Search Results (94)

Background and Objectives: Community fluoridation is an effective public health measure for dental caries prevention; however, knowledge and risk perception vary. This study assessed knowledge, attitudes, and sociodemographic determinants related to community fluoridation. Materials and Methods: A cross-sectional study was conducted in May–June 2023 among 200 adults from Iași, Romania, using a self-administered questionnaire. Chi-square tests were applied. Results: Most respondents were familiar with fluoride (94%) and its protective role (91%), but fewer knew fluoridation methods (34%) or dental fluorosis (53%). Educational level was associated with awareness of water fluoridation (χ² = 32.219, p < 0.001), and gender with safety perceptions (χ² = 6.031, p = 0.049). Perceived toxicity was strongly associated with fluoridation safety attitudes (χ² = 29.116, p < 0.001). Conclusions: Although general awareness is high, understanding remains limited. Sociodemographic factors influence knowledge and risk perception, highlighting the need for targeted communication. Full article

Fluoride is increasingly discussed as a geogenic risk factor for chronic kidney disease of uncertain etiology (CKDu); an epidemic of kidney disease is affecting hot tropical farming communities worldwide. Emerging evidence continues to support the association between high-fluoride exposure and kidney injury, particularly in regions with high fluoride levels. However, while fluoride’s geogenic nature leads to prolonged exposure through water and food sources, the direct impact on kidney health remains incompletely understood. This review explores the relationship between fluoride exposure and adverse kidney health outcomes, especially in the context of CKDu, synthesizing findings from epidemiological studies conducted worldwide. While a broad range of studies show widespread dental fluorosis prevalence in regions with high environmental fluoride levels in Sri Lanka, India, China, and Mexico, such correlation was not evident for CKDu and environmental fluoride levels. Notably, the spatial distribution patterns of CKDu and exposure risk through high fluoride levels in drinking water exhibit some inconsistencies, suggesting fluoride alone may not be the sole driver of CKDu. This review underscores the kidney health risks of fluoride exposure while emphasizing the need for further studies that consider multiple interacting factors beyond fluoride exposure in examination of environmental triggers of CKDu. Full article

Fluoride contamination in groundwater is a pressing environmental and public health issue, with chronic exposure linked to skeletal and dental fluorosis. Here, we report the synthesis of magnesium oxide nanoparticles via a controlled co-precipitation method employing dimethylformamide (DMF) as solvent and either ammonium hydroxide (MgO-1) or ammonium carbonate (MgO-2) as precipitating agents. The resulting materials were comprehensively characterized using thermogravimetric analysis (TGA/DSC), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), and scanning electron microscopy coupled with energy dispersive spectroscopy (SEM/EDS). Additionally, BET surface area and porosity analyses revealed mesoporous structures, with MgO-1 showing a slightly higher surface area (14.12 m² g⁻¹) than MgO-2 (13.87 m² g⁻¹). Both MgO-1 and MgO-2 exhibited high crystallinity, nanoscale particle sizes (81.6 nm and 128.1 nm, respectively), and distinct morphological features. Batch adsorption studies revealed maximum fluoride uptake capacities of 117.6 mg/g (MgO-1) and 94.5 mg/g (MgO-2) at neutral pH, with MgO-1 exhibiting superior performance due to its smaller particle size and higher specific surface area. Fluoride removal remained above 98% between pH 3–9, confirming stability across a wide pH range, with a minor decline at pH 11 due to OH⁻ competition. Adsorption equilibrium data were best described by the Temkin isotherm model, suggesting heterogeneous surface interactions and an exothermic process, while kinetic analyses indicated pseudo-second-order behavior for MgO-1 and pseudo-first-order for MgO-2. Both materials maintained high fluoride selectivity in the presence of competing anions and successfully reduced fluoride in tap water from 2.11 mg/L to below the WHO limits without altering water hardness. These findings underscore the potential of engineered MgO nanomaterials as efficient, selective, and sustainable adsorbents for water defluoridation, offering a promising pathway toward scalable remediation technologies in fluoride-affected regions. Full article

