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New Research on Fluoride
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FAN Science Watch
January 25, 2006
Issue #27: New Research on Fluoride
by Michael Connett
New scientific research on fluoride toxicity further highlights
the misguided emphasis of most fluoride research in the US.
Whereas the vast majority of fluoride studies in the US continue
to focus exclusively on fluoride’s impact on teeth, the
research identified below shows that fluoride’s impact
on health extends well beyond the shiny, or mottled, surface
of the tooth.
Listed below are recent studies investigating the relationship
between silicofluorides and blood lead levels in children, studies
investigating the interactive effects of fluoride and iodine,
and studies investigating the impact of fluoride on thyroid,
brain, insulin secretion, skeletal health, and the kidney.
We start first, however, with a new study bringing into question
the purported effectiveness of water fluoridation in preventing
cavities.
FLUORIDE & TOOTH DECAY
STUDY: Meyer-Lueckel H, et al. (2006). Caries
and fluorosis in 6- and 9-year-old children residing in three
communities in Iran. Community Dentistry and Oral Epidemiology
34:63-70.
“In the present
study, fluoridated water did not seem to have a positive effect
on dental health, as it might have been expected
in a community with the respective caries prevalence.”
COMMENTARY: This study is the latest among a growing
number of studies which call into question the effectiveness
of water fluoridation. When this German research team studied
the teeth of randomly selected children from 3 Iranian communities,
they were unable to find a correlation between the fluoride
content of water (0.2 ppm, 0.3 ppm, and 1.3 ppm) and the children’s
cavity experience.
If there is a weakness to this study, however, it is that the
authors did not control for the impact of income – a limitation
which the authors readily acknowledge and discuss. It is interesting
to note, in this context, the study by Colquhoun (1985), which
found that -- if income levels are carefully accounted for (a
rarity in fluoridation research) -- there is no difference in
cavity rates between fluoridated and unfluoridated areas. To
read Colquhoun’s study, see: http://www.fluoridealert.org/health/teeth/caries/colquhoun-1985.pdf
SILICOFLUORIDES AND BLOOD LEAD
STUDY: Macek M, et al. (2006). Blood lead concentrations
in children and method of water fluoridation in the United States,
1988-1994. Environmental Health Perspectives 114:130-134.
COMMENTARY: This study, co-authored by 2 scientists
from the Centers for Disease Control (CDC), attempted to replicate
the findings of Masters & Coplan (1999, 2000) on the relationship
between water fluoridation and lead levels in children’s
blood. While the authors conclude that their findings “do
not support concerns that silicofluorides in community water
systems cause higher PbB [lead] concentrations in children”
their study is by no means a clean refutation of Masters and
Coplan’s work. Indeed, the authors acknowledge that water
fluoridation may be associated with increased increased lead
levels among children living in houses built prior to 1946,
and in houses of “unknown age”. To quote:
“Controlling
for covariates, water fluoridation method was significant only
in the models that included dwellings built before 1946 and
dwellings of unknown age.”
Coming from a team of CDC scientists, with a strong institutional
bias in favor of fluoridation, I find this result to be quite
interesting and intriguing. After all, there is no short supply
of houses built prior to 1946.
Here’s a more nuanced description of the authors’
findings:
“fluoridation was significantly associated
with PbB [lead] concentration only for the “before 1946”
(adjusted Wald-F= 2.8; p= 0.03) and “unknown” (adjusted
Wald-F= 2.8; p= 0.03) strata. In the before-1946 model, however,
none of the individual fluoridation categories (including the
silicofluorides compounds) was significantly higher than the
reference no-fluoride category. In the unknown-year model, the
hydrofluosilicic acid category was significantly different than
the no-fluoride category: the GM PbB concentration for hydrofluosilicic
acid was 45% higher. This significant association between hydrofluosilicic
acid and GM PbB concentration seen in the unknown-year stratum
was not observed in the other strata. In addition, there was
no trend toward increasing GM ratios for the silicofluoride
categories with increasing dwelling age.”
I look forward to hearing Roger Masters’ & Mike Coplan’s
comments and analysis of this study.
FLUORIDE & INSULIN SECRETION
STUDY: Menoyo I et al. (2005). Effect of fluoride on
the secretion of insulin in the rat. Arzneimittelforschung
55:455-60.
