absolute consistency of associations lend strong support to the biological interdependence of the variables involved. In contrast, no associations were found between Mg ingestion and F utilization. Despite numerous inverse trends and some statistically significant inverse associations suggesting that dietary Al and Ca interfere with F uptake, the biological significance of the latter findings needs further exploration. Inhaled F amounted to less than 0.17% of the total F intake. The F content of frequently prescribed non-dental medicines ranged from below 0.00001 to 0.014 mg/g; their contribution to total F intake is considered insignificant.     

Effects of fluoride emissions from a modern primary aluminum smelter on a local population of white-tailed deer (Odocoileus virginianus)

The influence of fluoride emissions from a modern aluminum smelter on concentrations of skeletal fluoride and dental fluorosis in a resident population of white-tailed deer was studied. The smelter was located on Mount Holly Plantation in South Carolina, and concentrations of skeletal fluoride in the deer collected at Mount Holly increased approximately five-fold 3 yr after the operation began. Increases in skeletal fluoride of less than two-fold were observed in deer obtained from Medway Plantation which has its nearest boundary 1.6 km from the smelter site. No dental fluorosis was observed in deer collected at Medway Plantation, but mild dental fluorosis was observed in a significant number of deer collected at Mount Holly Plantation. The dental fluorosis that was observed was not associated with incisor wear or with fluoride-induced molar wear. Osteofluorosis of mandibles or metacarpals was not observed in any of the deer obtained from either plantation. The data obtained from this study indicated that the presence of a modern aluminum smelter caused a detectable increase in concentration of skeletal fluoride in the resident population of white-tailed deer, but that no adverse health effects were seen.     

Household water sources and their contribution towards fluoride consumption in Njoro Division,Nakuru District,Kenya

Fluoride is regarded as an essential element for the formation of healthy bones and teeth. However, high fluoride levels in drinking water have been associated with high incidences of dental fluorosis. A 1996–1997 study in Njoro Division, Nakuru District, established that the groundwater used for cooking and drinking, obtained from boreholes and wells, had fluoride levels much higher than the World Health Organisation recommended level of 0.7ppm.     

Enduring fluoride health hazard for the Vesuvius area population: the case of AD 79 Herculaneum

Background

The study of ancient skeletal pathologies can be adopted as a key tool in assessing and tracing several diseases from past to present times. Skeletal fluorosis, a chronic metabolic bone and joint disease causing excessive ossification and joint ankylosis, has been only rarely considered in differential diagnoses of palaeopathological lesions. Even today its early stages are misdiagnosed in endemic areas.

Methodology/Principal Findings

Endemic fluorosis induced by high concentrations of fluoride in water and soils is a major health problem in several countries, particularly in volcanic areas. Here we describe for the first time the features of endemic fluorosis in the Herculaneum victims of the 79 AD eruption, resulting from long-term exposure to high levels of environmental fluoride which still occur today.

Conclusions/Significance

Our observations on morphological, radiological, histological and chemical skeletal and dental features of this ancient population now suggest that in this area fluorosis was already endemic in Roman times. This evidence merged with currently available epidemiologic data reveal for the Vesuvius area population a permanent fluoride health hazard, whose public health and socio-economic impact is currently underestimated. The present guidelines for fluoridated tap water might be reconsidered accordingly, particularly around Mt Vesuvius and in other fluoride hazard areas with high natural fluoride levels.     

Systematic review of water fluoridation

ObjectiveTo review the safety and efficacy of fluoridation of drinking water.DesignSearch of 25 electronic databases and world wide web. Relevant journals hand searched; further information requested from authors. Inclusion criteria were a predefined hierarchy of evidence and objectives. Study validity was assessed with checklists. Two reviewers independently screened sources, extracted data, and assessed validity.Results214 studies were included. The quality of studies was low to moderate. Water fluoridation was associated with an increased proportion of children without caries and a reduction in the number of teeth affected by caries. The range (median) of mean differences in the proportion of children without caries was −5.0% to 64% (14.6%). The range (median) of mean change in decayed, missing, and filled primary/permanent teeth was 0.5 to 4.4 (2.25) teeth. A dose-dependent increase in dental fluorosis was found. At a fluoride level of 1 ppm an estimated 12.5% (95% confidence interval 7.0% to 21.5%) of exposed people would have fluorosis that they would find aesthetically concerning.ConclusionsThe evidence of a beneficial reduction in caries should be considered together with the increased prevalence of dental fluorosis. There was no clear evidence of other potential adverse effects.     

