FluorideKrysta McGinnis

The Power of Fluoride • Demonstrating how fluoride protects teeth• Before class, one hard boiled egg was soaking in

fluoridated mouthwash

What is fluoride?• Fluoride is the ionic form of fluorine

• Not an essential nutrient

History• 1529 – The mineral fluorspar was founded by Georgius

Agricola• 1886 – Henri Moissan isolated fluoride during an inorganic

experiment• 1901 – Dr. Fredrick McKay moved to Colorado Springs and

was unsure why residents had brown spots on their teeth• 1909 – Dr. G.V. Black moved to Colorado to collaborate

with McKay• After 6 years, together they determined:

• 1. permanent teeth that were already calcified did not develop stains

• 2. teeth affected by the “Colorado brown stain” were resistant to decay

• 1931 – Dr. McKay determined water containing fluoride caused brown stains, but prevented dental caries

• 1945 – Grand Rapids became the first city in the world to fluoridate its drinking water.

US Environmental Protection Agency • 1974 –the Safe Drinking Water Act was passed by

Congress• Law requires EPA to determine the level of

contaminants in drinking water at which no adverse health effects are likely to occur

• EPA set the fluoride protection based on the best available science to prevent potential health problems• Maximum contaminant level (MCL) for fluoride = 4.0

mg/L or 4.0 ppm

• Fluoride is voluntarily added to reduce the incidence of cavities among the treated population• The decision to fluoridate a water supply is made by

the state

http://gisetc.com/wp-content/uploads/2013/03/3-3b-fluoridation-map.png

Water Standards in Missouri• Triennial review process – Missouri’s Water Quality

Standards • reviewed and modified every 3 years

Maryville Water Plant• Began fluoridating water March 1, 1965

• 2012 Annual Water Quality ReportRegulated Contaminants

Collection Date Highest Value Range (low – high)

Unit MCL MCLG Typical Source

ATRAZINE 5/14/2012 1.35 0 - 1.35 ppb 3 3 Runoff from herbicide used on row crops

BARIUM 3/6/2012 0.0846 0.0846 ppm 2 2 Discharge of drilling wastes; Discharge from metal refineries; Erosion of natural deposits

FLUORIDE 3/6/2012 0.61 0.61 ppm 4 4 Natural deposits; Water additive which promotes strong teeth

NITRATE-NITRITE

11/20/2012 0.03 0.03 ppm 10 10 Runoff from fertilizer use; Leaching from septic tanks, sewage; Erosion of natural deposits

SIMAZINE 2/20/2012 0.99 0 - 0.99 ppb 4 4 Herbicide runoff

Absorption, Transportation, Storage, & Excretion• Absorption occurs in the stomach and small intestine via

passive diffusion• 80-90% of fluoride consumed is absorbed• Absorption is pH dependent

• Calcium and magnesium can decrease fluoride absorption

• Fluoride is transported in the blood steam• Stored in the teeth and skeleton• Amount deposited is greatest during infancy, childhood,

and adolescence• Excreted by the kidneys • Fluoride retention increases when a diet is low in

sodium chloride

Functions• Essential function have yet to be identified• Beneficial roles • Supports the deposition of calcium &

phosphorus in the teeth and bones• Prevents dental caries• Fluoride forms hydroxyfluorapatite crystals during

development which provides a greater resistance to bacteria and acid in the mouth

• Fluoride in the saliva• Promotes the remineralization of enamel lesions• Reduces the net loss of minerals from tooth

enamel

Dietary Needs • Adequate Intake • Infants up to 6 months• 0.01 mg/day

• Infants 6-12 months• 0.5 mg/day

• Young children & adolescents• 0.7-3 mg/day

• Adults• men = 3 mg/day• women = 4 mg/day

Sources of Fluoride• Major source • Fluoridated water• Not all public water sources are fluoridated

• Other sources • Food: tea, grape juice, seafood, & seaweed• Nondietary: fluoridated toothpaste, mouthwash, and

fluoride treatments• Reasons for considerable debate

• Most bottled water doesn’t contain fluoride

• Some home water treatments can reduce levels

Deficiency• No fluoride specific deficiency or disease• Lack of fluoride is associated with increased

incidence of dental caries

Toxicity • Acute toxicity • Rare, occurs rapidly, life threatening• Cause: excessive intake of fluoride due to fluoridated toothpaste,

mouth rinses, & supplements• Symptoms: nausea, vomiting, diarrhea, sweating, spasms,

convulsions, and coma

• Dental fluorosis • Can be mild to severe• Cause: excessive fluoride intake 2-5 times more than the AI• Symptoms: mottling and staining of the teeth

• Skeletal fluorosis • Increases bone mass• Cause: excessive fluoride intake over a long period of time• Symptoms: joint pain & stiffness, calcification of ligaments,

immobility, muscle wasting, and neurological problems related to spinal cord compression

Results of Experiment• Fluoride treated egg did not bubble in the vinegar• Untreated egg did bubble in the vinegar• Vinegar is an acid and attacks the minerals in the

egg shell• Fluoride is needed to protect teeth because acid can

easily destroy tooth enamel

Scientific Study• “Effects of the Fluoride on the Central Nervous System” • Conducted to determine if there was a correlation between

the consumption of fluoride and the central nervous system• Fluoride can pass unnoticed and be toxic• Consumption of excessive and continuous fluoride exposure

can be damaging to body tissues• Doesn’t cause physical malformations, but can cause damage

to the nervous system

• Clinical and experimental studies have found that fluoride can change cerebral morphology and the biochemistry that affects neurological development.

