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Fluoridation: Aspects of toxicity

[Malcolm Harris, Ph.D. (Wales), B.Pharm (Wales), FPS, Fss, FRSH]

Fluoridation: Errors and Omissions in Experimental Trials

[Chapters 19, 20 and 21. Philip Sutton. Originally published in 1960]

The Kinetics of Acetylcholinest'se Inhibition and the Influence of Fluoride and Fluoride Complexes on the Permeability of Erythrocyte Membranes

[Westendorf, 1975]

External links & refs
Please see the Papers index for all other links and references.

Cover | Introduction | 1a | 1b | 1c | 1d | 2a | 2b | 2c | 2d | 3

Errors and Omissions in Experimental Trials - References and Glossary

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B

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Brothers, PC. (1956) Aust. Dent. J 1: 307.

Brown, H.K. (1951) J. Canad. Dent. Assn 17: 609.

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Brown, H.K., (1955) Dental Effects of Water Fluoridation (Ottawa, Dental Health Division, Department of National Health and Welfare) pp. 2, 16-17, 27, 33, 35. Brown, H.K., Josie, G.H. and Stewart, B. (1953) J. Canad. Dent. Assn. 19: 652.

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C

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D
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E
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F
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G
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H

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I
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J
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K
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L
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M
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N
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O

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P

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Q

Quenouille M.H. (1952) The Design and Analysis of Experiment. (London, Griffin) p.5.

 

R

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S

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GLOSSARY

 

APPROXIMAL SURFACE
Adjacent surfaces of teeth in the same jaw (upper or lower)

 

"BLIND"
See Examinations "Blind"

 

CALIBRATIONS
Readings or assessments made in appropriate units

 

CARIES
Progressive decay of teeth (or bones). See Dental Caries

 

CARIES EXPERIENCE

The extent and severity of dental caries within a population - usually measured with indexes such as DMFS or DMFT etc.

 

CARIOGENIC SUBSTANCE

One which produces decay (within a tooth).

 

CARIOSTATIC
Decay retarding

 

DECIDUOUS TEETH

(Primary or "milk" teeth). These start to erupt around 6 months and are shed around 12 years when the permanent teeth start to appear.

 

DEMINERALIZATION

Reduction of the mineral content (principally, calcium and phosphorous) of a (issue, notably the enamel, dentine or cementum of teeth.

 

DENTAL CARIES

Disease of the teeth resulting in the demineralization, cavitation and breakdown of calcified dental tissues (enamel, dentine or cementum) by microbial activity.

 

DENTAL DECAY
See Dental Caries

 

DENTAL FLUOROSIS

A disturbance of tooth formation caused by fluoride being present in the tissue fluids over a prolonged period during tooth development. The disturbance results in the development of porous enamel which has an altered appearance ranging from the most mild forms, in which small flecks of white discolouration can be observed on the tooth surface, to the most severe forms, in which the enamel develops pitting and brown staining. Dental fluorosis must be distinguished from other disorders of enamel including: enamel opacities (see below) of non-fluoride origin; early `white spot' caries lesion; enamel hypoplasia; amelogenesis imperfecta; dentinogenesis imperfecta; and tetracycline stains.

 

DENTAL PROPHYLAXIS

The prevention of dental disease, especially dental caries.


DENTRIFICE ("TOOTHPASTE")
A pharmaceutical compound used in conjunction with the toothbrush to clean and polish teeth. It contains a mild abrasive, a detergent, flavouring agent, binder, and occasionally deodorants and various medicaments designed as caries preventives, for example, fluoride and antiseptics.


DENTITION
Natural teeth in the jaws


DEF, DMFT, DMFS, DIMFT, def, dft, dfs, dmft
Indexes describing the dental caries experience of individuals or populations. The DMFT index is computed by summing the number of permanent teeth which are Decayed, Missing or Filled. For any person, the index can range in value from zero to 32, the maximum number of teeth. The DMFS index is a count of the number of permanent tooth surfaces which are decayed, missing or filled. Teeth may have either four surfaces (incisors and canines) or five surface (premolars and molars) for the purposes of the DMFS index.

