The document summarizes recent literature on risk factors for dental fluorosis. Four major risk factors are consistently identified: use of fluoridated drinking water, fluoride supplements, fluoride dentifrice, and infant formulas. Studies show an association between early use of fluoride dentifrice before age 2 and dental fluorosis. Infant formulas reconstituted with fluoridated water are also a risk factor. While fluoride supplements can help prevent cavities, they are prescribed inappropriately in some areas and increase fluorosis risk when water is already fluoridated. Excessive fluoride from multiple sources during tooth development can lead to dental fluorosis.
This document discusses fluorosis, which is caused by prolonged consumption of drinking water containing excessive fluoride. It begins by providing background on fluoride, its sources, and recommended levels. It then describes the signs and symptoms of dental and skeletal fluorosis. Laboratory tests for detecting fluoride levels are also outlined.
The bulk of the document details India's National Programme for Prevention and Control of Fluorosis. It describes the objectives, strategies, and assistance provided to states. Activities are outlined at the community, CHC, district, state and central levels. Prevention, treatment, and health education approaches are summarized. Finally, it discusses adequate sampling methodology and references used.
This document provides an overview of fluorides and oral health in developed and developing countries. It discusses the historical evolution of fluoride and how it relates to reducing dental caries. Different methods of fluoride delivery are examined, including water fluoridation, salt fluoridation, and fluoridated toothpaste. The global scenarios of water fluoridation and excess fluoride in drinking water are also reviewed. The document evaluates the role of fluoride in dental caries prevention, remineralization, periodontal health, and orthodontic anomalies. Both community-based and professionally applied topical fluoride are discussed in relation to developed and developing countries.
Dental fluorosis is a condition caused by excessive fluoride intake during tooth development, characterized by hypomineralization of enamel. It is commonly seen in areas where drinking water contains over 1 ppm fluoride. The Dean's Fluorosis Index classifies fluorosis severity on a scale of 0 to 4 based on appearance, from questionable white flecks to severe pitting and brown staining of all tooth surfaces. States in India with highest prevalence include Gujarat, Rajasthan, and Andhra Pradesh.
This document discusses endemic fluorosis caused by high levels of fluoride in drinking water. It begins by providing background on fluoride as a micronutrient and describes dental and skeletal fluorosis that can result from deficiency or excess. It then discusses the magnitude of the problem globally and in India, explaining that 20 Indian states are affected. The clinical manifestations of dental, skeletal, and non-skeletal fluorosis are described. Prevention methods discussed include changing water sources, avoiding fluoride toothpaste for young children, and defluoridation techniques like the Nalgonda method using aluminum sulfate.
This document provides information about fluorine and its compounds. It discusses the properties of hydrogen fluoride, sodium fluoride, and fluorosilicic acid. It describes the major uses of inorganic fluorine compounds in industry and for municipal water fluoridation. The document also discusses how fluoride prevents dental caries by enhancing remineralization and inhibiting demineralization of tooth enamel. It provides facts about water fluoridation in the United States.
This document discusses fluorosis, a disease caused by excess fluoride intake. It is endemic in many countries, affecting over 70 million people worldwide. In India, over 25 million people suffer from dental, skeletal or non-skeletal fluorosis. The document outlines the epidemiology of fluorosis including sources of fluoride exposure, effects on health, prevalence in India and West Bengal, and interventions to address the problem.
Fluoride, Human Health and Caries PreventionIAU Dent
The document discusses the history and uses of fluoride for dental caries prevention. It notes that in the 1940s, researchers found that optimally fluoridating water at 1 part per million led to over a 60% reduction in tooth decay among children in Grand Rapids, Michigan. The document also outlines the physiology of fluoride absorption and excretion from the body, sources of fluoride intake, dental fluorosis risks from excess intake, and the mechanisms by which fluoride prevents tooth decay both systemically and topically.
This document discusses fluorosis, which is caused by prolonged consumption of drinking water containing excessive fluoride. It begins by providing background on fluoride, its sources, and recommended levels. It then describes the signs and symptoms of dental and skeletal fluorosis. Laboratory tests for detecting fluoride levels are also outlined.
The bulk of the document details India's National Programme for Prevention and Control of Fluorosis. It describes the objectives, strategies, and assistance provided to states. Activities are outlined at the community, CHC, district, state and central levels. Prevention, treatment, and health education approaches are summarized. Finally, it discusses adequate sampling methodology and references used.
This document provides an overview of fluorides and oral health in developed and developing countries. It discusses the historical evolution of fluoride and how it relates to reducing dental caries. Different methods of fluoride delivery are examined, including water fluoridation, salt fluoridation, and fluoridated toothpaste. The global scenarios of water fluoridation and excess fluoride in drinking water are also reviewed. The document evaluates the role of fluoride in dental caries prevention, remineralization, periodontal health, and orthodontic anomalies. Both community-based and professionally applied topical fluoride are discussed in relation to developed and developing countries.
Dental fluorosis is a condition caused by excessive fluoride intake during tooth development, characterized by hypomineralization of enamel. It is commonly seen in areas where drinking water contains over 1 ppm fluoride. The Dean's Fluorosis Index classifies fluorosis severity on a scale of 0 to 4 based on appearance, from questionable white flecks to severe pitting and brown staining of all tooth surfaces. States in India with highest prevalence include Gujarat, Rajasthan, and Andhra Pradesh.
This document discusses endemic fluorosis caused by high levels of fluoride in drinking water. It begins by providing background on fluoride as a micronutrient and describes dental and skeletal fluorosis that can result from deficiency or excess. It then discusses the magnitude of the problem globally and in India, explaining that 20 Indian states are affected. The clinical manifestations of dental, skeletal, and non-skeletal fluorosis are described. Prevention methods discussed include changing water sources, avoiding fluoride toothpaste for young children, and defluoridation techniques like the Nalgonda method using aluminum sulfate.
This document provides information about fluorine and its compounds. It discusses the properties of hydrogen fluoride, sodium fluoride, and fluorosilicic acid. It describes the major uses of inorganic fluorine compounds in industry and for municipal water fluoridation. The document also discusses how fluoride prevents dental caries by enhancing remineralization and inhibiting demineralization of tooth enamel. It provides facts about water fluoridation in the United States.
This document discusses fluorosis, a disease caused by excess fluoride intake. It is endemic in many countries, affecting over 70 million people worldwide. In India, over 25 million people suffer from dental, skeletal or non-skeletal fluorosis. The document outlines the epidemiology of fluorosis including sources of fluoride exposure, effects on health, prevalence in India and West Bengal, and interventions to address the problem.
Fluoride, Human Health and Caries PreventionIAU Dent
The document discusses the history and uses of fluoride for dental caries prevention. It notes that in the 1940s, researchers found that optimally fluoridating water at 1 part per million led to over a 60% reduction in tooth decay among children in Grand Rapids, Michigan. The document also outlines the physiology of fluoride absorption and excretion from the body, sources of fluoride intake, dental fluorosis risks from excess intake, and the mechanisms by which fluoride prevents tooth decay both systemically and topically.
This document discusses endemic fluorosis, a disease caused by excess fluoride intake. It is characterized by dental and skeletal fluorosis. Several factors determine onset, including fluoride levels in drinking water above 1.5 mg/L, climate, nutrition, and socioeconomic status. Rajasthan and Gujarat in India have the worst affected areas. Prevention focuses on defluoridation methods like lime treatment and alum precipitation to remove fluoride from drinking water.
This document provides an overview of fluorides and their role in dental health. It discusses the historical evolution of fluorides from their discovery in the early 1900s as the cause of mottled enamel. It describes how fluorides are naturally present in the environment and metabolism in our bodies, acting to strengthen tooth enamel and reduce cavities. The key mechanisms of action are increasing enamel resistance, promoting remineralization of early cavities, and interfering with cariogenic bacteria. While fluorides provide dental benefits when consumed in optimal amounts, both insufficient and excessive intake can impact health.
