Potential fluoride toxicity from oral medicaments: A review

Document Type: Review Article

Authors

1 Department of Oral Biology, Sindh Institute of Oral Health Sciences Jinnah Sindh Medical University, Karachi, Pakistan

2 Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia

3 Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad, Pakistan

Abstract

The beneficial effects of fluoride on human oral health are well studied. There are numerous studies demonstrating that a small amount of fluoride delivered to the oral cavity decreases the prevalence of dental decay and results in stronger teeth and bones. However, ingestion of fluoride more than the recommended limit leads to toxicity and adverse effects. In order to update our understanding of fluoride and its potential toxicity, we have described the mechanisms of fluoride metabolism, toxic effects, and management of fluoride toxicity. The main aim of this review is to highlight the potential adverse effects of fluoride overdose and poorly understood toxicity. In addition, the related clinical significance of fluoride overdose and toxicity has been discussed.  

Keywords


1. World Health Organization. Trace elements in human nutrition and health. Geneva: World Health Organization; 1996.

2. Mertz W. The essential trace elements. Science 1981; 213:1332-1338.

3. Tressaud A, Haufe G. Fluorine and health: molecular imaging, biomedical materials and pharmaceuticals. Amsterdam: Elsevier; 2008. P. 279-331.

4. Harrison PT. Fluoride in water: a UK perspective. J Fluorine Chem 2005; 126:1448-1456.

5. Nicholson JW, Czarnecka B. Fluoride in dentistry and dental restoratives. Fluoride in dentistry and dental restoratives. Fluorine and health: molecular imaging, biochemical materials and pharmaceuticals. Oxford: Elsevier; 2008. P. 333-378.

6. Akyuz S, Yarat A, Alturfan EE, Kaya S. Fluoride in saliva and its impact on health. In: Preedy VR, editor. Fluorine. London: Royal Society of Chemistry; 2015. P. 173-185.

7. Ullah R, Zafar MS. Oral and dental delivery of fluoride: a review. Fluoride 2015; 48:195-204.

8. Harrison PT. Fluoride in water: a UK perspective. J Fluorine Chem 2005; 126:1448-1456.

9. Spittle B. Fluoride fatigue: fluoride poisoning: is fluoride in your drinking water, and from other sources, making you sick? New Zealand: Paua Press; 2008.

10. Tahir MA, Rasheed H. Fluoride in the drinking water of Pakistan and the possible risk of crippling fluorosis. Drink Water Eng Sci 2013; 6:17-23.

11. Ramadan A, Hilmi Y. The influence of climate on the determination of the upper permissible fluoride level in potable water in Sudan. Fluoride 2014; 47:170-180.

12. Khan AK, Whelton H, O'Mullane D. A map of natural fluoride in drinking water in Pakistan. Int Dent J 2002; 52:291-297.

13. Farooqi A, Masuda H, Firdous N. Toxic fluoride and arsenic contaminated groundwater in the Lahore and Kasur districts, Punjab, Pakistan and possible contaminant sources. Environ Pollut 2007; 145:839-849.

14. Davies R, Ellwood RP, Davies GW. The rational use of fluoride toothpaste. Int J Dent Hyg 2003; 1:3-8.

15. Bentley E, Ellwood R, Davies R. Fluoride ingestion from toothpaste by young children. Br Dent J 1999; 186:460-462.

16. Künzel W. Systemic use of fluoride--other methods: salt, sugar, milk, etc. Caries Res 1993; 27:16-22.

17. Marino R. Should we use milk fluoridation? A review. Bull Pan Am Health Organ 1995; 29:287-298.

18. Zafar MS, Ahmed N. Therapeutic roles of fluoride released from restorative dental materials. Fluoride 2015; 48:184-194.

19. Zafar MS. Effects of surface pre-reacted glass particles on fluoride release of dental restorative materials. World Appl Sci J 2013; 28:457-462.

20. Khurshid Z, Zafar M, Qasim S, Shahab S, Naseem M, AbuReqaiba A. Advances in nanotechnology for restorative dentistry. Materials 2015; 8:717-731.

21. Shah FA. Fluoride-containing bioactive glasses: glass design, structure, bioactivity, cellular interactions, and recent developments. Mater Sci Eng C Mater Biol Appl 2016; 58:1279-1289.

