Nutritional Disorders by RMRCT

In April 1995, centre received a request from the collector and chief medical officer of Mandla district to investigate the cause of a mysterious disease characterized by pain and deformity (Genu valgum) in the lower limbs, mostly among children and adolescents below age 20 in two villages of the district. Thus this epidemiological investigation was undertaken with the objective to find the cause of the knock-knee deformity. The investigation was carried out in two affected villages of Mandla district. The first village was Tilaipani, located about 12 km east of the district headquarter Mandla; the second village was Hirapur, which was about 50 km southwest of Mandla City. Tilaipani had a population of 542 in various age groups, and Hirapur had about 620. Evaluation of data comprised of obtaining and recording of medical histories, detailed clinical and radiological examinations, examination of biochemical parameters of blood, fluoride levels in urine and in all drinking water sources and dietary surveys. Biochemical investigations included serum alkaline phosphatase, inorganic phosphorus and serum calcium. Dietary surveys were conducted using the 24-hr recall method. Fluoride levels were estimated using a fluoride ion selective electrode.

Serum Ionic Fluoride: Normal Range and Relationship to Age and Sex by Harry Husdan, Rudolph yogi, Dimitrios Oreopoulos, Cyril Gryfe and Abraham Rapoport

We used the Orion fluoride electrode systemtodeterminethe normal range of serum ionic fluoride concentrationsand to investigate its relationship to sex and age (A). 87normal men, age 18-92 years (mean, 46 years), and 49normal women, age 19-64 years (mean, 38 years), participatedin the study. At the 95% confidence limits, males<45 years old had a normal range of 0.29 to 1.52 moI/litre and males  45 years old 0.29 + 0.0101 (A-45)to 1.52+ 0.0101 (A-45) tmol/litre. Females, however, had anormal range of 0.022A - 0.32 to 0.022A + 1.07 tmol/litre. A group of 51 men 18-44 years old was comparedwith a group of 36 men 46-92 years old. The mean serumF of the older group was shown to be significantly greater(P <0.01)than that of the younger group. Factors relatedto serum ionic fluoride values are (a) tea as an importantsource of dietary F, (b) the lack of significant variationduring daytime hours, and (C) the lack of significant differencein concentration between serum and plasma F.Concentrations of serum constituents in normalpeople are in some cases affected by sex and age (1).Recently, in determining the normal range of serumionic fluoride in groups of males and females of differentages, we also noted that age and sex exerted some influence.Although chemical methods (2-5) for measuringserum fluoride have been known for over 25years, it is only since 1968 that it has been recognizedthat fluoride in human serum is partly ionized (6, 7)-chiefly because an instrument for convenientlymeasuring ionic fluoride (8-9) became commerciallyavailable in 1966. The importance of serum ionic fluoridemeasurements is further emphasized in view of theclinical use of fluoride as a treatment for osteoporosis,either alone (10, 11) or in combination with other substancessuch as calcium and vitamin D (12)


Open Source:
.http://www.clinchem.org/content/22/11/1884.full.pdf

Chronic Fluorosis: The Disease And Its Anaesthetic Implications By Dr. Madhuri S Kurdi

Chronic fluorosis is a widespread disease-related to the ingestion of high levels of fluoride through water and food. Prolonged ingestion of fluoride adversely affects the teeth, bones and other organs and alters their anatomy and physiology. Fluoride excess is a risk factor in cardiovascular disease and other major diseases, including hypothyroidism, diabetes and obesity. Although anaesthesiologists may be aware of its skeletal and dental manifestations, other systemic manifestations, some of which may impact anaesthetic management are relatively unknown. Keeping this in mind, the topic of chronic fluorosis was hand searched from textbooks, scientific journals and electronically through Google, PubMed and other scientific databases. This article concentrates on the effect of chronic fluorosis on various organ systems, its clinical features, diagnosis and the anaesthetic implications of the disease.