Fluorine is obtained primarily from drinking water, with recommended daily intake between 1.5-4 mg. It is readily absorbed in the stomach and small intestine and distributed to bones and teeth. Fluoride incorporates into hydroxyapatite to form fluoroapatite, increasing hardness and protecting against dental caries. Deficiency can cause dental caries, while toxicity from excessive amounts leads to dental and skeletal fluorosis characterized by discolored teeth and hypercalcification of bones respectively.
DENTAL FLUOROSIS: A CASE STUDY IN VAUVNIYA DISTRICT, DRY ZONE OF SRI LANKASivanesan Somanathar
This document summarizes a case study on dental fluorosis in the Vavuniya district of Sri Lanka. Water samples were collected from 72 wells and tested for fluoride concentration. Fluoride levels above the WHO recommended level of 1.5 mg/L were found to cause dental and skeletal fluorosis. The highest number of fluorosis patients were found in the Chettikulam area, where the highest fluoride level of 1.52 mg/L was recorded. Positive correlations were observed between fluoride levels and electrical conductivity, pH, and well depth. The study identified areas with high fluoride concentrations in groundwater and high rates of dental fluorosis. More research was recommended to develop techniques for removing fluoride from drinking water in affected rural
Dental fluorosis is caused by excessive fluoride intake during tooth development and results in hypomineralization of enamel. It ranges from mild to severe. Several indexes exist to measure and classify fluorosis severity, including Dean's Index and the Tooth Surface Index of Fluorosis. Risk factors include age, water fluoridation, fluoride supplements, and toothpaste usage. Mild to moderate fluorosis may be associated with lower caries rates.
This document discusses fluoride toxicity and its effects. It begins by classifying fluoride toxicity into acute and chronic categories. Acute toxicity results from excessive one-time fluoride ingestion and can cause nausea, vomiting, and even death in severe cases. Chronic toxicity occurs from small amounts of fluoride over long periods. This includes dental fluorosis, skeletal fluorosis, and non-skeletal fluorosis. Dental fluorosis ranges from mild white lines to severe enamel damage. Skeletal fluorosis stiffens joints and bones from very high fluoride levels over many years. Non-skeletal effects include muscle damage and infertility. The document provides details on symptoms, classifications, treatments and thresholds for the different toxicity types.
The document discusses endemic fluorosis, providing information on fluorine and fluorides, sources of fluoride exposure, definitions of fluorosis, and types of fluorosis including dental and skeletal fluorosis. It notes that dental fluorosis occurs when excess fluoride is ingested during tooth development and causes staining and pitting of enamel. Skeletal fluorosis results from long-term fluoride consumption and causes pain and stiffness in bones. India has a major problem with fluorosis affecting over 60 million people, with contaminated groundwater being the main source and certain states like Andhra Pradesh and Rajasthan seeing high levels of endemic fluorosis.
This document provides information about fluorosis, a disease caused by deposition of fluorides in tissues from excess fluoride intake. It discusses the global and national magnitude of fluorosis, highlighting India as one of the worst affected countries. The epidemiological triad of agent, host, and environmental factors that influence fluorosis are explained. Clinical features including dental and skeletal fluorosis are described. The document also outlines methods to test and treat fluorosis, as well as approaches for fluoride removal including the commonly used Nalgonda technique developed in India.
This document provides an overview of fluoride and its effects on health. Some key points:
- Fluoride is found naturally in drinking water in some parts of India at levels over 1.5 mg/L, which can cause health issues.
- Fluoride intake of less than 1 mg/day is considered safe and provides benefits for dental health. Higher intakes have been linked to conditions like dental and skeletal fluorosis.
- Studies have not found consistent relationships between water fluoridation and increased rates of cancer, birth defects, or other health issues. However, high fluoride exposure has been linked to increased risks of spina bifida in some areas of India.
- Fluoride can accumulate in red
This document provides an overview of dental caries epidemiology. It begins with definitions of epidemiology and dental caries. It then discusses the history of caries in prehistoric man and global and Indian caries scenarios. Several classic epidemiological studies on dental caries are summarized. Theories of caries etiology including Miller's chemico-parasitic theory are explained. Epidemiological factors influencing caries including the host, agents, environment and time are described. Saliva properties and their relationship to caries susceptibility are also summarized.
Fluoride is a mineral found in nature that helps prevent cavities in two ways. It concentrates in developing teeth and bones, helping to harden enamel. It also works during the natural demineralization and remineralization processes that occur in the mouth. Salivary fluoride levels vary depending on water fluoride levels and diet, and saliva impacts these processes. A study found that 8-year-old children with no cavities had significantly higher salivary fluoride levels than caries-prone children, indicating a relationship between dental caries and salivary fluoride concentration.
This document discusses fluoride contamination in groundwater in India and its health effects. It notes that over 200 districts across 20 states are affected, impacting over 66 million people. The main health issues are dental and skeletal fluorosis. Dental fluorosis causes tooth discoloration while skeletal fluorosis can lead to joint pain and bone deformities. Prevention efforts include providing alternate fluoride-free drinking water sources, water defluoridation methods, dietary supplements, and education programs. Treatment options for fluorosis are very limited since it is not reversible once symptoms appear.
This is a PPT which was spoken by Dr. J. Dinda , former CMOH , Bankura in the year 2012 in DH&FW advocacy meeting. Thanks to him for successful implementation of NPPCF at Bankura. Hi is no more with us unfortunately but his work regarding NPPCF is make him alive again.Till date i see you when i am in tense and remind you words to fight with the troubles and not to leave the station .......We are recruited for people who are in pain , to solve their problem and give them medical support .................Miss You a Lots .........Dibyendu Dutta
Systemic fluoride was used as early as 1874 to prevent dental caries. Fluoride ions are absorbed in the gut and nearly all retained fluoride is incorporated into developing bones and teeth, making enamel crystals larger and more stable. This affects crown morphology by making pits and fissures shallower, less likely to cause decay. Systemic fluoride includes water fluoridation, supplements, and adding fluoride to salt, milk, mineral water and sugar. Topical fluoride is most important for preventing decay by inhibiting demineralization and promoting remineralization in the mouth. Excessive fluoride can cause dental and skeletal fluorosis.
This document summarizes fluoride metabolism and toxicity. It discusses the history of fluoride use and poisoning cases. Fluoride is toxic in large amounts but provides dental benefits in small, regular amounts. The document outlines fluoride absorption, distribution, and excretion in the body. Both acute and chronic fluoride toxicity are addressed. Acute toxicity can cause death, while chronic exposure can lead to dental and skeletal fluorosis depending on the amount consumed over time. The critical period for fluorosis development is during the maturation phase of tooth development.
This document provides an overview of fluorides in dentistry. It discusses the chemistry and sources of fluoride, including water, food, air and consumer products. It describes the metabolism and distribution of fluoride in the body, including deposition in bones and teeth. The historical evidence supporting the role of fluoride in preventing dental caries is presented. The mechanisms of action are explained, such as fluoride incorporation into dental tissues and its cariostatic effects. Methods of delivering fluoride to the population to prevent tooth decay are covered, including water fluoridation and professionally or self-applied topical fluorides. Potential toxicity at high levels is also mentioned.
Skeletal fluorosis is caused by excessive fluoride intake over long periods of time. The main sources of fluoride are drinking water, tea, and indoor air pollution from burning coal. Fluoride is deposited in bones and teeth. At low levels it strengthens teeth and bones, but at high levels it leads to skeletal and dental fluorosis. Skeletal fluorosis causes bone and joint pain and stiffness, and if severe, bone deformities and crippling. It is a major public health problem affecting millions in India, China, and other parts of Asia and Africa. Reducing fluoride intake and ensuring adequate calcium and vitamin D can help prevent and treat skeletal fluorosis.