Epidemiological and geochemical evidence suggests that coal-burning fluorosis in Southwest China is mechanistically linked to the presence of fluoride-rich geochemical anomalies. However, the severity of dental fluorosis does not consistently align with the distribution pattern of fluoride geochemistry, suggesting that other factors may interfere with the dose–effect relationship of fluorosis. To investigate the potential biotoxicity impacts of fluoride, this study conducted an analysis of soil fluoride–selenium spatial correlation in the central areas of coal-burning fluorosis in China. The results revealed that 59.1% of soil fluoride contents were more than the average soil fluoride content of China (800 mg·kg⁻¹) and 77.9% of soil selenium contents were above 0.45 mg·kg⁻¹. Soil fluoride (1.11 × 10³ mg·kg⁻¹) and selenium contents (0.78 mg·kg⁻¹) were significantly high states, but agricultural products and drinking water sources showed relatively low levels, not significantly influenced by soil conditions. The severity of fluorosis was evaluated using Dean’s dental fluorosis index (DFI). The spatial association of soil selenium or fluoride with DFI suggested that there was a reverse relationship between soil selenium or selenium/fluoride and the DFI. The generalized additive model (GAM) showed the onset of DFI correlated with soil fluoride content, showcasing a distinctive “W” pattern, while DFI decreased steeply or gradually as soil selenium content or selenium/fluoride ratio increased. In conclusion, our findings suggest that the geochemical anomaly of soil fluoride likely contributes to the occurrence of fluorosis. However, the significantly elevated levels of soil selenium might alleviate the severity of dental fluorosis to some extent. Full article

Breastfeeding based on the use of follow-on milk may contain traces of xenobiotic elements that could pose a risk to the health of the vulnerable population for which it is intended. Fluorine is a non-essential element that, at high concentrations, can produce adverse health effects such as dental fluorosis, decreased IQ (intelligence quotient), thyroid alterations, and kidney damage. Given the vulnerability of infants and the possible presence of fluoride in this type of product, the content of this anion was determined in a total of 46 samples of follow-on milk from different brands and types (starter, follow-on, and hydrolysate formulas) using a fluoride ion-selective electrode (EWI). The highest mean concentration of fluoride was recorded in the hydrolysate formulas (3.38 ± 2.78 mg/L). The dietary intake assessment indicated that some brands of hydrolyzed formulas could pose a health risk, providing up to 94.1% of the UL (upper level) with only one 90 mL serving in the 0–6-month age group. It is recommended that consumers be aware of the fluoride content in the water used to prepare bottles, as it can further increase total fluoride intake and therefore pose a risk to the health of infants. Full article

Background: Dental caries remains one of the most prevalent chronic diseases worldwide. Fluoride has long been recognized as a cornerstone of caries prevention through enamel remineralization, inhibition of demineralization, and antibacterial activity. However, controversies persist regarding systemic exposure, potential health risks, and ethical debates over community water fluoridation. Previous reviews often focused on isolated interventions, whereas a critical synthesis of mechanisms, clinical efficacy, safety, and public health perspectives is still lacking. Methods: This narrative review synthesized peer-reviewed publications from 2000 to 2025 retrieved from PubMed, Scopus, Web of Science, and leading dental journals. Emphasis was placed on randomized controlled trials, systematic reviews, meta-analyses, and major policy documents. Evidence was thematically appraised across mechanisms of action, clinical applications, comparative efficacy, safety, and sociocultural considerations. Results: Fluoride consistently shows preventive and therapeutic benefits across multiple delivery forms, including toothpaste, varnishes, mouthrinses, supplements, and silver diamine fluoride, with particular advantages for high-risk groups such as children, orthodontic patients, and older adults. Nonetheless, study heterogeneity, variations in protocols, and concerns regarding fluorosis and possible neurodevelopmental effects highlight persistent uncertainties. Comparative analyses reveal trade-offs between efficacy and acceptance, for example, the high caries-arrest rate of silver diamine fluoride compared with its esthetic drawback. Emerging alternatives such as nano-hydroxyapatite, fluoride-containing bioactive glass, and probiotic-based approaches are promising but currently supported by limited clinical data. Conclusions: Fluoride remains central to caries prevention, yet its optimal use requires balancing benefits against risks, addressing cultural and socioeconomic barriers, and tailoring strategies to individual and community contexts. This narrative synthesis underscores the need for well-designed multicenter randomized controlled trials, longitudinal studies to refine safe exposure thresholds, evaluations of novel biomaterials and delivery systems, and the incorporation of patient-reported outcomes to guide future evidence-based policies and clinical practices. Full article

