Fluoride Action Network

Abstract

Despite increasing concerns about neurotoxicity of fluoride in children, sources of fluoride exposure apart from municipal water fluoridation are poorly understood. We aimed to describe the associations of demographics, drinking water characteristics, diet, and oral health behaviors with plasma fluoride concentrations in U.S. children. We used data from 3928 6–19-year-olds from the 2013–2016 National Health and Nutrition Examination Survey. We used a 24-h dietary recall to estimate recent consumption of fluoridated tap water and select foods. We estimated the associations of fluoridated tap water, time of last dental visit, use of toothpaste, and frequency of daily tooth brushing with plasma fluoride concentrations. The participants who consumed fluoridated (>0.7 mg/L) tap water (n = 560, 16%) versus those who did not had 36% (95% CI: 22, 51) higher plasma fluoride. Children who drank black or green tea (n = 503, 13%) had 42% higher plasma fluoride concentrations (95% CI: 27, 58) than non-tea drinkers. The intake of other foods and oral health behaviors were not associated with plasma fluoride concentrations. The consumption of fluoridated tap water and tea substantially increases plasma fluoride concentrations in children. Quantifying the contribution of diet and other sources of fluoride is critical to establishing safe target levels for municipal water fluoridation.


*Original full-text article online at https://www.mdpi.com/1660-4601/17/24/9205/htm


 

Funding

This research was funded by NATIONAL INSTITUTES OF HEALTH, grant numbers K23ES024803 and R01ES030101 and the Maine Economic Improvement Fund.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Appendix A

Table A1. Percent change in plasma fluoride by demographic characteristics and modifiable sources of fluoride consumption among 6–19-year-old National Health and Nutrition Examination Survey participants from 2013–2016.
Table A2. Characteristics of 6–19 year old respondents, by recent green/black tea consumption, National Health and Nutrition Examination Survey, 2013–2016.