Link : http://www.ijaweb.org/article.asp?issn=0019-5049;year=2016;volume=60;issue=3;spage=157;epage=162;aulast=Kurdi

Fluoride Exposure Effects And Dental Fluorosis In Children In Mexico City by Nelly Molina-Frechero , Enrique Gaona , Marina Angulo , Leonor Sanchez Perez , Rogelio Gonzalez Gonzalez , Martina Nevarez Rascon , Ronell Bologna-Molina

In recent decades, with the objective of preventing dental cavities, multiple topical and systemic fluorides have been incorporated into different diet products. The administration or ingestion of excessive fluorides leads to toxicity and causes the secondary effect of dental fluorosis. Dental fluorosis is a disorder that begins in the odontogenesis stage when the teeth are forming, and the clinical manifestations of this disease are more evident in permanent dentition. Clinically, dental fluorosis is characterized by stains that are white, opaque, and do not have the shine of enamel; the teeth can be striated or spotted, and extrinsic stains may be between yellow and dark brown. The affected dental organs can present greatly accentuated perikymata. More severe cases show dis-  connected pits and zones of hypoplasia in the enamel, which can cause the tooth to lose its normal morphology. The frequency and severity of the lesion increase as the ingestion of fluoride in the water increases above 0.7 ppm; in Mexico, this level is recommended to achieve a beneficial effect in the prevention of dental cavities due to the warm climate in Mexico, which leads the population to ingest a greater quantity of liquids.

Link : http://www.medscimonit.com/download/index/idArt/895351

Association Between Urine Fluoride And Dental Fluorosis As A Toxicity Factor In A Rural Community In The State Of San Luis Potosi By Lizet Jarquín-Yanez, Jose de Jesus Mejia-Saavedra, Nelly Molina-Frechero, Enrique Gaona, Diana Olivia Rocha-Amador, Olga Dania Lopez-Guzman, and Ronell Bologna-Molina

The aim of this study is to investigate urine fluoride concentration as a toxicity factor in a rural community in the state of San Luis Potosi, Mexico. Materials and Methods. A sample of 111 children exposed to high concentrations of fluoride in drinking water (4.13 mg/L) was evaluated. Fluoride exposure was determined by measuring urine fluoride concentration using the potentiometric method with an ion selective electrode.The diagnosis of dental fluorosis was performed by clinical examination, and the severity of damage was determined using Dean’s index and theThylstrup-Fejerskov (TF) index. Results.The range of exposure in the study population, evaluated through the fluoride content in urine, was 1.1 to 5.9 mg/L, with a mean of 3.14 ± 1.09 mg/L. Dental fluorosis was present in all subjects, of which 95% had severe cases. Higher urine fluoride levels and greater degrees of severity occurred in older children. Conclusions. The results show that dental fluorosis was determined by the presence of fluoride exposure finding a high positive correlation between the severity of fluorosis and urine fluoride concentration and the years of exposure suggested a cumulative effect.

Link : http://www.hindawi.com/journals/tswj/2015/647184/
 

Excessive Fluoride Delineating Biochemical Changes in Seminal Plasma: A Case Control Clinical Study By Dushyant Singh Chauhan, Sandeep Tripathi, Vivek Pratap Singh, Surabhi Tomar, Shobha Tomar, Mukesh Tiwari, Abbas Ali Mahdi

Fluorosis has become an endemic problem in India and  worldwide. Significant interest has occurred on potential decline in the semen quality due to contamination of fluoride in drinking water. The aim of the present study was to investigate the possible impact of fluoride exposure on the semen quality. In the present study, 150 subjects (age 25-40) were recruited from the high fluoride region of Rajasthan, India, where fluoride content in ground water was more than 2.0 ppm. The age matched controls were selected from the area where fluoride level was less than 1.5 ppm. The total protein, fructose, lipid, phospholipids and cholesterol levels were estimated in seminal plasma and correlates with the semen volume, liquefaction time, viability and motility followed by the estimation of fluoride concentration in serum and urine. A significant (p<0.05) reduction was observed in fructose, protein, lipids and phospholipids while the concentration of cholesterol was raised in subjects as compared to controls. Diminished semen quality in term of Volume, Liquefaction time, Viability and motility were noticed along with the elevated levels of fluoride in serum and urine. On the basis of results it may conclude that high exposure of fluoride through drinking water may be associated with reduced semen quality in population of endemic fluorosis areas.

