Fluorine deficiency

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Fluorine deficiency
Sodium fluoride tablets.jpg
Fluoride is sold in tablets for cavity prevention.
CausesLack of fluoride in the diet, poor oral hygiene
Risk factors Dental caries

Fluoride or fluorine deficiency is a disorder which may cause increased dental caries [1] and possibly osteoporosis, [2] [3] due to a lack of fluoride in diet. [4] [5] Common dietary sources of fluoride include tea, grape juice, wine, raisins, some seafood, coffee, and tap water that has been fluoridated. [6] The extent to which the condition truly exists, and its relationship to fluoride poisoning has given rise to some controversy. [7] Fluorine is not considered to be an essential nutrient, but the importance of fluorides for preventing tooth decay is well-recognized, [8] despite the effect is predominantly topical. [9] Prior to 1981, the effect of fluorides was thought to be largely systemic and preeruptive, requiring ingestion. [10] Fluoride is considered essential in the development and maintenance of teeth by the American Dental Hygienists' Association. [11] Fluoride incorporates into the teeth to form and harden teeth enamels. This makes the teeth more acid resistant, as well as more resistant to cavity-forming bacteria. [12] Caries-inhibiting effects of fluoride were first noticed 1902, when fluoride in high concentrations was found to stain teeth and prevent tooth decay.

Contents


Fluoride salts, particularly sodium fluoride (NaF), are used in the treatment and prevention of osteoporosis. [13] Symptoms such as fractured hips in the elderly or brittle and weak bones may be caused by fluorine deficiency in the body. [14] Fluoride stimulates bone formation and increases bone density; [15] however, bone with excess fluoride content has an abnormal structure resulting in increased fragility. Thus, fluoride therapy results in large increases in bone mineral density but the effect on fracture rates, while positive, is small. [15] [16] [17]

Disputes over the essential nature of fluorine date back to the 19th century, when fluorine was first observed in teeth and bones. [18] In 1973, a trial claimed to have found reduced reproduction in mice fed on fluorine-deficient diets; however, a subsequent investigation found that this was likely due to an iron-deficient diet. [19]

Role of fluoride

Fluoride increases resistance to the "demineralization of tooth enamel during attack by acidic bacteria". [20] While essential for all individuals, fluoride's effects are most significant in children, as the fluoride is incorporated into their developing enamel.This in turn causes their teeth to become less prone to decay. Therefore, a relationship can be formulated, in that the more fluoride entering the body, the overall decline in the rate of decay. [20]

Sources of fluoride

Fluorine is the 13th most abundant element in the Earth's crust. The ionic form of fluorine is called fluoride. Fluoride is most commonly found as inorganic or organic fluorides such as naturally occurring calcium fluoride, or synthetic sodium fluoride.[ citation needed ] There are a number of sources of fluoride.

Water

Fluoride occurs naturally within water supplies. As an example, in Australia, at a concentration of approximately 0.1 mg/L. However, this number varies amongst different populations, as specific fluoridated communities exceed this amount, ranging from 0.6 to 1.0 mg/L of fluoride present.[ citation needed ] The process of incorporating more fluoride into water systems is an affordable mechanism that has many long-term benefits

Toothpaste

Fluoride toothpaste started being produced in the 1890s, and has since become available in most countries.

Fluoride supplements

Fluoride supplements were first recognized and suggested by health professionals, in areas where the practice of fluoridating water was not accepted. This practice is recommended for individuals, primarily children (who are at a greater risk of caries) in low-fluoride areas.

Dietary recommendations

The U.S. Institute of Medicine (IOM) updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for some minerals in 1997. Where there was not sufficient information to establish EARs and RDAs, an estimate designated Adequate Intake (AI) was used instead. AIs are typically matched to actual average consumption, with the assumption that there appears to be a need, and that need is met by what people consume. The current AI for women 19 years and older is 3.0 mg/day (includes pregnancy and lactation). The AI for men is 4.0 mg/day. The AI for children ages 1–18 increases from 0.7 to 3.0 mg/day. As for safety, the IOM sets Tolerable upper intake levels (ULs) for vitamins and minerals when evidence is sufficient. In the case of fluoride, the UL is 10 mg/day. Collectively the EARs, RDAs, AIs and ULs are referred to as Dietary Reference Intakes (DRIs). [21]

