Fluoride content of solid foods impacts daily intake

Abstract Objective: To determine the amount of ﬂuoride received from solid foods for acohortof children.Methods:Parentswereaskedtocompletequestionnairesfortheprecedingweekanddietarydiariesfor3daysfortheirchildren.Datacollectedat6,9,12,16,20,24,36,48,and60monthswereanalyzedcross-sectionally.Results: At 6 months of age, children ingested an estimated mean of 8 percent ofdietary ﬂuoride from solid foods. At 12 months of age, children ingested an esti-mated 39 percent of dietary ﬂuoride from solid foods.Although the percentage ofﬂuoride intake from solid foods stabilized from 24 to 60 months (means of 36-39percent),some children received as much as 85-88 percent of their dietary ﬂuoridefromsolidfoods.Conclusions: Some children receive a substantial portion of dietary ﬂuoride fromsolidfoods.Despitetheadvancesinoralhealthcare,dentalcariesremainsone of the most common chronic diseases (1). Fluoride hasbeen established as one of the most important preventivetools against dental caries.Public water ﬂuoridation and theavailability of ﬂuoridated water have been associated with agreat decline in the prevalence of dental decay for manypopulations and have been credited with being one of thegreatest disease prevention methods of all time (2). The USCenters for Disease Control and Prevention has listed waterﬂuoridationasoneofthe10greatpublichealthachievementsof the20thcentury(3).Currentevidencesuggeststhatﬂuoridepreventscariespri-marily through its presence in the oral cavity and that itsprimary mechanism of action occurs posteruptively (1).Fluoride helps to prevent demineralization and to promoteremineralization of early carious lesions. Due to ﬂuoride’sposteruptive effects, exposure to low levels of ﬂuoride pro-videsdentalbeneﬁtstopeopleof allages.Exposuretohighlevelsofﬂuoridecanleadtothedevelop-ment of dental ﬂuorosis. Dental ﬂuorosis is the result ofexcessive systemic intake of ﬂuoride during enamel forma-tion. Due to the fact that ﬂuorosis can only occur duringenamel formation, it is important to better understand theﬂuorideintakeofyoungchildren(1).Excessiveintakeofﬂuo-ride can come from dietary sources (water, foods, and otherbeverages) and non-dietary sources, such as ingested tooth-paste.Thereisevidencethattheprevalenceofdentalﬂuorosishasincreased(4).Earlyresearchersempiricallydeterminedanddescribedan“optimal” ﬂuoride intake of 0.05-0.07 mg of ﬂuoride perkilogramofbodyweight(F/kgbw)(5-7).McClureestimatedthat children who ingested water optimally ﬂuoridated at1.0 ppm,inadditiontootherdietarysources,receivedabout0.05 mg F/kg bw, which later became the basis for theso-called“optimal”ﬂuoride intake. It is unclear exactly howthe upper limit of that range came into existence.This rangehas since been designated or stated as the optimal level forﬂuorideintakebymanyresearchers,althoughtherehasbeenno scientiﬁc validation of this range for being considered“optimal.”There has never been a clear deﬁnition as to whatthe range is optimal for; is it for caries prevention or is it forthepreventionof ﬂuorosis?This“optimal”rangewasestimatedbeforethewidespreaduse of topical ﬂuorides and other ﬂuoride exposures, andprior to the generalized, widespread distribution of bever-ages. Historically, tap water has been the primary source ofﬂuorideformostchildren.However,withimprovedaccesstoawidevarietyof otherbeverages,watermaynolongerbethe