Link : http://euacademic.org/UploadArticle/994.pdf

Clinical Study Of Lipid Domains In Erythrocyte Membrane In Chronic Fluorosis by Shashi A and Meenakshi G

The quantification of cholesterol, phospholipid, and proteins in erythrocyte membrane of patients exposed to varying concentrations of fluoride in drinking water was assessed to understand the mechanism of relationship between chronic fluorosis and erythrocyte membrane lipid bilayer. Cholesterol in erythrocyte membrane was determined in dry lipid extract of erythrocyte membrane by the enzymatic manual CHODPAP method in blood samples of 500 patients of male and female patients of fluorosis as well as in age and sex-matched 120 controls. The extract was used for estimation of erythrocyte membrane phospholipids. Aliquots of erythrocyte membrane were used to determine the protein content. The relationship of water as well as serum fluoride with cholesterol, phospholipid, cholesterol/phospholipid ratio, and proteins in erythrocyte membrane were assessed by correlation and linear regression analysis. The mean values for cholesterol in erythrocyte membrane in fluorotic patients of both sexes were elevated significantly (F = 1357.07, P<0.001) in all study groups in comparison to control. There was significant (F = 222.40, P<0.001) accumulation of phospholipids in erythrocyte membrane in the examined groups. The cholesterol/phospholipid ratio was significantly (F = 108.04, P<0.001) higher in fluorotic patients. The level of membrane protein was declined significantly (F = 1378770.14, P<0.001) in erythrocyte membrane in all study groups. Correlation and linear regression analysis showed a positive correlations (P<0.001) of water as well as serum fluoride with cholesterol, phospholipid and cholesterol/phospholipid ratio. Erythrocyte membrane proteins revealed negative correlations (P<0.001) with water and serum fluoride, that indicate water fluoride being the strong predictor of involvement in depletion of protein content and increased levels of serum fluoride. These pronounced alterations in erythrocyte membrane metabolites of fluorotic patients are responsible for the changes in erythrocyte membrane fluidity that
may play a direct role in destabilizing the plasma membrane.

Link : http://www.cibtech.org/J-MEDICAL-SCIENCES/PUBLICATIONS/2014/Vol_4_No_3/JMS-028-031-SHASHI-CLINICAL-FLUOROSIS.pdf

Disposable Platform Provides Visual And Color-Based Point-Of-Care Anemia Self-Testing By Erika A. Tyburski, Scott E. Gillespie, Rayford H. Bulloch, Jeanne Boudreaux , Craig R. Forest , Manila Gaddh , Karthik Thota , William A. Stoy , Robert G. Mannino , Alexander J. Weiss, Anyela Cardenas, Wilena Session, Traci Leong , L. Andrew Lyon , Wilbur A. Lam , Hanna J. Khoury , Siobhan O’Connor, Alexa F. Siu, Silvia T. Bunting

Anemia, defined by low hemoglobin (Hgb) concentrations in the blood, affects one-third of the world’s population, approximately 2 billion people, and is especially prevalent in young children, women of childbearing age, and the elderly (1). Symptoms of anemia range from weakness, fatigue, and dizziness in milder cases to life-threatening cardiovascular collapse in more severe cases, and chronic anemia leads to permanent neurocognitive deficits in children (2, 3). The most common causes of anemia are nutritional deficiencies (e.g., iron deficiency), primary hematologic diseases (e.g., sickle cell disease, thalassemia, myelodysplastic syndromes), drugs (e.g., cancer chemotherapy), and other chronic conditions that indirectly cause anemia (e.g., chronic kidney disease, inflammatory/autoimmune disorders, HIV) (4–7). Even in developed nations, anemia remains a major public health issue, as an estimated 85 million people are at high risk for anemia and 5 million people are afflicted by anemia, respectively, in the US alone (8–11).