Nuevas tecnologias virtudes y riesgos asc - 16 feb 2011José María
Acción social Católica (entidad fundadora de Caja Inmaculada, CAI), organizó un foro de opinión/debate bajo el tema "Nuevas tecnologías, virtudes y riesgos).
Platinum Lifestyle Group aims to become the leading luxury products and services provider online by connecting high-net-worth individuals. It offers various services through subsidiaries like Platinum Exclusive for lifestyle management, Platinum Big Wigs for social networking, and Platinum 007 for unique gifts. Current partners include telecom, credit card, and banking companies. The group seeks to expand through regional partnerships to achieve its goal of becoming the top global luxury brand.
This document discusses endemic fluorosis, a disease caused by excess fluoride intake. It is characterized by dental and skeletal fluorosis. Several factors determine onset, including fluoride levels in drinking water above 1.5 mg/L, climate, nutrition, and socioeconomic status. Rajasthan and Gujarat in India have the worst affected areas. Prevention focuses on defluoridation methods like lime treatment and alum precipitation to remove fluoride from drinking water.
This document provides an overview of fluorides and their role in dental health. It discusses the historical evolution of fluorides from their discovery in the early 1900s as the cause of mottled enamel. It describes how fluorides are naturally present in the environment and metabolism in our bodies, acting to strengthen tooth enamel and reduce cavities. The key mechanisms of action are increasing enamel resistance, promoting remineralization of early cavities, and interfering with cariogenic bacteria. While fluorides provide dental benefits when consumed in optimal amounts, both insufficient and excessive intake can impact health.
Fluorine is obtained primarily from drinking water, with recommended daily intake between 1.5-4 mg. It is readily absorbed in the stomach and small intestine and distributed to bones and teeth. Fluoride incorporates into hydroxyapatite to form fluoroapatite, increasing hardness and protecting against dental caries. Deficiency can cause dental caries, while toxicity from excessive amounts leads to dental and skeletal fluorosis characterized by discolored teeth and hypercalcification of bones respectively.
DENTAL FLUOROSIS: A CASE STUDY IN VAUVNIYA DISTRICT, DRY ZONE OF SRI LANKASivanesan Somanathar
This document summarizes a case study on dental fluorosis in the Vavuniya district of Sri Lanka. Water samples were collected from 72 wells and tested for fluoride concentration. Fluoride levels above the WHO recommended level of 1.5 mg/L were found to cause dental and skeletal fluorosis. The highest number of fluorosis patients were found in the Chettikulam area, where the highest fluoride level of 1.52 mg/L was recorded. Positive correlations were observed between fluoride levels and electrical conductivity, pH, and well depth. The study identified areas with high fluoride concentrations in groundwater and high rates of dental fluorosis. More research was recommended to develop techniques for removing fluoride from drinking water in affected rural
Dental fluorosis is caused by excessive fluoride intake during tooth development and results in hypomineralization of enamel. It ranges from mild to severe. Several indexes exist to measure and classify fluorosis severity, including Dean's Index and the Tooth Surface Index of Fluorosis. Risk factors include age, water fluoridation, fluoride supplements, and toothpaste usage. Mild to moderate fluorosis may be associated with lower caries rates.
This document discusses fluoride toxicity and its effects. It begins by classifying fluoride toxicity into acute and chronic categories. Acute toxicity results from excessive one-time fluoride ingestion and can cause nausea, vomiting, and even death in severe cases. Chronic toxicity occurs from small amounts of fluoride over long periods. This includes dental fluorosis, skeletal fluorosis, and non-skeletal fluorosis. Dental fluorosis ranges from mild white lines to severe enamel damage. Skeletal fluorosis stiffens joints and bones from very high fluoride levels over many years. Non-skeletal effects include muscle damage and infertility. The document provides details on symptoms, classifications, treatments and thresholds for the different toxicity types.
The document discusses endemic fluorosis, providing information on fluorine and fluorides, sources of fluoride exposure, definitions of fluorosis, and types of fluorosis including dental and skeletal fluorosis. It notes that dental fluorosis occurs when excess fluoride is ingested during tooth development and causes staining and pitting of enamel. Skeletal fluorosis results from long-term fluoride consumption and causes pain and stiffness in bones. India has a major problem with fluorosis affecting over 60 million people, with contaminated groundwater being the main source and certain states like Andhra Pradesh and Rajasthan seeing high levels of endemic fluorosis.
This document provides information about fluorosis, a disease caused by deposition of fluorides in tissues from excess fluoride intake. It discusses the global and national magnitude of fluorosis, highlighting India as one of the worst affected countries. The epidemiological triad of agent, host, and environmental factors that influence fluorosis are explained. Clinical features including dental and skeletal fluorosis are described. The document also outlines methods to test and treat fluorosis, as well as approaches for fluoride removal including the commonly used Nalgonda technique developed in India.
This document provides an overview of fluoride and its effects on health. Some key points:
- Fluoride is found naturally in drinking water in some parts of India at levels over 1.5 mg/L, which can cause health issues.
- Fluoride intake of less than 1 mg/day is considered safe and provides benefits for dental health. Higher intakes have been linked to conditions like dental and skeletal fluorosis.
- Studies have not found consistent relationships between water fluoridation and increased rates of cancer, birth defects, or other health issues. However, high fluoride exposure has been linked to increased risks of spina bifida in some areas of India.
- Fluoride can accumulate in red
This document provides an overview of dental caries epidemiology. It begins with definitions of epidemiology and dental caries. It then discusses the history of caries in prehistoric man and global and Indian caries scenarios. Several classic epidemiological studies on dental caries are summarized. Theories of caries etiology including Miller's chemico-parasitic theory are explained. Epidemiological factors influencing caries including the host, agents, environment and time are described. Saliva properties and their relationship to caries susceptibility are also summarized.
Fluoride is a mineral found in nature that helps prevent cavities in two ways. It concentrates in developing teeth and bones, helping to harden enamel. It also works during the natural demineralization and remineralization processes that occur in the mouth. Salivary fluoride levels vary depending on water fluoride levels and diet, and saliva impacts these processes. A study found that 8-year-old children with no cavities had significantly higher salivary fluoride levels than caries-prone children, indicating a relationship between dental caries and salivary fluoride concentration.
This document discusses fluoride contamination in groundwater in India and its health effects. It notes that over 200 districts across 20 states are affected, impacting over 66 million people. The main health issues are dental and skeletal fluorosis. Dental fluorosis causes tooth discoloration while skeletal fluorosis can lead to joint pain and bone deformities. Prevention efforts include providing alternate fluoride-free drinking water sources, water defluoridation methods, dietary supplements, and education programs. Treatment options for fluorosis are very limited since it is not reversible once symptoms appear.
This is a PPT which was spoken by Dr. J. Dinda , former CMOH , Bankura in the year 2012 in DH&FW advocacy meeting. Thanks to him for successful implementation of NPPCF at Bankura. Hi is no more with us unfortunately but his work regarding NPPCF is make him alive again.Till date i see you when i am in tense and remind you words to fight with the troubles and not to leave the station .......We are recruited for people who are in pain , to solve their problem and give them medical support .................Miss You a Lots .........Dibyendu Dutta
Systemic fluoride was used as early as 1874 to prevent dental caries. Fluoride ions are absorbed in the gut and nearly all retained fluoride is incorporated into developing bones and teeth, making enamel crystals larger and more stable. This affects crown morphology by making pits and fissures shallower, less likely to cause decay. Systemic fluoride includes water fluoridation, supplements, and adding fluoride to salt, milk, mineral water and sugar. Topical fluoride is most important for preventing decay by inhibiting demineralization and promoting remineralization in the mouth. Excessive fluoride can cause dental and skeletal fluorosis.
This document summarizes fluoride metabolism and toxicity. It discusses the history of fluoride use and poisoning cases. Fluoride is toxic in large amounts but provides dental benefits in small, regular amounts. The document outlines fluoride absorption, distribution, and excretion in the body. Both acute and chronic fluoride toxicity are addressed. Acute toxicity can cause death, while chronic exposure can lead to dental and skeletal fluorosis depending on the amount consumed over time. The critical period for fluorosis development is during the maturation phase of tooth development.
