Supplements fluoride

Based on limited epidemiologic evidence, fluoride supplements, with or without calcium, estrogen and vitamin D, are used by clinicians for the treatment of osteoporosis. However, knowledge of the effects of fluoride on calcium and phosphorus metabolism in normal animals is limited although Spencer et al. (32) reported that ingestion of fluoride by three osteoporotic men did not affect calcium absorption but caused a decrease in urinary excretion. Moreover, there is a need to determine the long-term effects of fluoride treatment on bone strength and on soft tissues ( ). 

Fluoride in diet, fluoride supplements, dental products and fluoridated salt and milk... 

The bioavailability of fluoride from diet and fluoride supplements in infants was about 90% [71]. 

The levels of fluoride in body fluids (plasma, saliva, urine) give some indication of recent fluoride intake. Fluoride ion does not produce any metabolites, and so is itself the measured indicator. This indicator, however, does not well reflect the fluoride body burden or the accumulation of fluoride in the body, because the relation between fluoride concentrations in bone and in extracellular fluids is incompletely defined. The concentration of fluoride in plasma, urine, saliva and dental plaque is dependent on the intake via water, diet, fluoride supplements and fluoride-containing dentifrices [92-97],... 

The concentration of fluoride in nails and hair appears to be proportional to intake over longer periods of time, taking into account their growth rate [100-103]. Exposure to fluoride may occur in the local environment at the place of residence or via occupational exposure. Daily intake from food, water, dentifrices or fluoride supplements also contributes. The major advantage of nails and hair over fluids and tissues as biomarkers for fluoride exposure is that they can easily be obtained in a non-invasive manner. In contrast to plasma, saliva and urine, whose fluoride concentrations provide a snapshot at a certain point of time and are subject to change due to recent fluoride intake and certain physiological variables, the concentration of fluoride in nails and hair is cumulative and reflects the average level of intake over a time period, but depends on how often the nails are clipped or hair cut. 

FLUORIDE IN DIET, FLUORIDE SUPPLEMENTS, DENTAL PRODUCTS AND FLUORIDATED SALT AND MILK... 

Dietary fluoride supplements, available in the form of tablets, drops, lozenges and rinse supplements, are recommended for caries prevention by medical societies in some countries, especially if the fluoride concentration from drinking water is low. These supplements contain different quantities of fluoride, usually 0.25, 0.50 and 1.00 mg of fluoride per unit, in the form of NaF [60]. Fluoride supplements are rarely prescribed for adults. 

Fluoride supplements are recommended by medical societies in some countries for caries prevention, especially if the concentration of fluoride in drinking water is low. It is likely that past use of dietary fluoride supplements has been a prime factor in the increased prevalence of dental fluorosis, a relationship which may stem from the days when fluoride supplement schedules were higher than they are today [11]. Table 7 shows a fluoride supplement dosage schedule that was approved for U.S. and Canadian children by the American Dental Association and Canadian Paediatric Society [8] and a fluoride supplement dosage schedule approved by German Nutrition Society, Austrian Nutrition Society, Swiss Society for Nutrition Research and Swiss Nutrition Association [165]. 

Table 7. The fluoride supplement dosage schedule that was approved by the American Dental Association and the Canadian Paediatric Society and the fluoride supplement dosage schedule approved by the German Nutrition Society, Austrian Nutrition Society, Swiss Society for Nutrition Research and Swiss Nutrition Association...

Fluoride supplement dosage schedule approved by the American Dental Association and the Canadian Paediatric Society... 

Fluoride supplement values are given in mg/day 2.2 mg of sodium fluoride contains 1.0 mg of fluoride. 

The total fluoride intake by age groups in children from diet, fluoride supplements and fluoridated toothpastes presented in Table 8 were estimated using the data from Tables 5-7. The lower and higher limits of fluoride intake listed in these were used to provide these estimates. 

Table 8. Estimated fluoride intake for infants and children from diet, fluoride supplements and toothpastes based on the intake presented in Tables 5-7... 

The aim of this section is to present a concise overview of separation, concentration and decomposition methods for sample pre-treatment and an overview of the analytical methods available for determining free inorganic fluoride and total fluorine in the environment (natural and drinking water, air and soil), biological and related materials, and fluoride supplements and dental products. 

Total fluorine in fluoride supplements and dental products could be determined with minimal samples pre-treatment as for example by direct acid extraction or heating in TISAB buffer solution and subsequent determination of fluoride using fluoride ISE for the reason that entire fluorine, in these products, should be, by definition, available as free inorganic fluoride. 

The wide variations in fluoride intake reported in the literature make its accurate estimation difficult. Our estimates show that the total intake of fluoride in infants and children from diet, fluoride supplements and use of fluoridated toothpaste is 0.008-0.111 (average 0.066) mg/day/kg body weight in non-fluoridated areas and 0.016-0.147 (average 0.063) mg/day/kg body weight in fluoridated areas. High intake of fluoride in non-fluoridated areas is ascribed to the use of fluoride supplements and in fluoridated areas to fluoride added into water. Both intakes exceed the lower threshold and are close to the upper threshold of 0.07 mg/day/kg body weight for the appearance of dental fluorosis. 

