ABSTRACT This study aimed to determine the fluoride and pH levels of beverages likely to be consumed by children in Malaysia and to estimate daily fluoride intake from consumption of these beverages. A convenience sampling of 120 ready-to-drink beverages were purchased and categorised into 11 groups (UHT recombined milk, fresh milk [pasteurised], cultured milk [probiotic], yogurt beverages, fresh fruit juices, fruit flavoured beverages, soy-based beverages, malt-based beverages, tea, carbonated beverages and bottled waters). Fluoride concentration was measured using a fluoride ion-selective electrode while the pH level was measured using a pH meter. The fluoride concentration in the beverages ranged from 0.02±0.00 mg/L to 2.77±0.06 mg/L. Tea was found to have the highest fluoride concentration. The intake of fluoride from consumption of other types of beverages is below the lowest-observed-adverse-effect level (except tea). The pH of the beverages included in the study ranged from 2.20±0.01 to 7.76±0.00. Carbonated beverages (mean pH: 2.98±0.50) were found to be extremely acidic followed by fresh fruit juices (mean pH: 3.38±0.34) and fruit flavoured beverages (mean pH: 3.90±0.92). The correlation between fluoride and pH levels was weak, τ = 0.058 and not statistically significant (p < 0.35). The majority of the beverages had a low fluoride level and their consumption is unlikely to cause fluorosis except for tea. Almost half of the beverages had a low pH level with carbonated beverages being the most acidic.
Fluoridation ; Carbonated Beverages ; Dental Care for Children ; Acid-Base Imbalance

nformation regarding water fluoridation (WF) in Malaysia has been substantially documented, but is scattered in various government publications and may be lost to the stakeholders. This paper is a review of water fluoridation in Malaysia and its effect on oral health: a history of WF in Malaysia, the current policy, the evidence of its effectiveness, the challenges and the future directions. A search for relevant physical and electronic documents of WF in Malaysia resulted in the identification of 70 documents for review. WF was gazetted as national policy with an optimal fluoride level of 0.7 parts-per-million (ppm) in 1972, with a reduction of the level to 0.5 ppm in 2005. Evidence showed that WF effectively reduced population dental caries while fluorosis was not a prevalent public health concern. Strong collaboration between stakeholders and the extensive network of piped water supplies resulted in 80% of the population receiving WF in 2013. However, the coverage was reduced to 74.1% in 2018, largely due to the cessation of WF in Pahang. The key challenges in WF included a lack of funding, weak legislation, use of reverse osmosis water filtration system, difficulty to maintaining an optimal level of fluoride in the water, and lack of local data on the impact of WF cessation on oral health, and its cost-effectiveness. This review will provide dental health professionals with scientific evidence on WF and oral health in Malaysia and assist them in answering relevant questions about WF raised by the public.
Dental Caries ; Fluorosis, Dental ; Malaysia ; Review [Publication Type] ; Fluoridation

OBJECTIVES: The community water fluoridation program was implemented in 1998 in Jinju city. The aim of the present study was to evaluate the effect of this 17-year community water fluoridation program on caries reduction in permanent teeth. METHODS: Evaluation surveys were conducted in 2015 on subjects aged 8, 10, 12, and 15 years in Jinju city. The examined dental data were compared with that of subjects of the same age groups living in the medium-sized cities from the 6th Korea National Health and Nutrition Examination Survey (KNHANES) (2013–2015). The total number of subjects was 1,026 in Jinju city and 453 in the control group. The odds ratio of caries experience rate and untreated tooth rate on permanent teeth in Jinju city compared to control group was estimated based on the differences in DMF and untreated teeth rates after adjusting for gender, age, and mean number of fissure-sealed teeth. The effect of community water fluoridation program on caries reduction in permanent teeth was estimated by the differences in adjusted DMFT scores between the program and control groups. RESULTS: The odds ratio of caries experience rate and untreated tooth rate on permanent teeth in Jinju city compared to control group was estimated as 0.501 and 0.178, respectively. The effect of community water fluoridation program on caries reduction in permanent teeth was estimated as 40.0%. CONCLUSIONS: These results suggested that the effect of community water fluoridation program on caries reduction in permanent teeth in Jinju city was so high that similar programs should be developed in other regions in Korea.
Dental Caries ; Fluoridation ; Fluorides ; Gyeongsangnam-do ; Humans ; Korea ; Nutrition Surveys ; Odds Ratio ; Tooth ; Water