References

  1. US Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Rep. 2015, 130, 318–331. [Google Scholar] [CrossRef]
  2. Green, R.; Lanphear, B.; Hornung, R.; Flora, D.; Martinez-Mier, E.A.; Neufeld, R.; Ayotte, P.; Muckle, G.; Till, C. Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada. JAMA Pediatr. 2019, 173, 940–948. [Google Scholar] [CrossRef]
  3. National Academies of Sciences, Engineering, and Medicine. Review of the Draft NTP Monograph: Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects; The National Academies Press: Washington, DC, USA, 2020. [Google Scholar] [CrossRef]
  4. Till, C.; Green, R.; Flora, D.; Hornung, R.; Martinez-Mier, E.A.; Blazer, M.; Farmus, L.; Ayotte, P.; Muckle, G.; Lanphear, B. Fluoride exposure from infant formula and child IQ in a Canadian birth cohort. Environ. Int. 2020, 134, 105315. [Google Scholar] [CrossRef]
  5. Grandjean, P. Developmental fluoride neurotoxicity: An updated review. Environ. Health 2019, 18, 110. [Google Scholar] [CrossRef]
  6. Bashash, M.; Thomas, D.; Hu, H.; Martinez-Mier, E.A.; Sanchez, B.N.; Basu, N.; Peterson, K.E.; Ettinger, A.S.; Wright, R.; Zhang, Z.; et al. Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico. Environ. Health Perspect. 2017, 125, 097017. [Google Scholar] [CrossRef] [PubMed]
  7. Jackson, R.D.; Brizendine, E.J.; Kelly, S.A.; Hinesley, R.; Stookey, G.K.; Dunipace, A.J. The fluoride content of foods and beverages from negligibly and optimally fluoridated communities. Community Dent. Oral Epidemiol. 2002, 30, 382–391. [Google Scholar] [CrossRef] [PubMed]
  8. U.S. EPA. Fluoride: Exposure and Relative Source Contribution Analysis; 820-R-10-015; Health and Ecological Criteria Division, Office of Water, U.S. Environmental Protection Agency: Washington, DC, USA, 2010. Available online: https://www.epa.gov/sites/production/files/2019-03/documents/fluoride-exposure-relative-report.pdf (accessed on 23 April 2020).
  9. Lu, Y.; Guo, W.F.; Yang, X.Q. Fluoride content in tea and its relationship with tea quality. J. Agric. Food Chem. 2004, 52, 4472–4476. [Google Scholar] [CrossRef] [PubMed]
  10. Stannard, J.G.; Shim, Y.S.; Kritsineli, M.; Labropoulou, P.; Tsamtsouris, A. Fluoride levels and fluoride contamination of fruit juices. J. Clin. Pediatr. Dent. 1991, 16, 38–40. [Google Scholar] [PubMed]
  11. Heilman, J.R.; Kiritsy, M.C.; Levy, S.M.; Wefel, J.S. Fluoride concentrations of infant foods. J. Am. Dent. Assoc. 1997, 128, 857–863. [Google Scholar] [CrossRef]
  12. Levy, S.M.; Warren, J.J.; Davis, C.S.; Kirchner, H.L.; Kanellis, M.J.; Wefel, J.S. Patterns of fluoride intake from birth to 36 months. J. Public Health Dent. 2001, 61, 70–77. [Google Scholar] [CrossRef]
  13. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Demographic Variables and Sample Weights (DEMO_I); U.S. Department of Health and Human Services, Centers for Disease Control and Prevention: Hyattsville, MD, USA, 2017. Available online: https://wwwn.cdc.gov/nchs/nhanes/2015-2016/DEMO_I.htm (accessed on 23 April 2020).
  14. Agricultural Research Service Beltsville Human Nutrition Research Center, Food Surveys Research Group. USDA Automated Multiple-Pass Method for Dietary Recalls. Available online: https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/ampm-usda-automated-multiple-pass-method/ (accessed on 23 April 2020).
  15. What We Eat in America, NHANES 2015–2016 Documentation: Dietary Interview-Ndividual Foods—First Day (DR1IFF_I); U.S. Department of Agriculture Agricultural Research Service, Beltsville Human Nutrition Research Center, Food Surveys Research Group: Beltsville, MD, USA; U.S. Department of Health and Human Services, Centers for Disease Conrol and Prevention, National Center for Health Statistics: Hyattsville, MD, USA, 2020. Available online: https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/DR1IFF_I.htm#Appendix_3 (accessed on 15 July 2018).
  16. Nutrient Data Laboratory. USDA National Fluoride Database of Selected Beverages and Foods—Release 2; Nutrient Data Laboratory, Beltsville Human Nutrition Research Center, ARS, USDA: Beltsville, MD, USA, 2005. Available online: https://www.ars.usda.gov/ARSUserFiles/80400525/Data/Fluoride/F02.pdf (accessed on 23 April 2020).
  17. What We Eat in America, NHANES: Dietary Methods Research; U.S. Department of Agriculture Agricultural Research Service, Beltsville Human Nutrition Research Center, Food Surveys Research Group: Beltsville, MD, USA; U.S. Department of Health and Human Services, Centers for Disease Conrol and Prevention, National Center for Health Statistics: Hyattsville, MD, USA, 2016. Available online: https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/dmr-food-categories/ (accessed on 23 April 2020).
  18. Waugh, D.T.; Godfrey, M.; Limeback, H.; Potter, W. Black Tea Source, Production, and Consumption: Assessment of Health Risks of Fluoride Intake in New Zealand. J. Environ. Public Health 2017, 2017, 5120504. [Google Scholar] [CrossRef] [PubMed]
