불소는 갑상선기능저하증의 원인이 될 수 있다? YES, 과도한 불소섭취와 갑상선기능저하증은 관련이 깊습니다.
Indian J Dent Res. 2018 May-Jun;29(3):358-363. doi: 10.4103/ijdr.IJDR_505_16.
A systematic analysis on possibility of water fluoridation causing hypothyroidism.
Chaitanya NCSK1, Karunakar P2, Allam NSJ1, Priya MH1, Alekhya B1, Nauseen S1.
1
Department of Oral Medicine and Radiology, Principal, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India.
2
Department of Conservative Dentistry and Endodontics, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India.
Abstract
Background:
Community water fluoridation is widely used worldwide and its role in preventive dental health care is well established. However, there is sufficient evidence of the ill effects of excessive fluoride content in water, causing skeletal and dental fluorosis. Alongside, there was also extraskeletal and dental manifestations of excessive fluorides reported. They include the effect on thyroid function, but the literature regarding this is sparse.
Aim:
The present systematic review aims to analyze the data from controlled studies about the effect of fluoride on thyroid function.
Materials and Methods:
A systematic literature search was performed using PUBMED, MEDLINE, EMBASE, COCHRANE Library, EBSCO search, and the internet search, with language restriction to English. The search included published studies which dealt with the association of fluorine with hypothyroidism, from January 1981 to November 2015. Literature search was done using keywords: fluoride and hypothyroidism, dental fluorosis and thyroid disorders, systemic fluorosis and thyroid disease, excessive water fluoridation and hypothyroidism, thyroid and fluoride, fluorosis and its adverse effects.
Results:
Out of 166 publications, related to search strategy, 37 full articles which were related with the association of fluoride and hypothyroidism were acquired for further inspection. Out of the 37 articles, 10 articles met the inclusion criteria. The data were extracted and placed in an excel sheet and were analyzed. The analysis suggested a positive correlation of excess fluoride and hypothyroidism.
Conclusion:
The present systematic review suggests a positive correlation between excess fluoride and hypothyroidism. This calls the need for further well-controlled studies in this otherwise emerging alarming issue. It also calls for considerable community network through health informatics for problem sensitization.
KEYWORDS:
Hypothyroidism; systematic analysis; water fluoridation
Cochrane Database Syst Rev. 2017 Oct 23;10:CD011850. doi: 10.1002/14651858.CD011850.pub2.
불소는 청소년의 신장과 간기능에 나쁜 영향을 줄 수 있다? YES
Environ Int. 2019 Nov;132:105012. doi: 10.1016/j.envint.2019.105012. Epub 2019 Aug 8.
Fluoride exposure and kidney and liver function among adolescents in the United States: NHANES, 2013-2016.
Malin AJ1, Lesseur C2, Busgang SA2, Curtin P2, Wright RO3, Sanders AP3.
1
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: Ashley.malin@mssm.edu.
2
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
3
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
BACKGROUND:
Hepato- and nephrotoxicity of fluoride have been demonstrated in animals, but few studies have examined potential effects in humans. This population-based study examines the relationship between chronic low-level fluoride exposure and kidney and liver function among United States (U.S.) adolescents. This study aimed to evaluate whether greater fluoride exposure is associated with altered kidney and liver parameters among U.S. youth.
METHODS:
This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2013-2016). We analyzed data from 1983 and 1742 adolescents who had plasma and water fluoride measures respectively and did not have kidney disease. Fluoride was measured in plasma and household tap water. Kidney parameters included estimated glomerular filtration rate (calculated by the original Schwartz formula), serum uric acid, and the urinary albumin to creatinine ratio. Liver parameters were assessed in serum and included alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, blood urea nitrogen, gamma-glutamyl transferase, and albumin. Survey-weighted linear regression examined relationships between fluoride exposure and kidney and liver parameters after covariate adjustment. A Holm-Bonferroni correction accounted for multiple comparisons.