Currently, the gold standard for anemia diagnosis is a complete blood count (CBC) using a hematology analyzer, which measures the Hgb levels of a venous blood sample. As CBCs require a venous blood draw from a trained phlebotomist and hematology analyzers require a skilled technician and electrical power to operate, these devices are currently housed in hospitals, clinics, and commercial laboratories, necessitating patients to travel outside of their home to be tested for anemia. With anemia’s widespread prevalence, an inexpensive, disposable, stand-alone point-of-care (POC) anemia diagnostic that is simple enough for untrained people to use as a self-test will enable (a) patients with chronic anemia to self-monitor their disease, improve their quality of life, and potentially improve clinical outcomes and (b) the general public to self-screen for anemia in a cost-effective manner. While several POC anemia diagnostics are currently available, all are currently designed for use by healthcare professionals and none are designed for home use as a self-test (12–16).

Link : https://www.jci.org/articles/view/76666/pdf

Fluoride Exposure From Groundwater As Reflected By Urinary Fluoride And Children's Dental Fluorosis In The Main Ethiopian Rift Valley By Tewodros Rango , Julia Kravchenko , Avner Vengosh , Christopher Paul , Marc Jeuland , Peter McCornick , Redda Tekle-Haimanot

This cross-sectional study explores the relationships between children's F− exposure from drinking groundwater and urinary F− concentrations, combined with dental fluorosis (DF) in the Main Ethiopian Rift (MER) Valley. We examined the DF prevalence and severity among 491 children (10 to 15 years old) who are life-long residents of 33 rural communities in which groundwater concentrations of F− cover a wide range. A subset of 156 children was selected for urinary F− measurements. Our results showed that the mean F− concentrations in groundwater were 8.5 ± 4.1 mg/L (range: 1.1–18 mg/L), while those in urine were 12.1 ± 7.3 mg/L (range: 1.1–39.8 mg/L). The prevalence of mild, moderate, and severe DF in children's teeth was 17%, 29%, and 45%, respectively, and the majority (90%; n = 140) of the children had urinary F− concentrations above 3 mg/L. Below this level most of the teeth showed mild forms of DF. The exposure–response relationship between F− and DF was positive and non-linear, with DF severity tending to level off above a F− threshold of ~6 mg/L, most likely due to the fact that at ~6 mg/L the enamel is damaged as much as it can be clinically observed in most children. We also observed differential prevalence (and severity) of DF and urinary concentration, across children exposed to similar F− concentrations in water, which highlights the importance of individual-specific factors in addition to the F− levels in drinking water. Finally, we investigated urinary F− in children from communities where defluoridation remediation was taking place. The lower F− concentration measured in urine of this population demonstrates the capacity of the urinary F− method as an effective monitoring and evaluation tool for assessing the outcome of successful F− mitigation strategy in relatively short time (months) in areas affected with severe fluorosis.

Link : https://www.researchgate.net/publication/264435431_Fluoride_exposure_from_groundwater_as_reflected_by_urinary_fluoride_and_children's_dental_fluorosis_in_the_Main_Ethiopian_Rift_Valley_Science_of_the_Total_Environment_496_188-197
 

Basic Methods For Assessment Of Renal Fluoride Excretion In Community Prevention Programmes For Oral Health By WHO

