Procena unosa fluorida putem vode za piće i paste za zube kod dece uzrasta od tri godine: preliminarni rezultati u Beogradu, Republika Srbija
Sažetak
Uvod/Cilj. Fluoridi imaju pozitivan efekat na prevenciju karijesa zuba kao i povećanje čvrstine zubnog emajla. Međutim, njihov unos iznad optimalnog može imati štetne efekte na zube i kosti, posebno kod male dece tokom intenzivnog rasta i razvoja zuba. Cilj ovog rada bio je da se proceni unos fluorida putem vode za piće i paste za zube kod dece uzrasta od tri godine u Beogradu, na teritoriji dve opštine, Vračar i Novi Beograd. Metode. Anketnim upitnicima (n = 40) za roditelje dobijeni su podaci o vrsti vode koju deca piju (česmenska i/ili flaširana), proizvodima koje koriste za čišćenje i negu zuba, učestalosti pranja zuba kao i količini paste za zube koja se koristi po jednom pranju. Sadržaj fluorida u vodi za piće i pastama za zube određen je elektrohemijski sa fluoridnom jon-selektivnom elektrodom. Unos fluorida procenjen je korišćenjem matematičkog modela datog od strane Američke agencije za zaštitu životne sredine. Rezultati. Dobijeni rezultati pokazuju da nema statistički značajne razlike u dnevnom unosu fluorida putem vode za piće i paste za zube između dece uzrasta od tri godine na Vračaru i Novom Beogradu (p > 0,05). Međutim, sve procenjene vrednosti unosa fluorida (0,089–0,625 mg/dan) značajno su niže od optimalnog dnevnog unosa za prevenciju karijesa (0,7 mg/dan za decu uzrasta do 4 godine, FNB-Nacionalnog instituta medicine, SAD) i dva do šest puta niže od tolerišućeg gornjeg nivoa unosa fluorida za decu istog uzrasta (1,3 mg/dan, FNB-Nacionalnog instituta medicine, SAD). Štaviše, izračunati dnevni unosi fluorida izraženi po kilogramu telesne mase potvrđuju veoma nizak unos fluorida kod dece ispitivanih opština u Beogradu, čak značajno niže od preporučenog optimalnog unosa (0,05 mg/kg/dan, EFSA). Zaključak. Ovim preliminarnim istraživanjem pokazano je da je dnevni unos fluorida kod trogodišnjaka u Beogradu značajno niži od tolerišućeg gornjeg nivoa unosa fluorida, čak niži od optimalnog unosa za prevenciju karijesa.
Reference
Petersen PE, Lennon MA. Effective use of fluorides for the prevention of dental caries in the 21st century: The WHO ap-proach. Community Dent Oral Epidemiol 2004; 32(5): 319‒21.
Everett ET. Fluoride's effects on the formation of teeth and bones, and the influence of genetics. J Dent Res 2011; 90(5): 552‒60.
Clark MB, Slayton RL. Fluoride use in caries prevention in the primary care setting. Pediatrics 2014; 134(3): 626‒33.
World Health Organization (WHO). Guidelines for Drinking-water Quality. 4th ed. Geneva: World Health Organization; 2011.
European Food Safety Agency (EFSA). Panel on Dietetic Prod-ucts, Nutrition and Allergies. Scientific opinion on Dietary Reference Values for fluoride. EFSA J 2013; 11(8): 3332.
Fawell J, Bailey K, Chilton J, Dahi E, Fewtrell L, Magara Y. Fluo-ride in Drinking-water. U: WHO Water Series. ISBN: 1900222965. London, UK: World Health Organization, IWA Publishing; 2006.
European Food Safety Authority (EFSA). Opinion of the Scien-tific Panel on Dietetic Products, Nutrition and Allergies on a request from the Commission related to the Tolerable Upper Intake Level of Fluoride. EFSA J 2005; 192: 1‒65.
Agency for Toxic Substances and Disease Registry (ATSDR). Toxi-cological Profile for Fluorides, Hydrogen Fluoride, and Fluo-rine. Atlanta, Georgia: U. S. Department of Health and Hu-man Services, Public Health Service; 2013.
