פלואוריד ותינוקות- כדאי שתלמד

1: J Public Health Dent 2001 Spring;61(2):70-7 לצערי תשובותיך לשאלתי לא היו רציניות מצ"ב חומר שחשוב ללמוד לכל רופא שיניים Patterns of fluoride intake from birth to 36 months. Levy SM, Warren JJ, Davis CS, Kirchner HL, Kanellis MJ, Wefel JS. N330 DSB, University of Iowa, Iowa City, Iowa 52242, USA. [email protected] OBJECTIVES: Dental fluorosis prevalence has increased in the United States, Canada, and other nations due to the widespread availability of fluoride in many forms, with fluoride ingestion during the first three years of life appearing most critical in fluorosis etiology. With few contemporary studies of fluoride ingestion in this age group, the purpose of this paper is to describe patterns of estimated fluoride ingestion from birth to 36 months of age from water, dentifrice, and dietary fluoride supplements and combined. METHODS: Repeated responses to separate series of questions about water intake, use of fluoride dentifrice, and use of fluoride supplements were collected by questionnaire as part of the longitudinal Iowa Fluoride Study and used to estimate fluoride intake. Estimated intake is reported by source and combined at different ages. Effects of subject age and other covariates on fluoride intake were assessed using regression methods appropriate for the analysis of correlated data. RESULTS: For most children, water fluoride intake was the predominant source, especially through age 12 months. Combined daily fluoride intake increased through 9 months, was lower at 12 and 16 months, and increased again thereafter. Mean intake per unit body weight (bw) was about 0.075 mg F/kg bw through 3 months of age, 0.06 mg F/kg bw at 6 and 9 months, 0.035 mg F/kg bw at 12 and 16 months, and 0.043 mg F/kg bw from 20-36 months. Depending on the threshold chosen (e.g., 0.05 or 0.07 mg F/kg bw), variable percentages of the children exceeded the levels, with percentages greatest during the first 9 months. Regression analyses showed fluoride intake (mg F/kg bw) from 1.5-9 months to decrease with increasing child's age, mother's age, and mother's education, with a complex three-way interaction among these factors. From 12-20 months, fluoride intake increased with increasing child age and decreased with increasing mother's age. No statistically significant relationships were found for fluoride intake from 24-36 months. CONCLUSIONS: There is considerable variation in fluoride intake across ages and among individuals. Longitudinal studies may be necessary to fully understand the relationships between fluoride ingestion over time and development of fluorosis. 1: J Public Health Dent 2000 Summer;60(3):131-9 Fluoride intake and prevalence of dental fluorosis: trends in fluoride intake with special attention to infants. Fomon SJ, Ekstrand J, Ziegler EE. Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City 52242-1083, USA. [email protected] BACKGROUND: Although the predominant beneficial effect of fluoride occurs locally in the mouth, the adverse effect, dental fluorosis, occurs by the systemic route. The caries attack rate in industrialized countries, including the United States and Canada, has decreased dramatically over the past 40 years. However, the prevalence of dental fluorosis in the United States has increased during the last 30 years both in communities with fluoridated water and in communities with nonfluoridated water. Dental fluorosis is closely associated with fluoride intake during the period of tooth development. METHODS: We reviewed the major changes in infant feeding practices that have occurred since 1930 and the changes in fluoride intakes by infants and young children associated with changes in feeding practices. RESULTS AND CONCLUSIONS: Based on this review, we conclude that fluoride intakes of infants and children have shown a rather steady increase since 1930, are likely to continue to increase, and will be associated with further increase in the prevalence of enamel fluorosis unless intervention measures are instituted. RECOMMENDATIONS: We believe the most important measures that should be undertaken are (1) use, when feasible, of water low in fluoride for dilution of infant formulas; (2) adult supervision of toothbrushing by children younger than 5 years of age; and (3) changes in recommendations for administration of fluoride supplements so that such supplements are not given to infants and more stringent criteria are applied for administration to children. 1: ASDC J Dent Child 2001 Jan-Feb;68(1):37-41, 10 Fluoride content of infant formulas prepared with deionized, bottled mineral and fluoridated drinking water. Buzalaf MA, Granjeiro JM, Damante CA, de Ornelas F. Department of Biological Sciences, Bauru Dental School, University of Sao Paulo, Brazil. Usually infant milk formula is the major source of fluoride in infancy. Fluoride concentrations in ten samples of powdered milk formulas, prepared with deionized, bottled mineral, and fluoridated drinking water were determined after HMDS-facilitated diffusion, using a fluoride ion specific electrode(Orion 9609). Fluoride concentrations ranged from 0.01 to 0.75 ppm; from 0.02 to 1.37 ppm and from 0.91 to 1.65 ppm for formulas prepared with deionized, bottled mineral (0.02 to 0.69 ppm F) and fluorinated drinking water (0.9 ppm F), respectively. Possible fluoride ingestion per Kg body mass ws estimated. With deionized water, only the soy-based- formulas should provide a daily fluoride intake of above the suggested threshold for fluorosis. With water containing 0.9 ppm F, however, all of them would provide it. Hence, to limit fluoride intakes to amounts <0.1 mg/kg/day, it is necessary to avoid use fo fluoridated water (around 1 ppm) to dilute powdered infant formulas. 1: J Clin Pediatr Dent 2000 Summer;24(4):299-302 Fluoride levels in breast milk and infant foods. Koparal E, Ertugrul F, Oztekin K. Ege University, School of Dentistry, Department of Pedodontics, 35100 Bomova, Izmir, Turkey. [email protected] The aim of the present study is to determine the fluoride concentrations of breast milk, several milk formulations, cow's milk and yogurt shake in a nonfluoridated area, in order to estimate the fluoride intake of infants and evaluate fluoride supplementation suggestions. Breast milk samples were collected from 57 lactating mothers. Ten brands of milk formulations, 9 different brands of cow's milk and 3 brands of yogurt shake were purchased from the market. Fluoride concentrations of the samples were analyzed using a specific fluoride electrode. The average fluoride level was 0.019 +/- 0.004 ppm in breast milk, 0.022 +/- 0.007 ppm in cow's milk and 0.022 +/- 0.003 ppm in yogurt shake. Fluoride levels of milk formulations prepared by distilled water were ranging between 0.118 to 0.021 ppm. It is concluded that in non-fluoridated areas, fluoride intake of infants from the above sources is not very high and fluoride supplements may be prescribed.

