Article Data

  • Views 695
  • Dowloads 213

Original Research

Open Access

Potential risk of dental fluorosis associated with different baby formulas and water brands marketed in Spain

  • Sandra M Gallego-Reyes1
  • Jaime A Cury2
  • Amparo Pérez-Silva3
  • Clara Serna-Muñoz3,*,
  • Icíar Fernández-Pizarro1
  • Yolanda Martínez-Beneyto4
  • Antonio J Ortiz-Ruiz3

1Faculty of Medicine-Dentistry, University of Murcia, Hospital Morales Meseguer, 30008 Murcia, Spain

2Piracicaba Dental School, University of Campinas, 13414-000 Campinas, SP, Brazil

3Department of Integrated Pediatric Dentistry, Faculty of Medicine-Dentistry, University of Murcia, Hospital Morales Meseguer, 30008 Murcia, Spain

4Department of Dermatology, Stomatology and Radiology, Faculty of Medicine-Dentistry, University of Murcia, Hospital Morales Meseguer, 30008 Murcia, Spain

DOI: 10.22514/jocpd.2024.013 Vol.48,Issue 1,January 2024 pp.111-119

Submitted: 15 May 2023 Accepted: 14 July 2023

Published: 03 January 2024

*Corresponding Author(s): Clara Serna-Muñoz E-mail: clara.serna@um.es

Abstract

Despite efforts to promote breastfeeding, many babies aged <6 months receive only baby formula reconstituted with bottled water. The intake of high levels of fluoride during amelogenesis has been associated with hypomineralization of the tooth enamel, with aesthetic and mechanical repercussions. The objective of this study was to determine the potential risk of dental fluorosis associated with baby formulas marketed in Spain. We measured 26 baby formulas frequently consumed in Spain; 17 brands for babies aged <6 months, 5 for those aged >6 months, and 4 ready-to-use brands. They were prepared with 4 types of water: distilled water and three brands of bottled water with different levels of fluoride. The fluoride concentration (mg/L or ppm F) was measured with an ion-specific electrode coupled to an ion analyzer. Each sample was prepared according to the manufacturer’s instructions and analyzed in triplicate. A descriptive analysis was carried out. The minimum fluoride level found was 0.04 mg/L and the maximum was 1.02 mg/L. Considering the daily intake of these formulas, none exceeded the clinically-acceptable daily dose limit risk for fluorosis (0.07 mg F/day/kg body weight) when mixed with bottled water with a low level of fluoride (0.1 mg/L). However, when the same brands of formula were reconstituted with bottled water with a higher fluoride content (0.99 mg/L), they all exceeded the daily dose limit for the risk of fluorosis. As the potential risk of dental fluorosis associated with the formulas tested depends exclusively on the fluoride concentration of the waters used for reconstitution, formula packaging should contain a warning.


Keywords

Dental fluorosis; Bottle feeding; Fluoride intake; Bottled water; Baby formula


Cite and Share

Sandra M Gallego-Reyes,Jaime A Cury,Amparo Pérez-Silva,Clara Serna-Muñoz,Icíar Fernández-Pizarro,Yolanda Martínez-Beneyto,Antonio J Ortiz-Ruiz. Potential risk of dental fluorosis associated with different baby formulas and water brands marketed in Spain. Journal of Clinical Pediatric Dentistry. 2024. 48(1);111-119.

References

[1] Aoun A, Darwiche F, Hayek SA, Doumit J. The fluoride debate: the pros and cons of fluoridation. Preventive Nutrition and Food Science. 2018; 23: 171–180.

[2] Pollick H. The role of fluoride in the prevention of tooth decay. Pediatric Clinics of North America. 2018; 65: 923–940.

[3] Ekstrand J, Spak CJ, Vogel G. Pharmacokinetics of fluoride in man and its clinical relevance. Journal of Dental Research. 1990; 69: 550–555.

[4] Buzalaf MAR, Whitford GM. Fluoride metabolism. Fluoride and the Oral Environment. 2011; 22: 20–36.

[5] Sastry MG, Mohanty S, Rao P. Role of placenta to combat fluorosis (in fetus) in endemic fluorosis area. National Journal of Integrated Research in Medicine. 2010; 1: 16–19.

[6] Koparal E, Ertugrul F, Oztekin K. Fluoride levels in breast milk and infant foods. Journal of Clinical Pediatric Dentistry. 2000; 24: 229–302.

[7] Frazão P, Peres MA, Cury JA. Drinking water quality and fluoride concentration. Journal of Public Health. 2011; 45: 964–973. (In Portuguese)

[8] Fernández CE, Giacaman RA, Cury JA. Fluoride concentration in bottled waters sold in Chile. Revista Medica de Chile. 2014; 142: 623–629. (In Spanish)

[9] Burt BA. The changing patterns of systemic fluoride intake. Journal of Dental Research. 1992; 71: 1228–1237.

[10] McKnight-Hanes MC, Leverett DH, Adair SM, Shields CP. Fluoride content of infant formulas: soy-based formulas as a potential factor in dental fluorosis. Pediatric Dentistry. 1988; 10: 189–194.

[11] Bussell RM, Nichol R, Toumba KJ. Fluoride levels in UK infant milks. European Archives of Paediatric Dentistry. 2016; 17: 177–185.

[12] Iheozor‐Ejiofor Z, Worthington HV, Walsh T, O’Malley L, Clarkson JE, Macey R, et al. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews. 2015; 2015: CD010856.

[13] Berg J, Gerweck C, Hujoel PP, King R, Krol DM, Kumar J, et al. Evidence-based clinical recommendations regarding fluoride intake from reconstituted infant formula and enamel fluorosis: a report of the American Dental Association Council on Scientific Affairs. The Journal of the American Dental Association. 2011; 142: 79–87.

