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Background/Aims: Currently available techniques for fluoride analysis are not standardized. Therefore, this study was designed to develop standardized methods for analyzing fluoride in biological and nonbiological samples used for dental research. Methods: A group of nine laboratories analyzed a set of standardized samples for fluoride concentration using their own methods. The group then reviewed existing analytical techniques for fluoride analysis, identified inconsistencies in the use of these techniques and conducted testing to resolve differences. Based on the results of the testing undertaken to define the best approaches for the analysis, the group developed recommendations for direct and microdiffusion methods using the fluoride ion-selective electrode. Results: Initial results demonstrated that there was no consensus regarding the choice of analytical techniques for different types of samples. Although for several types of samples, the results of the fluoride analyses were similar among some laboratories, greater differences were observed for saliva, food and beverage samples. In spite of these initial differences, precise and true values of fluoride concentration, as well as smaller differences between laboratories, were obtained once the standardized methodologies were used. Intraclass correlation coefficients ranged from 0.90 to 0.93, for the analysis of a certified reference material, using the standardized methodologies. Conclusion: The results of this study demonstrate that the development and use of standardized protocols for F analysis significantly decreased differences among laboratories and resulted in more precise and true values.

This study evaluated the effect of Er,Cr:YSGG laser irradiation and professional fluoride application on enamel demineralization and on fluoride formation and retention. In a blind in vitro study, 264 human enamel slabs were distributed into 8 groups: G1 – untreated; G2 – treated with acidulated phosphate fluoride gel (APF gel, 1.23% F) for 4 min; G3, G4 and G5 – irradiated with Er,Cr:YSGG at 2.8, 5.6 and 8.5 J/cm 2 , respectively; G6, G7 and G8 – preirradiated with Er,Cr:YSGG at 2.8, 5.6 and 8.5 J/cm 2 , respectively, and subjected to APF gel application. Twenty slabs of each group were submitted to a pH-cycling regimen, and enamel demineralization was evaluated in 10 slabs of each group. In the other 10 slabs, CaF 2 -like material was determined. To evaluate F formed, 10 additional slabs of each group, not subjected to the pH cycling, were submitted to analysis of CaF 2 -like material and fluorapatite, while the other 3 slabs of each group were evaluated by scanning electron microscopy. The F content was also measured in all pH-cycling solutions. Laser at 8.5 J/cm 2 and APF treatment reduced enamel demineralization compared to the control (p < 0.05), but the combination of these treatments was not more efficient than their isolated effect. A higher concentration of retained CaF 2 -like material was found in laser groups followed by APF in comparison with the APF gel treatment group. The findings suggest that laser treatment at 8.5 J/cm 2 was able to decrease hardness loss, even though no additive effect with APF was observed. In addition, laser treatment increased the formation and retention of CaF 2 on dental enamel.

Titanium is used as a metal for biocompatible materials such as dental implants or restorations because of its excellent chemical stability. However, the corrosion of Ti in the prophylactic fluoride-containing environment can become problematic. To clarify the effects of fluoride concentration and pH on the corrosion behavior of Ti, we conducted anodic polarization and immersion tests in NaF solution of various concentrations and pH values. The concentrations of dissolved Ti in the test solutions were analyzed by inductively coupled plasma mass spectroscopy. There were obvious limits of fluoride concentration and the pH value at which the corrosion behavior of Ti changed. The corrosion of Ti in the solution containing fluoride depended on the concentration of hydrofluoric acid (HF). When the HF concentration in the solution was higher than about 30 ppm, the passivation film of the Ti was destroyed. The results of this study revealed a relation between the fluoride concentrations and pH values at which Ti corrosion occurred and provided data on such corrosion in environments where the fluoride concentration and pH value are known.

The purpose of this study is to determine whether a calcium (Ca) prerinse used before a 228 µg/g (ppm) fluoride (F) rinse would induce the formation of ‘calcium fluoride-like' (CaF 2 -like) deposits in human dental plaque. Sixty minutes after the use of the Ca prerinse/F rinse, plaque samples were collected from 10 volunteers, homogenized, and split into 2 aliquots. The plaque mass from one aliquot was then extracted with a ‘plaque-like' solution that extracted all the CaF 2 -like deposits. The total F in both aliquots was then determined and compared. The results demonstrated that, as in previous studies, the Ca prerinse induced large increases in plaque fluid and total plaque F. However, unlike previous results without the Ca prerinse, 30% of the plaque F deposits were CaF 2 or CaF 2 -like. Given that maintaining an elevated F concentration in the vicinity of a developing lesion may play an important role in the cariostatic effect of this ion, and the potential advantages of CaF 2 -like deposits as an F source, these results suggest that a Ca prerinse may increase the cariostatic effect of topical agents.