Background/Objectives: Smile esthetics are a crucial aspect of facial attractiveness, playing a central role in social interactions. Dental students’ perception of smiling esthetics may evolve as they progress through their education and clinical exposure. This study aimed to investigate the influence of educational level on dental students’ perception of altered smile esthetics. Methods: A cross-sectional study was conducted among 410 undergraduate dental students across five academic years at the National and Kapodistrian University of Athens. Participants evaluated 22 digitally altered smile images, including single and combined esthetic discrepancies, using a visual analog scale (VAS). Perceived attractiveness scores were analyzed in relation to academic year, gender, and specific types of smile alterations. Results: The perception of smile attractiveness varied significantly across academic years for certain esthetic discrepancies, including central incisor length mismatch, midline diastema, and open gingival embrasures (p < 0.05). Clinical-year students (years 4–5) demonstrated a more critical assessment compared to preclinical students. Female students exhibited greater sensitivity to specific discrepancies, including fluorosis and reduced tooth lightness. The combination of a midline diastema, a gummy smile, and reduced lightness received the lowest attractiveness scores across all groups. Conclusions: The perception of altered smile esthetics among undergraduate dental students evolves throughout their education, although this progression does not follow a linear trajectory. Dental education appears to influence the perception of specific smile esthetic discrepancies, reflecting a selective influence on features. Clinical training appears to be a critical parameter of dental education, influencing the perception of smiling esthetics. Full article

Fluoride-enriched geothermal groundwater poses chronic health risks (e.g., dental and skeletal fluorosis) through prolonged exposure; nevertheless, hydrochemical-driven factors and the genetic mechanism of fluoride enrichment in such systems remain inadequately identified. This study employed hydrochemical characterization, isotopic tracing, and health risk models to elucidate the genetic mechanism of fluoride-enriched geothermal groundwater. The key findings reveal the following. (1) Geothermal groundwater (Cl-Na type; TDS 90–345 mg/L; pH 6.25–7.42) contrasts with alkaline river water (pH 7.48–8.05; SO₄-Na/HCO₃-Na) and saline seawater (TDS 23.9–28.2 g/L). Stable isotopes (δD, δ¹⁸O) confirm atmospheric precipitation recharge with an elevation of 69–635 m. (2) The Self-Organizing Map algorithm categorized 30 geothermal samples into three groups: Cluster I—low temperature and pH, high TDS; Cluster II—high temperature, low F⁻ concentration; and Cluster III—low TDS, and high pH and F⁻ concentration. (3) Fluoride enrichment in Cluster III originated from the evaporite/fluorite dissolution under alkaline conditions and cation exchange interactions, while the inhibition of CaF₂ dissolution by reverse cation exchange limited the accumulation of F⁻ in Cluster II and Cluster III samples. (4) Health risks disproportionately affect children (80% high risk) and women, necessitating pre-use defluorination. Full article

Background: Dental fluorosis (DF) is an irreversible alteration of tooth enamel formation caused by excessive fluoride (F) consumption during tooth growth, leading to skeletal fluorosis development due to the high F content of tap water, which should be detected. Objective: To detect the signs of skeletal fluorosis by comparison of the bone mineral density (BMD) of the lumbar spine, femoral neck, and total femur, and the fluor (F) intake from water between adults without and with DF from northwestern Mexico. Methods: Participants were 36 adults without DF (G1) and 42 with DF (G2). Dean criteria, DEXA, and SPADNS methods were used to evaluate DF, BMD, and F content in water, respectively. Results. G1 participants consumed 0.789 ± 1.55 mg F/d from water with 0.385 ± 0.32 mg F/L, while G2 participants drank 2.42 ± 2.65 mg F/d from water with 1.46 ± 0.59 mg F/L. The binary variable DF and BMD values were not associated (p > 0.05); however, according to severity degree, questionable DF was associated with total femur BMD (p = 0.025). BMD in the evaluated regions was no different between both groups and could be related to actual moderate levels of F in the tap water and to the partial or total consumption of bottled water. Conclusions. There was no association between DF and the measured BMD to infer skeletal fluorosis. Bone region BMD was no different between both evaluated groups and could be related to adequate F intake, with moderate F levels in tap water, and the consumption of negligible F content bottled water. Full article

