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					                      Lot 2 – Task 2
Related Activities
• Report of the Forum on Water Fluoridation
(www.fluoridationforum.ie).
• Project Flint: Fluoride Intake from Toothpaste (Ketley,
O’Mullane and Holbrook (2004), Community Dentistry and Oral
Epidemiology, Suppl 1, 32, 1-76).
       - methods of recording fluoride ingestion from toothpaste
       - development of a standardised photographic method for
       recording dental fluorosis
 Funded under the EU Biomed 2 Project
                    Lot 2 – Task 2
 Development of standard internationally
    agreed fluoride analytical methods
A review of literature and discussions with other researchers
indicated that there was considerable variation in the methods
used to analyse fluoride levels in body fluid/tissues and
food/beverages.
International collaboration should be initiated “to develop
simple global gold standard methods” for fluoride analysis of
different sample types. Develop international consensus on
methods for collection, storage and laboratory procedures”
(Clarkson J et al, 2000, International Collaborative Research on
Fluoride, J Dent Res 79; 893-904).
                          Lot 2 – Task 2
Development of standard internationally agreed fluoride
                   analytical methods
Indiana, U.S. (Stookey)
Campinas, Brazil (Cury)
Iowa U.S. (Levy)
Loma Linda, U.S. (Li)
Newcastle, U.K. (Maguire)
Barcelona, Spain (Margineda)
Thammasat, Thailand (Phantumvanit)
Chile (Villa)
Cork, Ireland (O’Mullane)
Georgia, U.S. (Whitford)
            Supported by NIDCR grant R21 DE 14716-1
            Lot 2 – Task 2
Development of standard internationally agreed
        fluoride analytical methods


               Hard Tissue
                  Saliva
                  Urine
                 Plasma
           Food Homogenate
                Beverages
                           Lot 2 – Task 2
       Development of standard internationally
          agreed fluoride analytical methods
Analysis of reference materials is now complete. The final phase
requiring the analysis of the different samples in all participating
laboratories is currently in progress.
“All participating laboratories were able to obtain precise and true
results, as defined by the ISO, using an agreed upon
standard operation procedure” (Martinez-Mier et al,
2003)




Martinez-Mier et al, Caries Research (ORCA                        Abstracts
2003, 2004, 2004 and 2005).
                   Lot 2 – Task 2
        Use of fingernail clippings to monitor
                  fluoride ingestion
The development of a reliable and accessible biomarker for
monitoring the amount of fluoride ingested and absorbed is
now regarded as a priority (see Clarkson, International
Fluoride Collaboration). In 1999, Whitford (Caries Res. 1999;
33:462-467) suggested that fluoride levels in fingernail
clippings could provide a reliable, inert and non-invasive
marker of the amount of fluoride ingested prior to clipping.
The OHSRC has collaborated with Dr Whitford and his team in
further developing this idea. To begin with, the
method of analysis of fingernail clippings to be used
by Dr Whitford’s group in Augusta, Georgia, USA and
Ms Eileen MacSweeney, Head of the OHSRC
Laboratory in Cork was agreed.
               Lot 2 – Task 2
Use of fingernail clippings to monitor fluoride
                   ingestion
Pilot Study
Samples of children in Bangor Co. Down, Northern Ireland
(fluoride levels in drinking water <0.2ppm) and in Cork City
(fluoride levels 0.9ppm) were included in the study. Children
aged 2-3 were chosen because they are thought to be most at
risk of developing enamel fluorosis in their maxillary
permanent incisors at this age.

Mc Donnell, S.T, O Mullane, D, Cronin, M, Mac Cormac C,
Kirk J. Community Dental Health 2004; 21:19-24.

(Funded by HRB)
                     Lot 2 – Task 2
          Use of fingernail clippings to monitor
                    fluoride ingestion

                                Fluoridation Status
                         Full           Non         Total

               n         25             25           50

Age           mean              30.2             29.3       29.7
(months)

Fl Conc      mean               3.21             1.71       2.46
                         Lot 2 – Task 2
Selecting best field method for recording dietary intake
                   in 2-3 year old children
 2 methods have been used:

 Three-Day Diary
 In this method the participant was asked to weigh and record, at
 the time of consumption, all foods and beverages over a three day
 period. Each individual food/beverage was then purchased by
 OHSRC, homogenized and tested for total fluoride content.
          - F content of each food/beverage item established

 Duplicate Portion

 This method involved the duplication, by the parent/guardian, of all
 foods and beverages consumed over three days. The daily dietary
 items are mixed together, homogenized and analyzed.
         - Total F intake for each day obtained; contribution of
           each food/beverage item not established.
                     Lot 2 – Task 2
Selecting best method for recording dietary intake in 2-
              3 year old children. Pilot Study