Pereira AC, da Cunha FL, Meneghim MC, Werner CW. Dental caries and fluorosis prevalence study in a nonfluoridated Bra-zilian community: Trend analysis and toothpaste association. ASDCJ Dent Child 2000; 67(2): 132‒5.
Wong MC, Clarkson J, Glenny AM, Lo EC, Marinho VC, Tsang BW, Worthington HV. Cochrane reviews on the benefits/risks of fluoride toothpastes. J Dent Res 2011; 90(5): 573‒9.
Ekambaram M, Itthagarun A, King NM. Ingestion of fluoride from dentifrices by young children and fluorosis of the teeth: A literature review. J Clin Pediatr Dent 2011; 36(2): 111‒21.
Lockner F, Twetman S, Stecksén-Blicks C. Urinary fluoride excre-tion after application of fluoride varnish and use of fluoride toothpaste in young children. Int J Paediatr Dent 2017; 27(6): 463‒8.
Evans RW, Stamm JW. An epidemiologic estimate of the criti-cal period during which human maxillary central incisors are most susceptible to fluorosis. J Public Health Dent 1991; 51(4): 251‒9.
Ellwood RP, Cury JA. How much toothpaste should a child un-der the age of 6 years use?. Eur Arch Pediatric Dent 2009; 10(3): 181‒7.
Kobayashi CA, Belini MR, Italiani FM, Pauleto AR, Araújo JJ, Tessarolli V, et al. Factors influencing fluoride ingestion from dentifrice by children. Community Dent Oral Epidemiol 2011; 39(5): 426‒32.
American Academy of Pediatric Dentistry (AAPD). Guideline on Fluoride Therapy. Clin Pract Guidelines 2014; 37(6): 177‒9.
European Academy of Paediatric Dentistry (EAPD). Guide-lines on the use of fluoride in children: An EAPD policy doc-ument. Eur Arch Pead Dent 2009; 10(3): 129‒35.
Ivanović M, Carević M, Marković D, Vulićević Z, Stevanović R, Petrović V, et al. The protocol for the use of fluoride in caries prevention in children and youth in Serbia. In: Ivanović M, Carević M, Marković D, Vulićević Z, Stevanović R, Pe-trović V, et al. Protocols in dentistry. Belgrade: University of Belgrade, School of Dentistry. 2009. p. 21‒47. (Serbian)
da Silveira Moreira, R. Epidemiology of dental caries in the world. In: Virdi M, editor. Oral Health Care – Pediatric, Re-search, Epidemiology and Clinical Practices. Rijeka: InTech; 2012. Available from: http://www.intechopen.com/books/ oral-health-care-pediatric-research-epidemiology-and-clinical-practices/epidemiology-of-dental-caries-in-the-world [ac-cessed 2016 December 28].
Tušek I, Tušek J, Ukropina S. Risk factors associated with early childhood caries in autonomous province of Vojvodina, Re-public of Serbia. Vojnosanit Pregl 2017; 74(6): 511‒9.
de Almeida BS, da Silva Cardoso VE, Buzalaf MA. Fluoride in-gestion from toothpaste and diet in 1- to 3-year-old Brazilian children. Community Dent Oral Epidemiol 2007; 35(1): 53‒63.
Institute of Medicine (US) Standing Committee on the Scien-tific Evaluation of Dietary Reference Intakes. Dietary Refer-ence Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington (DC): National Academies Press (US); 1997.
Đukić-Ćosić D, Antonijević E, Vićentijević N, Malešević N, Ćurčić M, Dilber S, et al. Validation of a questionnaire for assessing fluoride intake in preschool children. MD-Medical Data 2017; 9(2): 95‒100. (Serbian)
Omena LM, Silva MF, Pinheiro CC, Cavalcante JC, Sampaio FC. Fluoride intake from drinking water and dentifrice by children living in a tropical area of Brazil. J Appl Oral Sci 2006; 14(5): 382‒7.
U.S. Environmental Protection Agency (EPA). Guidelines for ex-posure assessment. Fed Reg 1992; 57: 22887‒938.
Food and Nutrition Board (FNB). Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington DC: Institute of Medicine National Academy Press; 2004.
