Kaminsky L S, Mahoney M C, Leach J, Melius J, Miller M J
Wadsworth Center for Labs and Research, New York State Department of Health, Albany 12201-0509.
Crit Rev Oral Biol Med. 1990;1(4):261-81. doi: 10.1177/10454411900010040501.
This summarizes current knowledge of the benefits and risks of fluoride ingestion. The preponderance of evidence indicates that fluoride can reduce the incidence of dental caries and that fluoridation of drinking water can provide such protection. Due to the ubiquitous nature of exposures to fluoride sources other than drinking water, it is currently impossible to draw firm conclusions regarding the independent effect of fluoride in drinking water on caries prevalence using an ecologic study design. Moderate dental fluorosis occurs in 1 to 2% of the population exposed to fluoride at 1 mg/l in drinking water and in about 10% of the population at 2 mg/l; moderate/severe fluorosis occurs in variable percentages ranging up to 33% of the population exposed to fluoride at 2.4 to 4.1 mg/l in drinking water. The issue of whether moderate or severe dental fluorosis represents an adverse health effect is still controversial. There is no evidence of skeletal fluorosis among the general U.S. population exposed to drinking water fluoride concentrations lower than 4 mg/l. Radiographically detected osteosclerosis after chronic exposure to fluoride in drinking water at 8 mg/l was not associated with clinical symptoms. Reports of crippling skeletal fluorosis associated with low concentrations of fluoride in drinking water in tropical countries have been attributed to other dietary factors. The available data suggest that some individuals may experience hypersensitivity to fluoride-containing agents. Further studies on hypersensitivity are required. There is no evidence of increased incidence of renal disease or renal dysfunction in humans exposed to up to 8 mg fluoride per liter in drinking water. Structural changes in kidneys of experimental animals have been detected at doses exceeding 1 to 5 mg fluoride per kilogram per day. Based on four case reports, individuals with renal insufficiency who consume large volumes of naturally fluoridated water at 2 to 8 mg/l are possibly at increased risk of developing skeletal fluorosis. Studies on the effects of fluoride in individuals with renal insufficiency are needed. There is no evidence that chronic exposure to concentrations of fluoride reported to be greater than 2 mg/l in drinking water increases human cancer mortality or incidence. A study of lifetime exposure to fluoride on cancer incidence in rats and mice has been completed, but assessment for cancer has not been completed. There is no evidence that fluoride is genotoxic except in some in vitro assays at cytotoxic concentrations. There is no in vivo evidence that fluoride affects human cellular enzyme activities.(ABSTRACT TRUNCATED AT 400 WORDS)
本文总结了目前关于摄入氟化物的益处和风险的知识。大量证据表明，氟化物可以降低龋齿的发病率，饮用水加氟能够提供这种保护。由于除饮用水外，接触氟化物来源广泛，目前使用生态学研究设计无法就饮用水中氟化物对龋齿患病率的独立影响得出确凿结论。在饮用水中氟化物含量为1毫克/升的人群中，1%至2%会出现中度氟斑牙，在氟化物含量为2毫克/升的人群中，约10%会出现；在饮用水中氟化物含量为2.4至4.1毫克/升的人群中，中度/重度氟斑牙的发生率高达33%，具体比例各不相同。中度或重度氟斑牙是否代表不良健康影响这一问题仍存在争议。在美国，饮用水中氟化物浓度低于4毫克/升的普通人群中，没有骨骼氟中毒的证据。长期接触饮用水中氟化物含量为8毫克/升的人群，经X光检查发现的骨质硬化与临床症状无关。热带国家关于饮用水中低浓度氟化物导致严重骨骼氟中毒的报告归因于其他饮食因素。现有数据表明，一些人可能对含氟制剂过敏。需要对过敏情况进行进一步研究。没有证据表明饮用水中氟化物含量高达8毫克/升时，接触人群的肾病或肾功能障碍发病率会增加。实验动物每天每千克摄入超过1至5毫克氟化物时，肾脏会出现结构变化。基于四份病例报告，肾功能不全且大量饮用氟化物含量为2至8毫克/升天然水的个体，患骨骼氟中毒的风险可能增加。需要开展针对肾功能不全个体的氟化物影响研究。没有证据表明长期接触饮用水中据报高于2毫克/升的氟化物会增加人类癌症死亡率或发病率。一项关于大鼠和小鼠终生接触氟化物对癌症发病率影响的研究已经完成，但癌症评估尚未完成。除了在细胞毒性浓度下的一些体外试验外，没有证据表明氟化物具有基因毒性。没有体内证据表明氟化物会影响人类细胞酶活性。（摘要截选至400字）