 

The DIMFT index includes, in addition to a count of decayed, missing and filled teeth, the number of teeth which are Indicated for (in need of) extraction. (DEF decayed, extracted, filled)

 

Lower case lettering refers to the deciduous dentition. Hence the dft index is count of the number of deciduous teeth which are decayed or filled, while the dfs index refers to the number of surfaces affected. Missing deciduous may also be included in the index, hence constituting the dmft index.


DISCRETIONARY FLUORIDE
Any form of fluoride which is used actively and preferentially by an individual in the prevention of decay. This includes fluoride tablets or drops, fluoridated toothpastes or mouthrinses, and professional topical applications. It does not include fluoridated drinking water.


DOSE (Fluoride)
The amount of fluoridated water drunk, consumed, ingested, by each person. This "dose" differs enormously depending on age, weight, size, state of health, temperature of day, different types of work and sport played etc.

 

EFFICACY
The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized controlled trial.


ENAMEL DISTROPHY
Defective formation of tooth enamel (or deterioration)


ENAMEL OPACITY
An opaque area on the normally transparent (translucent) enamel (often referred to as "mottled" teeth)


ENDEMIC AREA
Present within a localized area or peculiar to persons within such an area.


ERROR
BETWEEN-EXAMINER ERROR - variations between the assessments of two different examiners when the examining the same person.
WITHIN-EXAMINER ERROR - an examiner may record different opinions when examining the same mouth on different occasions.


EXAMINATIONS "BLIND"
Are carried out to avoid bias. The examiner should be unaware of the background or treatment of his patient.


EPIDEMIOLOGY
The study of the distribution and determinants of disease in human populations and the identification and evaluation of methods of preventing or alleviating illness.


EPIDEMIOLOGY - EXPERIMENTAL
A study in which a population is selected for a planned trial of a regimen 'whose effects are measured by comparing the outcome of the regimen in the experimental group with the outcome of another regimen in a control group. In some experiments, for example, fluoridation of drinking water, whole communities have been allocated (usually non-randomly) to experimental and control groups.


EVALUATION
A process that attempts to determine as systemically and objectively as possible the relevance, effectiveness, and impact of activities in the light of their objectives. Several varieties of evaluation can be distinguished, for example evaluation of structure, process and outcome.

 

FISSURE
A minute crack in the surfaces of a tooth (caused by the imperfect joining of enamel during development).

 

FISSURE SEALANT
An adhesive, plastic film applied to those surfaces of teeth which have pits or fissures to assist in the prevention of caries - however this film does not tend to last as long as prophylatic fillings.


FLUORIDATION
Is achieved by the mechanical addition of fluorides to a public water supply to attain a concentration of approx. 1 part fluoride to one million parts of water (lppm) (see also RATE) FLUORIDE COMPOUNDS Used to artificially fluoridate water supplies. They are derived from industrial processes and dissolve readily in water.


FLUORIDES
Are substances containing fluoride ions which are constituents of the element fluorine.


FLUORIDES (NATURAL)
Natural fluorides found in nature are those found in which the fluoride ions are bound to calcium and are very insoluble.


FLUORIDE VEHICLE
The means by which supplementary fluoride is provide for the prevention of dental caries. The principal fluoride vehicles are : water fluoridation, fluoride tablets or drops, fluoride toothpastes or mouthrinses, and professional dental applications.


FLUORINE
Is a rare and toxic gas (yellow, pungent), however the term fluorine in most cases can be substituted for fluoride (mainly European use).


FLUOROSIS
Fluoride poisoning due to ingesting or drinking too much fluoride in drinking water over a long period of time (or to ingestion of pesticides containing fluoride salts). Chronic fluorosis results in the "mottling" of (children's) teeth.

 

FLUOROSIS Dental - See Dental Fluorosis


FLUOROSIS Skeletal - See Skeletal Fluorosis

 

GEL (Fluoride gel)
Contains 1.23% Fluoride for direct application by dentists to teeth during prophylatic treatment.


GINGIVAL SURFACE
That part of the tooth surface which is adjacent to or immediately above the gum (gingiva).


HYPOPLASIA

Incomplete development of an organ or part.


INCIDENCE
The number of new cases of a given disease or other condition in a given population at risk of the disease during a designated time. The word is often used to mean incidence rate.


MFP
Monofluorophosphate - one formulation commonly used for the addition of fluoride to toothpaste.


