Systemic effects (risks) of water fluoridation

Abstract Since the 1950s, the benefits and risks of fluoridated water use have been debated worldwide. In the past, it was considered that the systemically ingested fluoride would exert its primary preventive effect after being incorporated into the enamel as fluorapatite, making the enamel more resistant to the caries process; however, it is now recognized that the main effect of water fluoridation is local and post eruptive. On the other hand, irrespective of the caries decline reported worldwide, the anticaries benefit of water fluoridation continues to be observed even in developed countries. Regarding the risks, water fluoridation is considered an acceptable community-based method for fluoride delivery, because the risk of developing dental fluorosis lesions due to the ingestion of fluoride during the enamel formation period has been deemed acceptable when contrasted to the anticaries benefits of fluoride. However, the use of fluoride in water to control caries has created a controversy due to data associating water fluoridation as the cause of some systemic diseases. Therefore, the aim of this descriptive review was to discuss the systemic effects (risks) of water fluoridation use.

Resumo Desde 1950, os benefícios e riscos do uso da água fluoretada têm sido debatidos mundialmente. No passado, foi considerado que o fluoreto ingerido sistemicamente exerceria seu efeito preventivo de cárie pela sua incorporação ao esmalte como fluorapatita, tornando o esmalte mais resistente ao processo de desenvolvimento de lesões de cárie; entretanto, é atualmente reconhecido que o principal efeito da fluoretação da água é local e pós-eruptivo. Por outro lado, independente do declínio de cárie que tem sido observado mundialmente, o benefício anticárie da fluoretação da água continua sendo observado mesmo em países desenvolvidos. Com relação aos riscos, fluoretação da água é considerada uma estratégia aceitável de saúde pública para uso de fluoreto, porque o risco de desenvolvimento de fluorose dental devido à ingestão de fluoreto durante o período de formação do esmalte foi considerado aceitável quando comparado aos benefícios anticárie do flúor. Entretanto, o uso de fluoreto na água para controlar cárie tem gerado controvérsias devido a dados de pesquisa que associam fluoretação da água como causa de algumas doenças sistêmicas. Assim, o objetivo dessa revisão descritiva foi discutir os efeitos sistêmicos (riscos) da fluoretação da água..

Effect of fluoride on major organs with the different time of exposure in rats

BACKGROUND@#High fluoride levels in drinking water in relation to the prevalence of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka were investigated using rats as an experimental model.@*METHOD@#The effects of fluoride after oral administration of Sodium fluoride (NaF) at levels of 0, 0.5, 5 and 20 ppm F were evaluated in adult male Wistar rats. Thirty-six rats were randomly divided into 4 groups (n = 9), namely, control, test I, II, and III. Control group was given daily 1 ml/rat of distilled water and test groups I, II, and III were treated 1 ml/rat of NaF doses of 0.5, 5, and 20 ppm, respectively, by using a stomach tube. Three rats from the control group and each experimental group were sacrificed after 15, 30, and 60 days following treatment. Serological and histopathological investigations were carried out using blood, kidney, and liver.@*RESULTS@#No significant differences were observed in body weight gain and relative organ weights of the liver and kidney in fluoride-treated groups compared to control group. After 60 days of fluoride administration, group I showed a mild portal inflammation with lytic necrosis while multiple areas of focal necrosis and various degrees of portal inflammation were observed in groups II and III. This was further confirmed by increased serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) activities. As compared with control and other treated groups, group III showed a significantly higher serum AST activity (p < 0.05) and ALT activity (p < 0.05) after 60 days and ALP activity with a significant difference (p < 0.05) after 15, 30, and 60 days. The renal histological analysis showed normal histological features in all groups with the elevated serum creatinine levels in group III compared to those in the groups I and II (p < 0.05) after 60 days. Significantly elevated serum fluoride levels were observed in group II of 30 and 60 days and group III after 15, 30, and 60 days with respective to control groups (p < 0.05).@*CONCLUSION@#Taken together, these findings indicate that there can be some alterations in liver enzyme activities at early stages of fluoride intoxication followed by renal damage.

Protective role of diet supplements Spirulina and Tamarind fruit pulp on kidney in sodium fluoride exposed Swiss albino mice: Histological and biochemical indices.