Based on the available literature and the current recommendations on fluoride intake, it is hard to say whether the current Al is appropriate, that is, too low or too high. The margin between the beneficial and deleterious effects of fluoride appears to be narrow. More accurate information on background amounts of fluoride intake, especially in children, from food, water, beverages, fluoride supplements and dentifrices is a pre-requisite for making correct decisions on the use of fluoride products. One is currently left with the question Enough or too... 

E. Newbrun, Current regulations and recommendations concerning water fluoridation, fluoride supplements, and topical fluoride agents, J. Dent. Res. 71 (1992) 1255-1265. 

Recently, we can witness many discussions about the benefits and risks of the fluoride supplementation. Also the question of aluminum toxicity in men has been discussed. The understanding of the mechanisms of their synergistic action could allow us to explain numerous observations about the effects of increased load of fluoride and aluminum in the environment and to reevaluate their widespread use. Understanding the role of phosphate and G-proteins in cell signaling forces us to accept the fact that aluminum in the environment, water, and food chains followed by fluoride ions could evoke various and multiple pathological symptoms. 

The American Dental Association recommends that fluoride supplements be taken in areas that do not have fluoridated water. Monfluoridated water is defined as that containing less than 0.3 mg F/liter. The recommendation is 0.25 mg F/day fmm ages 0 to 2 years, 0.5 mg F/day from ages 2 to 3 years, and 1.0 mg F/day from ages 3 to 13 years. Fluoride levels greater than 2 mg F/liter may produce dental fluorosis. 

Maximum benefits to both deciduous and permanent teeth may result from daily fluoride supplements from infancy until approximately 13 years of age, at which time all permanent teeth except the third molars should have erupted. Because cariostatic benefits may tend to diminish gradually after fluorides are discontinued, periodic applications of topical fluorides may then be necessary. 

The natural level of fluoride in drinking water where the child lives should be known before dietary fluoride is prescribed. At present, it is suggested that fluoride supplements be limited to where drinking water contains 60% or less of the optimal level of fluorides recommended for community water in the geographic area. 

For children under 6 months of age, experts question the value of prescribing fluoride supplements. 

Fluoride levels in human breast milk have been found to be less than 0.05 ppm. This concentration remains constant, regardless of drinking water and maternal plasma levels. Thus, breast-fed infants who receive no formula bottle feedings ingest considerably less fluoride than infants receiving formula mixed in 1 ppm fluoridated water. Fluoride supplementation for breastfed infants should be considered. 

The administration of fluoride supplements to expectant mothers in an effort to benefit the teeth of the offspring has been evaluated in several studies. ° The evidence, however, is not sufficiently conclusive to warrant recommendation. 

Glenn, F.B. Immunity conveyed by sodium-fluoride supplement during pregnancy Part II. ASDC J. Dent. Child. 1979, 4(5 (1), 17-24. 

Fluoride supplementation of salt, sugar, and milk has also been used in areas where fluoride is not added to water supplies. 

NOTE Studies in the 1980s determined that large doses of fluoride do not protect from osteoporosis (Sect. 10.2.3), or decrease the incidence of bone fractures. It appears that increased fluoride in the diet inhibits osteoblast activity more than osteoclast activity women on fluoride supplements suffer from more bone fractures, not less. Fluoride therapy for osteoporosis was popular in the 1980s, but the reports published after 1990 reduced enthusiasm for this treatment and it is not now recommended for post-menopausal bone loss. 

Supplements. Fluoride supplements are available only by prescription, and are intended for children living in areas with low water fluoride concentrations for the purpose of bringing their intake to approximately 1 mg/day. ... 

Despite this bound fluoride problem, the utility of the fluoride electrode for total plasma fluoride after direct diffusion is illustrated by fluoride analysis of unashed plasma of two rat groups reared on different fluoride intakes [161]. The plasma of rats raised from three weeks old on low fluoride diet (0.5 mg kg ) and distilled water contained apparent fluoride levels of 4.2 ( 0.8) X 10 and 3.7 ( 0.4) X 10 mol dm at five and eight weeks, respectively. The corresponding levels in another similar batch, except for supplementation of drinking water to 25 mg kg fluoride, were 6.8 ( 0.7) X 10 and 12.1 ( 0.5) X 10" mol dm fluoride. When the fluoride supplements were withdrawn, the plasma fluoride declined [161]. 

Fluoride contents of milks have been studied in relation to fluoride health programmes in infants [276,277]. Breast-fed infants obtain their fluid intake almost entirely from nursing mothers and a knowledge of fluoride in breast milk aids decisions over fluoride supplementation. Simpson and Tuba [276] found that mothers milk containing 10.5 0.05 jLtmol dm fluoride prior to the fluoridation of Edmonton water (13.7 0.3/imol dm ) rose to 25.8 0.16 /tmol dm after fluoridation of tap water supplies to 52.6 3.1 /rmol dm . Thus, breast-fed infants in fluoridated water communities probably receive adequate fluoride, otherwise daily supplementation of about 0.25 mg is recommended [276],... 

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