Jepe 13, No 4, 21612166 (2012) Dental Fluorosis [607029]

2161* For correspondence.Journal of Environmental Protection and Ecology 13 , No 4, 2161–2166 (2012)
Risk assessment
dental flUorosis as resUlt of CUMUlated
eXPosUre
A. Bechira*, r. sirBUb, e. s. Bechirc, M. P AcUrArc, D. l. GherGica,
o. c. ArGhird
aFaculty of Dental Medicine, ‘Titu Maiorescu’ University of Bucharest,
67A Gh. Petrascu Street, 031 593 Bucharest, Romania E-mail: [anonimizat]; [anonimizat]
bFaculty of Pharmacy, Ovidius University of Constanta, Constanta, Romania
cFaculty of Dental Medicine, Tg.Mures University of Medicine and Pharmacy,
Targu Mures, Romania
dFaculty of Medicine, Ovidius University of Constanta, Constanta, Romania
abstract. A considerable increase of dental fluorosis has been observed in recent years. Research indicates that fluorides may cause allergies, osteoporosis, and dental fluorosis, as well as neuro-logical damage. Exposure to fluorides determines the apparition of different effects in entire body, including the component parts of oral-facial system. scientists have noted an association between
mottled
enamel and fluoride exposure since the early 1900’s. Despite the recognition that fluoride
levels can be controlled to offer caries protection with minimum risk of fluorosis, the cosmetic defect
continues to appear. Tea trees (Camellia sinensis), abundant in fluoride, selectively absorb F– from
the surrounding soil and air, and accumulate mainly in the tea leaves in the form of Al and F com-plex. Long-term consumption of high fluoride contents tea leaves could determine chronic fluoride intoxication. The purpose of this clinical report is to present the case of a dental fluorosis as a result of cumulated exposure to fluorides, due through general and topical fluoridation, respectively high fluoride contents tea leaves ingestion.
Keywords: fluoridation, tea trees, dental fluorosis.
AiMs AND BAckGroUND
The aims of this clinical report is to present a case of dental fluorosis as a result of
cumulated exposure to fluorides, due through systemic (general) and topical (local)
fluoridation, respectively high fluoride contents tea leaves ingestion.
Fluoride is a mineral that occurs naturally in all water sources, even the
oceans. Fluoride compounds are constituents of minerals in rocks and soil. Water
passes over rock formations and dissolves the fluoride compounds that are present,
creating soluble fluoride ions which are present in all water sources, including the
ocean1.

2162Fluoride is normally present in the human body2. Approximately 75–90% of
the daily ingested fluoride are absorbed from the alimentary tract. Because of its
chemical affinity for calcium compounds, about half of that fluoride (more in grow-ing children) becomes associated with teeth and bones within 24 h of ingestion
3.
Tea plants (Camellia sinensis) (Fig. 1), mainly cultivated in tropical and sub-
tropical climates, is very high in fluoride content. It is known that some antioxidative compounds could be found in tea, such as rosemary tea
4. Tea leaves accumulate
more fluoride (from pollution of soil and air) than in any other edible plant. Fluoride in tea is much higher than the maximum contaminant level (MCL) set for fluoride in drinking water. chinese teas continue to release F
– throughout the first hour of
infusion, whereas release of F– from ceylon/indian teas is essentially completed
after 5 min (refs 5 and 6). The caffeine in tea has a great augmentative effect on the bio-availability of fluoride
7.
fig. 1. Tea plantation (left) and the aspect of Camelia sinensis (right)
Dental caries is an infectious transmissible disease, with multiple involved
factors. it affects a major part of the population of the entire world, especially in
the countries with a poor economy6.
Fluoride is effective in preventing and reversing the early signs of dental car –
ies. Fluoride also acts to repair or remineralise those areas in which acid attacks
have already begun8. The remineralisation effect of fluoride is important because
it reverses the early decay process as well as creating a tooth surface that is more resistant to decay (Fig. 2). Systemic or topical administration of fluorides, along the dietary habits, oral hygiene constitutes significant methods of prevention and control of dental caries
9.
Topical fluorides are used on the teeth already present in the mouth and in-
clude toothpastes, mouth rinses and professionally applied fluoride therapies. One method of topical fluoridation is self-applied topical fluoride. Professionally-applied fluorides are applied by a dentist or dental hygienist during dental visits. These fluorides are more concentrated than the self-applied fluorides, and therefore are not needed frequently
10.

