Do L G, Sawyer A, John Spencer A, Leary S, Kuring J K, Jones A L, Le T, Reece C E, Ha D H
School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Australia.
School of Psychology, The University of Adelaide, Australia.
J Dent Res. 2025 Mar;104(3):243-250. doi: 10.1177/00220345241299352. Epub 2024 Dec 18.
It is important to maintain confidence in the risk and benefit balance of major caries-preventive programs using fluoride. The ongoing debate about potential effects of early-life exposures to fluoride on cognitive neurodevelopment requires high-quality scientific evidence. This study aimed to investigate the potential effects of fluoride exposure on cognitive neurodevelopment assessed with the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV) in an Australian population-based sample. The sample was selected from the National Child Oral Health Study (NCOHS) 2012-2014. NCOHS collected data on socioeconomic factors, oral health behaviors, and residential history to estimate percentage lifetime exposure to fluoridated water during the first 5 y of life (%LEFW). NCOHS children were also examined by trained and calibrated examiners to assess dental fluorosis (a reliable and valid individual biomarker of total fluoride intake during early childhood). The sample was followed up in 2022-2023 to collect data on cognitive neurodevelopment (intelligence quotient [IQ]) using the WAIS-IV, which was administered by trained and calibrated qualified psychologists. Multivariable regression models were generated to investigate associations between the 2 exposure measurements (%LEFW and dental fluorosis) with full-scale IQ (FSIQ) scores, controlling for important confounding effects. Hypotheses of noninferiority were also tested, contrasting different levels of exposure to fluoride. Some 357 participants aged 16 to 26 y completed the WAIS-IV, with a mean FSIQ score of 109.2 (95% confidence interval [CI]: 107.8-110.5). The estimates of the multivariable regression models demonstrated slightly higher FSIQ scores among the exposed than the nonexposed. The adjusted β of 100%LEFW versus 0%LEFW was 1.07 (95% CI: -2.86, 5.01) and of having dental fluorosis versus no fluorosis was 0.28 (95% CI: -3.00, 3.57). The hypothesis of noninferiority tests found that FSIQ scores of those exposed and nonexposed to fluoride were equivalent. The study provided consistent evidence that early childhood exposure to fluoride does not have effects on cognitive neurodevelopment.
对使用氟化物的主要防龋项目的风险和益处平衡保持信心很重要。关于生命早期接触氟化物对认知神经发育的潜在影响的持续争论需要高质量的科学证据。本研究旨在调查在澳大利亚基于人群的样本中，接触氟化物对使用韦氏成人智力量表第四版（WAIS-IV）评估的认知神经发育的潜在影响。该样本选自2012 - 2014年的全国儿童口腔健康研究（NCOHS）。NCOHS收集了社会经济因素、口腔健康行为和居住史的数据，以估计生命最初5年中接触氟化水的终生百分比（%LEFW）。NCOHS的儿童还由经过培训和校准的检查人员进行检查，以评估氟斑牙（幼儿期总氟摄入量的可靠且有效的个体生物标志物）。2022 - 2023年对该样本进行随访，以收集使用WAIS-IV的认知神经发育数据（智商[IQ]），该量表由经过培训和校准的合格心理学家进行施测。生成多变量回归模型以研究两种暴露测量（%LEFW和氟斑牙）与全量表智商（FSIQ）分数之间的关联，并控制重要的混杂效应。还测试了非劣效性假设，对比了不同水平的氟化物暴露情况。约357名年龄在16至26岁的参与者完成了WAIS-IV测试，平均FSIQ分数为109.2（95%置信区间[CI]：107.8 - 110.5）。多变量回归模型的估计结果显示，暴露组的FSIQ分数略高于未暴露组。100%LEFW与0%LEFW相比的调整β值为1.07（95%CI：-2.86，5.01），有氟斑牙与无氟斑牙相比的调整β值为0.28（95%CI：-3.00，3.57）。非劣效性测试假设发现，接触氟化物和未接触氟化物者的FSIQ分数相当。该研究提供了一致的证据，表明幼儿期接触氟化物对认知神经发育没有影响。
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