MOTTLED TEETH
See Enamel Opacity and Dental Fluorosis


MOUTHRINSE, MOUTHWASH
A mouth rinse possessing cleaning, germicidal, and / or palliative properties.


OCCLUSAL SURFACE
The "biting" surface of the tooth which makes contact with that of the opposing jaw.


OSTEOPOROSIS
Porosity and brittleness of bones due to loss of protein from the bone matrix.


PERMANENT DENTITION

The set of natural, permanent teeth in the dental arches.


PPM
Parts per million - a measurement of the concentration of a substance. A concentration of one part per million is equivalent to one milligram per kilogram. For example, fluoridated water at l ppm contains one milligram of fluoride ion per litre of water.


PREVALENCE

The number of individual cases of a given disease or other condition in a given population at a designated time. The word is often used to mean prevalence rate.

 

PRIMARY DENTITION

The set of natural, primary (deciduous) teeth in the jaws.


PROPHYLATIC FILLINGS
Dental fillings which, in the past, were placed in the pits or fissures of sound (non-decayed) teeth with a view to preventing the development of advanced decay.


PROTOPLASMIC POISONS
Fluorides are generally protoplasmic poisons because of their capacity to modify the metabolism of cells by changing the permeability of the cell membrane by inhibiting certain enzyme systems.


PUBLIC HEALTH
Encompasses the problems affecting the health of a population, the collective status of health of the people, environmental health and health services, and the administration of health care services.


RANDOM VARIATION
This term is used to describe the differences which may occur constantly from year to year in treated or untreated areas due to the influence of many random factors which affect caries rates, some of which are unknown.


RANDOMIZED CONTROLLED TRIAL
An epidemiological experiment in which subjects in a population are randomly allocated into groups, usually called "study" and "control" groups, to receive or not to receive an experimental preventative or therapeutic procedure or intervention. The results are assessed by comparison of rates of the disease, death, recovery, or other appropriate outcome in the study and control groups, respectively. Randomized controlled trials are generally regarded as the most, scientifically rigorous method of hypothesis testing available in epidemiology.


RATE
The amount of fluoride (F) in the water either naturally or added by a water authority expressed as p.p.m. (parts per million) or mg/litre (milligrams per litre)


REMINERALIZATION
The process whereby a demineralized or hypomineralized tissue takes up minerals again (used here in the sense of ionic exchange in enamel).

 

SKELETAL FLUOROSIS
This is caused by excessive intakes of fluoride from many sources including drinking water supplies. Bone fractures caused by fluoride changing the structure and decreasing the tensile strength (although increasing bone mass). Advanced skeletal fluorosis is a crippling process causing stiffness of joints and limiting joint movement.


SMOOTH SURFACE CARIES
Dental caries occurring on those gingival and approximal surfaces of the teeth which do not have a natural pattern of fissures, pits or grooves.


SUPPLEMENTARY FLUORIDE
Any form for fluoride which is used by humans in addition to the amounts to which they would be exposed through the environment, foods and background levels in drinking water (typically at a concentration of 0.3 ppm fluoride or less). Sources of supplementary fluoride include fluoridated drinking water, fluoride tablets or drops, fluoridated toothpastes or mouthrinses, and professional dental applications. Hence, the term "supplementary fluoride" here is broader in scope than that used by some others to refer only to tablets or drops.

 

SYSTEMIC

Affecting the whole body.

 

TABLETS

See Discretionary Fluoride, Supplementary Fluoride and Fluoride Vehicle.

 

TOPICAL

Pertaining to or acting upon a particular surface area.

 

TOPICAL APPLICATION

Application locally (in the mouth onto the tooth surface).

 

TOPICAL FLUORIDE

The application of fluoride which is intended primarily to act locally on the teeth.

 

TOXICITY

The fluoride ion is toxic to all life when not "bound" (as when it occurs naturally). "Free" fluoride ions may exert toxic effects.

 

This glossary has been compiled from the work of Dr.P R.N.Sutton, Glen S.R. Walker, The Collins Dictionary and portions of information from the N.H. and M.R.C. (Australia).

Cover | Introduction | 1a | 1b | 1c | 1d | 2a | 2b | 2c | 2d | 3


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