2163Fluoride is normally present in the human body2. Approximately 75–90% of
the daily ingested fluoride are absorbed from the alimentary tract. Because of its
chemical affinity for calcium compounds, about half of that fluoride (more in grow-ing children) becomes associated with teeth and bones within 24 h of ingestion
3.
Tea plants (Camellia sinensis) (Fig. 1), mainly cultivated in tropical and sub-
tropical climates, is very high in fluoride content. It is known that some antioxidative compounds could be found in tea, such as rosemary tea
4. Tea leaves accumulate
more fluoride (from pollution of soil and air) than in any other edible plant. Fluoride in tea is much higher than the maximum contaminant level (MCL) set for fluoride in drinking water. chinese teas continue to release F
– throughout the first hour of
infusion, whereas release of F– from ceylon/indian teas is essentially completed
after 5 min (refs 5 and 6). The caffeine in tea has a great augmentative effect on the bio-availability of fluoride
7.
fig. 1. Tea plantation (left) and the aspect of Camelia sinensis (right)
Dental caries is an infectious transmissible disease, with multiple involved
factors. it affects a major part of the population of the entire world, especially in
the countries with a poor economy6.
Fluoride is effective in preventing and reversing the early signs of dental car –
ies. Fluoride also acts to repair or remineralise those areas in which acid attacks have already begun
8. The remineralisation effect of fluoride is important because
it reverses the early decay process as well as creating a tooth surface that is more resistant to decay (Fig. 2). Systemic or topical administration of fluorides, along the dietary habits, oral hygiene constitutes significant methods of prevention and control of dental caries
9.
Topical fluorides are used on the teeth already present in the mouth and in-
clude toothpastes, mouth rinses and professionally applied fluoride therapies. One method of topical fluoridation is self-applied topical fluoride. Professionally-applied fluorides are applied by a dentist or dental hygienist during dental visits. These fluorides are more concentrated than the self-applied fluorides, and therefore are not needed frequently
10.
fig. 2. Schedule of fluoride effects in caries prevention
Systemic fluoridation uses the fluorides ingestion, fluorides which are, sub-
sequently, incorporated into the tooth structures and include water, milk, juice
fluoridation, dietary fluoride supplements in the form of tablets, drops or lozenges, etc.
11
Dental fluorosis is a condition that results from exposure to excessive fluoride
during enamel formation. studies generally suggest that the early maturation stage
of enamel development is more critical with regard to the development of fluorosis
than is the earlier stage12,13.
At present, is observed a tendency towards the moderate dental fluorosis as
a reverse side of favourable action of fluoride (Fig. 3). Moderate dental fluorosis
defined as opaque spots on the enamel due to the excess of fluoride in the pre-emptive period is not considered a real health problem but one of cosmetic interest, which could be treated or accepted as it is
14.
fig. 3. Moderate dental fluorosis

2164cAse rePor T
A 12-year young girl was admitted in constanta clinical Pneumology hospital for a
nonspecific respiratory disorder and, after discharge, dental examination was asked
and performed. she had not seen the dentist for 5 years. The patient reported that
she is displeased because her molted aspect of teeth, aspect which was accentuated in the last two years. her medical history disclosed that her parents are overweight
and that she suffers first degree childhood obesity beginning at the 5-th year of her life, without any other medical problems, aside from their girlhood diseases. At presentation, the patient was overweight. The dental history of patient revealed that her current medication is represented only by fluoride supplements in the form of tablets (Zymafluor – Novartis consumer health), starting with the age of one and
a half year. Also, in the last 6 years, she effectuated three self-administration of topical fluorides (Fluocal gel – septodont), ‘in order to have health and beautiful
teeth ’ (Fig. 4). visual inspection of patient dental arches revealed a very good oral
hygiene, fact which was noticed during dental examination. The examination of dental arches not identified the presence of decays, but the teeth, especially the oral faces of incisors and canines presented opaque spots on the enamel (Fig. 5). The examination of patient occlusion not relieved any disorders. We questioned the patient eating habits to determine possible causes that induced her dental fluorosis. she said that all members of family consume daily, beginning at her 6-th year of life, 1–2 l of chinese green tea, since last year, for weight loss.
fig. 4. Presentation mode for Zymafluor tablets and Fluocal gel
fig. 5. Dental fluorosis: labial (left) and oral aspect (right)
The young patient parents begun her systemic fluoridation at 1½ year (not at
2 years), and overdoses the quantities of fluorides (the concentration of Zymafluor
tablets were for a 3-year old child, not for 1½). The young patient effectuated 3

2165topical fluoridation per year, not just twice/year. She utilised an excessive amount
of fluorined toothpaste (increased quantities/3 time daily). She drinked Chinese green tea like substitute for water to loss in weight.
Once the etiologic factors have been identified, palliative treatment and
measures to prevent the apparition of further opaque spots on the enamel of her
teeth were started. Prophylactic measures were instituted and were represented by
the minimisation of exposure to fluorides from any source
15. The specific dental
treatment was effectuated with Opalustre – Ultradent (Fig. 6) by chemical and
mechanical abrasion.
fig. 6. Presentation mode for Opalustre – Ultradent
DiscUssioN
The well-documented effect of fluoride is that this ion substitutes for a column
hydroxyl in the apatite structure, giving rise to a reduction of crystal volume and a concomitant increase in structural stability. But excess fluoride leads to anomalous enamel formation by retarding tissue maturation
16. The mechanisms by which exces-
sive uptake of fluoride interferes with tooth development are not clearly understood,
but altered protein metabolism appears to produce a disorganised crystal structure
and hypomineralisation. The resulting condition, dental fluorosis, is observed both
in primary and permanent teeth. effects in permanent teeth are typically aesthetic
and, on rare occasion, structural ones17.
The fluoride content of teeth reflects the biologically available fluoride at the
time of tooth formation. After this time, the levels of fluoride remain constant,
except for the outermost layer of the enamel18. even some scientists would argue
that this is a ‘minor cosmetic’ side effect of too much exposure to fluoride, but this teenager did not consider the damage to her teeth a minor problem
19.
coNclUsioNs
● Dental fluorosis is a foreseeable and objectionable cosmetic effect that can and
does occur following artificial fluoridation;
● Dental fluorosis is associated with high concentration of fluoride in water
and food, with eating habits, respectively the state of nutrition, physical activity and body size;
● The diet and the consumption of tea in particular, may contribute to the
manifestation of dental fluorosis;

2166● The revision of the fluoride standard must be individualised and should be
based on food habits, too.
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Received 15 December 2010
Revised 29 January 2011