Fluoride in the Oral Environment under Conditions of Salt Fluoridation

Fluoride in the Oral Environment
under Conditions of
Salt Fluoridation
Prof. Dr. Andreas G. Schulte
Department of Conservative Dentistry
Dental School
University of Heidelberg
Lecture on 9 September 2010 on the EADPH-Meeting 2010 in Constanta

Schulte A, Rossbach R, Tramini P:
Association between caries experience
of 12-year-old children from Heidelberg,
Germany, and Montpellier, France,
and different preventive measures
Community Dentistry and Oral Epidemiology
2001;; 29: 354-361

Association betwen Caries Experience
and Preventive Measures in 12-year-olds
(Data from Heidelberg 1998)
Use of F-Salt
Use of F-Gel
mean
DMFT
with
mean
DMFT
without
p-value
1.32 1.71 0.01
1.37 1.71 0.03
Use of F-Salt and F-Gel 1.01 1.82 0.03
Fissure Sealants 1.21 2.15 0.0001
Study Schulte et al. 2001

Association between Caries Experience
and 2 Preventive Measures in Germany
(12-year-old children;; National Data)
Mean
DMFT
Share
Fluoridated
Salt*
Proportion
Fissure
Sealants
1994 2.44 5% 6%
1997
1.81 19% 29%
2000 1.24 41% 62%
2004 0.98 61% 66%
From: Pieper K and Schulte AG, CDH (2004); Schulte AG et al., CDH (2006)

Pieper K, Born C, Hartmann T, Heinzel-
Gutenbrunner M, Jablonski-Momeini A:
Association of preventive measures
with caries experience
expressed by outcome variables.
Schweizer Monatsschrift für Zahnmedizin
2007;; 117: 1038-1044

Caries Experience in 12-year-old Children
from Marburg Region, Germany
Mean
D 3 MFT
Mean
D 3 MFS
Mean
D 1-2 S
With use of F-Salt 0.63 0.89 1.45
Without use of F-Salt 0.92 1.20 2.03
Difference significant yes yes yes
From: Pieper et al. 2007; Schweiz Monatsschr Zahnmed

Use of F-Salt and Mean DMFT in German
Adults with Mental Disabilities in 2007
with use of
F-Salt
no use of
F-Salt
p-Value
n 184 102
Mean age 33.8 35.1 >0.05
Mean DMFT 10.9 12.8

Market Shares of Salt with
Iodine and Fluoride in Germany

Featherstone JDB:
Prevention and reversal of dental caries: role
of low level fluoride.
Community Dentistry and Oral Epidemiology
1999;; 27: 31-40

Important Informations from the
Featherstone Paper
1. At fluoride concentrations of 0.03 ppm in saliva
remineralisation of enamel is enhanced.
2. Salivary F-concentration of children living in communities
with water fluoridation is the same as that of children
living in areas without water fluoridation.
3. In a follow-up study children with high individual salivary
F-content (>0.075 ppm) were more frequently caries-free
than children with lower salivary F-values.

Fluoride Concentration in Saliva of Adults
after Use of F-toothpaste
2.5
mg/l
2.0
1.5
1.0
0.5
0
-5 5 10 20 30 60 90 120 Minutes
From: Bernhart G and Schulte AG 2000; J Dent Res (Abstract)

Machiulskiene V, Richards A, Nyvad B:
Salivary Fluoride Concentrations in
Preschool Children after Use of
Fluoridated Salt or Fluoride Toothpaste
Caries Research 2004;; 38: 379
Abstract # 66

Design and Results of the Study from
Machiulskiene et al. 2004
- 10 children aged 5 years were in the test group
- In Kindergarten intake of a warm main meal
having been prepared with F-Salt
- Salivary samples taken prior to and after lunch
F-concentration in saliva:
0.03 mg/l prior to lunch
0.11 mg/l after lunch
Difference was statistically significant!

Björnström H, Naji S, Simic I, Sjöström I,
Twetman S:
Fluoride Levels in Saliva and Dental Plaque
after Consumption of Snacks prepared
with Fluoridated Salt
European Journal of Pediatric Dentistry
2004;; 5: 41-45

Design of the study from
Björnström et al. 2004
Participants: 11 adults
Type of meal: 500 ml salted popcorn per
participant
Contacttime: complete intake within 30 minutes
Collection of saliva: unstimulated whole saliva
Fluoride measurment: in centrifugated salivary
supernatent