COMMENTARY: This study is the latest in a series of studies
from an Argentinian research team (Rigalli et al). Their research
is nothing short of fascinating. In animal studies, human studies,
and in-vitro laboratory studies, they have shown that fluoride
inhibits the secretion of insulin – and at notably low
concentrations. For instance, the authors have repeatedly found
that fluoride at a concentration of just 95 parts per billion
(ppb), or 5 umol/L, significantly inhibits the secretion of
insulin. This concentration of fluoride is lower than the peak
blood fluoride concentrations following ingestion of some fluoridated
dental products, and lower than the blood fluoride concentrations
found in some individuals with kidney disease, heart disease,
osteoporosis, and combinations thereof.
The potential implications of this research (e.g. implications
for diabetes prevalence/severity?) is not yet known, but certainly
worthy of consideration – particularly since at least
one of the authors’ studies (Rigalli 1995) found a suggestive
effect of fluoride on insulin secretion at a concentration as
low as 38 parts per billion (a blood fluoride concentration
that many people in fluoridated and unfluoridated areas will
attain).
The authors’ summarize their findings as follows:
"We have shown that 1 h after the intake of 1.44 mmol
(60 mg) of NaF by fasting human volunteers, plasma fluoride
increased up to 15 umol/L and insulin levels decreased significantly
[1]. The same phenomenon was reproduced in rats. The oral
administration of sodium fluoride [40 umol/100 g body weight)
to fasting rats produced an immediate increase in plasma fluoride,
a fall in insulin levels and the consequent increase in glycemia.
With the washing-out of fluoride from plasma and soft tissues
(4-5 h), glycemia and insulin returned to normal levels. The
insulin secretion of isolated Langerhans islets perfused with
solutions containing 5-20 umol/L fluoride was found significantly
inhibited as a function of fluoride levels, both with basal
and stimulatory concentrations of glucose [1]. In agreement,
we have reported that in a group of 24 women and two men (44-66
years old, ex-residents of an area of endemic fluorosis) with
fasting fluoremias of 0.5 to 9.2 umol/L, the area under the
curve (AUC) of insulin during standard glucose tolerance tests
showed an inverse relationship with fluoremia [2]. The
overall information afforded by present experiments indicate
that extracellular concentrations of fluoride above 5 umol/L
[95 parts per billion] affect the insulin excretion.
The results suggest that fluoride affects some stage of insulin
secretion situated below the cascade of events that include
the participation of calmodulin, protein-kinase C and cyclic
AMP."
FLUORIDE & IODINE INTERACTIONS:
IMPACT ON THYROID & BRAIN
COMMENTARY: In reviewing the scientific literature on fluoride,
I have become particularly compelled by evidence indicating
that a deficiency of iodine can exacerbate the toxicity of fluoride
– and vice versa (Guan 1988; Lin Fa-Fu 1991; Zhao 1998).
With the CDC
recently reporting that 12%
of Americans have some degree of iodine deficiency, the
interactive effects of fluoride and iodine is a health issue
that demands much greater attention.
However, while Chinese research indicates that fluoride concentrations
as low as 0.91
ppm can increase
the neurological deficits of iodine deficiency in children,
virtually NO research on this issue has yet been conducted by
American scientists. Instead, fluoride research in the U.S.
continues to be dominated by the National Institute of Dental
and Craniofacial Research (NIDCR) and their near exclusive focus
on teeth.
Here are five new studies (2 human, and 3 animal) that add
yet further concern that fluoride exposure can worsen the impact
of low iodine and vice versa.
STUDY: Anon. (2005). [The specific features
of the development of iodine deficiencies in children living
under environmental pollution with fluorine compounds] Gigiena
i sanitariia Nov-Dec(6):53-5.
“Natural iodine deficiency and ambient
air pollution with fluorine compounds were examined for their
combined influence on the prevalence and severity of iodine-deficiency
disorders. The excess intake of fluorine was shown to
increase the incidence of thyroid diseases and to lower anthropometric
indices in children. The preventive measures performed
to eliminate iodine-deficiency disorders under intensive ambient
air pollution with fluorine compounds were found to be insufficiently
effective.”
STUDY: Ruiz-Payan A, Duarte-Gardea M, Ortiz M, Hurtado
R (2005). Chronic effects of fluoride on growth, blood chemistry,
and thyroid hormones in adolescents residing in northern Mexico.
