Fluoride and the Oral Environment

Fluoride and the Oral Environment

Monographs in Oral Science Vol. 22 Series Editors A. Lussi Bern M.C.D.N.J.M. Huysmans Nijmegen H.-P. Weber Boston, Mass.

Fluoride and the Oral Environment Volume Editor Marília Afonso Rabelo Buzalaf Bauru 50 figures, 31 in color, and 24 tables, 2011 Basel Freiburg Paris London New York New Delhi Bangkok Beijing Tokyo Kuala Lumpur Singapore Sydney

This monograph is dedicated to Gary Milton Whitford, my master and friend, who guided me through the avenues of Fluoride Research. Marília Afonso Rabelo Buzalaf

Marília Afonso Rabelo Buzalaf Department of Biological Sciences Bauru Dental School, University of São Paulo Al. Octávio Pinheiro Brisolla, 9-75 17012-901 Bauru-SP (Brazil) This volume received generous financial support from Procter & Gamble Library of Congress Cataloging-in-Publication Data Fluoride and the oral environment / volume editor, Marília Afonso Rabelo Buzalaf Bauru. p. ; cm. -- (Monographs in oral science, ISSN 0077-0892 ; v. 22) Includes bibliographical references and indexes. ISBN 978-3-8055-9658-9 (hard cover : alk. paper) -- ISBN 978-3-8055-9659-6 (e-isbn) 1. Dental caries--prevention. 2. Fluorides--Therapeutic use. I. Buzalaf, Marília Afonso Rabelo. II. Series: Monographs in oral science ; v. 22. 0077-0892 [DNLM: 1. Fluorides, Topical--therapeutic use. 2. Dental Caries--prevention & control. 3. Fluorosis, Dental. W1 MO568E v.22 2011 / QV 282] RK331.F558 2011 617.6'7--dc23 2011013013 Bibliographic Indices. This publication is listed in bibliographic services, including MEDLINE/Pubmed. Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2011 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel ISSN 0077 0892 ISBN 978 3 8055 9658 9 e-isbn 978 3 8055 9659 6

Contents IX List of Contributors XI Foreword Robinson, C. (Leeds) Fluoride Intake, Metabolism and Toxicity 1 Fluoride Intake of Children: Considerations for Dental Caries and Dental Fluorosis Buzalaf, M.A.R. (Bauru); Levy, S.M. (Iowa City, Iowa) 20 Fluoride Metabolism Buzalaf, M.A.R. (Bauru); Whitford, G.M. (Augusta, Ga.) 37 Contemporary Biological Markers of Exposure to Fluoride Rugg-Gunn, A.J. (Newcastle upon Tyne); Villa, A.E. (Santiago); Buzalaf, M.A.R. (Bauru) 52 Historical and Recent Biological Markers of Exposure to Fluoride Pessan, J.P. (Araçatuba); Buzalaf, M.A.R. (Bauru) 66 Acute Toxicity of Ingested Fluoride Whitford, G.M. (Augusta, Ga.) 81 Chronic Fluoride Toxicity: Dental Fluorosis DenBesten, P.; Li, W. (San Francisco, Calif.) Impact of Fluoride in the Prevention of Caries and Erosion 97 Mechanisms of Action of Fluoride for Caries Control Buzalaf, M.A.R. (Bauru); Pessan, J.P. (Araçatuba); Honório, H.M. (Bauru); ten Cate, J.M. (Amsterdam) 115 Topical Use of Fluorides for Caries Control Pessan, J.P. (Araçatuba); Toumba, K.J. (Leeds); Buzalaf, M.A.R. (Bauru) 133 Systemic Fluoride Sampaio, F.C. (João Pessoa); Levy, S.M. (Iowa City, Iowa) VII

146 Oral Fluoride Reservoirs and the Prevention of Dental Caries Vogel, G.L. (Gaithersburg, Md.) 158 Fluoride in Dental Erosion Magalhães, A.C. (Bauru); Wiegand, A. (Zurich); Rios, D.; Buzalaf, M.A.R. (Bauru); Lussi, A. (Bern) 171 Author Index 172 Subject Index VIII Contents

