Spencer A J, Do L G, Mueller U, Baines J, Foley M, Peres M A
1 Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide, Adelaide, Australia.
2 Chemical Safety and Nutrition Section, Food Standards Australia New Zealand, Canberra, Australia.
Adv Dent Res. 2018 Mar;29(2):144-156. doi: 10.1177/0022034517750592.
Policy on fluoride intake involves balancing caries against dental fluorosis in populations. The origin of this balance lies with Dean's research on fluoride concentration in water supplies, caries, and fluorosis. Dean identified cut points in the Index of Dental Fluorosis of 0.4 and 0.6 as critical. These equate to 1.3 and 1.6 mg fluoride (F)/L. However, 1.0 mg F/L, initially called a permissible level, was adopted for fluoridation programs. McClure, in 1943, derived an "optimum" fluoride intake based on this permissible concentration. It was not until 1944 that Dean referred to this concentration as the "optimal" concentration. These were critical steps that have informed health authorities through to today. Several countries have derived toxicological estimates of an adequate and an upper level of intake of fluoride as an important nutrient. The US Institute of Medicine (IOM) in 1997 estimated an Adequate Intake (AI) of 0.05 mg F/kg bodyweight (bw)/d and a Tolerable Upper Intake Level (UL) of 0.10 mg F/kg bw/d. These have been widely promulgated. However, a conundrum has existed with estimates of actual fluoride intake that exceed the UL without the expected adverse fluorosis effects being observed. Both the AI and UL need review. Fluoride intake at an individual level should be interpreted to inform more nuanced guidelines for individual behavior. An "optimum" intake should be based on community perceptions of caries and fluorosis, while the ultimate test for fluoride intake is monitoring caries and fluorosis in populations.
氟摄入政策涉及在人群中平衡龋齿与氟斑牙问题。这种平衡的起源在于迪恩对供水系统中的氟浓度、龋齿和氟斑牙的研究。迪恩确定氟斑牙指数中的0.4和0.6这两个切点至关重要。这分别相当于1.3毫克氟（F）/升和1.6毫克氟/升。然而，氟化项目采用的是最初被称为允许水平的1.0毫克氟/升。1943年，麦克卢尔基于这一允许浓度得出了“最佳”氟摄入量。直到1944年迪恩才将这个浓度称为“最佳”浓度。这些都是至关重要的步骤，至今仍为卫生当局提供参考。几个国家已经得出了作为重要营养素的氟的适宜摄入量和摄入上限的毒理学估计值。1997年，美国医学研究所（IOM）估计适宜摄入量（AI）为0.05毫克氟/千克体重（bw）/天，可耐受最高摄入量（UL）为0.10毫克氟/千克体重/天。这些估计值已得到广泛传播。然而，存在一个难题，即实际氟摄入量估计值超过了UL，但却未观察到预期的氟斑牙不良影响。AI和UL都需要重新审视。个体层面的氟摄入量解读应能为更细致的个体行为指南提供依据。“最佳”摄入量应基于社区对龋齿和氟斑牙的认知，而氟摄入量的最终检验是对人群中的龋齿和氟斑牙情况进行监测。