Dental fluorosis indicates past fluoride intake. People living in Mexico City are exposed to fluoridated salt, which contributes significantly to fluoride intake. This study aimed to (1) estimate fluoride intake during early childhood and fluorosis prevalence in permanent teeth in adolescence and (2) identify intake windows associated with higher fluorosis scores in upper central incisors (UCIs). We included 432 participants from the ELEMENT project (Early-Life Exposures in Mexico to Environmental Toxicants), with data on fluoride intake at ages 1–5 and fluorosis (TFI) at adolescence. Median intakes ranged from 0.56 at age 1 to 1.14 mg/day at age 5, exceeding recommendations. All adolescents had some level of fluorosis, predominantly mild (62% with TFI 2). For every 0.1 mg of daily fluoride intake at age 1, the odds of higher TFI in UCIs were 1.08 [95% CI: 1.00–1.17]. At age 2, the odds were marginally significant [OR: 1.07; 95% CI: 1.00–1.16]. In conclusion, for participants of ELEMENT: (1) fluoride intake during early childhood exceeded recommendations and the prevalence of mild fluorosis in adolescence was high, and (2) fluorosis in UCIs was associated with dietary exposure during the first two years of life and may be used in future ELEMENT studies as exposure biomarkers. Full article

Background: Dental fluorosis can affect the micromorphology of dentin, a fact that could present constraints relating to the structural, mechanical, and chemical stability of dentin when it is demineralized in operative maneuvers. Introduction: The aim of this article is to quantify the amount of calcium and the microhardness of both a healthy and a fluorotic dentin through conditioning with a two-step self-etching system (Optibond Versa, Kerr, CA, USA). Methods: Dentin samples were obtained from healthy molars diagnosed with mild, moderate, and severe fluorosis. The amount of calcium was quantified utilizing an atomic absorption spectrophotometer. The hardness was evaluated using a Vickers durometer. Two dentin samples from each study group were examined using scanning electron microscopy (SEM). Results: A one-way analysis of variance (ANOVA) and Tukey–Kramer test were applied as post hoc tests for determining the differences in calcium values between the study groups and to show the difference in the hardnesses evaluated. The Student’s t-test was applied to related samples. The level of significance was set at p < 0.05. Statistically significant results were obtained for the amount of calcium and microhardness of the healthy dentin group. The SEM images demonstrated irregular etching patterns in the fluorotic dentin, indicating potential bonding challenges. Conclusion: In conclusion, there is a lower amount of calcium and a significant reduction in microhardness in healthy dentin when applying the self-etching system compared to fluorotic dentin. Fluorotic dentin is more resistant to demineralization, which may influence adhesive bonding strategies. Clinicians should consider adjusting conditioning protocols for optimal adhesion in fluorotic teeth. Full article

Objectives: Early observations often fail to detect anomalies that may impact the health and quality of life of newborns. This study aimed to determine the prevalence of oral anomalies in newborns and explore their possible associations with sociodemographic factors. Methods: A cross-sectional study was conducted in Quito, Ecuador, analyzing a sample of 241 newborns. The presence of oral anomalies was recorded, and their association with sex, birth weight, maternal age, and gestational factors was evaluated. Results: The prevalence of oral anomalies was 72.3%, with Epstein’s pearls being the most common (50%). Other findings included Bohn’s nodules and dental lamina cysts, while no cases of natal teeth or congenital epulis were observed. Ankyloglossia was identified in 1.36% of newborns. No significant correlations were found between the presence of oral anomalies and sex, birth weight, maternal age, or gestational factors. Conclusions: The high prevalence (72.3%) of oral anomalies in the studied newborns underscores the importance of early detection and management. Epstein’s pearls were the most frequent anomaly, followed by Bohn’s nodules, dental lamina cysts, and ankyloglossia, while no cases of natal teeth or congenital epulis were identified. No statistically significant associations were found with sex, birth weight, maternal age, or pregnancy complications. These findings emphasize the need for early pediatric dental assessment and an interdisciplinary approach to ensure proper neonatal oral health. Further research is recommended to explore potential causes and interventions to optimize oral health from birth. Full article

