UNASSIGNED: The presence of dental caries impacts on children\'s daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae.
UNASSIGNED: To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils.
UNASSIGNED: A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations.
UNASSIGNED: Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school.
UNASSIGNED: Pupils aged 11-13 years at recruitment, who have their own mobile telephone.
UNASSIGNED: Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils\' mobile phones about toothbrushing, compared with routine education.
UNASSIGNED: Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children).
UNASSIGNED: Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (£1.02, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution.
UNASSIGNED: Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility.
UNASSIGNED: This trial is registered as ISRCTN12139369.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.
Tooth decay has an impact on children and young people’s daily lives, particularly those living in deprived areas. For young children, programmes to improve toothbrushing with fluoride toothpaste help prevent tooth decay. The Brushing RemInder 4 Good oral HealTh trial (BRIGHT) investigated whether a secondary-school-based toothbrushing programme would work. We developed a new programme which included a lesson and twice-daily text messages sent to pupils’ phones. In total, 4680 pupils, aged 11–13 years, from 42 secondary schools in the United Kingdom took part in the trial. At each school, one year group was randomly selected to receive the programme, while the other year group did not receive it. All pupils were followed up for 2.5 years to see whether there were any differences in levels of tooth decay, frequency of toothbrushing, plaque or quality of life. We also considered the programme’s value for money and the views of pupils and school staff. We followed up 2383 pupils and found no difference in tooth decay, plaque or quality of life. We found those who had the programme were more likely to brush their teeth twice daily after 6 months than those who did not. The programme was not good value for money overall. However, the programme appeared to be of more benefit at preventing tooth decay in pupils eligible for free school meals compared to those not eligible. In the schools with more pupils eligible for free school meals, the chance of the programme representing good value for money increased. The programme was generally liked by the pupils and school staff. Some pupils found the text messages useful, although others said they were annoying. The programme helped pupils brush their teeth more frequently in the short term, but this did not lead to less tooth decay. Further research is needed to understand how to prevent tooth decay in secondary-school pupils.

BACKGROUND: White spot lesions (WSL) are common side effects of orthodontic treatment with fixed appliances, in which the surface layer of enamel is demineralised. Thus, remineralisation, that is a partial or complete reversal, of these lesions can occur as they affect the surface enamel. Remineralisation with low-dose fluoride, in addition to optimal oral hygiene and diet, has been recommended to manage WSL. The aim of the planned trial is to assess the effectiveness of a fluoride-containing bioactive glass toothpaste (BioMin™) in its ability to remineralise post-orthodontic demineralised WSL.
METHODS: A single-centre, double-blind randomised clinical trial to assess intervention with Bio-Min toothpaste on WSL forming on the teeth of young people completing orthodontic treatment.
CONCLUSIONS: Remineralisation of WSL can vary depending on the individual and the site of the lesion. There is a range of oral fluoride delivery methods which include toothpastes, oral rinses, and gel preparations, which can aid remineralisation of these lesions. Identifying effective methods of remineralisation to manage this common and unsightly complication of fixed appliance therapy can improve the health and aesthetics of dentition.
BACKGROUND: ISRCTN.com International Standard Randomised Controlled Trials Number (ISRCTN) 14479893 . Registered on 14 May 2020.