Fluoride is a natural constituent of all types of human diet and is present, in varying amounts, in drinking water throughout the world. Because of its value in preventing decay (i.e. formation of dental caries), fluoride is increasingly being used for this purpose in several countries. Enamel     fluorosis (unsightly mottling of the teeth) is the only untoward effect of the use of fluoride, and the condition is known to occur in regions worldwide wherever drinking water contains high levels of     fluoride naturally. Most of the time throughout the day, teeth are bathed in saliva; hence, the teeth benefit from fl uoride ions present in the oral environment, originating from a number of sources to which the individual may be exposed. The concentration of fluoride in saliva varies among individuals, and depends on various factors such as salivary secretion rate and the type of fluoride exposure. To exert a cariostatic effect, fluoride levels need to rise above the predominantly low level several times throughout the day. When fluoride is added to vehicles such as water, salt or milk, it becomes available in the oral cavity at optimal levels several times a day, whereas tooth brushing with fluoride containing toothpaste provide concentrated fluoride twice a day. These methods of    fluoride supplementation are highly successful in reducing levels of dental caries in entire populations. Fluoride is also available through concentrated gels, rinsing solutions, lacquers or varnishes. These methods are most appropriate for selective use on individuals who are suffering from high caries activity.

Link : http://apps.who.int/iris/bitstream/10665/112662/1/9789241548700_eng.pdf

A Comparative Study of Fluoride Ingestion Levels, Serum Thyroid Hormone & TSH Level Derangements, Dental Fluorosis Status Among School Children From Endemic And Non-Endemic Fluorosis Areas by Navneet Singh , Kanika Gupta Verma , Pradhuman Verma , Gagandeep Kaur Sidhu and Suresh Sachdeva

The study was undertaken to determine serum/urinary fluoride status and comparison of free T4, free T3 and thyroid stimulating hormone levels of 8 to 15 years old children with and without dental fluorosis living in an endemic and non-endemic fluorosis area. A sample group of 60 male and female school children, with or without dental fluorosis, consuming fluoride-contaminated water in endemic fluoride area of Udaipur district, Rajasthan were selected through a school dental fluorosis survey. The sample of 10 children of same age and socio-economic status residing in non endemic areas who did not have dental fluorosis form controls. Fluoride determination in drinking water, urine and blood was done with Ion 85 Ion Analyzer Radiometer with Hall et al. method. The thyroid gland
functional test was done by Immonu Chemiluminiscence Micropartical Assay with Bayer Centaur Autoanalyzer. The significantly altered FT3, FT4 and TSH hormones level in both group1A and 1B school children were noted. The serum and urine fluoride levels were found to be increased in both the groups. A significant relationship of water fluoride to urine and serum fluoride concentration was seen. The serum fluoride concentration also had significant relationship with thyroid hormone (FT3/FT4) and TSH concentrations. The testing of drinking water and body fluids for fluoride content, along with FT3, FT4, and TSH in children with dental fluorosis is desirable for recognizing
underlying thyroid derangements and its impact on fluorosis.

Link : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890436/

Early Diagnosis And Complete Recovery From Fluorosis Through Practice Of Interventions by AK Susheela , NK Mondal , Nalini Tripathi , Rashmi Gupta

Fluorosis disease is a public health problem caused by consumption of fluoride (F ̄) through water, food and use of F ̄ containing dental products. Long term treatment with F ̄ containing drugs and exposure to industrial emission has severely affected the community in India.1,2 The first report on patients of Fluorosis from India was reported in 1937.3 Amarjeet Singh and Jolly had investigated patients and revealed their clinical, biochemical and radiological characteristics in great detail.4,5 What is most striking is that the initial reports by Indian medical professionals were focussing on skeletal and dental Fluorosis only. The concept was based on the fact that electronegative and highly reactive element fluorine reacted with the positively charged cations i.e. Ca++, abundantly found in the bones and teeth, resulting in skeletal and dental fluorosis entities. The concept that a chemical poison F ̄ can bind with Ca++ or other positively charged ions in tissues in the body other than bone and teeth was seldom explored.