List of Contributors Marília Afonso Rabelo Buzalaf Department of Biological Sciences Bauru Dental School, University of São Paulo Al. Octávio Pinheiro Brisolla, 9-75 17012-901 Bauru-SP (Brazil) Tel. +55 14 3235 8346, E-Mail mbuzalaf@fob.usp.br Pamela DenBesten Department of Orofacial Sciences, School of Dentistry University of California, San Francisco 513 Parnassus Avenue San Francisco, CA 94143 (USA) Tel. +1 415 502 7828 E-Mail Pamela.DenBesten@ucsf.edu Heitor Marques Honório Department of Pediatric Dentistry Orthodontics and Public Health Bauru Dental School, University of São Paulo Al. Octávio Pinheiro Brisolla, 9-75 17012-101 Bauru-SP (Brazil) Tel. +55 14 3235 8256, E-Mail heitorhonorio@usp.br Steven Marc Levy Departments of Preventive & Community Dentistry and Epidemiology, University of Iowa College of Dentistry Iowa City, IA 52242-1010 (USA) Tel. +1 319 335 7185, E-Mail steven-levy@uiowa.edu Wu Li Department of Orofacial Sciences, School of Dentistry University of California, San Francisco 513 Parnassus Avenue San Francisco, CA 94143 (USA) Tel. +1 415 476 1037, E-Mail wu.li@ucsf.edu Adrian Lussi Department of Preventive, Restorative and Pediatric Dentistry, University of Bern Freiburgstrasse 7 CH-3010 Bern (Switzerland) Tel. +41 31 632 25 10 E-Mail adrian.lussi@zmk.unibe.ch Ana Carolina Magalhães Department of Biological Sciences Bauru Dental School, University of São Paulo Al. Dr. Octávio Pinheiro Brisolla 9-75 17012-190 Bauru-SP (Brazil) Tel. +55 14 3235 8247, E-Mail acm@usp.br Juliano Pelim Pessan Department of Pediatric Dentistry and Public Health Araçatuba Dental School, São Paulo State University Rua José Bonifácio, 1193 16015-050 Araçatuba - SP (Brazil) Tel. +55 18 3636 3274, E-Mail jpessan@foa.unesp.br Daniela Rios Department of Pediatric Dentistry Orthodontics and Public Health Bauru Dental School, University of São Paulo Al. Dr. Octávio Pinheiro Brisolla 9-75 17012-190 Bauru-SP (Brazil) Tel. +55 14 32358218, E-Mail daniriosop@yahoo.com.br Colin Robinson Division of Oral Biology Leeds Dental Institute, University of Leeds Clarendon Way LS2 9LU, Leeds (UK) Tel. +44 113 343 6159, E-Mail c.robinson@leeds.ac.uk IX

Andrew John Rugg-Gunn Morven Boughmore Road Sidmouth Devon EX10 8SH (UK) Tel. +44 1395 578746 E-Mail andrew@rugg-gunn.net Fábio Correia Sampaio Federal University of Paraiba Health Science Centre Department of Clinical and Social Dentistry 58051-900 João Pessoa (Brazil) Tel. +55 83 3216 7795 E-Mail fabios@ccs.ufpb.br Jacob Martien ten Cate Department of Cariology Endodontology and Pedodontology Academic Center for Dentistry Amsterdam (ACTA) Gustav Mahlerlaan 3004 NL-1081 LA Amsterdam (The Netherlands) Tel. +31 20 518 8440, E-Mail J.t.Cate@acta.nl Kyriacos Jack Toumba Division of Child Dental Health Leeds Dental Institute, University of Leeds Clarendon Way LS2 9LU Leeds (UK) Tel. +44 113 343 6141, E-Mail k.j.toumba@leeds.ac.uk Alberto Enrique Villa Institute of Nutrition and Food Technology INTA, University of Chile Macul Santiago 783 0480 (Chile) Tel. +56 2 2212249 E-Mail avilla@inta.uchile.cl Gerald Lee Vogel American Dental Association Foundation Paffenbarger Research Center 100 Bureau Drive Stop 8546 National Institute of Standards and Technology Gaithersburg MD 20899-8546 (USA) Tel. +1 301 975 6821, E-Mail jvogel@nist.gov Gary Milton Whitford Department of Oral Biology School of Dentistry Medical College of Georgia 1120 15th Street Augusta, GA 30912 (USA) Tel. +1 706 721 0388, E-Mail gwhitfor@mcg.edu Annette Wiegand Department of Preventive Dentistry Periodontology and Cardiology University of Zurich Plattenstrasse 11 CH-8032 Zurich (Switzerland) Tel. +41 44 6343412 E-Mail annette.wiegand@zzm.uzh.ch X List of Contributors