Fluoride (F) is a trace element that is essential to the human body and occurs naturally in the environment. However, a deficiency or excess of F in the environment can potentially lead to human health issues. The pseudototal amount of F in soil often does not correlate directly with the F content in plants. Instead, the F content within plants tends to have a greater correlation with the bioavailable F in soils. In large-scale soil surveys, only the pseudototal elemental content of soils is typically measured, which may not be highly reliable for developing agricultural zoning plans. There are significant variations in the ability of different plants to accumulate F from soil. Additionally, due to variations in soil elemental absorption mechanisms among different plant species, when multiple crops are grown in an area, it is typically necessary to study the elemental absorption mechanisms of each crop. To address these issues, in this study, we examined the factors influencing F bioaccumulation coefficients in different crops based on 1:50,000 soil geochemical survey data. Using the random forest algorithm, four indicators-bioavailable P, bioavailable Zn, leachable Pb, and Sr-were selected from among 29 parameters to predict the F content within crops to replace bioavailable F in the soil. Compared with the multivariate linear regression (MLR) model, the random forest (RF) model provided more accurate and reliable predictions of the fluoride content in crops, with the RF model\'s prediction accuracy improving by approximately 95.23%. Additionally, while the partial least squares regression (PLSR) model also offered improved accuracy over MLR, the RF model still outperformed PLSR in terms of prediction accuracy and robustness. Additionally, it maximized the utilization of existing geochemical survey data, enabling cross-species studies for the first time and avoiding redundant evaluations of different types of agricultural products in the same region. In this investigation, we selected the Xining-Ledu region of Qinghai Province, China, as the study area and employed a random forest model to predict the crop F content in soils, providing a new methodological framework for crop production that effectively enhances agricultural quality and efficiency.

BACKGROUND: Fluoride plays a vital role in preventing dental caries, with its addition to oral care products significantly promoting oral hygiene. A no-rinse brushing method aims to increase fluoride retention in the oral cavity, as rinsing with water decreases fluoride levels in saliva, which could affect remineralization. While the no-rinse brushing method holds promise for improving fluoride retention in the oral cavity, critical inquiries persist regarding its safety. This study investigated the kinetics of oral fluoride and potential risks to fully assess its effectiveness and implications for oral health.
METHODS: Ten healthy adults participated in a crossover study comparing the no-rinse with the rinse method. All subjects followed American Dental Association (ADA) brushing guidelines. Levels of fluoride in saliva (supernatant and sediment) and urine were measured over time, and plasma fluoride was measured one hour after brushing. Pharmacokinetic parameters were also calculated from the data.
RESULTS: Participants using the no-rinse method had higher fluoride levels in supernatant immediately and up to 30 min post-brushing compared to the rinse method. Fluoride levels in sediment were higher only immediately after brushing. The total fluoride concentration in saliva remained elevated for up to 5 min with the no-rinse method. Systemic fluoride absorption showed no significant difference between the two methods based on blood and urine analysis.
CONCLUSIONS: This research indicates that the no-rinse method can enhance fluoride retention in the oral cavity for up to 30 min after a single brushing. In addition, our findings suggest that this method does not significantly influence systemic fluoride levels or toxicity.
UNASSIGNED: Thai Clinical Trials Registry, TCTR ( http://thaiclinicaltrials.org ).
BACKGROUND: TCTR20231104001 (4/11/2023).

Good quality water for human consumption, irrigation, and industrial use is very important. Today, around the world, water is contaminated by natural processes and human activities. This study aimed to evaluate the suitability of groundwater for drinking and irrigation, identify the source of fluoride and nitrate contamination, and assess the human health risks around the Cauvery River basin in southern India. A total of 30 groundwater samples were collected and analyzed for hydrochemical parameters, including EC, TDS, pH, Ca, Mg, Na, K, HCO3, Cl, SO4, NO3, and F-. The majority of groundwater samples in the study area are used for drinking and irrigation. The pH of groundwater in the study area was observed to be dominantly alkaline. The levels of TDS, Ca, Na, K, F, and TH exceeded the permissible limits recommended by BIS and WHO. Fluoride and nitrate levels in groundwater exceeded the permissible limits for drinking purposes in 43% and 50% of the samples, respectively. The excessive concentration of fluoride and nitrate in groundwater could pose serious human health problems. Fluoride and nitrate concentrations in groundwater vary between 0.1 and 2 mg/l and 12 and 95 mg/l, respectively. Based on the computation of the drinking water quality index, about 73% of groundwater samples were classified as excellent to good. Health risk was assessed for infants, children, and adults using non-carcinogenic risk indices such as hazard quotients (HQ), hazard indexes (HI), total hazard indices (THI), and carcinogenic risk indices (CR). Infants, children, and adults have different total hazards indexes ranging from 1.508 to 5.733, 1.579 to 6.003, and 0.011 to 0.046, respectively. Health risk assessment results indicated that the hazard index and hazard quotient were above the recommended limit of > 1 in most of the samples for infants and children. Non-carcinogenic risk and carcinogenic risks were more likely to affect infants and children rather than adults through ingestion of contaminated water.