RESULTS:
The average age of adolescents was 15.4 years. Median water and plasma fluoride concentrations were 0.48 mg/L and 0.33 μmol/L respectively. A 1 μmol/L increase in plasma fluoride was associated with a 10.36 mL/min/1.73 m2 lower estimated glomerular filtration rate (95% CI: -17.50, -3.22; p = 0.05), a 0.29 mg/dL higher serum uric acid concentration (95% CI: 0.09, 0.50; p = 0.05), and a 1.29 mg/dL lower blood urea nitrogen concentration (95%CI: -1.87, -0.70; p < 0.001). A 1 mg/L increase in water fluoride was associated with a 0.93 mg/dL lower blood urea nitrogen concentration (95% CI: -1.44, -0.42; p = 0.007).
CONCLUSIONS:
Fluoride exposure may contribute to complex changes in kidney and liver related parameters among U.S. adolescents. As the study is cross-sectional, reverse causality cannot be ruled out; therefore, altered kidney and/or liver function may impact bodily fluoride absorption and metabolic processes.
Hum Exp Toxicol. 2019 Mar;38(3):269-279. doi: 10.1177/0960327118814161. Epub 2018 Nov 25.
Exploring the role of excess fluoride in chronic kidney disease: A review.
1
National Center for Natural Products Research, School of Pharmacy, University of Mississippi, Oxford, MS, USA.
Abstract
This review covers nearly 100 years of studies on the toxicity of fluoride on human and animal kidneys. These studies reveal that there are direct adverse effects on the kidneys by excess fluoride, leading to kidney damage and dysfunction. With the exception of the pineal gland, the kidney is exposed to higher concentrations of fluoride than all other soft tissues. Therefore, exposure to higher concentrations of fluoride could contribute to kidney damage, ultimately leading to chronic kidney disease (CKD). Among major adverse effects on the kidneys from excessive consumption of fluoride are immediate effects on the tubular area of the kidneys, inhibiting the tubular reabsorption; changes in urinary ion excretion by the kidneys disruption of collagen biosynthesis in the body, causing damages to the kidneys and other organs; and inhibition of kidney enzymes, affecting the functioning of enzyme pathways. This review proposes that there is a direct correlation between CKD and the consumption of excess amounts of fluoride. Studies particularly show immediate adverse effects on the tubular area of human and animal kidneys leading to CKD due to the consumption of excess fluoride. Therefore, it is very important to conduct more investigations on toxicity studies of excess fluoride on the human kidney, including experiments using human kidney enzymes, to study more in depth the impact of excess fluoride on the human kidney. Further, the interference of excess fluoride on collagen synthesis in human body and its effect on human kidney should also be further investigated.
임신 중 불소를 섭취하면 태어나는 아기의 충치예방에 도움이 된다? NO
임신 중 불소섭취와 태어나는 아기의 충치예방과는 아무런 관련이 없습니다. 오히려 ADHD증상을 유발할 수 있습니다.
Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children.
Takahashi R1, Ota E, Hoshi K, Naito T, Toyoshima Y, Yuasa H, Mori R, Nango E.
1
Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan, 113-8549.
Abstract
BACKGROUND:
Dental caries (tooth decay) is one of the most common chronic childhood diseases. Caries prevalence in most industrialised countries has declined among children over the past few decades. The probable reasons for the decline are the widespread use of fluoride toothpaste, followed by artificial water fluoridation, oral health education and a slight decrease in sugar consumption overall. However, in regions without water fluoridation, fluoride supplementation for pregnant women may be an effective way to increase fluoride intake during pregnancy. If fluoride supplements taken by pregnant women improve neonatal outcomes, pregnant women with no access to a fluoridated drinking water supply can obtain the benefits of systemic fluoridation.
OBJECTIVES:
To evaluate the effects of women taking fluoride supplements (tablets, drops, lozenges or chewing gum) compared with no fluoride supplementation during pregnancy to prevent caries in the primary teeth of their children.
SEARCH METHODS:
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 25 January 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11) in the Cochrane Library (searched 25 January 2017); MEDLINE Ovid (1946 to 25 January 2017); Embase Ovid (1980 to 25 January 2017); LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 25 January 2017); and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 25 January 2017). We searched the US National Institutes of Health ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 25 January 2017. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA:
Randomised controlled trials (RCTs) of fluoride supplements (tablets, drops, lozenges or chewing gum) administered to women during pregnancy with the aim of preventing caries in the primary teeth of their children.