Paper presented at the XXVIth Conference of the International
Society for Fluoride Research. September 26-29. Fluoride
38: 46.
“This study was designed to evaluate adverse
health effects in adolescents from chronic exposure to various
water fluoride concentrations in three communities located in
northern Mexico: Ciudad Juarez, Samalayuca, and Villa Ahumada.
In these communities the fluoride concentration in water averages
0.3, 1.0, and 5.3 mg/L, respectively. The residents of Villa
Ahumada have been exposed to excessive levels of fluoride in
drinking water since their birth. Using urinary fluoride as
biomarker, we evaluated the effect of fluoride on dental fluorosis,
growth, thyroid hormones, hepatic function, lipids, uric acid,
and electrolytes. A total of 201 adolescents (106 female, 95
male), aged 15–20, were included in the study... In Villa
Ahumada 97 percent of all adolescents exhibited dental fluorosis,
and 18 percent of them have serious damage to their teeth. In
Samalayuca 53 percent of all adolescents exhibited mild dental
fluorosis, 15 percent of them have moderate dental fluorosis,
and 2 percent showed serious damage in their teeth. In Villa
Ahumada a significant inverse relationship was found between
urine fluoride levels and stature; this association suggests
that fluoride exposure may affect the teeth but also the growth
of adolescents. Serum samples of these individuals showed elevated
levels of alkaline phosphatase (ALP), potassium, magnesium,
calcium, and phosphate, and decreased levels of thyroid hormone
T3 and uric acid. These findings show
that high fluoride ingestion has a definite relationship with
the prevalence and severity of dental fluorosis, decrease of
stature, and decrease of thyroid hormone secretion. Uric
acid is one of the important antioxidants of plasma, and its
level was lower in fluorotic adolescents, indicating that fluoride
toxicity may involve a reduction on certain intrinsic scavengers
resulting in an increased vulnerability to oxygen free radical
toxicity.”
STUDY: Ge Y, et al. (2005). DNA damage in thyroid gland
cells of rats exposed to long-term intake of high fluoride and
low iodine. Fluoride 38: 318-323.
“SUMMARY: Thirty-two one-month-old Wistar
albino rats were divided randomly into four equal groups of
eight (female:male = 3:1). To assess damage to DNA in their
thyroid gland cells, the first group (1) of rats served as the
untreated control, the second group (2) was administered a high
concentration of fluoride (HiF, 100 mg NaF/ L [45 mg F–/L]
in their drinking water), the third group (3) was placed on
a low iodine intake (LI, 0.0855 mg I/kg diet), and the fourth
group (4) was exposed to the high fluoride and low iodine treatment
combined (HiF+LI). At 20 months of age, the rats were sacrificed
for experimental purpose and their thyroid gland cells were
removed for single cell gel electrophoresis (SCGE = comet assay).
In comparison with DNA damage in the thyroid gland cells of
the control group 1 (10.74 ± 12.59%), such DNA damage
in the LI, HiF, and HiF+LI groups 2, 3, and 4, was 83.50 ±
10.20%, 83.03 ± 12.11%, and 89.32 ± 8.21%, respectively.
Moreover, the proportion of grade III thyroid gland cell damage
increased by 32.26% in group 2, 47.83% in group 3, and 69.23%
in group 4, as compared to the control group 1. These
findings indicate that excessive long-term intake of fluoride,
with or without adequate I intake, is a significant risk factor
for the development of thyroid dysfunction.”
STUDY: Ge Y, et al. (2005). Effects of high fluoride
and low iodine on brain histopathology in offspring rats. Fluoride
38: 127-132.
“SUMMARY: Thirty-two Wistar rats were
divided randomly into four groups of six females and two males
each. The experimental groups were exposed to high fluoride
drinking water (45 mg F–/L from 100 mg NaF/L), low dietary
iodine (0.0855 mg/kg), or both together in order to assess the
effects of these three factors on the structure of the brain
of the offspring rats. After the animal model was established,
offspring rats were bred, and thirty-six rats from each group
(female:male = 1:1) were used for the study. The treatment of
the offspring rats was the same as that of their parents. In
comparison with the control rats, the nuclei of many nerve cells
were pyknosed and absent, the Nissl substance also showed various
degrees of decrease, and the dendrites were elongated. The
results indicate that the histopathological changes in the brain
were initially due to lipid peroxidation caused by the interaction
of high fluoride and low iodine. These changes
in brain histopathology apparently occurred mainly during the
period of embryonic development and in the early stage of brain
development after birth.”
