EC Clinical and Medical Case Reports

Nutrition in the first 6 months is breastfeeding and/or formula milk. The last 6 months are food and milk. Estimation of intake by measuring fluoride (F^-) in breast milk, formula milk and feeding in children from 7 to 12 months in kindergartens. F^- was measured by microdiffusion and specific electrode. Intake with F^- concentration and daily dose intake of fluoride (DDI-F) using children's weight.

With the percentage of exclusive breastfeeding, milk-formula consumption is inferred. With this combination, the intake of fluoride from milk is 0.1980 ± 0.0360 and 0.1653 ± 0.0391 mgF/day and the DDI-F is 0.0363 ± 0.0043 and 0.0293 ± 0.0050 mg F^-/kg/day.

Daily intake of F^- in children from 7 to 10 months’ ranges from 0.394 to 0.433 mg/day. Intake for 10 to 12 months varies from 0.387 to 0.483 mg/day. DDI-F for 7 to 10 months is 0.049 ± 0.009 mg F^-/kg/day and for 10 to 12 months it is 0.045 ± 0.006 mg F^-/kg/day.

Kindergartens provide 3 of 4 meals in the diet. This 4^th meal in children from 7 to 10 months is a bottle and dinner for 10 to 12 months. Water provides 150 ml for 7 to 10 months and 200 ml for 10 to 12 months. These contributions raise DDI-F for 7 to 10 months to 0.076 ± 0.007 and for 10 to 12 months to 0.070 ± 0.006 mg F^-/kg/day. Breastfeeding with milk-formula between 0 and 6 months indicates that DDI-F are below optimal. DDI-F in children from 7 to 12 months fed in day care centers is lower than optimal and additional contributions raise it above that value. DDI-F in children from 7 to 12 months are above optimal and should not receive additional foods (toothpaste) for safe intake.

 Keywords: Nutrition; Children from 0 to 12 Months; Intake of Fluoride; Daily Dose Intake of Fluoride; Kindergartens; Chile

