© Borgis - Nowa Stomatologia 1/2005, s. 3-6
Tamara Terekhova, Tatyana Popruzhenko, Natalia Shakovets
Experience of a systemic fluoride prevention of caries among children of Belarus
Department of Pediatric Dentistry, Belorussian State Medical University, in Minsk Republic of Belarus
THE PROBLEM OF DENTAL CARIES AMONG CHILDREN OF BELARUS
The tendency of decrease in the number of caries occurrences among children is observed in Belarus now as in the majority of the Eastern European countries, but the problem still remains. According to examinations conducted in 2000-2002 the prevalence of caries of primary teeth among two-year olds constituted 25% (0.79±0.09), three-year olds – 54.8% (2.22±0.07) and among 5-6 year olds – 95% (5.6±0.10). The prevalence of caries of permanent teeth among 12-year olds constituted 85.3% in urban areas, 94.2% in rural areas with intensity 3.04 ±0.08 and 4.27±0.09 correspondingly. The problem is aggravated by the fact that dentist services in the country are not able to provide the proper level of dentist help for children: this level amounts to 4.5% among two-year old children in urban areas, 29.3% among preschool children in urban areas and 8.3% in rural areas, for 12-year olds – 36% in urban and 11% in rural areas (1).
ESTIMATION AND ASSESSMENT OF THE LEVEL OF NATURAL FLUORIDE EXPOSURE AMONG CHILDREN
Natural sources of fluorides
One of the factors causing the high prevalence of caries among the population of Belarus is the low level of fluorides in drinking water: only 2% of water resources contain up to 0.4-0.5% ppmF, the remaining 98% contain 0.1-0.3 ppmF (2). The air of urban and rural areas of Belarus contains no more than 0.013 ppmF/m2 , that adds to daily fluoride exposure of 4-6 year old children about 0.07 mgF (3). The content of fluorides in main food products constitutes about 0.4 (vegetables) – 0.6 (dairy products) – 1.3 (meat) – 1.6 (bread) mgF/kg (4). According to estimates, a daily food ration of preschool children in kindergartens contains about 1.10±0.23 mgF, and a home-cooked food ration of children contains – 0.9±0.31 mgF (5).
Fluoride exposure of preschool children calculated by intake of fluorides and excretion of fluorides with urine
According to the estimates the natural daily fluorine load of the Belarusian preschool children is composed of fluorides in air, drinking water and food1 and constitutes from 0.4 to 1.2 mgF/day (6).
The values of kidney excretion of fluorides are calculated based on values of excretion of fluorides with urine among preschool children living in families and visting kindergarten and not having any additional sources of fluorides (see the table 1). The daily excretion of fluorides among children varies from 124±17.5 mkgF/day (in the Northern areas) to 223±12.9 mkgF/day (in the Central areas). If to think that kidney excretion of fluorides among children constitutes 50% of received fluorine, then the natural daily fluorine load of children corresponds to 0.24-0.45 mgF/day (7).
Table 1. Values of kidney excretion of fluorides among preschool children of Belarus under natural fluorine load conditions.
| Values | Time of kidney excretion of fluorides |
| after meal | nighttime | daytime |
| Content of fluoride in urine (mgF/litre) | 0.41?0.03 | 0.19?0.02 | 0.25?0.02 |
| Rate of kidney excretion of fluorides (mkgF/hour) | 9.8?0.51 | 5.6?0.29 | 7.81?0.29 |
Among children living in orphanages the values of fluoride excretion are somewhat higher ([F]=0.34±0.02 mgF/litre, rate of kidney excretion being 17.74±1.36 mkgF/hour), therefore the fluoride load calculated by these values constitutes 0.3±0.8 mgF/day (8).
Estimation of fluoride exposure deficit among children
The biological effects of fluorides on populations of the protozoa were studied to determine the upper limits of the recommended by T. Martaller were optimal for our conditions. The factual load preschool children in Belarus corresponds to the lower limits of the optimum calculated by energy inputs and is lower than the higher limits by 0.5 mgF/day minimum.
EXPERIENCE OF USING WATER CONTAINING 1.0-1.5 MGF/LITRE FOR DENTAL CARIES PREVENTION
In 1964 the country´s government decided to start fluoridation of tap water in 10 cities of the country, in 1987 the country had 22 fluoridating systems. But this experience couldn´t be called successful as the content of fluorine in water was neither constant ([F]=0.6±1.6 ppm F) nor stable (uninterruptible fluoridation was accomplished only in two cities) nor all-embarcing (fluoridated water was available only to 10% of population). As the result the preventing potential of the method was not fullfilled and communal fluoridation of tap water was stopped as inexpedient.