Today's fluoride-releasing varnishes (F-varnish) contain a wide variety of ingredients which present analytical challenges for measuring their total fluoride content. This study reports improved methods to measure fluoride content in F-varnishes. Six different commercially available F-varnishes that contain difluorosilane (0.1% F) or NaF (2.26% F) alone or in combination with calcium-phosphates were analyzed. In a vial, 1-3 drops (0.05-0.15 g) of varnish product was dispensed, dissolved in chloroform, equilibrated in TISAB and analyzed via fluoride ion-selective electrode. The average weight percentage of fluoride for all F-varnishes containing NaF ranged from 2.03 to 2.24% F, which is within 90% of the declared label concentration of 2.26% F. Analysis of the difluorosilane-containing product required an additional hydrolysis step. ANOVA found no significant difference between the 5% NaF varnishes at p < 0.05. This method for fluoride analysis yields reliable and reproducible results and can be used for a wide variety of F-varnishes. The standard uncertainty for this method is ±4%. This method may become the basis for national and international standards that ensure the F-varnish products used in clinical practice have the fluoride content declared in the product literature.

In this study, the quality of groundwater was assessed in a semi-arid region of India by using an entropy weighted water quality index (EWQI) and a pollution index of groundwater (PIG). The EWQI and PIG methods were used to evaluate data on physicochemical parameters in relation to drinking water quality standards. Groundwater samples were collected from the Dubbak region, Telangana state, India, and were analyzed for pH, total hardness, electrical conductivity, total dissolved solids, bicarbonate (HCO3−), chloride (Cl−), sulfate (SO42−), nitrate (NO3−), fluoride (F−), calcium (Ca2+), magnesium (Mg2+), sodium (Na+), and potassium (K+). The groundwater of the study region is alkaline in nature. The abundance of cations and anions based on their mean values is in the following order: Na+ > Ca2+ > Mg2+ > K+ and Cl− > HCO3− > NO3− > SO42− > F−, respectively. The calculated EWQI values ranged from 49.0 to 174.6, with an average of 93.3. Overall, EWQI data showed that only 60% of groundwater samples were of suitable quality for drinking, although only marginally, whereas the remaining 40% of samples were unsuitable for drinking purposes and would therefore require treatment. The values of PIG varied from 0.5 to 1.8, with an average of 1.0, which showed that only 63% of groundwater samples from the study area were suitable for drinking purposes.

When safe and adequate exposure of an essential trace element is exceeded it becomes potentially toxic . Fluoride is one classic example of such a double edged sword which both plays a fundamental role in the normal growth and development of the body for example the consumption of levels between 0.5–1.0 ppm via drinking water is beneficial for prevention of dental caries but its excessive consumption leads to development of fluorosis. Purpose of Review The abundance of fluorine in the environment as well as in drinking water sources are the major contributors to fluorosis. It is a serious public health concern as it is a noteworthy medical problem in 24 nations including India yet the threat of fluorosis has not been rooted out. The review focuses on recent findings related to skeletal fluorosis and role of oxidative stress in its development. The fluoride mitigation strategies adopted in recent years are also discussed. Recent Findings Based on Case Studies Recent findings revealed that consumption of fluoride at concentrations of 1.5 ppm is majorly responsible for skeletal fluorosis. The sampling from rural areas showed that 80% villages are having fluoride concentrations more than the WHO permissible limits and people residing in such areas are affected by the skeletal fluorosis and also in the regions of Africa and Asia endemic fluorosis have been accounted in the majority of the region affecting approximately 100 million people. Various mitigation programmes and strategies have been conducted all over the world using defluoridation. Summary Fluorosis is a slow and progressive malady affecting our body and a serious concern to be taken into consideration and to be dealt with effectively. The fluoride toxicity although reversible, is a slow process and the side effects lack treatment options. The treatment options available are either not approachable or affordable in the rural areas commonly suffering from the fluoride toxicity. No specific treatments are available to date to treat skeletal fluorosis affectively; therefore, prevention is one of most safest and best approach to fight fluorosis. The current review lays emphasis on the skeletal fluorosis and its prevalence in recent years. It also includes the recent findings as well as the current strategies related to combat skeletal fluorosis and provides findings that might be helpful to promote the research in the field of effective treatment for fluorosis as well as development of easy and affordable methods of fluoride removal from water.