OBJECTIVE: This study was performed to investigate the effects of external tooth bleaching with flouridation on the appearance of white spot lesions (WSLs) in vitro. METHODS: In total, 125 bracket-bonded bovine incisor enamel blocks with artificial WSLs were randomly divided into a control group and four treatment groups (home bleaching, home bleaching + fluoridation, in-office bleaching, and in-office bleaching + fluoridation). A spectroradiometer (SR) and digital images (DIs) were used to evaluate colorimetric parameters (Commission Internationale l'Eclairage L*a*b*) for all specimens. Color measurements were obtained before WSL formation (T1), after WSL formation (T2), and after completion of the external tooth bleaching treatment (T3). RESULTS: The SR-based color change after bleaching was significantly greater in the treatment groups than in the control group (p < 0.05). SR-based lightness (L*) and red-green (a*) values were significantly higher at T2 than at T1 (p < 0.001), with no significant changes in yellow-blue (b*) values. At T3, SR-based L* values had increased while a* and b* values had decreased in the treatment groups (p < 0.001). The DI-based color difference between the sound enamel and WSL areas (ΔE*DI) increased significantly from T1 to T2 in all groups (p < 0.001) and significantly decreased from T2 to T3 in the treatment groups (p < 0.001). No significant differences in ΔE*DI at T3 were shown between the four treatment groups (p > 0.05). CONCLUSIONS: The findings of this study suggested that external tooth bleaching with fluoridation can alleviate the conspicuity of WSLs.
Dental Caries* ; Dental Enamel ; Fluoridation* ; Fluorides ; In Vitro Techniques ; Incisor ; Tooth Bleaching

OBJECTIVES: The water fluoridation program has been implemented since 2008, in a region of Geoje City. This study aimed to evaluate the effectiveness of the water fluoridation program on caries prevention in the permanent dentition. METHODS: Evaluation surveys were conducted on 8-, 10- and 12-year-old children in the fluoridated and non-fluoridated regions of Geoje City, in 2015. The survey included 834 children from the fluoridated regions and 703 from the non-fluoridated regions. The data obtained from the survey were analyzed using the IBM SPSS statistical package version 23.0. The effectiveness of community water fluoridation in caries prevention was estimated by the differences in the decayed, missing, filled teeth (DMFT) and decayed, missing, filled surfaces (DMFS) scores, between the program and control groups. The mean numbers of fissure-sealed teeth and surfaces were adjusted to reduce their confounding effect. RESULTS: The mean DMFT and DMFS scores (0.69 and 0.91, respectively) of 10-year-olds from the fluoridated regions, after adjusting for the numbers of fissure-sealed teeth and surfaces, were significantly lower than those of the 10 year olds (DMFT: 0.95, DMFS: 1.32) from the non-fluoridated regions. The effectiveness of water fluoridation on caries prevention in the permanent dentition, estimated based on the differences in the mean DMFT and DMFS scores, adjusted for the number of fissure-sealed teeth and surfaces, between the program and control groups of 10-year-old children, was 27.4% and 31.1%, respectively. CONCLUSIONS: These results suggest that the effectiveness of water fluoridation on caries prevention in the permanent dentition, in Geoje City was so high that this program should be implemented in other regions in Korea as well.
Child ; Dental Caries ; Dentition, Permanent ; Fluoridation* ; Fluorides ; Gyeongsangnam-do* ; Humans ; Korea ; Tooth* ; Water*