As Belarus has extensive supplies of undrground waters with natural optimal and increased content of fluorides (0.9-3.5 ppmF), their extraction and further sale of bottled water has been actively conducted according to the project of group caries prevention using water containing 1.1 ppm F. This water (0.5 litre/man a day) was used daily over two years for cooking food and as beverages for children. The average daily level of fluoride excretions with urine increased up to 46.28±0.92 mkgF/hour. The expenditures for purchase and shipment of water constituted 0.8$/man a year. The clinical effectiveness of the project corresponded to the reduction of caries occurrence in the groups of children with different caries resistance on 46.4±60.1% lvel (9).
USE OF FLUORIDATED TABLE SALT FOR DENTAL CARIES PREVENTION
Table salt as the source of fluorides
Traditions of use of table salt in preschool establishments and home cooking. The helath service of the Republic of Belarus recommends using 3 g of table salt as the part of the daily consumed food products list for children from one to one and a half years old, 5 g for children from one and a half to 3-years old, from 3-years old and older – 8 g a day.
In reality a Belarusian child gets from 0,6 to 2,0 g of the so-called "table” salt with every main meal2. the actual daily intake of table salt with daily food ration cookted with adding of table salt in kindergartens constitutes from 3.3 to 9.1 g/day (5.9±1.4 g/day). The daily home cooked food ration for children contains about 3.53±1.65 g of "home” table salt. Almost all children get no more than 8 g of "home” table salt every day.
Content of fluorides in fluoridated salt ("Mozyrsol”) over different periods under different storage conditions. Fluoridated salt has been produced by the Belarusian enterprise Mozyrsol JSC since 1991. The table salt of "extra” class is enriched by potassium fluoride (KF)3 by aqueous method. Concentration of fluoride-ion in the salt varies within the limits defined by technical norms: 250±100 mgF/kg. Content of fluorides hardly changes for at least over one year when stored in factory package orin an open container.
Fluoride exposure control by means of consumption of fluoridated table salt by preschool children
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Piśmiennictwo
1. Melnikova EI.: Epidemiology of dental of dental disesases and level of dental care to the children of the Republic of Belarus. Sovremennaya stomatologia 2000, 4:34-36. 2.Gelfer E.A., Rudik V.A.: Fluorides in drinking water and the problem of water fluoridation. Zdravoohranenie Belarusi 1971, 7:64-66. 3.Popruzhenko T.V., Saley G.V.: Assessment of aerogenus fluorides´ load on Belarusian population. Sovremennaya stomatologia 2000, 3:32-34. 4.Shulyakovskaya O.V., et al.: Fluorides´ quantity in main foods from different regions of the Republic of Belarus. Sovremennaya stomatologia 2000, 4:37-38. 5.Popruzhenko T.V.: Fluorides in daily food ration in kindergartens in the Republic of Belarus. Zdravoohranenie Belarusi 2001, 10:16-18. 6.Popruzhenko T.V.: Additional home sources of fluorine load on children. Oral health of a child 2001, 68-71. 7.Popruzhenko T.V.: The Experiences of organization of the monitoring fluorine loading, children consuming fluoridated salt. New technologies in dentistry 2003, 59-61. 8.Shakovets N.V.: the control of daily fluorine load during systemic and combined fluoride prevention. Actual problems of present-day medicine 1998, 104-105. 9.Shakovets N.V.: Clinical efficiency of natural fluoridated water PROTERA intake. Abstracts of 4 joint meeting of IADR 2000, 114. 10.Popruzhenko T.V.: The use of fluoride toothpaste among Belorusin children. Novoe v stomatologii 2001, 2:87-90. 11.Melnichenko E.M., et al.: Fluorides in bottled waters of food market of the Republic of Belarus. Sovremennaya stomatologia 2000, 3:44-45. 12.Reznikova L.G., Shulyakovskaya O.V.: The fluoride content in of home-cooked pickled products, prepared with using fluoridated salt. Health and environment 2002, 169-170. 13.Melnichenko E.M., Terekhova T.N.: Scientific substantiation and experience of caries prevention in children of preschool age with fluoridated salt in the Republic of Belarus. Sovremennaya stomatologia 1998, 3:5-13.