  The parents/guardians of 2 to 3 year old children undertook both
  Three-Day Diary and Duplicate Diet Methods.
  Conclusion
  In order to get an initial assessment of fluoride ingested by 2 to 3
  year old children in Ireland, the Duplicate Diet method is the most
  practical approach. There is less laboratory time and the costs are
  also reduced.
  In the event of the results indicating high fluoride intake, then a
  follow up study using the 3 day diary method can be conducted in
  order to determine which food/beverage item is contributing to the
  raised fluoride level in the diet.
                              Lot 2 – Task 2
   Pilot Study - Daily fluoride intake of 2-3 year old children using
                    duplicate portion method (mg)


SUBJECT
IDENTITY
                                              MEAN       RANGE
  202      FROM SOLIDS (mg)                    0.04     0.03 -0.05
           FROM LIQUIDS (mg)                   1.27     0.87 - 1.67
           DIETARY FLUORIDE INTAKE             1.31     0.91 - 1.71
             WEIGHT OF SUBJECT (Kg)            15.00
           AVERAGE FLUORIDE INTAKE (mg/Kg/day) 0.09          -

  204      FROM SOLIDS (mg)                    0.014   0.009 - 0.011
           FROM LIQUIDS (mg)                   0.014         0
           DIETARY FLUORIDE INTAKE             0.029   0.028 - 0.030
             WEIGHT OF SUBJECT (Kg)           12.500
              AVERAGE FLUORIDE INTAKE (mg/Kg/day)
                              0.002                          -
                             Lot 2 – Task 2
  Pilot Study - Daily fluoride intake of 2-3 year old children using
                   duplicate portion method (mg)



103 FROM SOLIDS (mg)                             0.09    0.08 - 0.1
    FROM LIQUIDS (mg)                            0.20    0.16 - 0.24
    DIETARY FLUORIDE INTAKE                      0.29    0.24 - 0.34
      WEIGHT OF SUBJECT (Kg)                     13.50
        AVERAGE FLUORIDE INTAKE (mg/Kg/day)      0.02         -


105 FROM SOLIDS (mg)                             0.09    0.07 - 0.11
    FROM LIQUIDS (mg)                            0.22    0.19 - 0.25
    DIETARY FLUORIDE INTAKE                      0.31    0.26 - 0.36
      WEIGHT OF SUBJECT (Kg)                     16.00
        AVERAGE FLUORIDE INTAKE (mg/Kg/day)      0.02         -
                   Lot 2 – Task 2


For children under 8 years of age (i.e. those at risk of
developing dental fluorosis), it is accepted that the daily
intake of fluoride which will not produce mild fluorosis in
permanent teeth is 0.05 mg F/kg body weight/day, with
a range of 0.02 to 0.1 mg F/kg/day.


The lowest observed adverse effect level (LOAEL) is
0.1 mg F/kg/day.
               (www.fluoridationforum.ie)
                        Lot 2 - Task 3
Association between fluoridation of water supplies and the
        incidence of fracture of the neck of femur

There is consensus that in order to attain adequate sample sizes to
show differences in fracture rates between fluoridated and non-
fluoridated areas multi-centre studies are required.
                               Lot 2 - Task 3

    Association between fluoridation of water supplies and the
            incidence of fracture of the neck of femur
The OHSRC in collaboration with the Departments of Public Health and
Epidemiology in UCC and QUB, have developed a protocol to measure the
incidence of fracture of the neck of the femur amongst adults aged 50 years and
older in NI and RoI.

Information Sources
The Directorate of Information Systems (DIS) of the Department of Health and
Social Services and Public Safety in Northern Ireland (DHSSPSNI) annually
collates computerised hospital admission data [Patient Administration System
(PAS)].
The HIPE database in RoI is a computer-based information system designed to
record episodes of care in acute hospitals in Ireland.
      Ongoing Related Projects in OHSRC Include;

* The Limerick/Derry Study
  The relationship between fluoride levels in saliva, toothpaste use
  and the incidence of dental caries. Funded by industry and HRB.
  PhD Fellow Rose Kingston.

* The Benefits and Risks of Water Fluoridation
   Four year research programme funded by HRB.
   PhD Fellows Deirdre Browne, (Dental Caries and Dental Fluorosis)
   Edel Flannery, (Statistics)
  Tara Crowley, (Psychology)
      Ongoing Related Projects in OHSRC Include;
* The Dublin/Belfast Study
  “Winning Smiles” Toothpaste Use Evaluation. Funded by
   Dental Health Foundation and Queens University, Belfast.
                 Concluding Comments

The contribution of the User Group to the successful
conclusion of the Lot 2 Project is acknowledged.
As recommended in the Forum Report, the “New and
Emerging Issues” Sub-Committee of the Irish Expert Body
on Fluorides and Health is considering research priorities.
The daily intake of fluoride in different population groups is
recognised as a major research priority by a number of
international agencies.
Under Lot 2, the OHSRC in collaboration with its
international partners and the User Group has developed
techniques and technologies to answer a wide range of
research questions.

				
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