STUDY: Ge Y, et al. (2005). Comet assay of DNA damage
in brain cells of adult rats exposed to high fluoride and low
iodine. Fluoride 38:209-214.
“In conclusion, DNA strands in brain cell
are affected adversely when rats are exposed to high fluoride,
low iodine, and the interactive combination of these two factors
from the age of one month to 20 months. The rate and
degree of DNA damage in brain cells is higher in the High Fluoride
+ Low Iodine group than in either the High Fluoride or Low Iodine
group.”
FLUORIDE & REDUCED IQ IN CHILDREN
COMMENTARY: The following study by Wang is the latest
of a growing number of studies from China reporting an impairment
in mental ability among fluoride-exposed children. For more
information on these studies, see: http://www.fluoridealert.org/health/brain/
STUDY: Wang S, et al. (2005). Investigation and evaluation
on intelligence and growth of children in endemic fluorosis
and arsenism areas. Chinese Journal of Endemiology
24:179-182.
“This study investigated the effects of
arsenism and fluorosis on the mental ability (MA) and growth
of children living in areas endemic for arsenism, fluorosis
, or both. The children were divided into high arsenic/fluoride
group (group 1), high fluoride group (group 2), high arsenic
group (group 3), and control group. Group
2 [high fluoride group] showed significantly lower MA [mental
ability] than the control group ( P<0.01).
MA was lower in group 1 than in the control group (P<0.05),
but was almost similar between group 1 and group 2 (P>0.05).
Group 3 showed the lowest MA score among the groups (P <0.01).
The MA score was negatively correlated
with urinary arsenic (P<0.01) and fluoride levels (P<0.05).
The height of group 2 and the body weight of
group 3 children were significantly lower than those of the
control group ( P<0.05). The vital capacity of group 1 was
significantly lower than that of control children (P<0.05).
It is concluded that high exposure to arsenic, fluoride,
or both has significant negative effects on the MA and growth
of children.”
FLUORIDE & SKELETAL FLUOROSIS
STUDY: Bai G, et al. (2005). Radiological analysis
of endemic skeletal fluorosis in Dingbian county, Shaanxi province.
Chinese Journal of Endemiology 24:73-74.
“Objective: To determine radiological
changes in bones and joints among patients in Dingbian County,
China, where fluorosis is related to the supply of drinking
water. Methods: Radiographic films of the pelvis, right forearm,
and right leg were evaluated for randomly selected patients.
Results: Based on the results of the radiographic films, the
detection rate of skeletal fluorosis was 72.23%. Skeletal changes
were seen more on the forearm and legs as compared to the pelvis.
However, the radiographic diagnosis did not correspond to the
clinical diagnosis. Radiographic changes were positively correlated
with fluoride content in the drinking water. Thus, early
diagnosis of fluorosis is difficult due to non-concordance of
clinical features with radiographic changes.”
COMMENTARY: Bai’s study is interesting in that it contradicts
an important bit of orthodoxy long utilized by scientists working
for fluoride-polluting industries. The orthodoxy to date has
been that fluoride does not pose any risks to an individual’s
health prior to, and in the absence of, major changes to the
skeleton. Thus, if a worker is experiencing symptoms associated
with fluoride toxicity (e.g. degenerative arthritis), these
symptoms are dismissed as unrelated to fluoride if x-rays of
the workers’ bones do not reveal obvious fluorotic changes
in the worker’s bones. (This orthodoxy has proven quite
useful for industry, but quite detrimental to the health of
industrial workers.)
The study by Bai has added yet further evidence of the problems
with industry’s reliance on x-rays as a means of detecting
early fluoride injury. As noted by Bai, the symptoms of fluorosis
do not always correspond with the degree of bone changes detectable
by x-ray. Thus, someone experiencing fluoride-induced arthritis
may have very little obvious change to their bone structure,
while another person with obvious changes to their bone structure
may not always experience arthritic pain. According, therefore,
to Bai, “early diagnosis of fluorosis is difficult due
to non-concordance of clinical features with radiographic changes.”
For more information on the difficulty of diagnosing the early
stages of skeletal fluorosis, click
here.
