dental caries in children in Denmark over a 10 year period among 5 and year olds. For this review we are interested in the data of the 5 years olds only. Fluoride exposure was calculated as a weighted mean – a product of the fluoride concentration at each dwelling and the time spent at that address divided by the total number of years of exposure. Caries was measures as dmfs was dichotomised at dmfs =/> 2 for 5 year olds. Negative association between fluoride exposure through drinking water and caries after adjusting for gender and family income was confirmed. Children with >1mg/l exposure were half as likely(OR=0.51) to have caries as those with 0-0.1249mg/l exposure and the dose response relationship was seen at different levels of fluoride exposure. The authors noted that their findings were significant in light of the widespread use of fluoridated toothpaste. Dental caries was dichotomised at dmfs=/>2 which is a conservative cut off. The study did not provide prevalence rates of caries at different levels of drinking water fluoridation. Table 2 Review of search results (Question 2) – Fluoride intake and Fluorosis Report Overview Methodology Findings/estimates Comments Bergman et al. 2009 Authors have attempted to review the new evidence on Dietary Reference Intakes (DRI) for fluoride along with calcium, phosphorus, magnesium and vitamin D since these were established by IOM in 1997. A specific search strategy is not available although the relevant publications since 1997 have been reviewed. The importance of considering various fluoride sources including water, food, beverages and food prepared with fluoridated water in estimating total fluoride intake has been highlighted. Authors stressed that defining optimal intakes and establishing individual and synergistic activities of these nutrients would be rather complicated and therefore reviewing DRI for these nutrients could be an uphill task. No new information about either AI or UL was available. Clifford et Fluoride content A total of 53 different samples of infant formula Fluoride content of formula powder ranged Formula powders include
estimated. and hence these beverages would unlikely to cause fluorosis if considered individually. Graves et al. 2009 Given that about 15% of US households with private wells were ignored in national water fluoridation program the authors were aiming to estimate the fluoride content in private wells and the prevalence of dental fluorosis among the children who live in these households. Household drinking water samples were assessed and fluoride exposures were obtained from parents while primary school children were examined to diagnose dental fluorosis. Drinking water had fluoride ranging from 0.08 to 1.3mg/L which was not only lower than that expected to cause health concerns and also 94% below the level required for caries protection. The prevalence of mild dental fluorosis was about 19% which was in line with national level. Contrary to the previous reports these findings suggested relatively a lower exposure to fluoride. Hamasha et al. 2005 The aim of this study was to report fluoride supplement use from birth to 96 months of age in 1388 participants. Use of supplements was ascertained through the questionnaires mailed at 3 to 6- month intervals. Fluoride intake from supplements was derived in such a way to indicate it as a daily fluoride intake in mg. Daily average fluoride intake contribution from supplements increased with age from 0.06 mg (birth-12 months) to 0.07 mg (12-60 months) to 0.18 mg (60-96 months) although the proportion of users decreased with age. About 7-23% of the participants was living in areas with 0.6ppm fluoride in water and hence was inappropriately receiving supplements. Participants were not representative of any population group and over-represented by Whites with high education levels. Self-reported data were not validated. Dental fluorosis levels were not reported. Maguire et al. 2011 Stressing the importance of knowing total fluoride intake from all sources Indirect acid diffusion method and direct electrode method was used to analyse fluoride content of 122 infant foods. The median fluoride content ranged from 0.02μg/ml for milks to 0.2μg/g for baked goods. Authors suggested that RTF infant foods had Only RTF infant foods were analysed. selective
2009 concentration in infant formulas and fluoride intake in infants fed mainly on formula were estimated and compared with AI and UL recommended by IOM. liquid concentrate and 27 powdered formulas were purchased and analysed for their fluoride content using modified diffusion method by Taves. Both deionised water and fluoridated water containing 0-1ppm fluoride were used to reconstitute formula. though soy-based formulas had a higher content which was statistically not significant. If reconstituted with water containing F less than 0.4ppm infants aged 6-12 months would likely to receive F levels below AI while UL could be exceeded in some infants if formulas were reconstituted with water containing 1ppm F. exclusive formula feeding during the first year of life. Fluoride intake of infants mainly fed on formulas depends on the fluoride content of water used to reconstitute formula. Sohn et al. 2009 Fluoride intake in the US children based on their fluid consumption pattern was determined based on National Health and Nutrition Survey (NHANES III). A 24-hour recall diet survey was used to estimate fluid intakes of children aged 1-10 years. Fluoride intake from fluids was based on several assumptions as NHANES III had no information about individual sources. The amount of F ingested by children at the 75th and 90th percentile or higher F intake from fluids was 0.05 and 0.07mg F/kg/day or more which was consistent across all ages. Fluoride ingested by African-American children was significantly higher than that by White children. Socio-demographic factors might have an effect on fluoride ingestion which needs to be further studied since fluoride intake was based on assumptions and was under-estimated.
England was explored. Zohoori et al. 2014 Total daily fluoride intake (TDFI) in infants aged months living in fluoridated and non-fluoridated areas in England was ascertained. A three-day food diary was used to estimate fluoride intake and F content was analysed using an F-ion electrode and a diffusion method. Information on toothbrushing habits was obtained through a questionnaire combined with an interview. A total of 38 infants, 19 each from fluoridated and non-fluoridated areas completed the study with a mean TDFI of 0.11 and 0.12mg/kg/bw/day, respectively. For 87% of infants diet was the only source of fluoride while no one used fluoride supplements. TDFI from toothpastes ranged from 24-78% in infants whom toothbrushing/cleaning started. About 53 % of infants living in fluoridated areas exceeded the UL while almost all infants in non-fluoridated areas did not receive below optimal levels of fluoride. Sample size was rather small. Fluoride intake of infants from all sources was considered.