This document provides an overview of fluorides in dentistry. It discusses the chemistry and sources of fluoride, including water, food, air and consumer products. It describes the metabolism and distribution of fluoride in the body, including deposition in bones and teeth. The historical evidence supporting the role of fluoride in preventing dental caries is presented. The mechanisms of action are explained, such as fluoride incorporation into dental tissues and its cariostatic effects. Methods of delivering fluoride to the population to prevent tooth decay are covered, including water fluoridation and professionally or self-applied topical fluorides. Potential toxicity at high levels is also mentioned.
Skeletal fluorosis is caused by excessive fluoride intake over long periods of time. The main sources of fluoride are drinking water, tea, and indoor air pollution from burning coal. Fluoride is deposited in bones and teeth. At low levels it strengthens teeth and bones, but at high levels it leads to skeletal and dental fluorosis. Skeletal fluorosis causes bone and joint pain and stiffness, and if severe, bone deformities and crippling. It is a major public health problem affecting millions in India, China, and other parts of Asia and Africa. Reducing fluoride intake and ensuring adequate calcium and vitamin D can help prevent and treat skeletal fluorosis.
Nuevas tecnologias virtudes y riesgos asc - 16 feb 2011José María
Acción social Católica (entidad fundadora de Caja Inmaculada, CAI), organizó un foro de opinión/debate bajo el tema "Nuevas tecnologías, virtudes y riesgos).
Platinum Lifestyle Group aims to become the leading luxury products and services provider online by connecting high-net-worth individuals. It offers various services through subsidiaries like Platinum Exclusive for lifestyle management, Platinum Big Wigs for social networking, and Platinum 007 for unique gifts. Current partners include telecom, credit card, and banking companies. The group seeks to expand through regional partnerships to achieve its goal of becoming the top global luxury brand.
El documento resume las acciones realizadas por una empresa en diciembre de 2011, incluyendo reportajes en televisión y prensa escrita, la apertura de nuevos centros en varias ciudades de España, y el número de impactos generados cada mes en medios de comunicación sobre proyectos como premios y la incorporación de un nuevo perfil profesional.
El documento habla sobre el software, sus funciones, categorías y clasificaciones. Explica que el software está formado por instrucciones y datos que permiten aprovechar los recursos del computador para resolver problemas. Describe los tipos principales de software como el sistema operativo, las aplicaciones y el software de programación. Además, clasifica el software según su tipo de trabajo, método de distribución y evolución a través del tiempo. Finalmente, discute algunos mitos y principios erróneos comunes sobre el desarrollo de software.
Este documento presenta el programa del Módulo II de Atención Farmacéutica II. El módulo se llevará a cabo del 16 de julio al 27 de julio de 2012 con una carga horaria de 135 horas. El módulo se centrará en establecer una relación entre el farmacéutico y el paciente para prevenir y resolver problemas relacionados con los medicamentos. Los contenidos incluyen unidades sobre atención farmacéutica hospitalaria, manejo de bibliografía, validación de recetas médicas y seguimiento farmac
Este documento presenta los resultados de una encuesta realizada a 23 farmacias que tienen un contrato con una farmacia elaboradora de fórmulas magistrales. La mayoría de las farmacias encuestadas estaban satisfechas con las vías de comunicación, el tiempo de envío y la forma de envío de las fórmulas. Algunas sugirieron mejoras como el uso del correo electrónico en lugar del fax y acortar el tiempo de envío. En general, el servicio de la farmacia elaboradora fue considerado satisfactorio pero los comentarios de la encuesta ay
El documento compara Colombia, Japón y Suiza en términos de recursos naturales, industria y actitud versus aptitud. Colombia tiene una gran variedad de recursos naturales como metales, agricultura y fauna, mientras que Japón carece de muchos de estos debido a su pequeño tamaño. La industria colombiana no es tan avanzada tecnológicamente, mientras que la de Japón sí lo es en áreas como tecnología y ciencia. Finalmente, el documento distingue entre actitud (comportamiento) y aptitud (capacidad),
Recursos educativos en prevención de drogodependencias 2012Juan Carlos Melero
Este documento presenta los recursos educativos e informativos en prevención de drogas de una organización llamada EDEX. Explica que estos recursos se utilizan para construir propuestas preventivas basadas en procesos de comunicación educativa. Luego describe algunos de los recursos específicos que EDEX ha desarrollado para diferentes grupos de edad, como cuentos, cómics y materiales audiovisuales. Finalmente, discute el enfoque de EDEX en el desarrollo de habilidades para la vida y la adaptación de sus recursos a formatos digital
The document provides details for four proposals for a multi-purpose building at Taylor's University. Proposal 1 by Yap Zhi Jun outlines plans for a karaoke area, including objectives to provide entertainment and stress relief for students. Layout diagrams show the outer building design and inner floor plan with several karaoke rooms. Potential disadvantages like noise and absenteeism are addressed, and costs are estimated at RM883,200.
AUTO Registro Sede PP DP 275/2008 Pieza Separada Informe UDEF-BLA Nº22.510/13...TheDailyCorruption
1) La policía presentó un informe analizando documentos de una empresa contratada por el Partido Popular.
2) El informe indica pagos irregulares a la empresa que no estaban en la contabilidad oficial del partido.
3) El juez ordenó más investigaciones sobre posibles delitos financieros cometidos.
The 2014 creative task for getting in Hyper Island was all about creating movements, in fact, this was our brief:
"Choose something that you’re passionate about. How will you create awareness and enable people to lead the change in the future?"
El documento presenta información sobre la creación de modelos de negocios exitosos. Explica que el modelo de negocio Canvas proporciona un lenguaje común para describir modelos de negocios a través de nueve bloques clave: segmentos de mercado, propuestas de valor, canales, relación con los clientes, flujos de ingresos, recursos clave, actividades clave, red de socios y estructura de costos. Además, enfatiza la importancia de probar los modelos con clientes reales de manera rápida y hacer camb
Este documento propone un plan para integrar las tecnologías de la información y la comunicación (TIC) en la gestión de la Escuela Isaías Franco Guerrero. Actualmente la escuela tiene algunas computadoras y acceso limitado a Internet, pero carece de un laboratorio de informática completo. El plan busca fortalecer el liderazgo, la enseñanza, la evaluación y el currículo de la escuela mediante el uso de las TIC. Esto ayudaría a preparar mejor a los estudiantes para el futuro y elevar la calidad de la educación.
Desarrollan nuevo sistema que detecta las recaídas en pacientes con mieloma m...Yaquelin Rodriguez
Un nuevo sistema desarrollado por investigadores del Instituto de Investigación Biomédica de Salamanca y el Hospital 12 de Octubre de Madrid utiliza la tecnología de secuenciación masiva para detectar la enfermedad mínima residual en pacientes con mieloma múltiple y así poder diferenciar a aquellos que sufrirán recaídas de los que no, permitiendo ajustar mejor los tratamientos. Los resultados en 133 pacientes demostraron que esta técnica puede distinguir claramente entre pacientes con riesgo de recaída y los que no,
The document provides information about Capital Model United Nations (CAPMUN) conference being held from April 1-3, 2016 in Ottawa, Canada. It includes the conference schedule, list of committees which will discuss issues related to human migration and mobility, special events being organized alongside the conference and policies related to conduct and dress code for delegates. The document also outlines the rules of procedure that will be followed during committee sessions including how the speaker's list will be managed and process for introducing and passing resolutions.