STUDY: Sun DJ et al. (2005). Dose-response relationship
between dental fluorosis and fluoride in brick tea. Abstract.
Presented at the 26th International Society for Fluoride Research
in Wiesbaden, Germany (September 2005). Fluoride 38(3):253.
“The dose-response
relationship between fluoride in brick-tea and the prevalence
of skeletal fluorosis (SF) in adults was studied to determine
a safe upper limit for fluoride intake from brick-tea.
In brick-tea drinking endemic fluorosis areas of the Tibetan
pastoral areas of Sichuan province, cluster sampling was conducted
of residents above age thirty in Amu, Jiangrong, Anqu, Longrang,
and Maiwashi villages of Hongyuang County in Aba state. X-ray
technology was used to diagnose SF, and the daily fluoride intake
of each person from bricktea infusions was determined by a retrospective
cohort study. Results: Among the 207 residents examined, the
X-ray standardized prevalence rate of SF was 49.76%, which increased
with age and poor health, especially among persons over age
forty. Both the amount of drinking brick-tea infusions and the
amount of fluoride intake from them increased with age and were
higher in the SF group than that in the unaffected group. The
average daily fluoride intake was 4.49±1.51 mg/person/day)
in the SF group and 1.86±1.46 mg/person/day in the unaffected
group. The average daily fluoride intake of subjects with different
stages or grades of SF was 3.36±1.35 mg (stage I), 4.96±1.44
mg (stage II), and 6.42±1.33 mg (stage III), respectively.
There was a significant (p<0.05) positive
linear correlation between the logarithm of daily fluoride intake
from brick-tea and the prevalence of SF in each age group. The
95% normal upper-limit for daily fluoride intake from brick-tea
was 3.37 mg/person/day, but the 90% unilateral upper-limit was
2.94 mg/person/day, which reflected the SF status more truly
and avoided missing and misjudging diagnosis.”
COMMENTARY: Sun’s study from China reports evidence of
advanced skeletal fluorosis in communities with average daily
fluoride intakes of just 6.4 mg/day. This is below the dose
(10 mg/day) that the US Institute of Medicine says is safe for
everyone in the population to ingest every day of their life
after the age of 8. While the presence of aluminum in the brick-tea
may have led to an underestimation of the total fluoride intake
in this study, the authors’ dose-response analysis provides
a valuable addition to the scientific literature on skeletal
fluorosis. It is a study that should certainly be followed up,
because, if the authors are correct, than many Americans in
fluoridated and unfluoridated communities are currently ingesting
a daily dose of fluoride that can cause some form of skeletal
fluorosis.
FLUORIDE & the KIDNEYS
COMMENTARY: Last year, a study
from China (Liu 2005) reported that children drinking water
with more than 2 ppm fluoride have a higher
rate of kidney disease than children drinking low fluoride
water.
Included below are 4 new animal studies investigating fluoride’s
effects on the kidney. While the doses used in these studies
are generally higher than most humans ingest, the study by Shi
(2005) found adverse effects on rat kidney at just 5 ppm fluoride
in drinking water. This is quite a low concentration, particularly
since rats are recognized to be more resistant to fluoride toxicity
than humans. This is not, however, the first animal study to
find adverse effects at low fluoride concentrations. In 1998,
Varner and colleagues found damage to rat kidneys following
long-term administration of just 1 ppm fluoride, while in 1999
Borke and Whitford found damage to rat kidney with just 38 parts
per billion fluoride in the rats’ blood (a blood concentration
routinely exceeded by humans in fluoridated areas.)
Also interesting is the finding from Birkner that the impacts
of fluoride on kidney may be worsened by co-administration of
caffeine. While the doses of fluoride used by Birkner were quite
high relative to human exposures, their study raises important
questions – particularly for habitual coffee drinkers
who regularly brew their coffee (knowingly or unknowingly) with
fluoridated water.
For more information on fluoride’s impact on the kidneys,
click
here.
STUDY: Shi Y, et al. (2005). Effects of brick tea infusion
on bone, kidneys and liver morphology before and after defluoridation
with serpentine. Chinese Journal of Endemiology 24:
28-30.
