Medical Hyporhe.ws (WYO) 33. 21-22 0 Lon,gman Group UK Ltd I994

The Role of Caffeinated Fluorosis J. T.. CHAN, Department

Beverages

in Dental

T. T. YIP, A. H. JESKE of Pharmacology,

UTDB-Houston,

P.O. Box 20068, Houston,

Texas 77225, USA

Abstract - Recent studies have demonstrated that the incidence of dental fluorosis has increased during the past decade. Greater availability and use of fluoride-containing gels, mouth rinses, dentifrices, etc., improper prescribing of fluoride supplements and ingestion of fluoride dentifrice by some children are some of the suggested determinants of dental fluorosis. However, based on the increase in consumption of tea, coffee, and other caffeine-containing beverages by the children, and the augmentative effect of caffeine on fluoride bioavailability, we theorize that the rise in incidence of dental fluorosis in North America is mainly due to the replacement of water intake by caffeine-containing beverages among the young population.

Introduction

The importance of fluoride in drinking water in caries prevention is well documented. The incidence of dental caries is lower in communities supplied by water with optimal concentration of fluoride (1). The optimal level of fluoride is obtained by selecting the fluoride level which provides the greatest protection against caries yet causes the least amount of dental fluorosis. Recently, however, several studies have raised the concern that incidence of dental fluorosis has increased, even in communities with optimal levels of fluoride in the drinking water (2). It is sugg,ested that this may be the result of increased Date Date

received accepted

15 August 1989 21 November 1989

to the wide-spread exposure of children avaiIability and use of fluoride-containing dental products, such as topical fluoride gels, mouth rinses, dentifrices, etc. (3). It has been shown that some children swallow a large portion of these fluoride-containing products when applied topically in the oral cavity. The improper prescription of fluoride supplement by health care providers has also been suggested as one of the causes of increased dental fluorosis (4). The occurrence of dental fluorosis in optimally fluoridated or low fluoride communities could also be due to individual variation in the absorption and disposition of fluoride by the body. Recently. our laboratory has found that in Sprague-Dawley rats (5) as well as in human subjects (6). the simultaneous ingestion of fluoride and caffeine or caffeine-containing beverages 21

MEDICAL HYPOTHESES

22 such as tea, coffee and cola drinks resulted in significantly greater bioavailability of fluoride when plasma flurode concentration was followed. In chronic experiments, rats that were fed fluoride and caffeine simultaneously also demonstrated a higher plasma fluoride level when compared to control rats that were fed fluoride only. Several reports have suggested that soft drinks, beverages and juices are being consumed in greater quantities instead of water (7), especially among children and teenagers. Fluoride is known to be present in beverages and its concentration depends on the water used to prepare the beverage. Daily consumption of as much as 2600 ml of carbonated beverages, or 1300 ml of tea or- ISdo ml of coffee by sixth grade children was revealed in a recent Canadian study (8). In individual cases, beverages became the sole source of fluoride intake by the children. The range of fluoride available through beverage consumption contributes further complication in the prescription of fluoride supplements and the prevention of dental fluorosis. The augmentative effect of caffeine present in these beverages on fluoride bioavailability will further increase the risk of dental fluorosis in children whose fluid intake is largely composed of caffeine-containing cola, tea or coffee. Conclusion

Considering

the

results

reported

in previous

studies on source of fluoride intake in young children, the augmentative effect of caffeine on fluoride, and narrowness of the safety range of fluoride, we theorize that an increase in consumption of caffeinated beverages by children is a major contributing factor to the increase in incidence of dental fluorosis.

References 1. Arnold F A. Likins R C, Russell A L. Scott D B. Fifteenth year of the Grand Rapids flurodiation study. J Am Dent Assoc 65: 780. 1962. of 2. Leverett D H. Fluorides and the changing prevalence dental caries. Science 217: 26, 1082. of 3. Szpunar S M S. Burt B A. Trends in the prevalence dental fluorosis in the United States: A Review. J Pub1 Hlth Dent 47: 71. 1987. E R. 4. Bohaty B S. Parker W A, Scale N S. Zimmerman The prevalence of fluorosis-like lesions associated with topical and systemic fluoride usage in an area of optimal fluoridation. Ped Dent 11: 125. 1989. J G, Qiu C. Effect 5. Chan J T, Whitford G M, Weatherred of dietary coffee on plasma fluoride in rats. J Dent Res 67: 188. 1988. 6. Chan J T, Fry B W, Weatherred J G. Effect of dietary caffeine on plasma F levels in humans. J. Dent Res 67: 188. 1988. 7. Schultz E M. Fluoride content of popular carbonated beverages. J Prev Dent 3: 27. 1976. C J. Fluoride intake from beverage consump8. Hargreaves tion. Commun Dent Oral Epidemiol 16: 11. 1988.

The role of caffeinated beverages in dental fluorosis.

Recent studies have demonstrated that the incidence of dental fluorosis has increased during the past decade. Greater availability and use of fluoride...
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