Este documento presenta los fundamentos del programa de Ciencia de la Información y la Documentación, Bibliotecología y Archivística (CIDBA) de la Universidad del Quindío. Se estudian las asociaciones profesionales de la información a nivel nacional e internacional y sus aspectos más importantes. También se investigan los programas afines en otras universidades colombianas, analizando fortalezas y debilidades de CIDBA frente a estos. Adicionalmente, se enfatiza la importancia de mantener una actitud ética para los profesionales de
CommunesPlone gestionnaire de contenu opensource adapté aux contexte marocain
PloneGov est l’extension internationale du projet CommunesPlone qui
est un projet à l'initiative de communes wallonnes désireuses de diminuer leur
dépendance aux fournisseurs informatiques et de retrouver une plus grande
indépendance technologique. Pour cela, elles ont choisi de développer un
ensemble des outils informatiques et sites internet véritablement adaptés à leurs
besoins en ayant recours à des technologies open source.
Les outils actuellement proposés dans le cadre du projet CommunesPlone
s'appuient sur un logiciel de gestion de contenu (CMS) appelé Plone.
Plone est un CMS Open Source, convivial et puissant qui vous permet de
facilement ajouter et éditer tout type de contenu via le web, de produire de
navigation et de recherche de ce contenu et appliquer la sécurité et de workflow
à ce contenu.
Este documento contiene una lista de compañías de diferentes países que se dedican a la fabricación y reparación de aeronaves, trenes, automóviles, equipos eólicos y otros vehículos. Las compañías provienen principalmente de España, Francia, Brasil, Alemania y otros países europeos y algunas de América, Asia y África.
Manual de Identidade Visual - pág 171 até pág 195PMBA
O documento descreve as especificações para a Galeria dos Ex-Comandantes de uma unidade, incluindo o tamanho e material das placas, disposições para as fotografias dos comandantes e diretrizes para manter a padronização visual.
Fluoride is a mineral that is naturally present in varying amounts in water sources. Studies from the early 20th century found correlations between fluoride levels in water and rates of dental caries as well as dental fluorosis. This led to further research demonstrating that optimal levels of fluoride in community water supplies could reduce rates of dental caries. Several large-scale studies in the 1940s-1960s provided strong evidence that water fluoridation at levels around 1 part per million can reduce dental caries by around 25% on average. Fluoride works both systemically during tooth development before eruption and topically on tooth surfaces after eruption to strengthen enamel and make it more resistant to decay.
Systemic fluoride was used as early as 1874 to prevent dental caries. Fluoride ions are absorbed in the gut and nearly all retained fluoride is incorporated into developing bones and teeth, making enamel crystals larger and more stable. This affects crown morphology by making pits and fissures shallower, less likely to cause decay. Systemic fluoride intake can cause dental fluorosis if intake is too high during tooth development between ages 1-4. Topical fluoride is now recognized as more important for caries prevention than systemic fluoride.
Dental fluorosis is caused by excessive fluoride intake during tooth development and results in changes to enamel formation. It ranges from mild opaque white markings to brown stains and porous enamel. Prevention involves limiting fluoride from sources like water, toothpaste and supplements during ages 6-8 when teeth are developing. Treatment depends on severity and may include bleaching, microabrasion, composites, veneers or crowns.
This document summarizes information about fluorosis, a disease caused by excess fluoride deposition in tissues. It is most prevalent in India, China, and other parts of Asia and Africa. The document covers the magnitude of fluorosis globally and in India, the epidemiological triad of agent-host-environment factors, clinical signs including dental and skeletal fluorosis, and prevention through defluoridation methods like the Nalgonda technique.
Dental caries is a multifactorial disease caused by an interaction between cariogenic microbes, susceptible tooth surfaces, and fermentable carbohydrates. The document summarizes the epidemiology of dental caries globally and in Nepal. It describes that dental caries prevalence has decreased in western countries but increased in developing nations. In Nepal, 58% of children ages 5-6 have caries and 64% of adults have tooth decay. Environmental factors like climate, fluoride levels, and socioeconomic status also impact caries rates between different geographic locations.
This document provides information on the prevention of dental caries through the use of fluoride. It discusses that fluoride can be used systemically by ingesting it or topically by direct application. Fluoride works to prevent dental caries by strengthening enamel, inhibiting bacteria, and enhancing remineralization. Sources of fluoride include water, foods, dental products, and professional treatments. Both optimal levels and methods of delivery are covered.
This document discusses fluoride toxicity and fluorosis. It begins by outlining the learning objectives which are to understand the toxic effects of fluoride, safe dosages, and the pathologies of dental and skeletal fluorosis. It then discusses the classification of fluoride toxicity as either acute or chronic. Acute toxicity occurs with short term excessive intake and can be fatal, while chronic toxicity is from long term excessive intake and causes dental and skeletal fluorosis. The document outlines the signs and symptoms of dental fluorosis, which occurs from intake above recommended levels as a child, and skeletal fluorosis, which is caused by long term intake of higher levels and causes joint and bone pain and stiffness. It also discusses methods for diagnosing and managing fluorosis as
Fluoride helps prevent tooth decay through several mechanisms. It inhibits demineralization, promotes remineralization, alters the action of plaque bacteria, and improves enamel crystallinity and reduces solubility. Both pre-eruptive and post-eruptive exposure to fluoride provides caries prevention benefits, with maximal effects seen from high exposure both before and after tooth eruption. Community water fluoridation was first introduced in the 1940s and has been shown to reduce tooth decay rates by 40-59% in both primary and permanent teeth.
Fluorosis is a disease caused by deposition of fluorides in the hard and soft tissues of the body.
It is usually characterised by discoloration of teeth and crippling disorders of fluorine, duration and level of exposure.
Fluoride is a trace element found naturally in water sources and soils. It is beneficial for dental health when consumed in optimal amounts. Fluoride strengthens tooth enamel and promotes remineralization. It is most effectively delivered through community water fluoridation but can also be obtained through foods, supplements, and topical treatments like toothpaste. Both low and high fluoride intake can pose health risks like dental fluorosis. Careful monitoring of intake levels is important, especially for young children, to maximize dental benefits and avoid risks.
A comprehensive presentation about role of fluorides in caries prevention. Their sources, metabolism, history of fluorides, how to administer fluorides, advantages and disadvantages of different kinds of systemic fluorides.
This document discusses various ways to prevent dental caries through the use of fluoride. It begins by explaining the role of fluoride in increasing the remineralization of teeth and making enamel more resistant to decay. It then discusses water fluoridation as an effective public health measure for delivering fluoride and preventing cavities at the community level. Finally, it mentions some additional sources of fluoride beyond water, such as toothpaste, mouth rinses, and foods. The overall message is that maintaining adequate fluoride intake through various means can help strengthen tooth enamel and reduce the risk of cavities developing.
This document provides a critical review of the health impacts of fluoride. It discusses how fluoride is beneficial in low amounts for strengthening teeth and bones, but can be harmful at higher concentrations. The document summarizes the different types of fluorosis that can occur, including dental fluorosis, skeletal fluorosis, and non-skeletal fluorosis. Skeletal fluorosis occurs when too much fluoride is incorporated into bones over time, making them dense and brittle. The document also discusses how fluoride intake impacts diabetes and glucose levels based on studies showing fluoride can inhibit insulin secretion and impair glucose tolerance.
EPIDERMOLOGY AND PREVENTION OF DENTAL CARIESVajid Kurikkal
Dental caries is caused by an interaction between microorganisms, host factors, and the diet. Key microorganisms involved are Streptococcus mutans and lactobacilli, which produce acid as a byproduct of metabolizing sugars in the diet, leading to demineralization of enamel and dentin. Host factors like saliva and tooth morphology can increase or decrease risk of caries by impacting pH, cleansing, and ability to remove food debris. Increased consumption of fermentable carbohydrates, especially without proper oral hygiene, greatly increases the risk of dental caries. Prevention strategies aim to modify these risk factors, such as reducing sugar intake, increasing fluoride exposure, and improving plaque removal.
Zaid Hasan Khan presented on fluoride contamination in groundwater. High fluoride concentrations in groundwater are caused by weathering of fluoride-rich rocks, volcanic ash, and coal combustion. Consumption of groundwater with more than 1.5 mg/L fluoride can cause dental and skeletal fluorosis in humans. Defluoridation techniques like adsorption, precipitation, and reverse osmosis can be used to treat groundwater and make it safe for consumption.