”Brick tea infusion containing 100 mg/litre
fluorine was made according to the methods used by inhabitants
living in areas (in China) with endemic fluorosis. The infusion
was diluted to 5 or 50 mg/litre fluorine concentrations, followed
by the de-fluoridation. Wistar rats were randomly divided into
5 groups: Group A was given tap water (control); group B and
C were given brick tea with serpentine at 5.0-1.5 and 50.0-1.5
mg/litre, respectively; group D and E were given brick tea at
5 and 50 mg/litre, respectively. Fluoride contents in serum,
urine and bones were determined, and the morphological changes
in bones, kidneys and liver were observed under light microscopy
and transmission electron microscopy. The fluoride contents
in the urine and bones of fluoride treated rats were higher
than that in the controls. The pathological changes
in the bones, kidneys and livers were significantly more pronounced
in group E [50 ppm fluoride], and followed by group D [5 ppm
fluoride].”
STUDY: Xu H, et al. (2006). Effect of sodium fluoride
on the expression of bcl-2 family and osteopontin in rat renal
tubular cells. Biological Trace Element Research 109:55-60.
“Our earlier studies showed that the apoptosis
of renal tubules can be induced by sodium fluoride (NaF). The
present study was designed to estimated the effects of B-cell
lymphoma/leukemia 2 (Bcl-2), Bcl-2-associated protein X (Bax),
and osteopontin (OPN) on the apoptosis of renal tubular cells
induced by NaF at different levels. The technique of reverse
transcription-polymerase chain reaction and densitometer scanning
volume density were used to evaluate the changes of Bcl-2, Bax,
and OPN mRNA in tubular cells treated with different doses of
NaF (0, 1, 5, 7.5, 12.5 mgF-/L) for 48 h. Compared to control,
the level of Bax mRNA significantly increased at cells of the
7.5- and 12.5-mg F-/L groups and the expression of Bcl-2 mRNA
obviously decreased at cells of the 5- and 7.5-mg F-/L groups.
The NaF also enhanced the expression of OPN mRNA in
a dose-dependent manner, but the strongest expression of OPN
mRNA was observed at cells of the 7.5-mg F-/L group. The results
suggested that NaF induces the apoptosis in renal tubules via
activation of the Bax expression and Bcl-2 suppression;
OPN probably acts as protective role against apoptosis in fluoride-treated
renal cells.”
STUDY: Birkner E, et al. (2006). Influence of sodium
fluoride and caffeine on the kidney function and free-radical
processes in that organ in adult rats. Biological Trace
Element Research 109:35-48.
“An experiment was carried out on Sprague-Dawley
rats (adult males) that for 50 days were administered, in the
drinking water, NaF and NaF with caffeine (doses, respectively:
4.9 mg of NaF/kg body mass/24 h and 3 mg of caffeine/kg body
mass/24 h). Disturbances were noted
in the functioning of kidneys, which were particularly noticeable
after the administration of NaF with caffeine. Changes
in the functioning of kidneys were also confirmed by such parameters
as the level of creatinine, urea, protein, and calcium. Modifications
of the enzymatic antioxidative system (superoxide dismutase,
catalase, and glutathione peroxidase) and lipid peroxidation
(malondialdehyde) were also observed. Changes in the contents
of the above parameters as well as pathomorphological examinations
suggest increased diuresis, resulting in dehydration of the
rats examined.”
STUDY: Zhang W, et al. (2005). Intracellular ionized
calcium level and oxidative stress in renal of Wistar rats after
intaking of excessive fluoride. Chinese Journal of Endemiology
23: 25-27.
“The effects of excessive fluoride intake
on intracellular ionized calcium level and oxidative stress
in kidneys of Wistar rats were determined. The rats were fed
sodium fluoride in drinking water. The intracellular ionized
calcium level was measured using fura-2/AM, and glutathione
peroxidase (GSH-Px), superoxide dismutase (SOD) and malondialdehyde
(MDA) levels were tested using biochemical methods. Results
revealed that intracellular ionized calcium level was increased
in fluoride-exposed group as compared to control group. The
same increase was observed between the low calcium + fluoride
group and low calcium group. SOD activity was lower, whereas
MDA level was higher in low calcium + fluoride group than in
low calcium group. It is suggested
that the higher level of intracellular ionized calcium and oxidative
stress are possibly significant in fluorosis pathology.
The high level of intracellular ionized calcium and oxidative
stress after excessive fluoride intake, along with low calcium,
indicate that calcium nutrition has close connection with fluorosis
mechanism.”
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