DATA COLLECTION AND ANALYSIS:
Two review authors independently screened the titles and abstracts (when available) of all reports identified through electronic searches. Two review authors independently extracted data and assessed risk of bias, as well as evaluating overall quality of the evidence utilising the GRADE approach. We could not conduct data synthesis as only one study was included in the analysis.
MAIN RESULTS:
Only one RCT met the inclusion criteria for this review. This RCT showed no statistical difference on decayed or filled primary tooth surfaces (dfs) and the percentage of children with caries at 3 years (risk ratio (RR) 1.46, 95% confidence interval (CI) 0.75 to 2.85; participants = 938, very low quality of evidence) and 5 years old (RR 0.84, 95% CI 0.53 to 1.33; participants = 798, very low quality of evidence). The incidence of fluorosis at 5 years was similar between the group taking fluoride supplements (tablets) during the last 6 months of pregnancy and the placebo group.
AUTHORS' CONCLUSIONS:
There is no evidence that fluoride supplements taken by women during pregnancy are effective in preventing dental caries in their offspring.
임신 중 불소를 과도하게 섭취하면 태아의 뇌 발달에 영향을 줄 수 있다?
YES
임신 중 불소섭취와 ADHD(주의집중력결핍 및 과잉행동장애)와 관련이 있다는 연구결과가 다수 있습니다.
Environ Int. 2019 Dec;133(Pt B):105190. doi: 10.1016/j.envint.2019.105190. Epub 2019 Oct 22.
Association of water fluoride and urinary fluoride concentrations with attention deficit hyperactivity disorder in Canadian youth.
Riddell JK1, Malin AJ2, Flora D3, McCague H4, Till C3.
1
Faculty of Health, York University, ontario, Canada. Electronic address: jriddell@yorku.ca.
2
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
3
Faculty of Health, York University, ontario, Canada.
4
Institute for Social Research, York University, ontario, Canada.
Abstract
BACKGROUND:
Exposure to fluoride has been linked with increased prevalence of attention deficit hyperactivity disorder (ADHD) in the United States and symptoms of inattention in Mexican children. We examined the association between fluoride exposure and attention outcomes among youth living in Canada.
METHOD:
We used cross-sectional data collected from youth 6 to 17 years of age from the Canadian Health Measures Survey (Cycles 2 and 3). Urinary fluoride concentration adjusted for specific gravity (UFSG) was available for 1877 participants. Water fluoride concentration measured in tap water samples was available for 980 participants. Community water fluoridation (CWF) status was determined by viewing reports on each city's website or contacting the water treatment plant. We used logistic regression to test the association between the three measures of fluoride exposure and ADHD diagnosis. Linear regression was used to examine the relationship between the three measures of fluoride exposure and the hyperactivity/inattention score on the Strengths and Difficulties Questionnaire (SDQ).
RESULTS:
UFSG did not significantly predict ADHD diagnosis or hyperactive/inattentive symptoms. A 1 mg/L increase in tap water fluoride level was associated with a 6.1 times higher odds of an ADHD diagnosis (95% CI = 1.60, 22.8). A significant interaction between age and tap water fluoride level (p = .03) indicated a stronger association between tap water fluoride and hyperactivity/inattention symptoms among older youth. A 1 mg/L increase in water fluoride level was associated with a 1.5 SDQ score increase (95% CI: 0.23, 2.68, p = .02) for youth at the 75th percentile of age (14 years old). Similarly, there was a significant interaction between age and CWF. At the 75th percentile of age (14 years old), those living in a fluoridated region had a 0.7-point higher SDQ score (95% CI = 0.34, 1.06, p < .01) and the predicted odds of an ADHD diagnosis was 2.8 times greater compared with youth in a non-fluoridated region (aOR = 2.84, 95% CI: 1.40, 5.76, p < .01).
DISCUSSION:
Exposure to higher levels of fluoride in tap water is associated with an increased risk of ADHD symptoms and diagnosis of ADHD among Canadian youth, particularly among adolescents. Prospective studies are needed to confirm these results.