The European Food Safety Authority (EFSA) refers to the collective set of information as Dietary Reference Values, with Population Reference Intake (PRI) instead of RDA, and Average Requirement instead of EAR. AI and UL are defined the same as in the United States. For women ages 18 and older, the AI is set at 2.9 mg/day (includes pregnancy and lactation). For men, the value is 3.4 mg/day. For children ages 1–17 years, the AIs increase with age from 0.6 to 3.2 mg/day. These AIs are comparable to the U.S. AIs. [22] The EFSA reviewed safety evidence and set an adult UL at 7.0 mg/day (lower for children). [23]

See also

Related Research Articles

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<span class="mw-page-title-main">Toothpaste</span> Substance to clean and maintain teeth

Toothpaste is a paste or gel dentifrice used with a toothbrush to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it is an abrasive that aids in removing dental plaque and food from the teeth, assists in suppressing halitosis, and delivers active ingredients to help prevent tooth decay and gum disease (gingivitis). Owing to differences in composition and fluoride content, not all toothpastes are equally effective in maintaining oral health. The decline of tooth decay during the 20th century has been attributed to the introduction and regular use of fluoride-containing toothpastes worldwide. Large amounts of swallowed toothpaste can be poisonous. Common colors for toothpaste include white and blue.

Fluoride is an inorganic, monatomic anion of fluorine, with the chemical formula F−
, whose salts are typically white or colorless. Fluoride salts typically have distinctive bitter tastes, and are odorless. Its salts and minerals are important chemical reagents and industrial chemicals, mainly used in the production of hydrogen fluoride for fluorocarbons. Fluoride is classified as a weak base since it only partially associates in solution, but concentrated fluoride is corrosive and can attack the skin.

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<span class="mw-page-title-main">Tooth decay</span> Deformation of teeth due to acids produced by bacteria

Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors, from yellow to black. Symptoms may include pain and difficulty eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation. Tooth regeneration is an ongoing stem cell–based field of study that aims to find methods to reverse the effects of decay; current methods are based on easing symptoms.

<span class="mw-page-title-main">Water fluoridation</span> Addition of fluoride to a water supply to reduce tooth decay

Water fluoridation is the addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water contains fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride. Fluoridated water operates on tooth surfaces: in the mouth, it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities. Typically a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $1.32 per person-year. Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits. In 2011, the World Health Organization suggested a level of fluoride from 0.5 to 1.5 mg/L, depending on climate, local environment, and other sources of fluoride. In 2024, the Department of Health and Human Services' National Toxicology Program found that water fluoridation levels above 1.5 mg/L are associated with lower IQ in children. In 2024, U.S. court rulings have raised concerns about the potential health risks of water fluoridation, including findings by the EPA and new risk assessments that suggest the benefits may be waning. Bottled water typically has unknown fluoride levels.

Fluoride toxicity is a condition in which there are elevated levels of the fluoride ion in the body. Although fluoride is safe for dental health at low concentrations, sustained consumption of large amounts of soluble fluoride salts is dangerous. Referring to a common salt of fluoride, sodium fluoride (NaF), the lethal dose for most adult humans is estimated at 5 to 10 g. Ingestion of fluoride can produce gastrointestinal discomfort at doses at least 15 to 20 times lower than lethal doses. Although it is helpful topically for dental health in low dosage, chronic ingestion of fluoride in large amounts interferes with bone formation. In this way, the most widespread examples of fluoride poisoning arise from consumption of ground water that is abnormally fluoride-rich.

<span class="mw-page-title-main">Sodium fluoride</span> Ionic compound (NaF)

Sodium fluoride (NaF) is an inorganic compound with the formula NaF. It is a colorless or white solid that is readily soluble in water. It is used in trace amounts in the fluoridation of drinking water to prevent tooth decay, and in toothpastes and topical pharmaceuticals for the same purpose. In 2021, it was the 291st most commonly prescribed medication in the United States, with more than 600,000 prescriptions. It is also used in metallurgy and in medical imaging.

The water fluoridation controversy arises from political, ethical, economic, and health considerations regarding the fluoridation of public water supplies. For deprived groups in both maturing and matured countries, international and national agencies and dental associations across the world support the safety and effectiveness of water fluoridation. Proponents of water fluoridation see it as a question of public health policy and equate the issue to vaccination and food fortification, citing significant benefits to dental health and minimal risks. In contrast, opponents of water fluoridation view it as an infringement of individual rights, if not an outright violation of medical ethics, on the basis that individuals have no choice in the water that they drink, unless they drink more expensive bottled water. A small minority of scientists have challenged the medical consensus, variously claiming that water fluoridation has no or little cariostatic benefits, may cause serious health problems, is not effective enough to justify the costs, and is pharmacologically obsolete.