India has been dealing with fluoride contamination of groundwater for the past few decades. Long-term exposure of fluoride can cause skeletal and dental fluorosis. Therefore, an in-depth exploration of fluoride concentrations in different parts of India is desirable. This work employs machine learning algorithms to analyze the fluoride concentrations in five major affected Indian states (Andhra Pradesh, Rajasthan, Tamil Nadu, Telangana and West Bengal). A correlation matrix was used to identify appropriate predictor variables for fluoride prediction. The various algorithms used for predictions included K-nearest neighbor (KNN), logistic regression (LR), random forest (RF), support vector classifier (SVC), Gaussian NB, MLP classifier, decision tree classifier, gradient boosting classifier, voting classifier soft and voting classifier hard. The performance of these models is assessed over accuracy, precision, recall and error rate and receiver operating curve. As the dataset was skewed, the performance of models was evaluated before and after resampling. Analysis of results indicates that the RF model is the best model for predicting fluoride contamination in groundwater in Indian states.

To determine if fluoride\'s established negative impact on adult kidney health begins during gestation, an intergenerational model of Wistar rats was exposed to two doses of fluoride (2.5 or 5.0 mg/kg/day via gavage) 20 days before mating and during gestation (20 days). The results revealed that fluoride was distributed to the amniotic fluid and fetus, resulting in lower weight, more pronounced fetal restriction, and decreased creatinine, osmolarity, and amniotic fluid volume. At the kidney level, less development in the nephrogenic and cortical zones was observed in the fluoride treatment groups, with an imbalance in the number of glomeruli and \"S\" shaped bodies, an increase in the immunoexpression of the marker of proliferation Ki-67 in the nephrogenic zone, an increase in the expression of Wnt4 and more maturation of the renal tubules, indicating that fluoride exposure during pregnancy alters kidney development and promotes early maturation of tubular segments.

We aimed to investigate the chemical and physical properties of nano silver fluoride sustained release orthodontic elastomerics (NSF-RE) and determine their antimicrobial and antibiofilm formation activities against Streptococcus mutans. Orthodontic elastomerics were dip-coated with NSF solution in ethyl cellulose (EC) and polyethylene glycol 6000 (PEG). The studied groups included NSF (no EC/PEG), NSF-E (EC), NSF-EP1 (EC:PEG, 4:1), and NSF-EP2 (EC:PEG, 2:1). The cumulative release of silver nanoparticles (AgNPs) and fluoride, along with the compatibility of the tensile force with orthodontic brackets, was evaluated. The antimicrobial activity was evaluated using an agar diffusion test. The inhibition of biofilm formation was evaluated using colony-forming units (CFUs), biofilm thickness, and the live/dead cell ratio. NSF-RE containing EC sustained the release of AgNPs and fluoride for > 7 days. Tensile forces were not significantly different among the groups. The inhibition zone was 2.64- and 1.31-fold larger with NSF-EP2 than that with NSF and NSF-E, respectively. NSF-EP2 was the most effective in inhibiting biofilm formation with significant reductions in CFUs, biofilm thickness, and live/dead cell ratio by 57, 86, and 96%, respectively, as compared to those in the control group. Overall, sustained release of AgNPs and fluoride by NSF-RE provides antimicrobial and antibiofilm effects against S. mutans.

