Systemic Fluoride Flashcards
(37 cards)
pre-eruptive fluoride action
reduction in acid solubility of enamel by incorporation of fluoride into hydroxyapatite crystal structure
post-eruptive fluoride action
- promotion of remineralization
- inhibition of demineralization of early carious lesions
- inhibition of glycolysis
Tiel Culemborg Study on Fluoride Action
- compared a fluoridated community to a non
- cross-sectional study based on the use of bitewing x-rays
- data collected at multiple time points
- found that majority of benefit was delivered post-eruptively and caries progression beyond enamel was reduced in fluoridated areas
primary mechanism of action for fluoride
- post eruptive and local
- demineralization and remineralization processes lead to remineralized enamel crystals with surface rich in fluoride and lower in solubility
why is it important to provide F in early lesion micro-environment
F in plaque might be more important than in saliva as it inhibits production of extracellular polysaccharides
categorizing different F delivery vehicles is not easy because
the line between the two gets blurred
- Systemic vehicles such as water and salt have been shown to have some cariostatic topical action, and some topical vehicles such as F toothpaste can be swallowed inadvertently and have systemic effects (fluorosis)…
From a Public Health standpoint, systemic fluoridation is
the most cost-effective method for providing benefits
what are the sources for systemic fluorides
water
salt
milk
water fluoridation
- Controlled addition of a F compound to a public water supply to bring F concentration to an optimal level to prevent caries - Defluoridation: countries with natural areas of very high F
concentration (ex. India, Mexico)
*Units for expressing F concentration:
ppm (parts per million) = mg/L
Disparities refers to the
differences in health status between favored and unfavored groups in our society, arising from social factors and determinants that vary among racial-ethnic groups and those of different socioeconomic status (SES).
Fluoridation has the significant social advantage of
benefiting children in lower SES areas relatively more than those in higher SES areas.
As of 2024, the current policy is that the optimal level for water fluoridation in the United States should be
0.7 ppm
An increase in the prevalence of fluorosis since the time of the guidelines were developed indicates that
young people are ingesting more fluoride than they used to
Because we live in an increasingly climate-controlled environment
the original premise that people drink more water in hotter parts of the country becomes weaker
school water fluoridation
Fluoridation is set at 4.5x the optimal level of F for the local community
the US CDC stated that fluoridation is
one of the 10 most important public health measures of the 20th century
In 2025, Robert F Kennedy Jr. , an environmental lawyer, has
reignited the controversy surrounding fluoride in drinking water by claiming that fluoride causes serious health issues such as:
o Arthritis
o Bone cancer
o Bone fractures
o IQ loss
o Neurodevelopmental disorders o Thyroid disease
There has been political controversy ever since
the introduction of fluoride into the public water supply in Grand Rapids, Michigan in 1945
According to NIDCR*: no credible scientific evidence supports an association between fluoridated water and conditions such as
cancer, bone fractures, Down’s syndrome, or heart disease as claimed by some opponents of water fluoridation
although not definite, some studies link that chronic low-level prenatal fluoride exposure is associated with poorer neurodevelopmental outcomes including:
o Lower IQ
o Increased symptoms of ADHD
o Poorer executive function
o more symptoms of neurobehavioral problems
Arthritis: Study in China (1,128 adults) showed
▪ Higher fluoride exposure doubled the risk of knee osteoarthritis compared to low exposure levels
▪ China’s recommends higher levels of fluoride in drinking water than the United States
▪ The groundwater fluoride levels (0.9-60 mg/L) are significantly higher than the U.S. regulated level of 0.7 mg/l.
Bone Cancer Studies
Study of 2,566 bone cancer patients and 1,650 Ewing Sarcoma patients
▪ No link found between fluoride levels and these cancers
o WHO Research Review
▪ Insufficient evidence to suggest that fluoride in drinking water causes bone cancer.
Bone Fractures Studies
o U.S. Study (1,413 children and adolescents):
▪ Higher fluoride exposure linked to lower bone density, but findings were inconclusive.
▪ No connection found between bone density and fluoride levels in urine.
▪ Meta-analysis (28 studies)
▪ Fracture risk observed at fluoride levels more than double U.S. recommendations.
o WHO Report on Fracture Risk
▪ Observed fluoride levels above 4.3 mg/L for all fractures and above 6.5 mg/L for hip fractures- not statistically significant.
▪ Fluoride Exposure: China and India’s fluoride exposure from drinking water isn’t typically as high as exposure from food.
Thyroid Disease Studies
o Meta-analysis (33 studies)
▪ Abnormal thyroid hormone levels, a marker of thyroid disease, observed at fluoride levels above 2.0 mg/L- more than double the U.S. standard.
o Potential risk of thyroid disorders associated with fluoride exposure between 3 mg and 10 mg/L, far exceeding U.S. regulations.
o High doses of fluoride can affect iodine metabolism, which is related to thyroid function, however fluoride at the levels used in the United States does not pose a risk to thyroid health.