1. RW Evans and BW Darvell. “Refining the estimate of the critical period for susceptibility to enamel fluorosis in human maxillary central incisors”. Journal of Public Health Dentistry4 (1995): 238-249..
2. SM Levy., et al. “Primary tooth fluorosis and fluoride intake during the first year of life”. Community Dentistry and Oral Epidemiology4 (2002): 286-295.
3. JJ Warren., et al. “Prevalence of dental fluorosis in primary dentition”. Journal of Public Health Dentistry2 (2001): 87-91.
4. SJ Fomon and J Ekstrand. “Fluoride intake by infants”. Journal of Public Health Dentistry 4 (1999): 229-234.
5. P Bhagavatula., et al. “Timing of fluoride intake and dental fluorosis on late-erupting permanent teeth”. Community Dentistry and Oral Epidemiology 1 (2016): 32-45.
6. A Bardsen. “Risk periods associated with the development of dental fluorosis in maxillary permanent central incisors: a meta-analysis”. Acta Odontologica Scandinavica5 (1999): 247-256.
7. L Hong., et al. “Fluoride intake levels in relation to fluorosis development in permanent maxillary central incisors and first molars”. Caries Research6 (2006): 494-500.
8. MAR Buzalaf and SM Levy. “Fluoride intake of children: considerations for dental caries and dental fluorosis”. Monographs in Oral Science 22 (2011): 1-19.
9. AJ Spencer and LG Do. “Caution needed in altering the ‘optimum’ fluoride concentration in drinking water”. Community Dentistry and Oral Epidemiology2 (2016): 101-108.
10. BA Burt. “The changing patterns of systemic fluoride intake”. Journal of Dental Research5 (1992): 1228-1237.
11. FJ McClure. “Ingestion of fluoride and dental caries: quantitative relations based on food and water requirements for children 1 to 12 years old”. The American Journal of Diseases of Children4 (1943): 362-369.
12. B Forsman. “Early supply of fluoride and enamel fluorosis”. Scandinavian Journal of Dental Research1 (1977): 22-30.
13. V Baelum., et al. “Daily dose of fluoride and dental fluorosis”. Tandlaegebladet10 (1987): 452-456.
14. P Bhagavatula., et al. “The relationships between fluoride intake levels and fluorosis of late-erupting permanent teeth”. Journal of Public Health Dentistry2 (2018): 165-174.
15. RW Evans and BW Darvell. “Refining the estimate of the critical period for susceptibility to enamel fluorosis in human maxillary central incisors”. Journal of Public Health Dentistry4 (1995): 238-249.
16. L Hong., et al. “Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors”. Community Dentistry and Oral Epidemiology 4 (2006): 299-309.
17. TA Marshall., et al. “Associations between intakes of fluoride from beverages during infancy and dental fluorosis of primary teeth”. Journal of the American College of Nutrition 2. (2004): 108-116.
18. A Spencer., et al. “Understanding optimum fluoride intake from population-level evidence”. Advances in Dental Research 2 (2018): 144-156.
19. T Tomori., et al. “Fluoride analysis of foods for infants and estimation of daily fluoride intake”. The Bulletin of Tokyo Dental College1 (2004): 19-32.
20. “Scientific opinion on dietary reference values for fluoride”. EFSA Journal 11.8 (2013): 3332-3378.
21. N Molina-Frechero., et al. “Fluoride exposure effects and dental fluorosis in children in Mexico city”. Medical Science Monitor 21 (2015): 3664-3667.
22. “Preventing disease through healthy environments. Inadequate or excess fluoride: A major public health concern”. World Health Organization (2019).
23. “Children’s environmental health. Water and sanitation - household water security”. World Health Organization (2019).
24. Z Iheozor-Ejiofor., et al. “Water fluoridation for the prevention of dental caries”. Cochrane Database of Systematic Reviews 6 (2015): CD01085.
25. ED Beltrán-Aguilar., et al. “Prevalence and severity of dental fluorosis in the United States, 1999-2004”. NCHS Data Brief1 (2010): 1-8.
26. TM García-Escobar., et al. “Moderate and severe dental fluorosis in the rural population of Anantapur, India: ¿Change in their biological susceptibility?” International Journal of Environmental Research and Public Health18 (2022): 11293.
27. FV Zohoori., et al. “Fluoride intake of infants living in non-fluoridated and fluoridated areas”. British Dental Journal 2 (2014): E3.
28. SM Levy., et al. “Patterns of fluoride intake from birth to 36 months”. Journal of Public Health Dentistry2 (2001): 70-77.
29. “School Feeding Program”. JUNAEB School Feeding Program.
30. “Growth patterns for nutritional evaluation of children and adolescents, from birth to 19 years of age”. Ministry of Health. Department of Nutrition and Food (2018).
31. FV Zohoori., et al. “Fluoride retention in infants living in fluoridated and non-fluoridated areas: Effects of weaning”. British Journal of Nutrition 1 (2018): 74-81.
32. EA Martínez-Mier., et al. “Development of gold standard ion-selective electrode-based methods for fluoride analysis”. Caries Research1 (2011): 3-12.
33. “Global Strategy for Infant and Young Child Feeding”. World Health Organization Geneva (2003).
34. “Manual of Breastfeeding”. Exempt Resolution No 109 March 2 (2010).
35. “Studies of Breastfeeding and Infant Feeding Practices”. Breastfeeding CDC (2005-2007).
36. National Institute of Statistics Spain. “Feeding and Oral Hygiene. Type of breastfeeding according to gender and social class based on the occupation of the reference person. Population from 6 months to 4 years”. INE data (2011).
37. AKSZ Köseoğlu. “Assessment of fluoride intake in children according to the world health organization and European union guidelines”. European Journal of Science and Technology 33 (2022): 354-362.
38. European Commission DG Health & Consumers. “Critical review of any new evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking water”. SCHER (2011): 1-59.
39. “Improving young children’s diets during the complementary feeding period”. UNICEF Programming Guidance. UNICEF (2020): 1-76.
40. A Imdad., et al. “Effect of consumption of animal milk compared to infant formula for non-breastfed/mixed-fed infants 6-11 months of age: a systematic review (protocol)”. British Medical Journal Open 2 (2021): e046370.
41. “Guiding principles for complementary feeding of the breastfed child”. PAHO (2005): 1-40.
42. Ministry of Health. “Feeding guide for children under 2 years and feeding guide up to adolescence”. Department of Nutrition and Food. Ministry of Health (2023): 1-145.
43. “Feeding Guide for Children from 6 Months”. Faculty of Medicine. Self-Care Nursing Center (2003): 1-3.
44. KK Tiwari., et al. “Recent advancements in fluoride impact on human health: A critical review”. Environmental and Sustainability Indicators 20 (2023): 100305.
45. WHO & FAO. “Principles and methods for the risk assessment of chemicals in food” (2009).
46. “Opinion of the scientific panel on dietetic products, nutrition and allergies (NDA) on a request from the commission relating to the tolerable upper intake level of fluoride”. EFSA Journal 3.3 (2005): 1-65.
47. A Casaglia., et al. “Dietary fluoride intake by children: When to use a fluoride toothpaste?” International Journal of Environmental Research and Public Health11 (2021): 5791.