[14] Toumba KJ, Twetman S, Splieth C, Parnell C, van Loveren C, Lygidakis NΑ. Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document. European Archives of Paediatric Dentistry. 2019; 20: 507–516.

[15] Hong L, Levy SM, Warren JJ, Broffitt B, Cavanaugh J. Fluoride intake levels in relation to fluorosis development in permanent maxillary central incisors and first molars. Caries Research. 2006; 40: 494–500.

[16] Rozier RG, Adair S, Graham F, Iafolla T, Kingman A, Kohn W, et al. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs. The Journal of the American Dental Association. 2010; 141: 1480–1489.

[17] Clark MB, Keels MA, Slayton RL, Braun PA, Fisher-Owens SA, Huff QA, et al; Section on oral health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2020; 146: e2020034637.

[18] Instituto Nacional de Estadística. Type of breastfeeding by sex and autonomous community. Population aged 6 months to 4 years. 2022. Available at: https://www.ine.es/jaxi/Datos.htm?path=/t15/p419/a2006/p07/l0/&file=03111.px (Accessed: 24 April 2022).

[19] Bravo Pérez M, Almerich Silla JM, Canorea Díaz E, Casals Peidró E, Cortés Martinicorena FJ, Expósito Delgado AJ, et al. Oral Health Survey in Spain 2020. 2020. Available at: https://rcoe.es/articulo/115/encuesta-de-salud-oral-en-espaa-2020 (Accessed: 28 June 2023).

[20] Vélez-León EM, Albaladejo-Martínez A, Ortíz-Ortega P, Cuenca-León K, Armas-Vega A, Melo M. Distribution of dental fluorosis in the Southern Zone of Ecuador: an epidemiological study. Dentistry Journal. 2023; 11: 71.

[21] Thylstrup A. Distribution of dental fluorosis in the primary dentition. Community Dentistry and Oral Epidemiology. 1978; 6: 329–337.

[22] Warren JJ, Kanellis MJ, Levy SM. Fluorosis of the primary dentition: what does it mean for permanent teeth? The Journal of the American Dental Association. 1999; 130: 347–356.

[23] Wong MC, Glenny AM, Tsang BW, Lo EC, Worthington HV, Marinho VC. Topical fluoride as a cause of dental fluorosis in children. Cochrane Database of Systematic Reviews. 2010; 2010: CD007693.

[24] Everett ET. Fluoride’s effects on the formation of teeth and bones, and the influence of genetics. Journal of Dental Research. 2011; 90: 552–560.

[25] HealthyChildren.org. Amount and schedule of baby formula feedings. 2022. Available at: https://www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/Amount-and-Schedule-of-Formula-Feedings.aspx (Accessed: 03 December 2022).

[26] Asociación Española de Pediatría de Atención Primaria. Growth curves and tables. Faustino Orbegozo Eizaguirre Foundation. 2022. Available at: https://www.fundacionorbegozo.com/el-instituto-de-investigacion-del-crecimiento-y-desarrollo/graficas-y-tablas/ (Accessed: 24 April 2022).

[27] Official Journal of the European Union. Commission Directive 2006/141/EC of 22 December 2006 on infant formulae and follow-on formulae and amending Directive 1999/21/EC Text with EEA relevance. 2006. Available at: http://data.europa.eu/eli/dir/2006/141/oj/spa (Accessed: 20 April 2023).

[28] Noh HJ, Sohn W, Kim BI, Kwon HK, Choi CH, Kim H. Estimation of fluoride intake from milk-based infant formulas and baby foods. Asia Pacific Journal of Public Health. 2015; 27: NP1300–NP1309.

[29] Gallego Reyes SM, Martínez Beneyto Y, Serna-Muñoz C, Pérez-Silva A, Cury JA, Ortiz Ruiz AJ. Fluoride and heavy metals concentration in bottled waters: barrier measures against dental caries and fluorosis. Revista Espanola de Salud Publica. 2019; 93: e201912110. (In Spanish)

[30] Opydo-Szymaczek J, Opydo J. Dietary fluoride intake from infant and toddler formulas in Poland. Food and Chemical Toxicology. 2011; 49: 1759–1763.

[31] Agha Y, Kowash M, Hussein I, AlSalami A, Al-Halabi M. Fluoride concentration of commercially available infant formulae in the United Arab Emirates. European Archives of Paediatric Dentistry. 2020; 21: 657–666.

[32] Vitoria I, Maraver F, Almerich-Silla JM. Fluoride content in tap water in Spain and prevention of dental caries. Gaceta Sanitaria. 2014; 28: 255–256. (In Spanish)

[33] Hujoel PP, Zina LG, Moimaz SAS, Cunha-Cruz J. Infant formula and enamel fluorosis: a systematic review. The Journal of the American Dental Association. 2009; 140: 841–854.

[34] Farkas CS, Farkas EJ. Potential effect of food processing on the fluoride content of infant foods. Science of the Total Environment. 1974; 2: 399–405.

[35] Hossein Mahvi A, Ghanbarian M, Ghanbarian M, Khosravi A, Ghanbarian M. Determination of fluoride concentration in powdered milk in Iran 2010. British Journal of Nutrition. 2012; 107: 1077–1079.

[36] Nagata ME, Delbem ACB, Kondo KY, de Castro LP, Hall KB, Percinoto C, et al. Fluoride concentrations of milk, infant formulae, and soy-based products commercially available in Brazil. Journal of Public Health Dentistry. 2016; 76: 129–135.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time

Conferences

Top