OBJECTIVE: To study the effect of incorporating chitosan and fluoride-loaded chitosan nanoparticles into a glass-ionomer cement (GIC) to prevent secondary caries.
METHODS: A standard cervical cavity (mesio-distal width 6 mm, cervico-occlusal width 2 mm, and depth 2 mm) was prepared on 30 molars for the following restoration groups: group 1, conventional GIC restoration; group 2, chitosan (10%) modified GIC restoration; group 3, fluoride loaded chitosan nanoparticles (10%) modified GIC restoration. The restored teeth were subjected to 1,500 thermal cycles before undergoing a multi-species cariogenic biofilm challenge. The restored teeth were examined by micro-computed tomography (micro-CT), scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/EDX). Data were analyzed by the one-way ANOVA, Tukey HDS, Kruskal Wallis, and Dunn\'s test.
RESULTS: Micro-CT determined outer lesion depths for groups 1-3 were: 614 ± 20 μm, 589 ± 17 μm, and 560 ± 19 μm respectively. Both modifications with chitosan and fluoride-loaded chitosan nanoparticles significantly affected outer lesion depth (p < 0.05). The modification with fluoride-loaded chitosan nanoparticles statistically significantly decreased the outer lesion depth compared to all other groups (p < 0.05). SEM/EDX showed an increase of calcium, phosphorus, and fluoride at the root dentine adjacent to the restoration in groups 2 and 3 (modified GIC). This increase was statistically significantly higher in the group modified with fluorine-loaded nano chitosan particles compared to the other groups (p < 0.05).
CONCLUSIONS: Incorporation of 10% chitosan and 10% fluoride-loaded chitosan nanoparticles into GIC restorative material can prevent secondary root caries development. 10% fluoride-loaded chitosan nanoparticles were more effective.
CONCLUSIONS: Glass ionomer cement modified with fluoride-loaded chitosan nanoparticles may be a promising restorative material in pediatric and preventive dentistry due to their controlled release properties.

The contribution of mica mining activities to fluoride (F-) contamination in groundwater has been chased in this study. For the purpose, groundwater samples (n = 40, replicated thrice) were collected during the post-monsoons (September-October) from a mica mining area in the Tisri block of Giridih district, Jharkhand. The study has employed a synergy of classical aquifer chemistry, statistical approaches, different indices, Self-Organising Maps (SOM), and Sobol sensitivity index (SSI) to unveil the underlying aquifer chemistry, identify the impacts of mining activities on groundwater quality and its associated health hazard. Fluoride levels varied from 0.34 to 2.8 ppm, with 40% of samples exceeding the World Health Organization\'s permissible limit (1.5 ppm). Physicochemical analysis revealed significant differences in electrical conductivity (EC), total dissolved solids (TDS), total hardness (TH) and major ion concentrations (Na+, HCO3-, Ca2+) between fluoride-contaminated (FC) and fluoride-uncontaminated (FU) groups. Higher Na+ and HCO3- associated with F- contaminated samples, were indicative of silicate weathering and carbonate dissolution as primary geogenic sources for this ion. Health risk assessment (HRA) revealed hazard quotient (HQ) values exceeding unity, indicating non-carcinogenic risks, particularly for children in most samples from group FC. The mean Water Quality Index (WQI) of FC group (156.76 ± 7.30) was significantly higher (p < 0.05) than group FU indicating of its unsuitability. SOM could accurately (80%) predict presence of fluoride in water samples based on other major ions. Sobol sensitivity analysis successfully identified fluoride concentration and body weight as most impactful parameters affecting human health. The integration of advanced modelling techniques and geospatial analysis as Inverse Distance Weightage (IDW) maps has provided a robust framework for ongoing groundwater quality monitoring in mining-affected regions and can help proactive intervention in risk-prone areas. Overall, this comprehensive study takes us a step ahead towards ensuring safe drinking water access for the global community.