Fluoride toxicity through potable water, particularly ground water, is not uncommon in countries such as India, China, Iran, Iraq, Turkey, parts of Africa and Afghanistan. Kidney being the main organ involved in fluoride removal, it accumulates considerable amount of fluoride. Here, we report toxic effects of oral exposure of Swiss albino mice to fluoride (sub-acute: 190 mg/kg body wt. for 7days; and sub-chronic: 94 mg/kg body wt. for 90 days) and recovery of sub-chronic fluoride exposed mice after 90 days of sodium fluoride (NaF) withdrawal. The role of diet supplements (Spirulina and tamarind fruit pulp @ 230 mg/kg body wt. independently as well as in combination) in amelioration of fluoride toxicity has also been screened. Compared with controls, feed intake decreased from 3-43%, body wt. 4-18%, and kidney wt. 5-12% in treated mice (except diet supplement groups of sub-chronic exposure) while their water intake increased from 4-43%. Histopathological changes in the cortical region of kidney in fluoride treated mice were as follows: dilation of bowman’s capsule and thickening of its parietal and visceral layer; alterations in glomeruli size and their sclerotization; increase in bowman’s space; proliferation of mesangial cells; reduction in podocyte counts; and dilation of proximal and distal tubules. Fluoride exposure altered tissue biochemistry (protein, acid phosphatase and alkaline phosphatase content) and increased urea (23-58%) and creatinine content (14-127%) in the serum. Sub-acute exposure was found more toxic. The diet modulation not only reduced fluoride toxicity but also led to better recovery of treated mice after withdrawal, especially in combination.

Effects of fluoride on germination, early growth and antioxidant enzyme activities of legume plant species Prosopis juliflora.

Prosopis juliflora (Mimosoideae) is a fast growing and drought resistant tree of semi-arid region of India where fluoride (F) toxicity is a common problem. In the present investigations this species was fluoride tested to check their capacity as bioindicator plant and its efficiency to accumulate. To achieve this aim, P. juliflora seedlings grown in hydroponic culture containing different concentrations of F were analyzed for germination percentage together with some biochemical parameters viz, antioxidant enzyme activities, total chlorophyll and accumulation of F in different plant parts. After 15 days of treatment, root growth (r = -0.928, p<0.01), shoot growth (r = -0.976, p<0.01), vigor index (r = -0.984, p<0.01) were in decreasing trend with increasing concentration of NaF. Both catalase (3.2 folds) and peroxidase (2.7 folds) enzymes activity increased with increase in F concentration. Plant accumulated larger portion of the F in the roots (1024.63 µg g-1 d.wt.) followed by shoot (492.30 µg g-1 d.wt.). As P. juliflora did not show any morphological changes (marginal and tip chlorosis of leaf portions, necrosis and together these features are referred to as leaf “tip-burn”) therefore, this species may be used as suitable bioindicator species for potentially F affected areas. Further, higher accumulation of F in roots indicates that P. juliflora is a suitable species for the removal of F in phytoremediation purposes.

Effect of maternal fluoride exposure on developing CNS of rats: Protective role of Aloe vera, Curcuma longa and Ocimum sanctum.

Fluoride is toxic to neuronal development and its excessive intake during pregnancy cause adverse effects on neonatal development. The present study examined the presence of oxidative stress during maternal exposure of fluoride and the therapeutic strategy of Aloe vera, Curcuma longa and Ocimum sanctum extracts in functional prevention of fluoride led oxidative stress. The pregnant Wistar rats were exposed to 100 ppm fluoride in drinking water and pups born to them were supplemented with phytoextracts daily. On 21st postpartum day, the pups were sacrificed to analyse fluoride and oxidative stress markers. Fluoride exposure significantly increased its accumulation, lipid peroxidation and decreased the activities of catalase, superoxide dismutase, glutathione peroxidase, glutathione-S-transferase and glutathione levels in discrete regions of the central nervous system (CNS) of pups indicating oxidative stress and inhibited antioxidant defense. The results implied the vulnerability of developing CNS to fluoride toxicity. On phytoextract supplementation, the oxidant devastation was suppressed by regaining antioxidant homeostasis near normal level proving efficacy and therapeutic strategy. Among the phytoextracts supplemented the Ocimum sanctum is found to be more effective.

Arsenic and fluoride: Two major ground water pollutants.

Increasing human activities have modified the global cycle of heavy metals, non metals and metalloids. Both arsenic and fluoride are ubiquitous in the environment. Thousands of people are suffering from the toxic effects of arsenicals and fluorides in many countries all over the world. These two elements are recognized worldwide as the most serious inorganic contaminants in drinking water. Many studies have reported as regards to simple fluorosis and arsenicosis, but the knowledge of the joint action of these two elements is lacking and the results derived from previous studies were inconclusive. Contradictory results were reported in experimental studies in which different joint actions such as independent, synergistic and antagonistic effects were observed. This indicates that interaction mechanism of these two elements is considerable complicated and requires extensive studies. When two different types of toxicants are simultaneously going inside a human body they may function independently or can act as synergistic or antagonistic to one another. Thus there is an urge to resolve the question that how arsenic and fluoride act in condition of concomitant exposure. Although there have been reports in literature of individual toxicity of arsenic and fluoride however, there is very little known about the effects following the combined exposure to these toxicants. This review focused on recent developments in the research on the condition of individual exposure to arsenic and fluoride along with the recent updates of their combined exposure to better understand the joint action of these two toxicants.