• Inform individuals that too much fluoride can cause damage to an individuals’ health up to 20 years or more after consumption

EAL Question• What is the evidence for a relationship between exposure to high

levels of fluoride in drinking water and IQ in children?

• 4 studies conducted• Negative relationship between chronic exposure to high levels of fluoride

and IQ in children when compared to children who live in areas with lower levels of fluoride in the drinking water• High fluoride levels = > 3.15 mg/L• Low fluoride levels = <1.0 mg/L

• One study did find a statistically significant increase in the proportion of children with IQ less than 80 when the mean fluoride levels in water were approximately 2.46 mg/L

• Limitations• Fluoride levels are often confounded, but for the study they were naturally

occurring• All populations studied were non-US setting• Exposure levels and confounding factors may be different than the US

• Although the studies did not find an association between IQ and fluoride levels, the research can not be used to identify a safe upper limit

Quiz• Why isn’t fluoride an essential element?

• What are sources of fluoride?

• What minerals decrease fluoride absorption?

• What are the adequate intake levels for men and women?

Works Cited• "Basic Information about Fluoride in Drinking Water." United States Environmental Protection

Agency, 23 July 2013. Web. 21 Nov. 2013. • Buzalaf, M. A., and G. M. Whitford. "Fluoride Metabolism." NCBI. U.S. National Library of Medicine, 23

June 2011. Web. 21 Nov. 2013.• Christie, Karl, and Stefan Schneider. "Fluorine (F) (chemical Element)." Encyclopedia Britannica

Online. Encyclopedia Britannica, 2013. Web. 21 Nov. 2013. • "Consumer Confidence Reports (CCR)." Home. United States Environmental Protection Agency, 03

Jan. 2013. Web. 21 Nov. 2013. • "Fluoride in Diet: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine. U.S. National

Library of Medicine, 31 Oct. 2013. Web. 21 Nov. 2013. • Gurien, Molly. "Benedict's Test for Reducing Sugars." Ohio University. N.p., 08 Sept. 2013. Web. 21

Nov. 2013. • "Incredible Meswak, Complete Oral Care." Meswak | Meswak Toothpaste | Premium Herbal

Toothpaste. Dabur, 22 Nov. 2013. Web. 24 Nov. 2013.• Levy, S. M., Eichenberger-Gilmore, J., Warren, J. J., Letuchy, E., Broffitt, B., Marshall, T. A., & Torner, J.

C. (2009). Associations of fluoride intake with children’s bone measures at age 11. Community Dentistry & Oral Epidemiology, 37(5), 416-426. doi:10.1111/j.1600-0528.2009.00478.x

• "Linus Pauling Institute Micronutrient Research for Optimum Health." Linus Pauling Institute at Oregon State University. Oregan State University, 2013. Web. 22 Nov. 2013.

• Lubkowska, A., Chlubek, D., Machoy-Mokrzynska, A., & Nowacki, P. (2012). Distribution of fluoride in selected structures of the central nervous system in rats exposed to NaF and AICI3 in drinking water. Trace Elements & Electrolytes, 29(3), 162-171. doi:10.5414/ATE0X1224

• "Maryville 2012 Annual Water Quality Report." Mo.gov. Department of Natural Resources, 09 May 2013. Web. 21 Nov. 2013.

• "Missouri Department of Health & Senior Services." Water Fluoridation. Mo.gov, n.d. Web. 21 Nov. 2013.

Works Cited Continued• "Missouri Department of Natural Resources." Water Protection Program. Missouri Department of

Natural Resources, n.d. Web. 21 Nov. 2013. • "Oral Health Data Systems, My Water's Fluoride Safe, Effective Prevention of Tooth Decay for People

of All Ages: Know If Your Water Is Optimally Fluoridated." My Water's Fluoride. CDC, 06 Feb. 2008. Web. 21 Nov. 2013.

• "Science Blogs." Starts With A Bang. Science Blogs, 2013. Web. 21 Nov. 2013. • "Science Experiments." Experiments. Delta Dental of New Jersey, 2013. Web. 21 Nov. 2013. • "The Story of Fluoridation." The Story of Fluoridation. National Institute of Dental and Craniofacial

Research, 18 July 2013. Web. 21 Nov. 2013. • Valdez-Jimenez, L., Soria Fregozo, Miranda Beltran, Gutierrez Coronado, and Perez Vega. "Effects of

the Fluoride on the Central Nervous System." NCBI. U.S. National Library of Medicine, 26 June 2011. Web. 21 Nov. 2013.

• Wafa K. M., T., Manal El., s., Ola M., O., & Somaiya A., E. (2013). The Effect of Miswak and Fluoride Toothpastes on Dental Plaque, A Comparative Clinical and Microbiological Study. Nature & Science, 11(9), 1-7.

• Wardlaw, Gordon M., and Carol Byrd-Bredbenner. Wardlaw's Perspectives in Nutrition. New York: McGraw-Hill, 2013. 558-60. Print.

• "What Is the Evidence for a Relationship between Exposure to High Levels of Fluoride in Drinking Water and IQ in Children?" Evidence Analysis Library. Academy of Nutrition and Dietetics, Apr. 2009. Web. 21 Nov. 2013.

• "Water and Waste Water Treatment - Maryville, MO." Water and Waste Water Treatment - Maryville, MO. N.p., n.d. Web. 21 Nov. 2013.

• "World Water Week: U.S. Water Fluoridation Map." GISetc. GISetc, 19 Mar. 2013. Web. 21 Nov. 2013.