OBJECTIVES: This study details a survey taken to ascertain the residents' opinions on the introduction of a community water fluoridation program (WFP) at the water treatment plant in the district of Namdong, Incheon Metropolitan City. METHODS: This cross-sectional study was conducted by a specialized institution and was based on a public opinion poll. The views of 1,000 adults who had lived in the district where tap water was supplied by the Namdong water treatment plant, Incheon were collected over a 1-year period. The dependent variable was the assent of the WFP. The independent variables were demographic and socioeconomic characteristics (sex, age, education, residence period, and income), awareness of WFP, drinking and cooking water, and decisional organization of WFP introduction. Statistical analysis was performed using chi-squared test with SPSS statistics 23.0 (SPSS Inc., Chicago, IL, USA). Variables related to the approval of the WFP were analyzed using a multivariate logistic regression model. One hundred and twenty-seven respondents who selected 'doesn't matter' were excluded. The significance level was set at α=0.05. RESULTS: The responses citing approval for the introduction of WFP comprised 58.7%, while the 'dissent' group accounted for 28.6%, and 12.7% stated that it does not matter. Respondents citing approval who were in the age group beyond fifties accounted for 66.0%; further, 67.6% of respondents aware of the WFP were in favor of the approval for WFP introduction. The decision to undertake water fluoridation was favored by the Regional Head and city council. There were no significant differences in the assent of WFP based on the respondents' sex, education level, job, and drinking and cooking water. The strongest correlation was observed between the awareness of WFP and the approval rate for WFP. CONCLUSIONS: To promote the introduction of WFP, active measures are required for educating people regarding effectiveness of caries prevention and safety of WFP.
Adult ; Cooking ; Cross-Sectional Studies ; Drinking ; Education ; Fluoridation* ; Fluorides ; Head ; Humans ; Incheon* ; Logistic Models ; Plants* ; Public Opinion ; Surveys and Questionnaires ; Water Purification* ; Water*

OBJECTIVES: The aim of this study is to evaluate the effect of suburban community water fluoridation programs on preventing caries in permanent teeth. METHODS: In 2012, surveys were administered to children aged 8, 12, and 15 years residing in fluoridated Habcheon township area. Samples collected during the national survey in 2012 from children of the same age residing in non-fluoridated township areas were used as the control, and the caries prevalence data from this sample were used to estimate the caries preventive effect in the studied regions. This study included 457 subjects from the Habcheon township area and 1,792 in the control group. The data obtained from the survey were analyzed using the IBM SPSS statistical package version 21.0. The caries preventive effect exerted by fluoride in the community water supply was determined by calculating the differences in the DMFT and DMFS indices between the study and control groups. The cofounders of the mean number of fissure-sealed teeth and surfaces were controlled to estimate the effectiveness of caries prevention. RESULTS: The odds ratio of subjects with no dental caries in the fluoridated region was 0.75 compared to that in the control group. The mean DMFT scores or DMFS scores adjusted for the number of fissuresealed teeth or tooth surfaces were lower than those in the control group. The caries prevention fraction was estimated to be 23.4% based on the difference in the adjusted mean DMFT scores between the control and study groups. CONCLUSIONS: These results suggest that fluoridation of the community water in the suburban area was highly effective in preventing dental caries in permanent teeth, and therefore, this community water fluoridation program should be implemented in other regions in Korea.
Child ; Dental Caries ; Dentition, Permanent* ; Fluoridation* ; Fluorides ; Humans ; Korea ; Odds Ratio ; Prevalence ; Tooth* ; Water Supply ; Water*

