{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T03:18:08Z","timestamp":1762053488694,"version":"build-2065373602"},"reference-count":73,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T00:00:00Z","timestamp":1654819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>There is currently no consensus among researchers on the optimal level of fluoride for human growth and health. As drinking water is not the sole source of fluoride for humans, and fluoride can be found in many food sources, this work aimed to determine the incidence and severity of dental fluorosis in Poland, in areas where a low fluoride content characterizes the drinking water, and to assess the impact of fluoride on the enamel composition and microstructure. The dental examination involved 696 patients (aged 15\u201325 years) who had since birth lived in areas where the fluoride concentration in drinking water did not exceed 0.25 mg\/L. The severity of the condition was evaluated using the Dean\u2019s Index. Both healthy teeth and teeth with varying degrees of fluorosis underwent laboratory tests designed to assess the total protein and fluoride content of the enamel. Protein amount was assessed spectrophotometrically while the level of fluoride ions was measured by DX-120 ion chromatography. The clinical study revealed 89 cases (12.8%) of dental fluorosis of varying severity. The enamel of teeth with mild and moderate fluorosis contained a significantly higher protein (p-value &lt; 0.001 and 0.002, respectively) and fluoride level (p &lt; 0.001) than those with no clinical signs of fluorosis. SEM images showed irregularities in the structure of the fluorotic enamel. An excessive fluoride level during amelogenesis leads to adverse changes in the chemical composition of tooth enamel and its structure. Moreover, dental fluorosis present in areas where drinking water is low in fluorides indicates a need to monitor the supply of fluoride from other possible sources, regardless of its content in the water.<\/jats:p>","DOI":"10.3390\/ijerph19127153","type":"journal-article","created":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T10:25:12Z","timestamp":1654856712000},"page":"7153","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Assessing Fluorosis Incidence in Areas with Low Fluoride Content in the Drinking Water, Fluorotic Enamel Architecture, and Composition Alterations"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7058-3614","authenticated-orcid":false,"given":"Izabela","family":"Stru\u017cycka","sequence":"first","affiliation":[{"name":"Department of Comprehensive Dentistry, Medical University of Warsaw, 02-097 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aneta","family":"Olszewska","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Temporomandibular Disorders, Poznan University of Medical Sciences, 60-567 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2050-2898","authenticated-orcid":false,"given":"Agnieszka","family":"Bogus\u0142awska-Kapa\u0142a","sequence":"additional","affiliation":[{"name":"Department of Comprehensive Dentistry, Medical University of Warsaw, 02-097 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4388-286X","authenticated-orcid":false,"given":"Szymon","family":"Hryhorowicz","sequence":"additional","affiliation":[{"name":"Institute of Human Genetics, Polish Academy of Sciences, 60-479 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0173-5431","authenticated-orcid":false,"given":"Marta","family":"Kaczmarek-Ry\u015b","sequence":"additional","affiliation":[{"name":"Institute of Human Genetics, Polish Academy of Sciences, 60-479 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1633-7145","authenticated-orcid":false,"given":"Beniamin Oskar","family":"Grabarek","sequence":"additional","affiliation":[{"name":"Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, The University of Technology in Katowice, 41-800 Zabrze, Poland"},{"name":"GynCentrum, Laboratory of Molecular Biology and Virology, 40-851 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0781-6534","authenticated-orcid":false,"given":"Rafa\u0142","family":"Staszkiewicz","sequence":"additional","affiliation":[{"name":"Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, The University of Technology in Katowice, 41-800 Zabrze, Poland"},{"name":"5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izabela","family":"Kuciel-Polczak","sequence":"additional","affiliation":[{"name":"Trauma Centre, Department of Ophthalmology, St. Barbara Hospital, 41-200 Sosnowiec, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agata","family":"Czajka-Jakubowska","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Temporomandibular Disorders, Poznan University of Medical Sciences, 60-567 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,10]]},"reference":[{"key":"ref_1","unstructured":"European Commission Directorate General for Health and Consumers (2010). Critical Review of Any New Evidence on the Hazard Profile, Health Effects, and Human Exposure to Fluoride and the Fluoridating Agents of Drinking Water, Publications Office."