Salivary Fluoride Concentration
after Intake
of Snacks prepared with F-Salt
mg/l
0.40
0.36
0.32
0.28
0,24
0.20
0.16
0.12
0.08
0.04
0
prior to
meal
*statistically significant
*
Test group
*
Control group
30 60 120
minutes after intake of snacks
*
Study Björnström et al. 2004

Hedman J, Sjöman R, Sjöström I,
Twetman S:
Fluoride Concentration in Saliva
after Consumption of a Diner prepared
with Fluoridated Salt
Caries Research 2006;; 40: 158-162

Design of the study from
Hedman et al. 2006
Participant: 10 adolescents (11 to 16 years old)
Test meal: Spaghetti with sauce and meat
salted with F-Salt
Control meal: Spaghetti with sauce and meat
salted with F-free Salt
Eating procedure: intake of 350-g-portion
together with one drink (250 ml fat reduced milk)
Collection of saliva: stimulated whole saliva
Fluoride measurement: in centrifugated salivary
supernatant

Mean salivary Fluoride Concentration after
Intake of a Diner prepared with F-Salt
mg/l
0.20
0.18
0.16
0.14
0.12
0.10
0.08
0.06
0.04
0.02
0
Prior to
meal
test group control group
*
*
*
5 10 30 180
minutes after intake of diner
*statististically significant
Study Hedman et al. 2006

Kaiser D, Neumeister V, Stößer L,
Hetzer G:
Fluoride Concentration
in Saliva and Plaque
after Intake of Food prepared with F-Salt
(in German with English abstract)
Oralprophylaxe und Kinderzahnheilkunde
2006;; 26: 110-114

Design of the Study from
Kaiser et al. 2006
Participants: 15 adults
Type of meals: spaghetti;; rice;; mashed potatoes;;
fluoridated water
Contact time: 2 minutes each
Collection of saliva: unstimulated whole saliva
Fluoride measurement: in whole saliva

Mean Fluoride Concentration in Saliva
after Intake of
Foods prepared with F-Salt
mg/l
0.20
0.18
0.16
0.14
0.12
0.10
0.08
0.06
0.04
0.02
0
spaghetti rice mashed potatoes water
Prior to
intake of food
*statistically significant
*
*
*
* * *
5 30 60
minutes after intake of food
*
*
Study Kaiser et al. 2006

Schulte AG, Gräber R, Kasperk C,
Koch MJ, Staehle HJ
Influence of Fluoridated Salt on
Urinary Excretion of Adults
Caries Research2002;; 36: 391-397

Design of the Study from
Schulte et al. 2002
Participants: 260 adults between 18 and 60 years old
Test group: 200 persons taking main meal in cafeteria A
where F-Salt is used
Control group: 60 persons taking main meal in cafeteria B
where no F-salt is used
Collection times: Before introduction of F-Salt in cafeteria A
as well as 3, 6, 9, 12, 24 and 36 months after introduction of
F-Salt in cafeteria A
Collection of urine: for 24 h in 3 fractions
Fluoride measurement: in urine samples

F-Salt in the Canteen of Heidelberg
Medical and Dental School
Foto: Kirsten Stoik, Heidelberg

Mean Fluoride Excretion
in 24h-Urine
µg/d
1000
800
600
400
200
Test group
Control group
0
baseline 3 6 9 12 24 36
Monate
No statistically significant difference within both groups (p>0,33)!

Mean Fluoride Excretion
in Morning-Urine
µg/h
60
50
40
30
20
10
Test group
Control group
0
baseline 3 6 9 12 24 36
months
No statistical difference within the 2 groups (p>0,45)!

Mean Fluoride Excretion
in Afternoon-Urine
µg/h
60
test group
control group
50
40
30
33,932,6
43,6 42,4
28,8
31,1
47,8
26,9
41,5
33,9
39,7
29,5
46,7
33,3
20
10
0
baseline 3 6 9 12 24 36
months
Statistical difference only within test group (p=0,002).

Mean Fluoride Excretion
in Evening- and Night-Urine
µg/h
60
50
40
30
20
10
test group
control group
0
baseline 3 6 9 12 24 36
months
No statistically significant difference within the 2 groups (p>0,45)!

Conclusions
Even under conditions where a lot of caries preventive
measures are applied fluoridated salt contributes to a
a distinct reduction of caries prevalence
Intake of a meal prepared with F-salt leads to a
significant increase of salivary F-concentration for
30 minutes.
Intake of snacks prepared with F-salt leads to a
significant increase of salivary F-concentration for at
least 60 minutes
F-salt has mainly a topical effect in the oral cavity by
enhancing remineralisation.
F-salt should not only be available for households but
should also be used in cafeterias, canteens and
restaurants.

Thank you Very much for Your attention!