  19. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Tap Water Fluoride Laboratory Procedure Manual; U.S. Department of Health and Human Services, Centers for Disease Control and Prevention: Hyattsville, MD, USA, 2017. Available online: https://wwwn.cdc.gov/nchs/data/nhanes/2015-2016/labmethods/FLDEW_I_MET.pdf (accessed on 2 February 2020).
  20. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Plasma Fluoride Laboratory Procedure Manual; U.S. Department of Health and Human Services, Centers for Disease Control and Prevention: Hyattsville, MD, USA, 2017. Available online: https://wwwn.cdc.gov/nchs/data/nhanes/2015-2016/labmethods/FLDEP_I_MET.pdf (accessed on 2 February 2020).
  21. Ekstrand, J.; Ehrnebo, M. The relationship between plasma fluoride, urinary excretion rate and urine fluoride concentration in man. J. Occup. Med. 1983, 25, 745–748. [Google Scholar] [CrossRef] [PubMed]
  22. National Research Council (NRC). Fluoride in Drinking Water: A Scientific Review of EPA’s Standards; The National Academies Press: Washington, DC, USA, 2006.
  23. Kleinbaum, D.G.; Kupper, L.L.; Nizam, A.; Muller, K. Applied Regression Analysis and Other Multivariable Methods, 4th ed.; Duxbury: Belmont, MA, USA, 2008. [Google Scholar]
  24. Malinowska, E.; Inkielewicz, I.; Czarnowski, W.; Szefer, P. Assessment of fluoride concentration and daily intake by human from tea and herbal infusions. Food Chem. Toxicol. 2008, 46, 1055–1061. [Google Scholar] [CrossRef] [PubMed]
  25. Choi, A.L.; Sun, G.; Zhang, Y.; Grandjean, P. Developmental fluoride neurotoxicity: A systematic review and meta-analysis. Environ. Health Perspect. 2012, 120, 1362–1368. [Google Scholar] [CrossRef] [PubMed]
  26. Jain, R.B. Concentrations of fluoride in water and plasma for US children and adolescents: Data from NHANES 2013–2014. Environ. Toxicol. Pharmacol. 2017, 50, 20–31. [Google Scholar] [CrossRef] [PubMed]
  27. Till, C.; Green, R.; Grundy, J.G.; Hornung, R.; Neufeld, R.; Martinez-Mier, E.A.; Ayotte, P.; Muckle, G.; Lanphear, B. Community Water Fluoridation and Urinary Fluoride Concentrations in a National Sample of Pregnant Women in Canada. Environ. Health Perspect. 2018, 126, 107001. [Google Scholar] [CrossRef] [PubMed]
  28. Waugh, D.T.; Potter, W.; Limeback, H.; Godfrey, M. Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation. Int. J. Environ. Res. Public Health 2016, 13, 259. [Google Scholar] [CrossRef]
  29. Whyte, M.P.; Essmyer, K.; Gannon, F.H.; Reinus, W.R. Skeletal fluorosis and instant tea. Am. J. Med. 2005, 118, 78–82. [Google Scholar] [CrossRef]
  30. Zhang, R.; Cheng, L.; Zhang, T.; Xu, T.; Li, M.; Yin, W.; Jiang, Q.; Yang, Y.; Hu, T. Brick tea consumption is a risk factor for dental caries and dental fluorosis among 12-year-old Tibetan children in Ganzi. Environ. Geochem. Health 2019, 41, 1405–1417. [Google Scholar] [CrossRef]
  31. Ramesh, M.; Narasimhan, M.; Krishnan, R.; Chalakkal, P.; Aruna, R.M.; Kuruvilah, S. The prevalence of dental fluorosis and its associated factors in Salem district. Contemp. Clin. Dent. 2016, 7, 203–208. [Google Scholar] [CrossRef]
  32. Cao, J.; Zhao, Y.; Liu, J. Brick tea consumption as the cause of dental fluorosis among children from Mongol, Kazak and Yugu populations in China. Food Chem. Toxicol. 1997, 35, 827–833. [Google Scholar] [CrossRef]
  33. Jin, C.; Yan, Z.; Jian-Wei, L.; Ruoden, X.; Sangbu, D.; Zeguo; Zhouma, S. Prevention and control of brick-tea type fluorosis–a 3-year observation in Dangxiong, Tibet. Ecotoxicol. Environ. Saf. 2003, 56, 222–227. [Google Scholar] [CrossRef]
  34. Trautner, K.; Siebert, G. An experimental study of bio-availability of fluoride from dietary sources in man. Arch. Oral. Biol. 1986, 31, 223–228. [Google Scholar] [CrossRef]
  35. Rozier, R.G.; Adair, S.; Graham, F.; Iafolla, T.; Kingman, A.; Kohn, W.; Krol, D.; Levy, S.; Pollick, H.; Whitford, G.; et al. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: A report of the American Dental Association Council on Scientific Affairs. J. Am. Dent. Assoc. 2010, 141, 1480–1489. [Google Scholar] [CrossRef]
  36. Levy, S.M.; Warren, J.J.; Broffitt, B. Patterns of fluoride intake from 36 to 72 months of age. J. Public Health Dent. 2003, 63, 211–220. [Google Scholar] [CrossRef]
  37. Bohaty, B.S.; Parker, W.A.; Seale, N.S.; Zimmerman, E.R. The prevalence of fluorosis-like lesions associated with topical and systemic fluoride usage in an area of optimal water fluoridation. Pediatr. Dent. 1989, 11, 125–128. [Google Scholar]
  38. Franzman, M.R.; Levy, S.M.; Warren, J.J.; Broffitt, B. Fluoride dentifrice ingestion and fluorosis of the permanent incisors. J. Am. Dent. Assoc. 2006, 137, 645–652. [Google Scholar] [CrossRef]
  39. Centers for Disease Control and Prevention Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion. 2016 Fluoridation Statistics. Available online: https://www.cdc.gov/fluoridation/statistics/2016stats.htm (accessed on 28 April 2020).
  40. Duperon, D.F.; Jedrychowski, J.R.; Kong, J. Fluoride content of Los Angeles County water. J. Calif. Dent. Assoc. 1995, 23, 45–46. [Google Scholar]

*Original full-text article online at https://www.mdpi.com/1660-4601/17/24/9205/htm