ניב שלום! תודה על המאמרים ! לא נראה לי שאתה מחדש לי משהו במאמרים אלו ! נראה לי ששאלתך שנשאלה בעבר נוסחחה בצורה לא נכונה ! שאלת מה ריכוז הפלואוריד שתינוק במשקל 6 ק"ג רשאי לקלוט ביממה ונענית בהתאם לשאלתך . אשמח לראות דברים חדשים מן הריכוז 0.9 חל"מ כמומלץ למי שתייה והאזהרה למנוע מילדים מתחת לגיל 5 שימוש במשחת פלואוריד מחשש לפלואורוזיס .

ניב תודה על המאמרים שצירפת . עשית לי את הסמינר השבוע . המסקנות שלך ממאמרים לא סרורות לי בכלל. האם זה אומר לא לתת לתינוק חלב או תחליף חלב , בלי שבדקנו אותו במעבדה מיוחדת לריכוז פלואור ?

הבעיה לא לגמרי פשוטה מהסיבות הבאות. א. כל גורמי הבריאות בודקים את ריכוזי הפלור במים כי למשל באיזורים המקבלים מי מעיינות המים עניים בפלור ביוד ובעוד דברים חשובים באיזורים כמו במספר מקומות בנגב ריכוז הפלור גבוה יותר ואיתו גם ריכוז הסידן והמגננזיום וכתוצאה בעיות אחרות ב. ריכזז פלור מעל רמה מסויימת כאשר מקבלים פלוריד ממי שתיה ומחומרים אחרים מועשרים בפלור יכול לגרום לתופעה של פלואורוזיס המתבטא באיזורי ארוזיות בשיניים ג. פלור שהוא הלוגן והאפיניות שלו היא הגדולה ביותר מבין ההלוגנים יכול להחליף את היוד בתרכובות שונות וכך יכולות 4 מולקולות פלור להתקשר לאלומיניום וליצור מולקולה הדומה לתרכובות פוספט עתירות אנרגיה היכולות להפעיל רצפטורים ולשחרר מסנגר תוך תאי יש עבודות שונות בשטח זה. ד. השאלה שהעליתי היא חשובה ולא מבוטלת בתינוקות קטנים לא נראה לי שפתרו את הבעיה. פשוט אני עוסק בשטחים אחרים ומלמד בשתי פקולטות. חשבתי שפ-ורום זה מקצועי ואקבל תשובה מדעית - חבל שההתיחסות לשאלות היא כזו בהצלחה לך