천연불소는 치약 등에 들어가는 불소화합물보다 안전하고 생체친화적이다? NO
자연상태(지하수)등에 함유된 고농도 불소는 치아불소증, 골격불소증 등의 원인이 되며 독성이 강한 물질입니다.
Cien Saude Colet. 2019 Aug 5;24(8):2909-2922. doi: 10.1590/1413-81232018248.19172017.
Prevalence of dental fluorosis in regions supplied with non-fluoridated water in the Brazilian territory: a systematic review and meta-analysis.
[Article in English, Portuguese; Abstract available in Portuguese from the publisher]
Lima IFP1, Nóbrega DF2, Cericato GO3, Ziegelmann PK4, Paranhos LR5.
1
Programa de Pós-Graduação em Odontologia, Universidade Federal do Rio Grande do Sul (UFRGS). R. Ramiro Barcelos 2492, Santa Cecília. 90035-004. Porto Alegre RS Brasil. igorfelipe002@gmail.com.
2
Mestrado Profissional Pesquisa em Saúde, Centro Universitário Cesmac. Maceió AL Brasil.
3
Curso de Odontologia, Faculdade Meridional. Passo Fundo RS Brasil.
4
Departamento de Estatística, UFRGS. Porto Alegre RS Brasil.
5
Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia, Universidade Federal de Uberlândia. Uberlândia MG Brasil.
Abstract
in English, Portuguese
This systematic review and meta-analysis aimed to estimate and compare the prevalences of dental fluorosis in Brazilian cities supplied with non-fluoridated water and in locations that uses groundwater. In December of 2016, cross-sectional studies were searched in eight databases, including the "grey literature". The prevalences were estimated through a mixed random effects model considering the locations as subgroups. The heterogeneity among the studies was assessed with I2 statistics and the Cochran's Q test. A total of 1038 records were found, from which only 18 articles met the inclusion criteria and were subjected to analysis. The meta-analytic model estimated a prevalence of dental fluorosis of 8.92 % (95 % CI: 5.41 % to 14.36 %) in cities supplied with non-fluoridated water, and of 51.96 % (95 % CI: 31.03 % to 72.22 %) in cities supplied by artesian wells. The heterogeneity among the studies was high: I2 = 95 % (p < 0.01) in the first subgroup of cities and I2 = 98 % (p < 0.01) in the second subgroup. The prevalence was significantly higher (p < 0.001) in populations exposed to artesian well water, indicating that the presence of natural fluoride at high concentrations represents a risk factor for the occurrence of dental fluorosis.
치아불소증은 불소의 과다공급에 의해 생긴 자연스러운 것이고 치아의 손상이나 질환과는 관련이 없다? NO 치아불소증은 치아에나멜의 영구적인 손상으로 미관상 좋지 않아 여러 치료방법이 논의 되고 있으나 마땅히 효과적인 치료방법은 아직까지 없습니다.
J Esthet Restor Dent. 2018 Nov;30(6):502-508. doi: 10.1111/jerd.12408. Epub 2018 Sep 8.
Interventions for dental fluorosis: A systematic review.
Di Giovanni T1, Eliades T1, Papageorgiou SN1.
1
Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
Abstract
OBJECTIVE:
Dental fluorosis has considerable implications on the patients' quality of life. The present study assesses the comparative effectiveness of the various interventions for the treatment of fluorosed enamel.
MATERIALS AND METHODS:
Nine databases were searched from inception to December 2016 for randomized trials. After duplicate study selection, data extraction, and risk of bias assessment, mean differences (MD) or Relative Risks and the corresponding 95% confidence intervals (CIs) were calculated and assessed with the GRADE approach.
RESULTS:
Six trials with a total of 348 patients (at least 40% male/60% female) with a mean age of 17.7 years treated with bleaching, microabrasion, or resin infiltration were included. Evidence of low quality indicated that microabrasion resulted in smaller esthetic improvement compared to bleaching (MD = -2.9; 95% CI = -3.4 to -2.5). Evidence of moderate quality indicated that compared to bleaching a greater esthetic improvement was seen with resin infiltration (MD = 3.6; 95% CI = 2.7-4.6) or a combination of bleaching with resin infiltration (MD = 3.5; 2.8-3.7). However, all comparisons were supported from single trials and therefore caution is warranted.