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<span class="mw-page-title-main">Dental fluorosis</span> Tooth enamel discoloration due to excessive fluoride ingestion

Dental fluorosis is a common disorder, characterized by hypomineralization of tooth enamel caused by ingestion of excessive fluoride during enamel formation.

<span class="mw-page-title-main">Early childhood caries</span> Dental disease of young children

Early childhood caries (ECC), formerly known as nursing bottle caries, baby bottle tooth decay, night bottle mouth and night bottle caries, is a disease that affects teeth in children aged between birth and 71 months. ECC is characterized by the presence of 1 or more decayed, missing, or filled tooth surfaces in any primary tooth. ECC has been shown to be a very common, transmissible bacterial infection, usually passed from the primary caregiver to the child. The main bacteria responsible for dental cavities are Streptococcus mutans (S.mutans) and Lactobacillus. There is also evidence that supports that those who are in lower socioeconomic populations are at greater risk of developing ECC.

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<span class="mw-page-title-main">Water fluoridation by country</span>

Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay, and is handled differently by countries across the world. Fluoridated water contains fluoride at a level that is proven effective for preventing cavities; this can occur naturally or by adding fluoride. Fluoridated water creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes, and increases the rate at which it remineralizes in the early stages of cavities. Typically, a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $1.32 per person-year. Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits. In 2011, the World Health Organization suggested a level of fluoride from 0.5 to 1.5 mg/L, depending on climate, local environment, and other sources of fluoride. Bottled water typically has unknown fluoride levels.

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<span class="mw-page-title-main">Water fluoridation in the United States</span>

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Fluorine may interact with biological systems in the form of fluorine-containing compounds. Though elemental fluorine (F2) is very rare in everyday life, fluorine-containing compounds such as fluorite occur naturally as minerals. Naturally occurring organofluorine compounds are extremely rare. Man-made fluoride compounds are common and are used in medicines, pesticides, and materials. Twenty percent of all commercialized pharmaceuticals contain fluorine, including Lipitor and Prozac. In many contexts, fluorine-containing compounds are harmless or even beneficial to living organisms; in others, they are toxic.

Topical fluorides are fluoride-containing drugs indicated in prevention and treatment of dental caries, particularly in children's primary dentitions. The dental-protecting property of topical fluoride can be attributed to multiple mechanisms of action, including the promotion of remineralization of decalcified enamel, the inhibition of the cariogenic microbial metabolism in dental plaque and the increase of tooth resistance to acid dissolution. Topical fluoride is available in a variety of dose forms, for example, toothpaste, mouth rinses, varnish and silver diamine solution. These dosage forms possess different absorption mechanisms and consist of different active ingredients. Common active ingredients include sodium fluoride, stannous fluoride, silver diamine fluoride. These ingredients account for different pharmacokinetic profiles, thereby having varied dosing regimes and therapeutic effects. A minority of individuals may experience certain adverse effects, including dermatological irritation, hypersensitivity reactions, neurotoxicity and dental fluorosis. In severe cases, fluoride overdose may lead to acute toxicity. While topical fluoride is effective in preventing dental caries, it should be used with caution in specific situations to avoid undesired side effects.