许家窑人幼年个体的釉质发育缺陷

上世纪70年代在许家窑-侯家窑地点发现的人类化石对了解东亚中晚更新世过渡时期古人类的形态演化起到了重要作用。除形态特征外,针对许家窑人病理表现也开展过相关研究,其中许家窑人幼年个体前部牙齿上出现的黄色小坑被认为是患有氟斑牙病的证据,且可能代表世界范围内该牙病的最早实例。然而,经电子显微镜和显微断层扫描显示,这些黄色小坑或凹陷是釉质发育不良表现,而不是代表个体患有氟斑牙病后牙齿受咀嚼压力而产生的物理破损。同步辐射扫描显示,许家窑幼年个体前部牙齿釉质密度均匀,没有出现浅层釉质矿化减小的现象,不支持该个体因釉质矿化过程受影响而患有典型氟斑牙的结论。尽管如此,后部牙齿上大量坑状的釉质缺陷和坑状缺陷底部的加重生长线特征不排除是个体氟摄入过量而影响釉质形成的分泌期而导致的。除表面坑状釉质缺陷外,许家窑幼年个体恒齿不同部位的釉质内部出现缺失（空间结构一般为圆球状）。缺失主要集中在浅层区域,沿齿尖-齿颈方向的密集程度变化与釉质发育不良位置具有一定相关性。釉质内部缺失有时互连并与釉质表面垂直。以上特征显示釉质内部缺失是釉质形成过程受影响所致,且影响因素和发生机理可能与釉质发育不良的类似。许家窑幼年个体不同牙齿在外部釉质缺陷和内部釉质缺失密集程度上的差别可能反映的是个体在发育过程中所需应对的外界扰动因素程度不同。未来研究可对包含许家窑人化石的堆积物中以及许家窑人牙齿中的氟含量进行测定,以进一步研究许家窑人个体的生活环境中是否有过量的氟以及许家窑人是否摄入了过量氟元素,从而对许家窑人的牙齿发育缺陷机理有一个进一步的了解。     

基于体视显微镜观察两种鼠氟斑牙的形态变化

目的:通过对染氟大鼠和小鼠氟斑牙的观察,进一步确定氟斑牙作为慢性氟中毒的诊断指标的重要性。方法:通过不同浓度和不同时间的氟染毒,利用数码体视显微镜观察Wistar大鼠和C57BL/6J小鼠氟斑牙的形态变化。将Wistar大鼠随机分为4组,每组8只,共计32只,分笼饲养,C57BL/6J小鼠4组,每组12只,共计48只,分8笼饲养。对照组:蒸馏水组,实验组三组:氟化钠分别为50 mg/L组,100 mg/L组和150 mg/L组。在染氟至6个月时,应用在体视显微镜观察大鼠和小鼠牙齿的动态改变。结果:染氟组Wistar大鼠和C57BL/6J小鼠牙齿均出现规则的斑纹、白垩状、延迟断裂、缺损等症状。随着染氟时间的延长,C57BL/6J小鼠氟斑牙的损伤程度大于Wistar大鼠。在慢性氟中毒大鼠和小鼠的牙齿变化中发现,大鼠和小鼠的牙齿变化程度与种属有着密切的关系。结论:通过利用体视显微镜对Wistar大鼠和C57BL/6J小鼠染氟6个月进行氟斑牙的观察分析,为慢性氟中毒鼠模型提供氟斑牙的形态学的详实依据。并且,可根据研究需要适宜选择氟斑牙的动物模型。     

Reversal of fluoride induced cell injury through elimination of fluoride and consumption of diet rich in essential nutrients and antioxidants

The objective of the present communication is to address the issues concerning reversal of fluoride induced cell injury and disease (i.e. fluorosis) through the elimination of fluoride and consumption of a diet containing essential nutrients and antioxidants. Humans afflicted with fluorosis, as a result of consuming fluoride contaminated water or food, have been investigated. Hospital based diagnostic procedure for early detection of fluorosis, through retrieval of history, clinical complaints, testing of blood, urine and drinking water for fluoride using ion selective electrode technology, along with X-ray of the forearm have been carried out. Confirmed cases of fluorosis were introduced to an intervention protocol consisting of (1) provision of safe drinking water with fluoride levels less than 1 mg/L and (2) counselling on nutritional supplementation with focus on adequate intake of calcium, vitamins C, E and antioxidants. The patients were monitored at frequent intervals up to one year and the results are reported. With a standardized early diagnosis, elimination of fluoride intake and supplementation of a diet rich in essential nutrients and antioxidants, we have shown that the fluorosis can be reversed.     