In Vitro Effect of Sodium Fluoride on Malondialdehyde Concentration and on Superoxide Dismutase, Catalase, and Glutathione Peroxidase in Human Erythrocytes by Jose Gutierrez-Salinas, Liliana Garcia-Ortiz, Jose A. Morales Gonzalez, Sergio Hernandez-Rodriguez, Sotero Ramirez-Garcia, Norma R. Nunez-Ramos, and Eduardo Madrigal-Santillan

The aim of this paper was to describe the in vitro effect of sodium fluoride (NaF) on the specific activity of the major erythrocyte antioxidant enzymes, as well as on the membrane malondialdehyde concentration, as indicators of oxidative stress. For this purpose, human erythrocytes were incubated with NaF (0, 7, 28, 56, and 100 μg/mL) or NaF (100 μg/mL) + vitamin E (1, 2.5, 5 and 10 μg/mL). The malondialdehyde (MDA) concentration on the surface of the erythrocytes was determined, as were the enzymatic activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GlPx). Our results demonstrated that erythrocytes incubated with increasing NaF concentrations had an increased MDA concentration, along with decreased activity of antioxidant enzymes. The presence of vitamin E partially reversed the toxic effects of NaF on erythrocytes. These findings suggest that NaF induces oxidative stress in erythrocytes in vitro, and this stress is partially reversed by the presence of vitamin E.

Link : https://www.researchgate.net/publication/258504569_In_Vitro_Effect_of_Sodium_Fluoride_on_Malondialdehyde_Concentration_and_on_Superoxide_Dismutase_Catalase_and_Glutathione_Peroxidase_in_Human_Erythrocytes

Prevalence of Dental Fluorosis in School Children of Bangarpet Taluk, Kolar District by Shruthi Narayanamurthy , Anil Navale Santhuram

Fluorosis is an endemic disease resulting due to excess ingestion of fluoride. Ground water has been a significant water source for domestic, irrigating, and industrial purposes in India. India is placed in a geographical fluoride belt. Kolar, a drought prone area with semiarid climate, is one among 16 fluorosis endemic districts of Karnataka. Aims: To study the prevalence of dental fluorosis among school children and to estimate the fluoride levels in drinking water sources. Settings and Design: A cross-sectional study was conducted among school-going children. Materials and Methods: School-going children from two randomly selected schools of two randomly selected Panchayat areas of Kyasamballi and Gollahalli were studied in August 2011. All the children in these schools were evaluated for dental fluorosis based on Dean’s index. Fluoride levels of drinking water sources in these communities were estimated by ion-electrode method. Statistical analysis: The data were analyzed with Epi-info 7 statistical software and expressed in proportions. Chi square test was employed to test the significance. Results: A total of 380 children in the age group of 6-15 years were studied. The prevalence of dental fluorosis was 31.05%, predominant in females. The community fluorosis index was 0.718 indicating slight public health importances. The fluoride levels in drinking water sources exceeded 1.5 mg/L. Conclusion: Dental fluorosis is a public health problem in Kolar. High fluoride content in the sources of drinking water is the main reason for dental fluorosis, suggesting an urgent need for defluoridation of water sources with sustainable long-term measures in Kolar.

Link : http://www.jofs.in/temp/JOrofacSci52105-1979788_052957.pdf

An Epidemiological study on FLUOROSIS in Amatikra village of Podi Uproda in Korba District, Chhattisgarh by Jan Swasthya sahyog Ganiyari, Bilaspur Chhattisgarh

Fluorine is the 13th most abundant element available only in the earth crust. As the ground water passes through the fluoride rich rocks it carries fluoride with it, hence most of the fluoride is found in ground water than surface water. Fluoride has been shown to cause significant effect on human health through  drinking water. Different forms of fluoride exposure are of importance and have shown to affect its body content and thus increasing risk of fluoride prone disease. It has a beneficial effect on teeth by preventing and reducing the risk of tooth decay. In fact, concentrations lower than 0.5mg/L intensify risk of tooth decay. However, higher concentration (more than 1.5 – 2mg/L) fluoride becomes quite detrimental to health. Excessive ingestion causes dental fluorosis as well as skeletal fluorosis and osteoporosis as a result.