CONCLUSIONS:
Based on the existing limited evidence, resin infiltration seems to be the most promising treatment for dental fluorosis, followed by bleaching and microabrasion.
CLINICAL SIGNIFICANCE:
For this systematic review, which was registered beforehand in PROSPERO (CRD42016053492), we synthesized evidence from existing randomized clinical trals on humans to see which treatment is most effective for the esthetic rehabilitation of dental fluorosis, the prevalence of which is seeing a worldwide steady increase. We found that resin infiltration seems to be the most effective treatment approach for lesions of mild to moderate severity, followed by bleaching, and finally microabrasion. Our study's strengths are its a priori registration, wide search, quality check according to Cochrane guidelines, and the use of a new robust analytic method to provide valid clinical recommendations according to the principles of evidence-based medicine.
치약에 들어 있는 불소의 함량이나 농도가 높을수록 충치예방효과가 뛰어나다?
NO. 불소의 농도와 충칭예방은 별 상관관계가 없으며 오히려 치아불소증 예방을 위해 적당한 불소농도의 치약을 잘 선택해 사용해야 합니다.
Cochrane Database Syst Rev. 2019 Mar 4;3:CD007868. doi: 10.1002/14651858.CD007868.pub3.
Fluoride toothpastes of different concentrations for preventing dental caries.
Walsh T1, Worthington HV, Glenny AM, Marinho VC, Jeroncic A.
1
Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland Building 3, Oxford Road, Manchester, UK, M13 9PL.
Abstract
BACKGROUND:
Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). Regular toothbrushing with fluoride toothpaste is the principal non-professional intervention to prevent caries, but the caries-preventive effect varies according to different concentrations of fluoride in toothpaste, with higher concentrations associated with increased caries control. Toothpastes with higher fluoride concentration increases the risk of fluorosis (enamel defects) in developing teeth. This is an update of the Cochrane Review first published in 2010.
OBJECTIVES:
To determine and compare the effects of toothpastes of different fluoride concentrations (parts per million (ppm)) in preventing dental caries in children, adolescents, and adults.
SEARCH METHODS:
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 August 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7) in the Cochrane Library (searched 15 August 2018); MEDLINE Ovid (1946 to 15 August 2018); and Embase Ovid (1980 to 15 August 2018). The US National Institutes of Health ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 August 2018). No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA:
Randomised controlled trials that compared toothbrushing with fluoride toothpaste with toothbrushing with a non-fluoride toothpaste or toothpaste of a different fluoride concentration, with a follow-up period of at least 1 year. The primary outcome was caries increment measured by the change from baseline in the decayed, (missing), and filled surfaces or teeth index in all permanent or primary teeth (D(M)FS/T or d(m)fs/t).
DATA COLLECTION AND ANALYSIS:
Two members of the review team, independently and in duplicate, undertook the selection of studies, data extraction, and risk of bias assessment. We graded the certainty of the evidence through discussion and consensus. The primary effect measure was the mean difference (MD) or standardised mean difference (SMD) caries increment. Where it was appropriate to pool data, we used random-effects pairwise or network meta-analysis.