Erdal S, Buchanan SN. A quantitative look at fluorosis, fluo-ride exposure, and intake in children using a health risk as-sessment approach. Environ. Health Perspect 2005; 113(1): 111‒7.
Glavaški M, Ćurčić M, Đukić-Ćosić D, Plamenac-Bulat Z, Matović V. Fluoride content in bottled mineral waters of Serbia. Arh Farm 2009; 59: 321‒30. (Serbian)
Petrović TM, Zlokolica Mandić M, Veljković N, Papić PJ, Poznanović MM, Stojković JS, et al. Macro and microelements in bottled and tap waters of Serbia. Hem Ind 2012; 66(1): 107‒22. (Serbian)
Mandinić Z, Ćurčić M, Antonijević B, Charles P, Lekić CP, Carević M. Relationship between fluoride intake in Serbian children living in two areas with different natural levels of fluorides and occurrence of dental fluorosis. Food Chem Toxicol 2009; 47(6): 1080‒4.
Mandinić Z, Ćurčić M, Antonijević B, Carević M, Mandić J, Djukić-Ćosić D, et al. Fluoride in drinking water and dental fluorosis. Sci Total Environ 2010; 408(17): 3507‒12.
Antonijević E, Mandinic Z, Curcic M, Djukic-Cosic D, Milicevic N, Ivanovic M, et al. "Borderline" fluorotic region in Serbia: Corre-lations among fluoride in drinking water, biomarkers of expo-sure and dental fluorosis in schoolchildren. Environ Geochem Health 2016; 38(3): 885‒96.
Twetman S, Axelsson S, Dahlgren H, Holm A, Källestål C, Lager-löf F, et al. Caries-preventive effect of fluoride toothpaste: a systematic review. Acta Odontol Scand 2003; 61(6): 347‒55.
Weyant RJ, Tracy SL, Anselmo T, Beltrán-Aguilar ED, Donly KJ, Frese WA, et al. Topical fluoride for caries prevention: execu-tive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc 2013; 144(11): 1279‒91.
Giacaman RA, Carrera CA, Muñoz-Sandoval C, Fernandez C, Cu-ry JA. Fluoride content in toothpastes commercialized for children in Chile and discussion on professional recommenda-tions of use. Int J Paediatr Dent 2013; 23(2): 77‒83.
Cury JA, Oliveira MJ, Martins CC, Tenuta LM, Paiva SM. Avail-able fluoride in toothpastes used by Brazilian children. Braz Dent J 2010; 21(5): 396‒400.
Oganessian E, Ivancakova R, Lencova E, Broukal Z. Alimentary fluoride intake in preschool children. BMC Public Health 2011; 11: 768.
Nascimento HA, Soares FJ, Granville-Garcia AF, Brito CE, Al-meida CA, Sampaio FC. Estimation of toothpaste fluoride in-take in preschool children. Braz Dent J 2013; 24(2): 142‒6.
Cochran JA, Ketley CE, Duckworth RM, van Loveren C, Holbrook WP, Seppä L, et al. Development of a standardized method for comparing fluoride ingested from toothpaste by 1. 5-3. 5-year-old children in seven European countries. Part 2: Inges-tion results. Community Dent Oral Epidemiol 2004; 32(Suppl 1): 47‒53.
Levy SM, Broffitt B, Marshall TA, Eichenberger-Gilmore JM, War-ren JJ. Associations between fluorosis of permanent incisors and fluoride intake from infant formula, other dietary sources and dentifrice during early childhood. J Am Dent Assoc 2010; 141(10): 1190‒201.
Kumar S, Tadakamadla J, Johnson NW. Effect of Toothbrushing Frequency on Incidence and Increment of Dental Caries: A Systematic Review and Meta-Analysis. J Dent Res 2016; 95(11): 1230‒6.
Rethman MP, Beltrán-Aguilar ED, Billings RJ, Burne RA, Clark M, Donly KJ, et al. Nonfluoride caries-preventive agents. Ex-ecutive summary of evidence-based clinical recommendations J Am Dent Assoc 2011; 142(9): 1065‒71.