Relationships between fluoride intake, urinary fluoride excretion and fluoride retention in children and adults: an analysis of available data.

The aim of this study was to examine the relationship between total daily fluoride intake (TDFI), daily urinary fluoride excretion (DUFE) and fractional fluoride retention (FFR) using available data, in order to clarify the ability of DUFE to predict TDFI and, therefore, the risk of fluorosis development. Examination of published reports of simultaneous measurement of TDFI and DUFE, together with data from two unpublished Chilean studies, yielded data for 212 children aged less than 7 years and for 283 adults aged 18-75 years, providing a total of 212 and 269 data points, respectively. The relationship between DUFE and TDFI was studied for children and adults, separately. Daily fluoride retention (DFR) was estimated as a function of TDFI in children and adults assuming an average 90% fluoride absorption, and the numerical relationships between the estimated FFR and the TDFI were explored. Limiting FFR values of 0.55 and 0.36 were found for children and adults, respectively, above a threshold of TDFI of 0.5 and 2 mg, respectively. Neutral fluoride balances were predicted when the TDFI was equal to approximately 0.07 mg F/day for children and 0.8 mg F/day for adults. For children and adults, it is possible to obtain reasonably good estimations of community-based TDFI and DFR, using DUFE data. The advantages and limitations of these relationships, together with the need for future studies, are discussed.

The fractional urinary fluoride excretion of adults consuming naturally and artificially fluoridated water and the influence of water hardness: a randomized trial.

AIMS: To assess whether there was any significant difference in the average fractional urinary fluoride excretion (FUFE) values among adults consuming (NaF) fluoridated Ca-free water (reference water), naturally fluoridated hard water and an artificially (H2SiF6) fluoridated soft water. DESIGN: Sixty adult females (N=20 for each treatment) participated in this randomized, double-blind trial. The experimental design of this study provided an indirect estimation of the fluoride absorption in different types of water through the assessment of the fractional urinary fluoride excretion of volunteers. RESULTS: Average daily FUFE values (daily amount of fluoride excreted in urine/daily total fluoride intake) were not significantly different between the three treatments (Kruskal-Wallis; p = 0.62). The average 24-hour FUFE value (n=60) was 0.69; 95% C.I. 0.65-0.73. CONCLUSIONS: The results of this study suggest that the absorption of fluoride is not affected by water hardness.

Fractional urinary fluoride excretion of young female adults during the diurnal and nocturnal periods.

OBJECTIVES: This study aimed to confirm a previously obtained value for the fractional urinary fluoride excretion (FUFE) over a 24-hour period in adults and to assess whether there are significant differences between FUFE measured during the diurnal (7 a.m. and 6 p.m.) and the subsequent nocturnal (6 p.m. until 7 a.m. of the following day) periods. METHODS: Urine was collected over 24 h from 60 healthy female volunteers residing in Santiago, Chile. The individuals' fluoride intakes over the diurnal and nocturnal periods were calculated from their corresponding F ingestion, measured by dietary analysis. Separate urine collections during both periods were obtained from each volunteer. The fluoride concentrations were measured with a fluoride-ion-selective electrode either directly (urine, water and beverages) or after sample treatment with the microdiffusion technique (food). RESULTS: The average 24-hour FUFE value was 0.69, with a 95% CI of 0.65-0.72, while the average FUFE for the diurnal period was 0.46 (95% CI: 0.42-0.50), and the corresponding result for the nocturnal period showed a significantly higher (paired t test, p < 0.0001) amount of 1.09 (95% CI: 0.97-1.22). CONCLUSIONS: A recently published result for the daily FUFE value (0.71) in adults was confirmed. The diurnal average FUFE value is significantly lower than the average nocturnal one. Accepting that approximately 10% of the fluoride intake is not absorbed, the daily fluoride retention can be preliminarily estimated as 20% of the ingested fluoride.

The fractional urinary fluoride excretion in young children under stable fluoride intake conditions.