References

  1. ↑ Selwitz, Robert H (2007). "Dental Caries". The Lancet. 369 (9555): 51–9. doi:10.1016/S0140-6736(07)60031-2. PMID   17208642. S2CID   204616785.
  2. ↑ Kleerekoper, M. (1998). "The Role of Fluoride in the Prevention of Osteoporosis". Endocrinology and Metabolism Clinics of North America. 27 (2): 441–452. doi:10.1016/S0889-8529(05)70015-3. PMID   9669148.
  3. ↑ 'Vilela';'Nunes', 'Pedro'; 'Teresa' (2011). "Osteoporosis International". Neuroradiology. 53: 185–189. doi:10.1007/s00234-011-0925-4. PMID   21863428.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ↑ "Fluorine". Merck . Retrieved 2009-01-04.
  5. ↑ Ilich, J. Z.; Kerstetter, J. E. (2000). "Nutrition in Bone Health Revisited: A Story Beyond Calcium". Journal of the American College of Nutrition. 19 (6): 715–737. doi:10.1080/07315724.2000.10718070. PMID   11194525. S2CID   18598975.
  6. ↑ "Fluoride in the UK diet". 2014. Retrieved 2015-04-16.{{cite journal}}: Cite journal requires |journal= (help)
  7. ↑ Gazzano, E.; Bergandi, L.; Riganti, C.; Aldieri, E.; Doublier, S.; Costamagna, C.; Bosia, A.; Ghigo, D. (2010). "Fluoride Effects: The Two Faces of Janus". Current Medicinal Chemistry. 17 (22): 2431–2441. doi:10.2174/092986710791698503. PMID   20491635.
  8. ↑ Olivares M, Uauy R (2004). "Essential nutrients in drinking-water (Draft)" (PDF). WHO. Archived from the original (PDF) on 2012-10-19. Retrieved 2008-12-30.
  9. ↑ Pizzo G, Piscopo MR, Pizzo I, Giuliana G (September 2007). "Community water fluoridation and caries prevention: a critical review". Clin Oral Investig. 11 (3): 189–93. doi:10.1007/s00784-007-0111-6. PMID   17333303. S2CID   13189520.
  10. ↑ Aoba T, Fejerskov O (2002). "Dental fluorosis: chemistry and biology". Crit. Rev. Oral Biol. Med. 13 (2): 155–70. doi:10.1177/154411130201300206. PMID   12097358. Archived from the original on 2012-07-07.
  11. ↑ "Nutritional Factors in Tooth Development". ADHA. Archived from the original on 2013-01-06. Retrieved 2008-12-30.
  12. ↑ "Effect of Inorganic Fluoride on Living Organisms of Different Phylogenetic Level". 2010.{{cite journal}}: Cite journal requires |journal= (help)[ permanent dead link ]
  13. ↑ Wood, A. J. J.; Riggs, B. L.; Melton, L. J. (1992). "The Prevention and Treatment of Osteoporosis". New England Journal of Medicine. 327 (9): 620–627. doi:10.1056/NEJM199208273270908. PMID   1640955.
  14. ↑ "Health Supplements and Nutritional Guides". Archived from the original on 2016-08-07. Retrieved 2015-04-15.
  15. 1 2 Riggs, BL; Hodgson, SF; O'Fallon, WM; Chao, EY; Wahner, HW; Muhs, JM; Cedel, SL; Melton LJ, 3rd (22 March 1990). "Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis". The New England Journal of Medicine. 322 (12): 802–9. doi: 10.1056/nejm199003223221203 . PMID   2407957.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  16. ↑ Mamelle, N; Meunier, PJ; Dusan, R; Guillaume, M; Martin, JL; Gaucher, A; Prost, A; Zeigler, G; Netter, P (13 August 1988). "Risk-benefit ratio of sodium fluoride treatment in primary vertebral osteoporosis". Lancet. 2 (8607): 361–5. doi:10.1016/s0140-6736(88)92834-6. PMID   2899773. S2CID   43513696.
  17. ↑ Kleerekoper, M; Peterson, EL; Nelson, DA; Phillips, E; Schork, MA; Tilley, BC; Parfitt, AM (June 1991). "A randomized trial of sodium fluoride as a treatment for postmenopausal osteoporosis" (PDF). Osteoporosis International. 1 (3): 155–61. doi:10.1007/BF01625446. hdl: 2027.42/45905 . PMID   1790403. S2CID   15552937.
  18. ↑ Meiers P. Fluoride Research in the 19th and early 20th century . Retrieved 2009-1-4.
  19. ↑ Tao S, Suttie JW (August 1976). "Evidence for a lack of an effect of dietary fluoride level on reproduction in mice". J. Nutr. 106 (8): 1115–22. doi:10.1093/jn/106.8.1115. PMID   939992.
  20. 1 2 Gluckman, P.; Skegg, D. (2014). "Health effects of water fluoridation: A review of the scientific evidence" (PDF). Royal Society of New Zealand. Retrieved 15 April 2015.
  21. ↑ Institute of Medicine (1997). "Fluoride". Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride. Washington, DC: The National Academies Press. pp. 288–313. doi:10.17226/5776. ISBN   978-0-309-06403-3. PMID   23115811.
  22. ↑ "Overview on Dietary Reference Values for the EU population as derived by the EFSA Panel on Dietetic Products, Nutrition and Allergies" (PDF). 2017.
  23. ↑ Tolerable Upper Intake Levels For Vitamins And Minerals (PDF), European Food Safety Authority, 2006
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