22. Levine M. Topics in dental biochemistry. Berlin, Germany: Springer Science & Business Media; 2010.

23. Yang K, Liang X. Fluoride in drinking water: effect on liver and kidney function. New York: Elsevier; 2011. P. 769-775.

24. Jha SK, Mishra VK, Sharma DK, Damodaran T. Fluoride in the environment and its metabolism in humans. In: anonymous reviews of environmental contamination and toxicology. New York: Springer; 2011. P. 121-142.

25. Buzalaf MA, Whitford GM. Fluoride metabolism. Monogr Oral Sci 2011; 22:20-36.

26. Barbier O, Arreola-Mendoza L, Del Razo LM. Molecular mechanisms of fluoride toxicity. Chem Biol Interact 2010; 188:319-333.

27. Ozsvath DL. Fluoride and environmental health: a review. Rev Environ Sci Bio Technol 2009; 8:59-79.

28. Ponikvar M. Exposure of humans to fluorine and its assessment. Fluorine Health 2008; 7:487-549.

29. Martínez-Mier EA. Fluoride: its metabolism, toxicity, and role in dental health. J Evid Based Complement Alternat Med 2012; 17:28-32.

30. World Health Organization. Basic methods for assessment of renal fluoride excretion in community prevention programmes for oral health. Geneva: World Health Organization; 2014.

31. Niazi F, Naseem M, Khurshid Z, Zafar MS, Almas K. Role of Salvadora persica chewing stick (miswak): a natural toothbrush for holistic oral health. Eur J Dent 2016; 10:301-308.

32. Buzalaf MA, Levy SM. Fluoride intake of children: considerations for dental caries and dental fluorosis. Monogr Oral Sci 2011; 22:1-19.

33. Smith FA. Fluoride toxicity. New York: Handbook of Hazardous Materials; 2012. P. 277-283.

34. Whitford GM. Acute toxicity of ingested fluoride. Monogr Oral Sci 2011; 22:66-80.

35. Limaleite AD, Buzalaf CP, Buzalaf M. Fluoride intake in the context of dental fluorosis. Fluorine: Chemistry, Analysis, Function and Effects; 2015. P. 22-38.

36. Denbesten P, Li W. Chronic fluoride toxicity. Dental fluorosis. Monogr Oral Sci 2011; 22:81-96.

37. Kidd EA. Essentials of dental caries. Oxford; New York: Oxford University Press; 2005.

38. García MG, Borgnino L. Fluoride in the context of the environment. Fluorine: Chemistry, Analysis, Function and Effects; 2015. P. 3-21.

39. World Health Organization. Oral health surveys: basic methods. Geneva: World Health Organization; 2013.

40. Cameron AC, Widmer RP. Handbook of pediatric dentistry. New York: Elsevier Health Sciences; 2013.

41. Ranjan R, Ranjan A. Fluoride toxicity in animals. New York: Springer; 2015.

42. Nabavi SF, Daglia M, Sureda A, Nabavi SM. Fluoride-induced oxidative stress in the liver. Fluorine: Chemistry, Analysis, Function and Effects; 2015. P. 271.

43. Craig L, Lutz A, Berry KA, Yang W. Recommendations for fluoride limits in drinking water based on estimated daily fluoride intake in the upper east region, Ghana. Sci Total Environ 2015; 532:127-137.

44. Valdez-Jiménez L, Fregozo CS, Beltrán MM, Coronado OG, Vega MP. Effects of the fluoride on the central nervous system. Neurología 2011; 26:297-300.

45. Naseem M, Khurshid Z, Khan HA, Niazi F, Zohaib S, Zafar MS. Oral health challenges in pregnant women: Recommendations for dental care professionals. Saudi J Dental Res 2016; 7:138-146.

46. Yu Y, Yang W, Dong Z, Wan C, Zhang J, Liu J, et al. Neurotransmitter and receptor changes in the brains of fetuses from areas of endemic fluorosis. Fluoride 2008; 41:134-138.

47. Feng D, Huang H, Yang Y, Yan T, Jin Y, Cheng X, et al. Ameliorative effects of N-acetylcysteine on fluoride-induced oxidative stress and DNA damage in male rats’ testis. Mutat Res Gen Toxicol Environ Mutagen 2015; 792:35-45.

48. Bayless JM, Tinanoff N. Diagnosis and treatment of acute fluoride toxicity. J Am Dent Assoc 1985; 110:209-211.