Background: In Mexico, tooth decay is common among children and is on the rise. A strong relationship exists between behavioral, socioeconomic, demographic, and biological factors and the severity and development of dental caries. Objective: The present study analyzed the risk factors contributing to dental caries in a Mexican pediatric population. Materials and Methods: This study employed a cross-sectional design. One hundred fifty-one children were evaluated after providing their assent and the informed consent of their legal guardians. The study subjects recruited underwent dental assessments, dietary habits, and physical activity examinations. Results: Only 36 children were classified as overweight or obese, while 121 children had a high quality of life related to oral health. Most of the children showed deficient eating and physical activity habits. Additionally, nearly half displayed severe dental carie lesions. The occurrence of caries was linked to both age and tooth brushing habits. The median of teeth with initial caries lesions was higher among female children. Furthermore, parental education was associated with the presence of fluorosis and the frequency of tooth brushing. Conclusion: Our study revealed deficient eating habits and a high prevalence of dental caries among children aged 6–12. Additionally, parents and guardians demonstrated insufficient knowledge about general oral health issues, the risk factors for caries, and their potential consequences, which means a need for both preventive and corrective treatments. This highlights the need for strategies focused on improving oral health care and prevention. Full article

Groundwater fluoride levels have begun to be a global concern, posing significant challenges to the safe utilization of water resources and mitigating potential impacts on human health. Chronic exposure to elevated levels of naturally occurring fluoride in groundwater affects millions worldwide. Prolonged exposure can lead to health issues such as dental fluorosis and skeletal fluorosis. The World Health Organization (WHO) has established a maximum fluoride concentration guideline of 1.5 mg/L for drinking water. However, groundwater quality is not regularly tested in many regions, leaving communities unaware if water sources, such as wells and springs, contain harmful fluoride levels. In the Balasore area, Odisha, India, rising fluoride concentrations and spatial variability necessitate accurate predictions for effective groundwater management. This article proposes four predictive models, Random Forest (RF), Support Vector Regression (SVR), Gradient Boosting (XGBoost), and Stacking Regressor (SR), to estimate fluoride concentrations using physicochemical parameters and sampling depth as predictor variables. The performance of these models is assessed using the coefficient of determination (accuracy), mean square error (MSE), and mean absolute error (MAE). This article compared fluoride concentrations of machine learning models, including SR, RF, XGBoost, and SVR, in groundwater in Balasore, Odisha. Based on predictive performance, an SR model yielded the lowest MSE and MAE scores at 0.01817 and 0.10327, respectively. These findings underscore the superiority of ensemble learning approaches in addressing complex datasets and provide a robust framework for effective groundwater fluoride management. This article highlights the potential of advanced machine learning in improving public health outcomes in fluoride-affected regions. Finally, the recommendations for decreasing the fluoride concentrations and the guidelines for future research will be proposed. Full article

Fluoride contamination in water sources presents critical public health challenges, particularly in regions where groundwater exhibits elevated fluoride levels. Chronic exposure can result in dental and skeletal fluorosis, necessitating efficient and sustainable remediation strategies. This study investigates the spherical agglomeration technique (SAT) as an alternative fluoride removal method, assessing the performance of sunflower oil versus n-heptane as humectants and evaluating the synergistic effects of Agave durangensis leaf extract. A factorial experimental design optimized dosage parameters in aqueous models and well water samples, ensuring reliable fluoride removal. Sunflower oil significantly outperformed n-heptane, achieving fluoride removal efficiencies of up to 95.19% under optimal conditions (5 mL _Hum/g _TMCs at pH 6.5). Incorporating A. durangensis extract sustained high fluoride removal while reducing the required extract dosage to 0.5 g _Extr/g _TMCs. When applied to well water samples, the SAT consistently maintained an 88.9% fluoride removal efficiency. Compared to conventional methods such as coagulation–flocculation and adsorption, the SAT demonstrated enhanced effectiveness with a lower environmental footprint. These findings reinforce the viability of sunflower oil and A. durangensis extract as eco-friendly alternatives to n-heptane, positioning the SAT as a scalable, cost-effective solution for large-scale fluoride remediation. Full article