MAIN RESULTS:
We included 96 studies published between 1955 and 2014 in this updated review. Seven studies with 11,356 randomised participants (7047 evaluated) reported the effects of fluoride toothpaste up to 1500 ppm on the primary dentition; one study with 2500 randomised participants (2008 evaluated) reported the effects of 1450 ppm fluoride toothpaste on the primary and permanent dentition; 85 studies with 48,804 randomised participants (40,066 evaluated) reported the effects of toothpaste up to 2400 ppm on the immature permanent dentition; and three studies with 2675 randomised participants (2162 evaluated) reported the effects of up to 1100 ppm fluoride toothpaste on the mature permanent dentition. Follow-up in most studies was 36 months.In the primary dentition of young children, 1500 ppm fluoride toothpaste reduces caries increment when compared with non-fluoride toothpaste (MD -1.86 dfs, 95% confidence interval (CI) -2.51 to -1.21; 998 participants, one study, moderate-certainty evidence); the caries-preventive effects for the head-to-head comparison of 1055 ppm versus 550 ppm fluoride toothpaste are similar (MD -0.05, dmfs, 95% CI -0.38 to 0.28; 1958 participants, two studies, moderate-certainty evidence), but toothbrushing with 1450 ppm fluoride toothpaste slightly reduces decayed, missing, filled teeth (dmft) increment when compared with 440 ppm fluoride toothpaste (MD -0.34, dmft, 95%CI -0.59 to -0.09; 2362 participants, one study, moderate-certainty evidence). The certainty of the remaining evidence for this comparison was judged to be low.We included 81 studies in the network meta-analysis of D(M)FS increment in the permanent dentition of children and adolescents. The network included 21 different comparisons of seven fluoride concentrations. The certainty of the evidence was judged to be low with the following exceptions: there was high- and moderate-certainty evidence that 1000 to 1250 ppm or 1450 to 1500 ppm fluoride toothpaste reduces caries increments when compared with non-fluoride toothpaste (SMD -0.28, 95% CI -0.32 to -0.25, 55 studies; and SMD -0.36, 95% CI -0.43 to -0.29, four studies); there was moderate-certainty evidence that 1450 to 1500 ppm fluoride toothpaste slightly reduces caries increments when compared to 1000 to 1250 ppm (SMD -0.08, 95% CI -0.14 to -0.01, 10 studies); and moderate-certainty evidence that the caries increments are similar for 1700 to 2200 ppm and 2400 to 2800 ppm fluoride toothpaste when compared to 1450 to 1500 ppm (SMD 0.04, 95% CI -0.07 to 0.15, indirect evidence only; SMD -0.05, 95% CI -0.14 to 0.05, two studies).In the adult permanent dentition, 1000 or 1100 ppm fluoride toothpaste reduces DMFS increment when compared with non-fluoride toothpaste in adults of all ages (MD -0.53, 95% CI -1.02 to -0.04; 2162 participants, three studies, moderate-certainty evidence). The evidence for DMFT was low certainty.Only a minority of studies assessed adverse effects of toothpaste. When reported, effects such as soft tissue damage and tooth staining were minimal.
AUTHORS' CONCLUSIONS:
This Cochrane Review supports the benefits of using fluoride toothpaste in preventing caries when compared to non-fluoride toothpaste. Evidence for the effects of different fluoride concentrations is more limited, but a dose-response effect was observed for D(M)FS in children and adolescents. For many comparisons of different concentrations the caries-preventive effects and our confidence in these effect estimates are uncertain and could be challenged by further research. The choice of fluoride toothpaste concentration for young children should be balanced against the risk of fluorosis.
Update of
Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. [Cochrane Database Syst Rev. 2010]
수돗물에 불소를 넣으면 충치를 획기적으로 줄일 수 있다?
글쎄요? 아래 영국의 연구논문에 따르면 수돗물 불소화화 충치예방과 그다지 관련이 있지 않고 오히려 치아불소증 증가와는 확실한 관련이 있다고 합니다.
Cochrane Database Syst Rev. 2015 Jun 18;(6):CD010856. doi: 10.1002/14651858.CD010856.pub2.
Water fluoridation for the prevention of dental caries.
Iheozor-Ejiofor Z1, Worthington HV, Walsh T, O'Malley L, Clarkson JE, Macey R, Alam R, Tugwell P, Welch V, Glenny AM.
1
Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Coupland 3 Building, Oxford Road, Manchester, UK, M13 9PL.
Abstract
BACKGROUND:
Dental caries is a major public health problem in most industrialised countries, affecting 60% to 90% of school children. Community water fluoridation was initiated in the USA in 1945 and is currently practised in about 25 countries around the world; health authorities consider it to be a key strategy for preventing dental caries. Given the continued interest in this topic from health professionals, policy makers and the public, it is important to update and maintain a systematic review that reflects contemporary evidence.
OBJECTIVES:
To evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries.To evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis.