The effects of fluoride exposure on the functions of reproductive and endocrine systems have attracted widespread attention in academic circle nowadays. However, it is unclear whether the gene-environment interaction may modify the secretion and activity of hypothalamus-pituitary- ovarian (HPO) axis hormones. Thus, the aim of this study was to explore the influence of fluoride exposure and follicle stimulating hormone receptor (FSHR) gene polymorphism on reproductive hormones in Chinese women. A cross sectional study was conducted in seven villages of Henan Province, China during 2010-2011. A total of 679 women aged 18-48 years were recruited through cluster sampling and divided into three groups, i.e. endemic fluorosis group (EFG), defluoridation project group (DFPG), and control group (CG) based on the local fluoride concentration in drinking water. The serum levels of gonadotropin releasing hormone (GnRH), follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were determined respectively and the FSHR polymorphism was detected by real time PCR assay. The results provided the preliminary evidence indicating the gene-environment interaction on HPO axis hormones in women.
Adolescent ; Adult ; Age Factors ; Asian Continental Ancestry Group ; China ; Cross-Sectional Studies ; Estradiol ; blood ; Female ; Fluoridation ; adverse effects ; Fluorides ; administration & dosage ; adverse effects ; urine ; Follicle Stimulating Hormone ; blood ; Gene-Environment Interaction ; Gonadotropin-Releasing Hormone ; blood ; Humans ; Hypothalamus ; physiology ; Luteinizing Hormone ; blood ; Middle Aged ; Ovary ; physiology ; Pituitary Gland ; physiology ; Polymorphism, Single Nucleotide ; Receptors, FSH ; genetics ; Tobacco Smoke Pollution ; Young Adult

OBJECTIVES: The aim of this study was to estimate the economic costs and benefits of a water fluoridation program in the city of Jinju, Korea. METHODS: In 2009, dental surveys were conducted on 2,315 children aged 6-12 years in Jinju, which had been fluoridated for 11 years. The decayed/missing/filled teeth (DMFT) scores of children in Jinju were compared to the DMFT scores of same-aged children in non-fluoridated small- and medium-sized cities in the fourth Korean National Health and Nutrition Examination Survey conducted from 2007 to 2009 by the Korea Centers for Disease Control and Prevention. The reduced number of decayed permanent teeth by the water fluoridation program was estimated as the difference between the DMFT scores of children in Jinju and those in non-fluoridated small- and medium-sized cities. The economic benefits were estimated by the savings from reduced dental treatment costs by using the reduced number of decayed permanent teeth from the water fluoridation program. All annual costs and benefits were calculated from 1998 to 2009. The social rate and untreated rate of decayed teeth were applied as 3% and 20%, respectively. The annual benefit-cost ratio was estimated by using the annual benefits and cumulative program costs. RESULTS: The economic benefit in 2009 from a water fluoridation program was estimated as 57,496,000,000 Korean Won (KRW), and the cumulative cost in 2009 was estimated as 1,387,000,000 KRW. The net present value in 2009 from a water fluoridation program was 56,109,000,000 KRW. The benefit-cost ratio in 2009 was estimated as 41.4. CONCLUSIONS: The economic benefit of a water fluoridation program in Jinju city was evaluated as excellent.
Centers for Disease Control and Prevention (U.S.) ; Child ; Cost-Benefit Analysis* ; Dental Caries ; Fluoridation* ; Gyeongsangnam-do ; Health Care Costs ; Humans ; Income ; Korea ; Nutrition Surveys ; Tooth

OBJECTIVES: This study aimed to confirm the efficacy of the urinary fluoride concentration/creatinine ratio for monitoring fluorine intake in fluoridated and non-fluoridated communities. METHODS: The correlations among the fluoride concentration in drinking water and that in the urine and fingernails of 52 preschool children (age, 60-72 months) from fluoridated and non-fluoridated communities were analyzed. RESULTS: The urinary fluoride concentration/creatinine ratio had a relatively high correlation with the fluoride concentration in drinking water (Pearson's correlation coefficient, 0.606; P<0.05). Further, this ratio was significantly positively correlated with the urinary fluoride concentration (Pearson's correlation coefficient, 0.374; P<0.01). However, there was no significant correlation between this ratio and the fluoride concentration in fingernails (Pearson's correlation coefficient, 0.145; P>0.05). CONCLUSIONS: The findings of this study suggest that the urinary fluoride concentration/creatinine ratio in children can be utilized as an index for monitoring excess fluoride intake in fluoridated communities.
Child ; Child, Preschool ; Drinking ; Drinking Water ; Fluoridation ; Fluorides ; Fluorine ; Humans ; Nails