This document reviews literature on slow-release fluoride devices. It describes two main types - the copolymer membrane type and glass bead type. Studies show these devices effectively raise intraoral fluoride levels, resulting in a caries-protective effect. Animal and human studies found the devices reduced dental caries development, including protection of occlusal surfaces not normally protected by conventional fluoride regimens. However, device retention over time has been a challenge limiting their effectiveness in clinical practice. Further randomized clinical trials are still needed to validate the use of slow-release fluoride devices.
HISTORY & MECHANISM OF ACTION SYSTEMIC FLUORIDES.pptxRUCHIKA BAGARIA
EVERYTHING YOU NEED TO KNOW ABOUT SYSTEMIC FLUORIDES.
HISTORY, MECHANISM OF ACTION, METABOLISM, DIETARY SUPPLEMENTS AND RECENT ADVANCES.
LETS STUDY SYSTEMIC FLUORIDE TOGETHER.
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This document summarizes the classification and detection of dental caries. It discusses how caries can be classified based on anatomic site (pit and fissure caries, smooth surface caries, root caries), severity (incipient, occult, cavitation), progression (arrested, recurrent, radiation), and chronology (early childhood, teenage, adult). It also describes various methods for detecting caries, including visual and tactile examination, radiography, fiber optic transillumination, fluorescence, electronic resistance measurement, ultrasonics, and dyes.
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3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
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4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Exposição ao flúor e fluorose dental uma revisão de literatura
1. T he decline in dental caries revalence and incidence in the last two decades is eonsidered to be largely
~to ..th~wead use of fluoride. owever, the prevalence of dental fluorosis has increased
simultane slv, The inerease is in the mild and very mild forms of fluorosis, both in fluoridated and in non-
'"fluoridated areas. A large arnount of epidemiologieal data demonstrates that the occurrenee of dental fluorosis
is associated with exeessive fluoride intake throughout the period oftooth development. Multiple sources of
fluoride intake have been identified. This review deseribes the condition and summarizes the recent literature
on the risk faetors for dental fluorosis. Four major risk faetors have been eonsistently identified: use of
fluoridated drinking water, fluoride supplements, fluoride dentifrice and infant formulas. In addition, some
manufaetured ehildren foods and drinks may also be important contributors to total daily fluoride intake.
UNITERMS: Fluoride; Dental fluorosis, risk.
p <"4~f~ f LJ-DPJ:6u
INTRODUCTION the recent literature on risk factors for dental
fluorosis.
J:here has been a decline in dental caries r Dental fluorosis is a fluoride- induced disturbance
prevalence and incidence durin the last two in tooth formation, which results in hypomineralized
decades both in economicali develo d36,60,61,69 and , enamel with increased porosity". It is caused by
in economicaliy developing countries37,67, This107. I excessive fluoride intake but only during the period
I
Jige~se is considered to be largely due tolhe of tooth development'v'v'<". The most important
~.§pr:ead use of fluoride. Concurrent with the risk factor for fluorosis is the total amount of fluoride
~ decline in caries, an increase in the revalence of consumed from ali sources during the critical period
dental fluorosis has been documented, in of tooth development' 5.17,3 . 1.63
êommunities with43,55,101,103 without fluoridated
and The clinical appearance of mild dental fluorosis
arrnking water43,55.80.101.
Concem with the increase is characterized by bilateral, diffuse (not sharply
in the prevalence of fluorosis has led to many studies demarcated) opaque, white striations that run
on the reasons for the increase, and in identifying horizontally across the enamel. These may be
the important risk factors. These studies have had invisible to the individual and the clinician but often
different designs and employed different can be seen after the enamel has been dried. The
populations, many with multiple sources offluoride opacities may coalesce to form white patches. In
exposure. Further, they have used different indices the more severe forms the enamel may become
to diagnose and score dental fluorosis. This has discolored andlor pitted24,26,97,98. eruption into
Upon
made it difficult to compare the results of these the mouth, fluorosed enamel is not discolored - the
studies. The purpose of this review is to summarize stains develop over time due to the diffusion of
2. ___ o
BUZALAF, M. A. R.; CURY, J. A.; WHITFORD, G.M.
FLUORIDEEXPOSURESANDDENTALFLUOROSIS:AUTERATUREREVIEW
exogenous ions (eg, iron and copper) into the per day as the exposure level above which dental
abnormally porous enameL fluorosis occurs", although studies in Kenya have
~e~ underlyin the de elQ me..!!!.Q[ found fluorosis with a daily fluoride intake of less
dental fluorosis lias not been conc1u~ely than 0.03 mg Flkg body weight per day from
~as believed previously that water-". In these latter studies, however, the teeth
éxCesslve fliíoride intake interfered with the function were dried in order to detect the mildest forms of
of ameloblasts, perhaps inhibiting the secretion of, fluorosis. A daily fluoride intake between 0.05 and
or altering the composition of enamel matrix 0.07 mg/kg "ooây-weiglit -peidãy is generall y
proteins. lt now appears that this is unlikely for regarded as optimum for prevention of dental
several reasons inc1uding the fact that the risk of caries?". Other factors that may increase the
dental fluorosis is lowest during the secretory stage Susceptibility of indi viduals to dental fluorosis are
of enamel development 16,17,27,28. altitudel.42,57.59.93,1I0,111,114, SeM
renal insufficiency45,46,82,104, d '.!~I
,..
Microscopically, the structural arrangement of and malnutrition?':'!". Some of these~, .-
the crystals appears normal, but the width of the however, can produce enamel changes tha~~~ble
intercrystalline spaces is increásed,@!ng po~ dental fluorosis in the absence of signíficant
The degree and extent of porosity depends on the exposure to fluoride. ~
concentration of fluoride in the tissue fluids during Studies of dental fluorosis, done in areas Wi~
tooth development25.I02 ln fac, e risk of dental and without fluoridated drinking water, have
fluorosis base on animal shidies, is directl~ identified four major risk factors: use of fluoridated
'-<o the interaction o clrculatlllg fIuoru e drinking water, fluoride supplements, fluoride
coíiêêiitrations and time, fe:'- the area under the time- dentifrice, and infant formulas before the age of
concentration curve Thus it appeãrs that dental seven years. Some manufactured children foods and
~
fluorosis can result from a range of plasma fluoride drinks may also be important contributors to total
concentrations provided that they are maintained for daily fluoride intake.
sufficientl y long periods 111With increasing severity
.
of fluorosis, the fluoride concentration throughout Fluoridated drinking water
the enamel, the depth of enamel involvement, and
the degree of porosity also íncreases"-". Clinical Dean 14, n 1942, stated that some 10% of children
i
studies of dental fluorosis have demonstrated that in optimally fluoridated (1.0 ppm) areas were
/"...---- - -- - -.---
the most critical period for efevelopment of fluomsís
- affected by mild or very mild fluorosis in the
ís during thê õSf-secr:eto"ry or early maturati2!!- permanent teeth and that less than 1% were so
phase of tooth development 2;26-;52;7~:S4,J(J~ affected in low-fluoride areas. These degrees of ri A~n S
; Fluorosis islesãprêvalent and le;-apparent in prevalence were recorded p@~ the availability
prirnary teeth than in permanent teeth, and, in any of fluoridated dental products when fluoridated
case, fluorosis of the prirnary teeth has only short- drinking water was the only significant source of
term rather than long-term consequences. Therefore, fluoride intake-". In North America, the prevalence
the major concern about fluorosis is with the of dental fluorosis now ranges between 7.7% to 69%
permanent teeth. Since the different permanent teeth in fluoridated communities, and from 2.9% to 42%
~ atmfferent~~'period in non-fluoridated communities. The studies done
~.e den@~ ex.!.~nds frol!1eleven mc:nths after the 1980s have shown the highest prevalences'".
