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. 2024 Jan 1;16(1):e51-e61.
doi: 10.4317/jced.61052. eCollection 2024 Jan.

Enamel fluorosis related with fluoride-containing water ingestion and urinary excretion in schoolchildren

Farith González-Martínez  1   2   3 , Ruth Gómez-Scarpetta  3   4 , Olga-Bibiana Salcedo  5 , Patricia Bermúdez-Reyes  6 , Patricia Castro-Villamizar  7 , María Del Pilar Cerezo  8 , Carmen Martínez  9 , Lesbia Tirado-Amador  10 , Andrés Salas-Zambrano  11 , Alexandra Saldarriaga  12 , Marisol Sánchez-Molina  13 , Luis-Armando Vila  14
Affiliations

Enamel fluorosis related with fluoride-containing water ingestion and urinary excretion in schoolchildren

Farith González-Martínez et al. J Clin Exp Dent. .

Abstract

Background: Natural water sources are considered as the major environmental exposure of fluoride, resulting in increased prevalence of enamel fluorosis. This type of natural exposure should be permanently monitored to avoid the interactions with other non-natural fluoride sources. We evaluated the prevalence of enamel fluorosis in Colombian schoolchildren and its relationship with fluoride-containing water ingestion exposure dose and urinary fluoride excretion.

Material and methods: We included 923 schoolchildren aged 7-12 years residing in eight municipalities in Colombia. Sampling of consumption water was performed in major aquifers used for daily supply. Samples were collected in 98 polyethylene containers and refrigerated until analysis. Water and urine fluoride concentrations were measured using the fluoride selective electrode method. Enamel fluorosis was evaluated using Thylstrup and Ferjerskov Index (TFI). Demographic and anthropometric characteristics were assessed. Besides, other exposures to non-natural fluoride were also evaluated. Logistic regression was applied for multiple analyses.

Results: The median fluoride concentration in water and urine samples was 10.5 mg/L and 0.63 mg/L respectively, with the highest value found in Algarrobo-Magdalena, and the lowest value found in Manzanares-Caldas. The overall prevalence of enamel fluorosis was 86.1%, being more frequent the mild codes with TFI-1 to TFI-2. The highest prevalence was found in Margarita-Bolívar and Manzanares-Caldas, and the most severe codes (TFI-5 to TFI-9) were detected in Manzanares-Caldas. The multiple analysis revealed water ingestion exposure dose, urinary excretion, involuntary intake of toothpaste, amount of table salt consumption and sex as significant factors (p< 0.001).

Conclusions: The fluoride ingestion exposure dose and its subsequent urinary excretion could be used as estimators of past fluoride exposure, explaining the current prevalence of enamel fluorosis in Colombian schoolchildren. Key words:Fluoride, groundwater ingestion, enamel fluorosis, prevalence, severity.

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Conflict of interest statement

Conflicts of interest The authors have declared that no conflict of interest exist.

Figures

Figure 1
Figure 1
Location map of the study municipalities (Colombia, 2018). Source: own elaboration.
See this image and copyright information in PMC

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