Groundwater quality investigations were carried out in one of the urban parts of south India for fluoride and nitrate contaminations, with special focus on human health risk assessment for the rapidly growing and increasingly industrialized Coimbatore City. Twenty-five groundwater samples were collected and analyzed for physico-chemical parameters (EC, pH, TDS, Ca 2+ , Mg 2+ , Na + , K + , Cl − , SO 4 2− , HCO 3 − , PO 4 3− , NO 3 − , and F − ) and the piper diagram characterized 60% of them as Ca-Mg-Cl type. Analysis of fluoride (0.1 to 2.4 mg/l) shows that 32% of the groundwater samples contain F − over the permissible limit, affecting a region of 122.10 km 2 . Nitrate (0.1 to 148 mg/l) is over the permissible limit in 44% of the groundwater samples spread over an area of 429.43 km 2 . The total hazard indices (THI) of non-carcinogenic risk for children (0.21 to 4.83), women (0.14 to 3.35), and men (0.12 to 2.90) shows some of the THI values are above the permissible limit of the US Environmental Protection Agency. The THI-based non-carcinogenic risks are 60%, 52%, and 48% for children, women, and men. This investigation suggests higher health risk for children and also recommends that proper management plan should be adopted to improve the drinking water quality in this region in order to avoid major health issues in the near future.

The aim of the study was to evaluate salivary fluoride (F) availability after toothbrushing with a high-F dentifrice. Twelve adult volunteers took part in this crossover and blind study. F concentration in saliva was determined after brushing with a high-F dentifrice (5000 µg F/g) or with a conventional F concentration dentifrice (1100 µg F/g) followed by a 15 mL distilled water rinse. Samples of nonstimulated saliva were collected on the following times: before (baseline), and immediately after spit (time = 0) and after 1, 2, 3, 4, 5, 10, 15, 20, 30, 45, 60, 90, and 120 min. F analysis was performed with a fluoride-sensitive electrode and the area under curve of F salivary concentration × time (µg F/mL × min−1) was calculated. At baseline, no significant difference was found among dentifrices (P > 0.05). After brushing, both dentifrices caused an elevated fluoride level in saliva; however salivary F concentration was significantly higher at all times, when high-F dentifrice was used (P < 0.01). Even after 120 min, salivary F concentration was still higher than the baseline values for both dentifrices (P < 0.001). High-F dentifrice enhanced the bioavailability of salivary F, being an option for caries management in patients with high caries risk.

Several million people are exposed to fluoride (F−) via drinking water in the world. Current review emphasized the elevated level of fluoride concentrations in the groundwater and associated potential health risk globally with a special focus on Pakistan. Millions of people are deeply dependent on groundwater from different countries of the world encompassing with an elevated level of fluoride. The latest estimates suggest that around 200 million people, from among 25 nations the world over, are under the dreadful fate of fluorosis. India and China, the two most populous countries of the world, are the worst affected. In Pakistan, fluoride data of 29 major cities are reviewed and 34% of the cities show fluoride levels with a mean value greater than 1.5 mg/L where Lahore, Quetta and Tehsil Mailsi are having the maximum values of 23.60, 24.48, > 5.5 mg/L, respectively. In recent years, however, other countries have minimized, even eliminated its use due to health issues. High concentration of fluoride for extended time period causes adverse effects of health such as skin lesions, discoloration, cardiovascular disorders, dental fluorosis and crippling skeletal fluorosis. This review deliberates comprehensive strategy of drinking water quality in the global scenario of fluoride contamination, especially in Pakistan with prominence on major pollutants, mitigation technologies, sources of pollution and ensuing health problems. Considering these verities, health authorities urgently need to establish alternative means of water decontamination in order to prevent associated health problems.