The purpose of this study was to determine the fraction of the total daily fluoride intake that is excreted through the urine (FUEF) of children aged 3-5 years under usual intake conditions. Participating children were residents of an area with a fluoride (F) concentration of 0.5-0.6 mg/L in their drinking water. Assessments were made on two successive 24-h periods on 20 children, measuring the total amount of fluoride ingested through liquid and food consumption, and from ingestion of fluoridated toothpaste (500 microg F/g), together with the determination of the amount of fluoride excreted through urine. Fluoride retention was also estimated assuming a constant average F fraction of 10% excreted through faeces. It was found that the average proportion of liquids, solid foods, and toothpaste to the daily fluoride intake (1.02-mg F/day on average) were 40.8, 34.6, and 24.5%, respectively. The average FUEF value was 35.5% (95% C.I.=31.7-39.3%), and the estimated fractional F retention was 54.5%. The present data suggest a slight relationship between FUEF values and the inverse of the daily fluoride dose (1/dose) (r=0.513; P=0.021). When the present results are combined with those from previous studies on F-retention and urinary excretion, the correlation between both FUEF and fractional retention and 1/dose are very strong and highly significant (r=0.98, P<0.0001, and r=-0.986, P<0.0001, respectively). A possible mechanism is suggested in order to explain this latter finding. The potential usefulness of the current FUEF value for the estimation of daily F intake (or dose) from urinary F excretion data is also discussed.

Estimation of the fraction of an ingested dose of fluoride excreted through urine in pre-school children.

OBJECTIVE: To determine the fraction of an ingested fluoride dose of 1 mg in 50 mL orange juice that is excreted through the urine (FUEF) of children aged 3-5 years. METHODS: Eighty-eight controlled determinations involving 24-hour urinary collections from a total of 48 children were carried out during consecutive control and test days. Net fluoride urinary excretion due to the ingested dose was calculated as the difference between the total amount of fluoride excreted by each child on test and control days. RESULTS: Excretion of the fluoride ingested from the single fluoride dose presented an average value of 30.7% (95% CI: 28.9-32.5%). No significant associations were found between individual FUEF values with either anthropometrical variables or urinary pH values. The average FUEF value found in the present study lies between previously reported values for infants and young adults. The epidemiological usefulness of the FUEF values in estimating daily fluoride dose in pre-school children is discussed.

Dental fluorosis in Chilean children: evaluation of risk factors.

The purpose of this case-control study was to determine the association between very-mild-to-moderate enamel fluorosis and exposure during early childhood to fluoridated water, mainly through ingestion of powdered milk. Analysis was performed on 136 residents of the optimally fluoridated community of San Felipe in the Chilean Fifth Region, who were categorised into one of three groups according to their age when water fluoridation was introduced in 1986: Group I was born after 1986; Group II was 16-24 months old in 1986; and Group III was >24 months of age. The case and control subjects were selected on the basis of a clinical examination given in July 1996. Dean's scoring system was used to determine fluorosis status. Risk factor exposure was ascertained by a questionnaire used in interviews with mothers of participating children. Logistic regression analysis, after adjustment for confounding variables, revealed that very-mild-to-moderate enamel fluorosis of permanent central maxillary incisors (CMI) was strongly associated both with the age of the subjects when water fluoridation began and with breast-feeding duration for children belonging to Group I. Subjects in Group I were 20.44 times more likely (95% CI: 5.00-93.48) to develop CMI fluorosis than children who were older than 24 months (Group III) when fluoridation began. Subjects who were between 16 and 24 months old when water fluoridation began were 4.15 times more likely (95% CI: 1.05-16.43) to have CMI fluorosis than children older than 24 months. An inverse association was found with breastfeeding duration (OR=0.86, 95% CI: 0.75-0.98) among Group I subjects but not in Groups II and III. Results obtained suggest that the current fluoride concentration in drinking water may be contributing to fluorosis. Further studies will be necessary to determine the relative competing risks of dental fluorosis and dental caries in Chilean children in order to establish the most appropriate water fluoridation level in Chile.

Studies related to progesterone-induced hamster sperm acrosome reaction.

Experiments were designed to characterize the effect of progesterone on the hamster sperm acrosome reaction (AR). Progesterone stimulated exocytosis of previously capacitated spermatozoa in a dose-dependent manner. Progesterone-3-(O-carboxymethyl)oxime:BSA conjugate also induced AR when added to capacitated sperm suspensions. EGTA and La3+, added 10 min before progesterone, completely abolished the steroid-stimulatory effect. Benzamidine, a trypsin inhibitor, also inhibited AR when added to sperm cells 10 min before progesterone. This effect was avoided when spermatozoa were treated with the Ca2+ ionophore ionomycin. Conversely, the H+ ionophore FCCP, or the Na+/K+ ionophore nigericin, did not prevent the effect of the inhibitor. Results suggest that progesterone acts on the hamster sperm plasma membrane to stimulate exocytosis, which requires external Ca2+ and presumably Ca2+ influx. In addition, a sperm trypsin-like protease may be part of the mechanism by which progesterone stimulates AR. Since the ionomycin-induced AR does not require this proteolytic activity, the possible involvement of such an enzyme in the progesterone-stimulated Ca2+ influx necessary for the occurrence of AR is discussed.