Reversal of fluoride induced cell injury through elimination of fluoride and consumption of diet rich in essential nutrients and antioxidants

The objective of the present communication is to address the issues concerning reversal of fluoride induced cell injury and disease (i.e. fluorosis) through the elimination of fluoride and consumption of a diet containing essential nutrients and antioxidants. Humans afflicted with fluorosis, as a result of consuming fluoride contaminated water or food, have been investigated. Hospital based diagnostic procedure for early detection of fluorosis, through retrieval of history, clinical complaints, testing of blood, urine and drinking water for fluoride using ion selective electrode technology, along with X-ray of the forearm have been carried out. Confirmed cases of fluorosis were introduced to an intervention protocol consisting of (1) provision of safe drinking water with fluoride levels less than 1 mg/L and (2) counselling on nutritional supplementation with focus on adequate intake of calcium, vitamins C, E and antioxidants. The patients were monitored at frequent intervals up to one year and the results are reported. With a standardized early diagnosis, elimination of fluoride intake and supplementation of a diet rich in essential nutrients and antioxidants, we have shown that the fluorosis can be reversed.     

Modifying Role of GSTP1 Polymorphism on the Association between Tea Fluoride Exposure and the Brick-Tea Type Fluorosis

Background

Brick tea type fluorosis is a public health concern in the north-west area of China. The association between SNPs of genes influencing bone mass and fluorosis has attracted attention, but the association of SNPs with the risk of brick-tea type of fluorosis has not been reported.

Objective

To investigate the modifying roles of GSTP1 rs1695 polymorphisms on this association.

Methods

A cross-sectional study was conducted. Brick-tea water was tested by the standard of GB1996-2005 (China). Urinary fluoride was tested by the standard of WS/T 89-2006 (China). Skeletal fluorosis was diagnosed by X-ray, the part we scheduled was forearm, shank, and pelvic, then diagnosed the skeletal fluorosis by the standard of WS/192-2008 (China). Gene polymorphism was tested by Sequenom MassARRAY system.

Result

The prevalence rate in different ethnical participants was different: Tibetan individuals had the highest prevalence rate of skeletal fluorosis. There were significant differences in genotype frequencies of GSTP1 Rs1695 among different ethnical participants (p<0.001): Tibetan, Mongolian and Han subjects with homozygous wild type (GSTP1-AA) genotype were numerically higher than Kazakh and Russian subjects (p<0.001). Compared to Tibetan participants who carried homozygous A allele of GSTP1 Rs1695, Tibetan participants who carried G allele had a significantly decreased risk of skeletal fluorosis (OR = 0.558 [95% CI, 0.326-0.955]). For Kazakh participants, a decreased risk of skeletal fluorosis among carriers of the G allele was limited to non high-loaded fluoride status (OR = 0. 166 [95% CI, 0.035–0.780] vs. OR = 1.478 [95% CI, 0.866–2.552] in participants with high-loaded fluoride status). Neither SNP-IF nor SNP-age for GSTP1 Rs1695 was observed.

Conclusion

The prevalence rate of the brick tea type fluorosis might have ethnic difference. For Tibetan individuals, who had the highest prevalence rate, G allele of GSTP1 Rs1695 might be a protective factor for brick tea type skeletal fluorosis.     

Effect of altitude on urinary,plasma and nail fluoride levels in children and adults in Nepal

IntroductionA greater prevalence of dental fluorosis has been reported in higher- versus lower-altitude communities. This study, for the first time, examined several aspects of fluoride metabolism in children, aged 4–5 years, and their parent, living at lower altitude (<78 m) and higher altitude (>1487) areas in Nepal.MethodsThe study assessed total daily fluoride intake (TDFI), 24 h urinary fluoride excretion (UFE), and fluoride concentrations of toe- and finger-nail (FC_toenail, FC_fingernail) in children and parents as well as fluoride concentration of plasma (FC_plasma) in parents. Fractional urinary fluoride excretion (FUFE) was calculated as the ratio between UFE and TDFI. FC_toenail, FC_fingernail and FC_plasma were normalised for TDFI by dividing the variables by TDFI and the ratio was reported as the percentage.ResultsIn total, 89 children and 80 parents took part in the study: 42 children and 41 parents from the lower altitude area; 47 children and 39 parents from the higher altitude area. Fluoride concentration of drinking water was significantly (P < 0.001) higher at lower altitude (0.395 mg F/l) than at higher altitude (0.104 mg F/l). TDFI was significantly (p < 0.001) higher in both children and parents living in lower altitude than those living at higher altitude.There was a statistically significant (p = 0.044) difference in the mean FUFE of children living at lower altitude (53%) and higher altitude (46%). However, no significant difference in FUFE was found between parents living at lower altitude (47%) compared with higher altitude (41%).In both children and parents, no statistically significant differences in normalised FC_toenail, FC_fingernail were found between the two altitude areas. However, normalised FC_plasma was statistically significantly (P = 0.005) higher in parents living at higher altitude (0.15%) compared with those living at lower altitude (0.11%).ConclusionThe results suggest that higher altitude living results in decreased urinary fluoride excretion, and consequently increased fluoride retention in children for a given dose (amount) of fluoride.