Link : http://www.indiawaterportal.org/sites/indiawaterportal.org/files/fluorosis_report.pdf

A Clinical, Hematological, Biochemical and Radiological Assessment of Dental Fluorosis in Endemic Fluoridated Area of Maharashtra, India By Rawlani S M, Rahul Bhowate, Mukta Motwani, Shirish Degwekar, Shobha Rawlani, Rakhi M Chandak

There is worldwide evidence that fluoride intake above tolerance levels over certain period leads to cumulative effect resulting in systemic illness and osteosclerosis. The study was conducted where the drinking water content of fluoride was 4.7 ppm to evaluate the effect of fluorosis. Materials and methods: Study was conducted in Maharashtra, India. An ethical clearance was obtained. Clinical, biochemical, hematological and radiological assessment of all the patients were done. Results: Clinical grading of dental fluorosis in male (M) and female (F) patients was 1.85 ± 0.84 and 1.91 ± 0.86. RBC count in M/F was 4.93 ± 0.49 and 4.50 ± 0.47 (p-value 0.003). Hb% in M/F was 12.14 ± 1.76 and 11.21 ± 1.34 (p-value 0.038). Alkaline phosphate level in M/F was 279.68 ± 152.09 and 271.68 ± 169.97. ESR count in M/F was 10.41 ± 8.75 and 12.29 ± 7.37. Radiological finding shows, enlarge pulp chamber 31.37%, prominent marrow 52.94%, thickening of inner and outer tables 83.92%, and barrowing of long bone 7.84%. Conclusion: Early diagnosis and identification of endemic area for fluorosis helps to prevent the further dental and skeletal changes. There is direct association between high concentration of fluoride in drinking water and involvement of dental structures.

Link : http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=2537&Type=FREE&TYP=TOP&IN=_eJournals/images/JPLOGO.gif&IID=203&isPDF=YES

Contemporary Biological Markers of Exposure to Fluoride by Andrew J. Rugg- Gunna , Alberto E. Villa ,Marília Afonso Rabelo Buzalaf

Contemporary biological markers assess present, or very recent, exposure to fluoride: fluoride concentrations in blood, bone surface, saliva, milk, sweat and urine have been considered. A number of studies relating fluoride concentration in plasma to fluoride dose have been published, but at present there are insufficient data on plasma fluoride concentrations across various age groups to determine the ‘usual’ concentrations. Although bone contains 99% of the body burden of fluoride, attention has focused on the bone surface as a potential marker of contemporary fluoride exposure. From rather limited data, the ratio surface- to- interior concentration of fluoride may be preferred to whole bone fluoride concentration. Fluoride concentrations in the parotid and sub-mandibular/sublingual ductal saliva follow the plasma fluoride concentration, although at a lower concentration. At present, there are insufficient data to establish a normal range of fluoride concentrations in ductal saliva as a basis for recommending saliva as a marker of fluoride exposure. Sweat and human milk are unsuitable as markers of fluoride exposure. A proportion of ingested fluoride is excreted in urine. Plots of daily urinary fluoride excretion against total daily fluoride intake suggest that daily urinary fluoride excretion is suitable for predicting fluoride intake for groups of people, but not for individuals. While fluoride concentrations in plasma, saliva and urine have some ability to predict fluoride exposure, present data are insufficient to recommend utilizing fluoride concentrations in these body fluids as biomarkers of contemporary fluoride exposure for individuals. Daily fluoride excretion in urine can be considered a useful biomarker of contemporary fluoride exposure for groups of people, and normal values have been published.

