- Relationships between F in water, fingernails, and urine; and enamel fluorosis (EF) were established.
- Fingernail F was assessed as a biomarker for EF in a high-F region for the first time.
- F biomarker levels were more related to children’s EF than adults, indicating their greater F– exposure during early childhood.
- Children’s EF may be useful as a biomarker for other health effects that depend on early-life F exposure.
This study examined the relation between fluoride (F–) concentrations in fingernail clippings and urine and the prevalence and severity of enamel fluorosis (EF) among Ethiopian Rift Valley populations exposed to high levels of F– in drinking water. The utility of fingernail clippings as a biomarker for F– exposure and EF was also assessed for the first time in a high-F– region. The study recorded the EF status of 386 individuals (10 to 50 years old), who consume naturally contaminated groundwater with widely varying F– concentration (0.6–15 mg/L). The mean F– concentrations among residents of communities with primary reliance on groundwater were 5.1 mg/kg (range: 0.5–34 mg/kg) in fingernails and 8.9 mg/L (range: 0.44–34 mg/L) in urine. We show strong positive correlations between F– in drinking water and 12-hour urinary excretion (r = 0.74, p < 0.001, n = 287), fingernail F– content (r = 0.6, p < 0.001, n = 258), and mean individual measures of EF severity as measured using the Thylstrup and Fejerskov (TF) Index (r = 0.42, p < 0.001, n = 316). The data indicate that both fingernail and urine measures are good biomarkers for F– exposure and EF outcomes, the latter being slightly more sensitive. Cases of moderate/severe EF were significantly more common among younger subjects (10 to 15 years old) than older subjects (mostly > 25 years old) (p < 0.001), consistent with their greater exposure to F– during early childhood, which is the only period of life the enamel is at risk of fluorosis. In this younger population, EF may be useful as a biomarker for identifying individuals with other potential health effects that depend on a specific age window of susceptibility. The finding of exceptionally high F– concentrations in water, fingernail clippings and urine in this region should motivate further investigations of other potential health consequences such as bone disease and abnormalities in the function of the neurological and endocrine systems.
*Original abstract online at https://www.sciencedirect.com/science/article/abs/pii/S0048969717308501?via%3Dihub
**Full-text article online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5528157/
Biomarkers for the Assessment of Fluoride Exposure in Children.
Due to practical difficulties in quantifying fluoride exposure, the ability of various biomarkers to predict exposure has been investigated previously. However, the results are inadequate for validation of their application and usefulness. This study aimed to investigate the association between contemporary/recent biomarkers of fluoride exposure and total daily fluoride intake
Effect of altitude on urinary, plasma and nail fluoride levels in children and adults in Nepal.
Highlights Several aspects of fluoride metabolism were examined in child-parent dyads living at a lower- and higher-altitudes in Nepal. Fluoride concentration of finger- and toe-nail was not related to either fluoride intake or altitude. In children, higher altitude leads to decreased urinary fluoride excretion when given the same fluoride dose.
Fractional urinary fluoride excretion and nail fluoride concentrations in normal, wasted and stunted 4-5 year-old children in Nepal.
Highlights It is suggested that undernourished children may be more likely develop dental fluorosis. Fluoride intake and excretion were measured in normal, wasted and stunted children. Proportion of ingested fluoride excreted via urine was not related to nutritional status. Nutritional status affected fingernail- but not toenail- fluoride concentration. Abstract Introduction It has
A Systematic Review and Meta-Analysis of the Relationship Between the Severity of Dental Fluorosis and Fluoride Biomarkers in Endemic Areas.
The intake of high concentrations of fluoride, mainly through drinking water, diet and fluoridated dentifrices, produces fluorosis, which in its early stages is manifested as dental fluorosis (DF). To recognize exposure to fluoride in endemic areas and to evaluate the risk of developing health impairment, the WHO has established several
Possible Association Between Polymorphisms in ESR1, COL1A2, BGLAP, SPARC, VDR, and MMP2 Genes and Dental Fluorosis in a Population from an Endemic Region of West Bengal.
Dental fluorosis (DF) is the most prevalent form of fluorosis in India affecting millions of people all over the country. As estrogen receptor 1 (ESR1), collagen type 1 alpha 2 (COL1A2), bone ?-carboxyglutamic acid protein (BGLAP), secreted protein acidic and cysteine-rich (SPARC), vitamin D receptor (VDR), and matrix metallopeptidase 2
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Racial Disparities in Dental Fluorosis
In 2005, the Centers for Disease Control published the results of a national survey of dental fluorosis conducted between 1999 and 2002. According to the CDC, black children in the United States have significantly higher rates of dental fluorosis than either white or Hispanic children. This was not the first time that black children were found to suffer higher rates of dental fluorosis. At least five other studies -- dating as far back as the 1960s -- have found black children in the United States are disproportionately impacted by dental fluorosis.
Moderate/Severe Dental Fluorosis
In its "moderate" and severe forms, fluoride causes a marked increase in the porosity of the enamel. After eruption into mouth, the porous enamel of moderate to severe fluorosis readily takes up stain, creating permanent brown and black discolorations of the teeth. In addition to extensive staining, teeth with moderate to severe fluorosis are more prone to attrition and wear - leading to pitting, chipping, and decay.
Severe Dental Fluorosis: Perception and Psychological Impact
[caption id="attachment_8879" align="aligncenter" width="550"] Severe fluorosis - Photograph by David Kennedy, DDS[/caption] In its severe forms, dental fluorosis causes highly disfiguring brown and black staining of the teeth, which can cause chronic embarrassment and social anxiety for the impacted child. In 1984, a panel from the National Institute of Mental Health (NIMH) warned
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The vast majority of research has found that patients, parents, and the general public alike view mild fluorosis (TF score 3) as a significant blemish of the teeth, one that is likely to embarrass the affected child to a degree that cosmetic treatment would be warranted.
Diagnostic Criteria for Dental Fluorosis: The TSIF ("Total Surface Index of Fluorosis")
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