SEARCH METHODS:
We searched the following electronic databases: The Cochrane Oral Health Group's Trials Register (to 19 February 2015); The Cochrane Central Register of Controlled Trials (CENTRAL; Issue 1, 2015); MEDLINE via OVID (1946 to 19 February 2015); EMBASE via OVID (1980 to 19 February 2015); Proquest (to 19 February 2015); Web of Science Conference Proceedings (1990 to 19 February 2015); ZETOC Conference Proceedings (1993 to 19 February 2015). We searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization's WHO International Clinical Trials Registry Platform for ongoing trials. There were no restrictions on language of publication or publication status in the searches of the electronic databases.
SELECTION CRITERIA:
For caries data, we included only prospective studies with a concurrent control that compared at least two populations - one receiving fluoridated water and the other non-fluoridated water - with outcome(s) evaluated at at least two points in time. For the assessment of fluorosis, we included any type of study design, with concurrent control, that compared populations exposed to different water fluoride concentrations. We included populations of all ages that received fluoridated water (naturally or artificially fluoridated) or non-fluoridated water.
DATA COLLECTION AND ANALYSIS:
We used an adaptation of the Cochrane 'Risk of bias' tool to assess risk of bias in the included studies.We included the following caries indices in the analyses: decayed, missing and filled teeth (dmft (deciduous dentition) and DMFT (permanent dentition)), and proportion caries free in both dentitions. For dmft and DMFT analyses we calculated the difference in mean change scores between the fluoridated and control groups. For the proportion caries free we calculated the difference in the proportion caries free between the fluoridated and control groups.For fluorosis data we calculated the log odds and presented them as probabilities for interpretation.
MAIN RESULTS:
A total of 155 studies met the inclusion criteria; 107 studies provided sufficient data for quantitative synthesis.The results from the caries severity data indicate that the initiation of water fluoridation results in reductions in dmft of 1.81 (95% CI 1.31 to 2.31; 9 studies at high risk of bias, 44,268 participants) and in DMFT of 1.16 (95% CI 0.72 to 1.61; 10 studies at high risk of bias, 78,764 participants). This translates to a 35% reduction in dmft and a 26% reduction in DMFT compared to the median control group mean values. There were also increases in the percentage of caries free children of 15% (95% CI 11% to 19%; 10 studies, 39,966 participants) in deciduous dentition and 14% (95% CI 5% to 23%; 8 studies, 53,538 participants) in permanent dentition. The majority of studies (71%) were conducted prior to 1975 and the widespread introduction of the use of fluoride toothpaste.There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries across socioeconomic status (SES) levels.There is insufficient information to determine the effect of stopping water fluoridation programmes on caries levels.No studies that aimed to determine the effectiveness of water fluoridation for preventing caries in adults met the review's inclusion criteria.With regard to dental fluorosis, we estimated that for a fluoride level of 0.7 ppm the percentage of participants with fluorosis of aesthetic concern was approximately 12% (95% CI 8% to 17%; 40 studies, 59,630 participants). This increases to 40% (95% CI 35% to 44%) when considering fluorosis of any level (detected under highly controlled, clinical conditions; 90 studies, 180,530 participants). Over 97% of the studies were at high risk of bias and there was substantial between-study variation.
AUTHORS' CONCLUSIONS:
There is very little contemporary evidence, meeting the review's inclusion criteria, that has evaluated the effectiveness of water fluoridation for the prevention of caries.The available data come predominantly from studies conducted prior to 1975, and indicate that water fluoridation is effective at reducing caries levels in both deciduous and permanent dentition in children. Our confidence in the size of the effect estimates is limited by the observational nature of the study designs, the high risk of bias within the studies and, importantly, the applicability of the evidence to current lifestyles. The decision to implement a water fluoridation programme relies upon an understanding of the population's oral health behaviour (e.g. use of fluoride toothpaste), the availability and uptake of other caries prevention strategies, their diet and consumption of tap water and the movement/migration of the population. There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across SES. We did not identify any evidence, meeting the review's inclusion criteria, to determine the effectiveness of water fluoridation for preventing caries in adults. There is insufficient information to determine the effect on caries levels of stopping water fluoridation programmes. There is a significant association between dental fluorosis (of aesthetic concern or all levels of dental fluorosis) and fluoride level. The evidence is limited due to high risk of bias within the studies and substantial between-study variation.