Oral Health Status Of 5-Year-Old Aborigine Children Compared With Similar Aged Marginalised Group In South Western India by Abhinav Singh , Bharathi Purohit , Peter Sequeira and Shashidhar Acharya

To compare and assess oral health status of 5-year-old Aborigine children with similar aged, marginalised children in coastal region of south western India. Materials and methods: A total of 418 Aborigine children were invited to participate in the study and a total of 428, 5-year-olds were selected randomly for comparison from other government schools to form the other marginalised group. The WHO (1997) proforma was used for clinical examinations. Chi Square test was used to compare between categorical variables. Mann–Whitney U-test was used for comparison between the two groups for quantitative variables. Logistic and linear regression analysis was performed to determine the importance of the factors associated with caries status. Odds ratio was calculated for all variables with 95% confidence intervals. P £ 0.05 was considered as statistically significant. Results: Dental fluorosis was present in 50 (11.9%) Aborigine children, whereas in the other marginalised group 7 (1.6%) children had dental fluorosis (P £ 0.001). Untreated dental caries was 76.3% for the Aborigine children and 70.3% in the comparison group. Mean dmft values in the two groups were 4.13 ± 3.90 and 3.58 ± 3.60, respectively (P > 0.01). High frequency of between-meal sugar consumption was related to dental caries (OR = 1.20; P = 0.001). Utilisation of dental care and dental fluorosis were inversely related to dental caries (OR = 1.16; P = 0.001 and OR = 1.91; P = 0.001). Conclusion: The study revealed poor oral health status among both the marginalised groups. Significant differences were noted between the two groups with respect to oral hygiene practices, dietary habits, and dental utilisation pattern. Schools for tribal children, male gender, low frequency of cleaning teeth and higher in between meal sugar consumption were significantly related to dental caries.

Comparison Of Two Village Primary Schools In Northern Tanzania Affected By Fluorosis By James P. Shorter , John Massawe , Nadiah Parryc, Richard W. Walker

High fluoride levels in drinking water sources are a problem throughout the East African Rift Valley and can lead to dental fluorosis (DF) and skeletal fluorosis (SF) in exposed local populations. Two villages in the Hai District of northern Tanzania in which fluoride has been identified as a problem were investigated in a pilot study. Fluoride levels in drinking water sources were measured and the prevalence of DF and deformities due to SF were assessed in children attending school in the two villages. The assessment also recorded the source of drinking water as well as children’s height, weight and 3-day food diaries. Over one-quarter of the children in both villages had skeletal deformities, despite one village having much  higher levels of fluoride in its drinking water sources. More than 90% of children in both villages had DF. SF and DF are major problems in this area. Deformities relating to SF are common, but the reasons for individual susceptibility remain unclear and may include a low calcium diet, ingestion of magadi (local salt) with high fluoride, or genetic factors.

Serum Parathyroid Hormone Levels in Chronic Endemic Fluorosis by Banu Kale Koroglu & Ismail Hakki Ersoy & Mert Koroglu & Ayşe Balkarli & Siddika Ersoy & Simge Varol & Mehmet Numan Tamer

Endemic waterborne fluorosis is a public health problem in Isparta, a city located in southern Turkey. Fluoride is a cumulative element that increases metabolic turnover of the bone and also affects the homeostasis of bone mineral metabolism. There are number of similarities between the effects of excess parathyroid hormone (PTH) and fluorosis on bone. So fluoride might show its effect via PTH. We aimed to determine PTH levels in patients with endemic fluorosis to estimate the possible toxic effects of chronic fluoride intake. Fifty-six patients with endemic fluorosis and 28 age-, sex-, and body-mass-index-matched healthy controls were included in this study. Endemic fluorosis was diagnosed according to the clinical diagnosis criteria of Wang. The urine fluoride levels of fluorosis
patients were significantly higher than those of control subjects as expected (1.9±0.1 vs. 0.4±0.1 mg/L, respectively; P<0.001). PTH levels in fluorosis group were significantly higher than control group (65.09±32.91 versus 47.40±20.37, respectively; P=0.01). The results of our study demonstrate that serum PTH levels are increased in patients with endemic fluorosis. Fluoride, by interfering calcium balance, may be the cause of secondary hyperparathyroidism.

Link : https://www.academia.edu/19145772/Serum_Parathyroid_Hormone_Levels_in_Chronic_Endemic_Fluorosis