Foreword Working and publishing in the field of skeletal and dental tissues for the past 40 years, in particular on the biology of dental enamel, it became apparent to me at a very early stage that fluoride, a minor tissue constituent, was an inextricably important aspect of this area of study. Indeed the effects of fluoride seemed at odds with the extremely small amounts present. Also, unlike other important minor components of the skeletal and dental tissue mineral, such as carbonate and magnesium, fluoride concentrations vary widely and depend to a great extent on exposure to external sources. Fluoride came to prominence by virtue of its effect on skeletal tissue development, particularly in relation to environmental exposure. In cases of exposure to relatively high concentrations, its presence during formation as well as its direct incorporation into the skeletal mineral phase led to pathological changes in both skeletal and dental tissues. Tooth enamel was found to be particularly sensitive in this respect. The effects can be profound since pathology related to high levels of fluoride exposure involves changes in both tissue structure as well as chemistry. However, a paradox emerged from this field of study in which it became clear that exposure to smaller amounts of fluoride, while often leading to changes in the dental tissues, conferred considerable protection against the most widely spread and costly of diseases dental caries. The protection was dramatic and was first ascribed to fluoride- induced changes to the tooth tissues during their development. This concept, however, was later challenged as topical exposure to fluoride in the oral environment was shown to be extremely effective in reducing dental caries. The role of developmentally acquired fluoride in this respect remains intriguingly open to question. Such an important advantageous clinical effect, together with the concomitant possibility of pathological change, led to a wide range of intense investigations. These centered on how fluoride is obtained from the diet, how it is dealt with after absorption and also its interaction with the calcium phosphate/apatite phase of dental tissues. The chemistry of biological calcium phosphates is, however, very complex. As a result of this, the deposition and behavior of the highly substituted and defect calcium hydroxyapatite crystals of the skeletal and dental tissues has received an enormous amount of attention. The interaction of fluoride with this system added further to this complexity, and as a consequence studies of fluoride and skeletal and dental mineral have generated a vast literature. With the obvious potential for improving the protective effect against dental caries, attention was focused upon the effect of fluoride on the developing tooth. Focus then moved towards studies of the role of fluoride in the complex interactions between the tooth tissues and their environment of plaque biofilm, saliva and pellicle. It is from these studies that many of the specific benefits XI

of the role of fluoride in caries prevention have emerged. While mechanisms behind fluoride- induced change to skeletal and dental tissues and the way fluoride behaves in protecting against dental caries are much clearer than they were 40 years ago, the area is still very complex and the plethora of literature is sometimes confusing. This monograph has brought together current concepts relating to fluoride and its role in relation to the prevention of dental caries. Information from a large and complex field has been assembled in a clear sequence and presented in a very lucid fashion. Of particular note are the diagrams, which are very clear and a great help in presenting highly complex data in an easily understood context. With this in mind, the text will be valuable for research workers or postgraduate students beginning a career in this or allied fields, and provide a clear up- to- date summary of current thinking in this area. Established researchers and teachers, whether in clinical or basic sciences, will also find the monograph a valuable addition to their libraries. The value of this text stems from the contributions of distinguished researchers in this field. The editor, whose own laboratory has contributed substantially to this area in recent years, has brought together a number of internationally known authors with an impressive series of publications across the width of the fluoride research area. With regard to the structure of the monograph, the first section deals with the availability of fluoride and how it is dealt with by the body from a physiological and metabolic standpoint. This forms the basis for and introduction to fluoride toxicity and the subject of fluorosis and the importance of monitoring intake. For the clinician, this highlights and clarifies the advantages of fluoride as well as possible hazards. The second section focuses in more detail on modes of fluoride application and the way in which fluoride has been and is used to effect the dramatic reductions in dental caries with which it is associated. The complex mechanisms by which fluoride exerts its effects are described with clarity, and the entire text is accompanied by particularly useful illustrations. Whether to those new to the field or to the established worker, this monograph will prove to be a most valuable resource to the field of fluoride research. Colin Robinson, Leeds XII Foreword