불소는 생태계를 오염시키고 인간을 위협하는 환경오염물질인가? YES
Ecotoxicol Environ Saf. 2019 Oct 30;182:109362. doi: 10.1016/j.ecoenv.2019.06.045. Epub 2019 Jun 26.
Fluoride contamination, health problems and remediation methods in Asian groundwater: A comprehensive review.
Yadav KK1, Kumar S2, Pham QB3, Gupta N1, Rezania S4, Kamyab H5, Yadav S6, Vymazal J7, Kumar V1, Tri DQ8, Talaiekhozani A9, Prasad S2, Reece LM10, Singh N11, Maurya PK12, Cho J4.
1
Institute of Environment and Development Studies, Bundelkhand University, Kanpur Road, Jhansi, 284128, India.
2
Centre for Environment Science and Climate Resilient Agriculture, Indian Agricultural Research Institute, New Delhi, 110012, India.
3
Department of Hydraulic and Ocean Engineering, National Cheng-Kung University, Tainan 701, Taiwan.
4
Department of Environment and Energy, Sejong University, Seoul, 05006, South Korea.
5
UTM Razak School of Engineering and Advanced Technology, Universiti Teknologi Malaysia, Malaysia.
6
Department of Civil Engineering Rabindranath Tagore University Raisen, Madhya Prades, India.
7
Czech University of Life Sciences Prague, Faculty of Environmental Sciences, Kamýcká 129, 165 21 Praha 6, Czech Republic.
8
Sustainable Management of Natural Resources and Environment Research Group, Faculty of Environment and Labour Safety, Ton Duc Thang University, Ho Chi Minh City, Viet Nam. Electronic address: doanquangtri@tdtu.edu.vn.
9
Department of Civil Engineering, Jami Institute of Technology, Isfahan, Iran.
10
Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX, 77555, USA.
11
Department of Botany, University of Delhi, New Delhi, 110007, India.
12
Department of Zoology and Environmental Science, Gurukula Kangari Vishwavidyalaya, Haridwar, Uttarakhand, India.
Abstract
In low concentration, fluoride is considered a necessary compound for human health. Exposure to high concentrations of fluoride is the reason for a serious disease called fluorosis. Fluorosis is categorized as Skeletal and Dental fluorosis. Several Asian countries, such as India, face contamination of water resources with fluoride. In this study, a comprehensive overview on fluoride contamination in Asian water resources has been presented. Since water contamination with fluoride in India is higher than other Asian countries, a separate section was dedicated to review published articles on fluoride contamination in this country. The status of health effects in Asian countries was another topic that was reviewed in this study. The effects of fluoride on human organs/systems such as urinary, renal, endocrine, gastrointestinal, cardiovascular, brain, and reproductive systems were another topic that was reviewed in this study. Different methods to remove fluoride from water such as reverse osmosis, electrocoagulation, nanofiltration, adsorption, ion-exchange and precipitation/coagulation were introduced in this study. Although several studies have been carried out on contamination of water resources with fluoride, the situation of water contamination with fluoride and newly developed technology to remove fluoride from water in Asian countries has not been reviewed. Therefore, this review is focused on these issues: 1) The status of fluoride contamination in Asian countries, 2) health effects of fluoride contamination in drinking water in Asia, and 3) the existing current technologies for defluoridation in Asia.
불소는 필수 영양소이다?
NO. 불소는 칼슘이나 마그네슘과 같은 미네랄 처럼 우리 인체의 성장과 발달을 위한 필수적인 물질이 아닙니다(US National Library of Medicine National Institutes of Health). 그러나 충치를 예방하는 효과가 있습니다. 그러나 과도한 불소의 섭취나 노출은 치아불소증, 골격불소증 등의 부작용을 유발할 수 있어 주의가 필요합니다. 또한 불소의 섭취로 인해 우리인체에 얻는 득 보다는 해로움(부작용)이 더 크며 충치예방을 위해서라면 치아에만 국소적으로 필요한 용량을 도포하는 것이 바람직합니다.치아에 국소적으로 도포하는 경우라도 삼키지 않도록 해야 합니다.
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