The studies by Spuznar; Burt'? and Riordan" are in
---- -----
to seven years of ag~ The permanent maxillary
--- _-
..- ..
central incisors are of greatest cosmetic importance agreement that the risk of fluorosis in areas where
ánd they appear most at risk of fluorosis between the water fluoride concentration is 0.8 ppm is four
ages of fifteen and twenty-four months for males" times higher than in non-fluoridated
ãiíQ-oetween fwenty-oiiê"ãiid thiity moº~s fm- communities'T'=". However, water fluoride
,females23. Howéver:ãmeta-analysis of the risk probably has its greatest impact on fluorosis
periods ássociated with the development of dental prevalence indirectly, through being used in the
fluorosis in maxillary permanent central incisors processing of infant formulas, other children' s foods
showed that the duration of excessi ve fluoride and soft drinks". ln a systematic review of 214
exposure throughout amelogenesis, rather than studies on water fluoridation, McDonagh et al.?'
specific risk periods, would seem to explain the observed an increase in the proportion of caries-
development of dental fluorosis". free children and a reduction in the number of teeth
Some authors regard to 0.1 mg Flkg body weight affected by caries. They also noted a dose-dependent
3. Rev.FOB
V.9, n.1/2, p.1-10,jan./jun. 2001
increase in dental fluorosis. At a fluoride level of 1 fluoridated water, they provide a daily fluoride
ppmin the drinking water, they estimated that 12.5% intake above that likely to cause some degree of
of exposed people would have fluorosis that they dental fluorosis'<". Therefore, to reduce the risk of
would find of esthetic concem, a prevalence much fluorosis the recommendation is to use ready-to-
higher than that reported by Dean 14in 1942 who feed formulas whose fluoride concentrations are
~--
found virtually no cases of moderate or severe known to be low, or low-fluoride bottled water to
/>«: _
fluorosis. The present-day prevalence of fluorosis dilute the formula concentrate.-- ~
indicates ~~g c~~tíng
.;-----
waer.
- ----------
:f:1ÍÍÔfidefromsources in aaartíOi1to tha~Lllg Fluoride dentifrice
Ripa" reviewed studies that investigated the
" . Dietary fluoride supplements possible association between the use of fluoride
dentifrice and prevalence of dental fluorosis. He
Fluoride supplements are recommended for concluded that of the ten studies reviewed,
children living in fluoride deficient areas. The nine7.9.18.39,49.74,96.99,113 find an association.
failed to
recommended dai1y dose is based on the age of the These studies, however, were not designed with
child and on the fluoride concentration in the fluoride dentifrice effects as the major focus 01' used
drinking water. However, there are many reports surrogate measures to evaluate fluoride dentifri[;~
showing that supplements are prescribed exposure.From this group of studies, the only oniV
inappropriately to children in fluoridated used case control methodologles to assess t e
areasS1,7S,100.
Many studies have identified fluoride relationship between dental fluorosis and enfiTrice
supplements as risk factors for dental fluorosis, both use: The aüthors iâêiiliIie õii1y tWlrfa-e ar , 00
in fluoridated+":" and non-fluoridated areas40,43,49. brushing with fluoride containing dentifrice prior
"'< Sl,74,7S.IOS.fluoridated areas the risk of dental
In to 25 months of age and prolonged use of infant
~ fluorosis from use of fluoride supplements is almost formula beyond 13 months of age, as being
~ 4 times higher than in non- flu2.ti.da~ed af_t:.as63,S7. significantly associated with dental fluorosis in a
~ ~e, the risk of dental fluorosis from the use of fluoridated community.
fluoride supplements is well established. Clinicians More recent studies specifically addressed
must be sure of the water fluoride concentrations, dentifrice use in more -detail, with most finding a
âSWell as of the caries risk of the child, before relationship between early dentifrice use and dental
preSciibing fluori e supplements. The U.S. Centers fluorosis21,62,66.80.
Moreover, other studies have used
1OfOlsease . onlíOl an revention has recently case control methods to assess the relationship
Qublished uidelines for the judicious rescription between dental fluorosis and the early use of fluoride
?f dietary fluoride su lements 11. dentifrices. All these studies have demonstrated
si~ficant relationships between fluoride dentifrice
Infant Formulas use àiíd dental fluorosis. A study of 157 patients
~--- -
aged 8~17-years attending a university pediatric
Because of its very low fluoride contcentration, dentistry clinic in Iowa City identified exposure to
human breast milk is a poor source of fluoride. In fluoride water and ~~oride dentifrice as risk factors
infancy the major source of fluoride is considered for dental fluorosib A larger study of a similar
to be infant formulas. A number of studies have design was conducted in a pediatric dental practice
implicated the consumption of infant formulas as a in Asheville, North Carolina". This study found that
risk factor for dental fluorosis, particularly in initiating tooth brushing with fluoride dentifrice
fluoridated areaslO.44·S3.71,SS,94,10S, in non-
but not prior to age two was significantly associated with
fluoridated áreas". Soy-based formulas have been dental fluorosis. In addition, for those drinking non-
reported to have-sDmewhat high~:t:l.!liiíide_ fluoridated water, daily fluoride supplement use was
êóncenfrations than milk-based formulas 1 OS 0,94.1and strongly associated with dental fluorosis.
'this has been attribí.ife~~er end~~~ls Of particular interest are a series o , -:- -designed
Õf1-1iíõfidem the soy extract44·54.65. However, the case control studies conducted by,Pendr)l and co-
most important factor when considering infant workers74.76.78 in both fluoridated-ând non-
'formUlãS-as risk'factors for dental fluorosis isthe fluoridated areas in New England In these studies,
water used to reconstitute them. When infant parents completed detailed, self-administered
formulas are recorisfitutedwith optimally questionnaires regarding infant feeding patterns,
..;
4. BUZAIAF, M. A. R.; CURY, J. A.; WHITFORD, G. M.
FLUORIDEEXPOSUKESANDDENTALFLUOROSIS: A UTERATUREREVIEW
residence history, fluoride supplement use, brushing exposures had occurred. Thus, ali studies relating
(with fluoride dentifrice) frequency, and amount of dentifrice use to dental fluorosis are prone to recall
dentifrice used per brushing up to eight years of bias. Nevertheless, there is now compelling evidence ~/(
age. Among residents in fluoridated areas, mild-to- that tlie early use of fluoride dentifrice is ª1! 1
moderate dental fluorosis was associated with inWOrtant risk factor for dental fluorosis, as young
(inappropriate) supplement use, frequent brushing êIíIl ren swa ow conSI era le amounts of
prior age of eight, and use of larger than pea-sized dentifrice. In fact, the amount of fluoride ingested
amounts of dentifrice. The estimated percentage of !smversely related to the age of the child.
cases of dental fluorosis attributable to greater Dentifrices with a fluoride concentration of 1,000
dentifrice use was~l %7,77, (Pendrys et al. 1994, ppm contain 1.0 mg of fluoride per gram. In children
1995), younger than 6 years of age, the mean quantity of
Among residents of non-fluoridated areas, dentifrice per brushing episode is about 0.55 g86,
Pendrys; Katz" found that mild-to-moderate dental corresponding to a fluoride exposure of about 0.55
fluorosis was strongly associated with fluoride mg. An average of 48% of thi~Q.unt is ingested
supplement use and high household income, but the by2-to 3-year olds, 42% by 4-year-olds and 34%
use of infant formula and fluoride dentifrice were by 5-year=0Ids5,20,38,86. Assuming mean bod weights
not associated with increased risk for fluorosis. of 15, 18 -and~20 kg;-respectively, fluoride intake
However, a later study " identified fluoride ~ one rusmng per ay resITlls ün.'ngesttmrof-
supplement use and frequent, early toothbrushing 18, 13 and 9 mglkglday, respecti vely. So, it is evident
habits as significantly associated with mild-to- that toothbrushing substantially Íncreases the
moderate fluorosis in both early and late enamel
forming surfaces in the permanent teeth.
