{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:22:02Z","timestamp":1784308922260,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100022771","name":"Borrow Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022771","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Fluoride exposure in children is commonly estimated using questionnaires or urinary biomarkers. However, no study has yet compared these methods for classifying participants into five intake categories ranging from low to high. This study aimed to estimate the extent of agreement and classification consistency between questionnaire\u2010 and urinary\u2010based methods for assessing total daily fluoride intake (TDFI) in children aged 4\u20137\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 104 healthy children across three countries (UK, Brazil, Chile) receiving one of three fluoridation modalities (non\u2010fluoridated\u2010water, fluoridated\u2010water, or fluoridated\u2010milk) provided a 24\u2010h urine sample and completed validated dietary and oral hygiene questionnaires. TDFI was estimated from dietary sources and toothpaste ingestion, adjusted for body weight. Urinary fluoride concentration was measured and 24\u2009h\u2010UFE determined by multiplying urine volume by fluoride concentration. TDFI was predicted from 24\u2009h\u2010UFE using the WHO's recommended method. Method agreement was assessed using paired t\u2010tests and Bland\u2013Altman analysis to evaluate continuous fluoride intake estimates. Cohen's kappa was used to assess agreement between categorical intake classifications, while descriptive statistics reported the percentage of children in each intake group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The questionnaire method estimated a higher mean TDFI (0.072\u2009mg\/kgbw\/day) than the urine\u2010based method (0.058\u2009mg\/kgbw\/day,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). Bland\u2013Altman analysis showed good agreement for lower mean TDFI values (&lt;\u20090.10\u2009mg\/kgbw\/day) but increasing variability at higher fluoride intake levels. The questionnaire classified a larger proportion of children as high exposure (\u2265\u20090.1\u2009mg\/kgbw\/day) than the urine method (19.2% vs. 11.5%), with the greatest discrepancy observed in the fluoridated milk group (46.2% vs. 7.7%). Despite these classifications, Cohen's kappa revealed minimal agreement between methods (\u03ba\u2009=\u20090.034,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.508), suggesting that classification concordance was likely due to chance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This first study comparing questionnaire and urinary methods for assessing TDFI in children found significant discrepancies and minimal agreement, especially in higher exposure groups, highlighting the risk of misclassification and the need for research into combined assessment approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cdoe.70015","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T05:54:38Z","timestamp":1755842078000},"page":"667-675","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Assessing Total Fluoride Intake in Children: Reliability of Commonly Used Methods"],"prefix":"10.1111","volume":"53","author":[{"given":"Fatemeh Vida","family":"Zohoori","sequence":"first","affiliation":[{"name":"School of Health and Life Sciences Teesside University  Middlesbrough UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilia Afonso Rabelo","family":"Buzalaf","sequence":"additional","affiliation":[{"name":"Bauru School of Dentistry University of Sao Paulo  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Maguire","sequence":"additional","affiliation":[{"name":"School of Dental Sciences, Faculty of Medical Sciences Newcastle University  Newcastle UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9580-4751","authenticated-orcid":false,"given":"Roy","family":"Sanderson","sequence":"additional","affiliation":[{"name":"School of Natural &amp; Environmental Sciences Newcastle University  Newcastle UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3362-5173","authenticated-orcid":false,"given":"Rodrigo A.","family":"Giacaman","sequence":"additional","affiliation":[{"name":"Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry University of Talca  Talca Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6505-8356","authenticated-orcid":false,"given":"Stefania","family":"Martignon","sequence":"additional","affiliation":[{"name":"UNICA \u2013 Caries Research Unit, Research Department Universidad El Bosque  Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar O.","family":"Beltran","sequence":"additional","affiliation":[{"name":"UNICA \u2013 Caries Research Unit, Research Department Universidad El Bosque  Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Eskandari","sequence":"additional","affiliation":[{"name":"School of Health and Life Sciences Teesside University  Middlesbrough UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"Kronic","sequence":"additional","affiliation":[{"name":"School of Health and Life Sciences Teesside University  Middlesbrough UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karla","family":"Gambetta\u2010Tessini","sequence":"additional","affiliation":[{"name":"Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry University of Talca  Talca Chile"},{"name":"National Dental Research Institute National Dental Centre Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia Mauad","family":"Levy","sequence":"additional","affiliation":[{"name":"Bauru School of Dentistry University of Sao Paulo  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Dietary Reference Intakes for Calcium, Magnesium, Vitamin D, and Fluoride","author":"Institute of Medicine","year":"1997"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12254"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000279325"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/08959374940080011001"},{"key":"e_1_2_13_6_1","unstructured":"WHO \u201cBasic methods for assessment of renal fluoride excretion in community prevention programmes for oral health \u201d(2014) World Health Organisation France."},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1159\/000472263"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1752-7325.2003.tb03502.x"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1079\/BJN19940064"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000321657"},{"key":"e_1_2_13_11_1","volume-title":"Database of the Fluoride (F) content of Selected Drinks and Foods in the UK. Teesside University and Newcastle University","author":"Zohoori F. V.","year":"2015"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000445981"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.2903\/j.efsa.2013.3332"},{"issue":"2","key":"e_1_2_13_14_1","first-page":"188","article-title":"Compliance With School F\u2010Milk and Non\u2010F Milk Intake in 3 to 4 and 6 to 7 Year Old Children","volume":"29","author":"Walls R.","year":"2012","journal-title":"Community Dental Health"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jphd.12542"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12373"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1752-7325.1999.tb03273.x"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1159\/000325107"},{"issue":"4","key":"e_1_2_13_19_1","first-page":"237","article-title":"Effect of Gastric Contents on the Bioavailability of Fluoride in Humans","volume":"12","author":"Shulman E. R.","year":"1990","journal-title":"Pediatric Dentistry"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/froh.2025.1526262"}],"container-title":["Community Dentistry and Oral Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cdoe.70015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T04:37:25Z","timestamp":1763527045000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cdoe.70015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,21]]},"references-count":19,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/cdoe.70015"],"URL":"https:\/\/doi.org\/10.1111\/cdoe.70015","archive":["Portico"],"relation":{},"ISSN":["0301-5661","1600-0528"],"issn-type":[{"value":"0301-5661","type":"print"},{"value":"1600-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,21]]},"assertion":[{"value":"2025-03-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}