Fluoride 1994; 27(2): 59-66
Dental Caries: A Disorder of High Fluoride and Low Dietary Calcium Interactions (30 Years of Personal Research)
S P S Teotia and M Teotia
Postgraduate Department of Human Metabolism and Endocrinology, LLRM Medical College, Meerut, 250-004, India.
SUMMARY: This comprehensive epidemiological study --- performed during the period 1963-1993 on 0.4003 million children residing in non-endemic (F > 1.0 ppm) and endemic (F > 1.0 ppm) fluorosis villages of India was designed to investigate the essentiality or otherwise of fluoride and calcium nutrition in the prevention and control of dental caries. In non-endemic areas, of the children with adequate calcium nutrition, 7 percent showed dental fluorosis and 2 percent had dental caries, while of children with inadequate calcium nutrition 14.2 percent showed dental fluorosis and 31.4 percent had dental caries. In endemic areas, of the children with adequate calcium intakes, 59 percent had dental fluorosis and 10 percent had dental caries, while in the calcium-inadequate group, 100 percent exhibited dental fluorosis and 74 percent had dental caries.
Our findings indicate that dental caries was caused by high fluoride and low dietary calcium intakes, separately and through their interactions. Dental caries was most severe and complex in calcium-deficient children exposed to high intakes of endemic fluoride in drinking water.
The only practical and effective public health measure for the prevention and control of dental canes is the limitation of the fluoride content of drinking water to < 0.5 ppm, and adequate calcium nutrition (dietary calcium > 1 g/day). The World Health Organisation policy and recommendations on fluorides are not universally acceptable, especially for the environment of developing countries, with nutritional deficiencies, endemic fluorosis, and different caries prevalence trends. In the light of our scientific data, WHO recommendations require modifications to achieve dental health for all by the year AD 2000.
Results and Discussion (page 65)
...From our present study two sets of important observations have emerged: 1) In India, exposure to high intakes of natural fluoride in drinking water is associated with high prevalence's of dental fluorosis and dental caries, both having a very strong direct correlation with the increasing fluoride content of drinking water. Taken together, the correlation and the dose-response relationship suggest a causal relationship. Specifically, high intakes of fluoride increase the prevalence of dental fluorosis as well as dental caries. Similar observations were made by one of us (SPST in 1990) during short term surveys and examinations of schoolchildren in endemic fluorosis villages of Zilin Province of China. 2) Adequate dietary calcium intakes (>800 mg/day) provide an effective control and prevention of dental fluorosis and dental caries. Dietary calcium deficiency (Ca intakes < 300 mg/day) aggravates the toxic dental effects of fluoride making them more severe and complex. Even the marginally high intakes of fluoride (>2.5 mg/day) continuously for more than six months in calcium-deficient children may cause severe dental fluorosis and caries (25). On the basis of our comprehensive epidemiological data, supported by the benefits of intervention with calcium supplements, we recommend the limitation of fluoride in the drinking water to < 0.5 ppm, and adequate calcium nutrition (Ca intake > 1 g/day), as the most effective strategies for the prevention and control of dental caries. Oral and dental health care and avoiding consumption of refined carbohydrates are additional factors requiring attention. The World Health Organisation policy and recommendations on fluoride are not universally applicable. In the light of our studies, WHO needs to recognise that fluoridation of public water supplies cannot be documented as a scientifically proven and community-acceptable method for the prevention of dental caries. The conclusions reached in this report - we believe the mostcomprehensive and single largest epidemiological study on dental caries in the world literature - are based on our experience over thirty years (1963-1993) studying the effects of endemic fluoride in the drinking water and community calcium nutrition status.
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