-
fluorioeexposure, particularly for 2- to 3-year-o
......---- --- -------
children, and, of course, especially for children that
o
As a follow up to their trial of low fluoride 6ríish more thãii-onCFâaily31:1riformation life thIs
dentifrice in children between the ages of three t0 for economically developing countries is rare".
five years in a fluoridated area!" Holt and co~
clt Studies conducted with 2-3-year-old Brazilian
workers40 compared the prevalence o dental children, that lived in areas with fluoridated water,
fluorosis amo'ilg high (1,055 ppm fluoride) andlow showed that they ingested 0.061 mg fluoride/kg
(550 ppmfluoriâe)IluorKIedentifrice grou s, w en body weight per day (range 0.011-0.142) from
children werê 9-10 years õf agti: 'Í'hi§~yJQ.l!!!.<! dentifrice" and that dentifrice contributed with 55%
that use of fluoride supplements and use of standard of the total amount of fluoride ingested daily". 1/(
dentifrice (1,055 ppm fluofiêie)"significantly Based on these findings, it is c1ear that measures
permanent teeth. -- -----
increased the riskof deiiial Tluorosfâ'If t e to reduce fluoride intake by children at risk o en
fuor~~e n~essary. Two ~t~matives have been
""'"tff1heir study of eight-year-old Norwegian suggestecCTnelrSt one would be to reduce the
children whose water was not fluoridated, Wang and amount of dentifrice used. This is an important
co-workers'P identified regular supplement use and measure, but we cannot forget that nowadays in most
use of fluoride toothpaste prior to age 14 months as families both parents work and people who take care
the only significant risk factors for dental fluorosis. of the children not always follow parents'
Rock; Sabieha'" conducted a study of 325 8-9- instructions. In addition, the fla vor of most childr.eJJ
year-old children living in optirnally-fluoridated dentifrices e~ages in estion. Because of this,
Birmingham, England and found a strong It as een proposed that dentifrices with lower
association between fluorosis in the maxillary fluoride concentrations should be developed and
central incisors and early dentifrice use and use of marketed for use by young children, as has been
dentifrice with a high (1,500 ppm ) fluoride done in many countríesv" . The European Academy -;r:. X r'
concentration. J1: was also observed that-a_higher~ of Paediatric Dentistry" advises the use of a very -~) ..,
pro ortion of children without fluorosis had used a . small amount of low fluoride dentifrice from 6 ~~ li]
~'---~'---~77~--~--77~~~~
commercially available lQF:fulOride dentifnce. - months to 2 years of age and the use of a pea-sized ( {j ,
" While case control methodologies, more âetalled amount of 500 ppm fluoride twice daily from 2 to 6 V
survey instruments, and multivariate analysis used years. A higher fluoride concentration dentifrice
in many of these recent studies lend more credence (1,000-1,500 ppm) should be used as soon as the
to the conclusions than the earlier studies, ali of these first permanent molars erupt. However, in some
studies have relied on retrospective assessment of countries (like Brasil and USA) the sale of low
fluoride exposures, often eight to ten years after the fluoride dentifrices is not aliowed untillarge clínical
5. Rev.FOB
V.9, n.112, p.I-IO,jan./jun. 2001
tn s have demonstrated safety and efficacy. -<----- It is conducted.
~le that reducing the fluoride concentratio oL Thus, even without corroborating studies, it
~denttfrices could reduce
_ _ the anti-cari
_--..:~-,-=-=-......;.:.::....co.-..;..-,=~. ap~a(the bestbâ1ãiiCeõetween prevention of
effectiveness. Therefore, the ideallower fluoride caries and dental fluorosis favors reduced
"'---
I dentifrice should not only reduce fluoride ingestion, cC:Ucentrations of about 500-550 ppm fluoride QL.
but also be equally effective in caries prevention as ~lefS:-However, those groups or individuals
currently marketed formulations of 1,000-1,100 judged to be at increased risk for dental caries might
ppm fluoride. Some researchers have developed low have a more favorable benefit/risk ratio with the use
fluoride formulations (550 ppm, NaF) that were as of standard 1,000-1,100 ppm fluoride dentifrices.
effective as the "gold-standard" Crest (1,100 ppm) While additional studies are needed for young
in terms of reducing enamel demineraliza~OI? and children that are not at high risk for caries but may
enhancing enamel remineralization in sit~ The be at risk for dental fluorosis, it is appropriate to
cariostatic effecti veness of this formulation, consider recommendations that dentifrices
j however, has not yet been tested in longitudinal containing 500-550 ppm fluoride be marketed and
clinical studies. endorsed for use by preschool children.
There have been many longitudinal clinical trials Any decision taken by official health organs
ofthe effectiveness of dentifrices with lowerfluoride should take into account both anti-caries
concentrations. Some of them found no significant effectiveness and risk for dental fluorosis. In
IJ differences between standard (1,000-1, 100 ppm) and addition, official health organs should review
:4 low fluoride dentifrices (250-550 ppm labeling requirements for dentifrice to make the
~ fluoride )32,35,47. In contrast, Reed 83, Mitropoulos and fluoride concentrations more apparent and should
,~ co-workers" and Koch and co-workers" found the formulate guidelines for instructions regarding
r-. low-fluoride dentifrices to be somewhat less prudent use in young children. The Support
'- ~ effective than the 1,000 ppm dentifrices. Agencies should finance additional well-controlled
~t~ce, these studies might suggest that c' .cal trials oflow- fluoride dentifrices of sufficient
low-fluoridê dentifrices are less effective in terms 'auration and follow-up to assess both dental caries
of caries prevention than standard 1,000 ppm 'ãiiã fluorosis prevention. Such trials should bé"
dentifrices. However, of these studies, only one" 'éõnducted with populations of children in the
was conducted on the appropriate, preschool age targeted preschool age group. Furthermore,
group. This study did not find a statistically manufacturers should be encouraged to aggressively
significant difference between 250 ppm and 1,000 market dentifrice dispensers with small orifices or
ppm dentifrices. In view of the negative results of fixed amount "pumps" for use by young children.
the studies cited above, however, it may be that a They should be encouraged or required also to warn
fluoride concentration of 250 ppm is too much of a parents concerning excessi ve use and ingestion of
departure from the standard 1,000 ppm dentifrice. dentifrices flavored for children. Dentists,
A more practical formulation may have ~ride physicians, and other professionals, as well as
concentrations in the range of 500-550 pp~ dentifrice manufacturers should continue to
The only study of low-fluoride dentifrice that recommend the use of a small "pea-sized" amount
. used both a sample of young, preschool children of dentifrice (no more than 0.25 g) for young
and a 500-550 ppm 1Ôtifrice was reported by children. In addition, preschool children should be
~ Winter and co-workerU This three-year, double well-supervised in their use of fluoride dentifrice,
blind trial compared effectiveness of 550 and 1,055 and the dentifrice should be placed on a child-size
ppm fluoride dentifrices in children who were two toothbrush by a parent or other adult'?'.
years of age at baseline by measuring dmf
increments. The caries increment was slightly higher Infant foods and drinks
(I 0%) in the low-fluoride dentifrice group after three
years, but the difference was not statistically During infancy the main sources of fluoride are
significant. The authors concluded that "the low considered to be commercially available foods and
fluoride toothpaste possessed a similar anticaries beverages. Many studies have shown that the
activity to the control paste and could therefore be fluoride concentrations of infant foods and
recommended for use by young children." However, beverages span a wide range and depends mainly
their conclusion was based on a single study and on the fluoride concentration in the water used to
additional trials of such dentifrices should be manufacture them29,30, 106.
6. BUZALAF, M. A. R.; CURY, J. A.; WHITFORD, G. M.
FLUORIDEEXPOSURESANDDENTALFLUOROSIS:ALlTERATUREREVIEW
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