},{"key":"ref_2","first-page":"69","article-title":"Fluoride and Oral Health","volume":"33","author":"Baez","year":"2016","journal-title":"Community Dent. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.clnesp.2021.10.021","article-title":"Fluoride Concentration in Bottled Drinking Water from a Fluoride Endemic Area: A Market-Based Survey","volume":"46","author":"Kerdoun","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ciosek, \u017b., Kot, K., Kosik-Bogacka, D., \u0141anocha-Arendarczyk, N., and Rotter, I. (2021). The Effects of Calcium, Magnesium, Phosphorus, Fluoride, and Lead on Bone Tissue. Biomolecules, 11.","DOI":"10.3390\/biom11040506"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"11","DOI":"10.4103\/2278-0203.197392","article-title":"Timing Considerations on the Shear Bond Strength of Orthodontic Brackets after Topical Fluoride Varnish Applications","volume":"6","author":"Cossellu","year":"2017","journal-title":"J. Orthodont. Sci."},{"key":"ref_6","first-page":"217","article-title":"Fluoride and bone metabolism","volume":"17","author":"Yamaguchi","year":"2007","journal-title":"Clin. Calcium"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Solanki, Y.S., Agarwal, M., Gupta, A.B., Gupta, S., and Shukla, P. (2022). Fluoride Occurrences, Health Problems, Detection, and Remediation Methods for Drinking Water: A Comprehensive Review. Sci. Total Environ., 807.","DOI":"10.1016\/j.scitotenv.2021.150601"},{"key":"ref_8","first-page":"66","article-title":"Prevention of Dental Caries through the Use of Fluoride\u2014The WHO Approach","volume":"33","author":"Petersen","year":"2016","journal-title":"Community Dent. Health"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"(2021). Deciphering the Interaction of a Macrocyclic Tetranuclear Zn(II) Complex with Biomimicking Surfactant: A Case Study Using Cetyltrimethylammonium Bromide. Biointerface Res. Appl. Chem., 12, 2462\u20132472.","DOI":"10.33263\/BRIAC122.24622472"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1515\/reveh-2019-0059","article-title":"The Impact of Stopping or Reducing the Level of Fluoride in Public Water Supplies on Dental Fluorosis: A Systematic Review","volume":"35","author":"Nor","year":"2020","journal-title":"Rev. Environ. Health"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sunkari, E.D., Adams, S.J., Okyere, M.B., and Bhattacharya, P. (2022). Groundwater Fluoride Contamination in Ghana and the Associated Human Health Risks: Any Sustainable Mitigation Measures to Curtail the Long Term Hazards?. Groundw. Sustain. Dev., 16.","DOI":"10.1016\/j.gsd.2021.100715"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1007\/s00244-020-00794-z","article-title":"Fluoride Geochemistry and Exposure Risk through Groundwater Sources in Northeastern Parts of Rajasthan, India","volume":"80","author":"Keesari","year":"2021","journal-title":"Arch. Environ. Contam. Toxicol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4678","DOI":"10.1021\/acs.chemrev.0c01263","article-title":"Chemical Aspects of Human and Environmental Overload with Fluorine","volume":"121","author":"Han","year":"2021","journal-title":"Chem. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Rajendiran, M., Trivedi, H.M., Chen, D., Gajendrareddy, P., and Chen, L. (2021). Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases. Molecules, 26.","DOI":"10.3390\/molecules26072001"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"883","DOI":"10.3109\/02656736.2015.1092172","article-title":"Thermal Build-up, Decay and Retention Responses to Local Therapeutic Application of 448 KHz Capacitive Resistive Monopolar Radiofrequency: A Prospective Randomised Crossover Study in Healthy Adults","volume":"31","author":"Kumaran","year":"2015","journal-title":"Int. J. Hyperth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.bbrc.2016.09.083","article-title":"Fluorosis Increases the Risk of Postmenopausal Osteoporosis by Stimulating Interferon \u03b3","volume":"479","author":"Lv","year":"2016","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1007\/s12011-015-0479-0","article-title":"Effects of Excess Fluoride and Iodide on Thyroid Function and Morphology","volume":"170","author":"Jiang","year":"2016","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5661","DOI":"10.1007\/s11033-021-06523-6","article-title":"Recent Advances in Cellular Effects of Fluoride: An Update on Its Signalling Pathway and Targeted Therapeutic Approaches","volume":"48","author":"Nagendra","year":"2021","journal-title":"Mol. Biol. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.14219\/jada.archive.1934.0220","article-title":"Classification of Mottled Enamel Diagnosis","volume":"21","author":"Dean","year":"1934","journal-title":"J. Am. Dent. Assoc. (1922)"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1177\/00220345960750120401","article-title":"Protein Characterization of Fluorosed Human Enamel","volume":"75","author":"Wright","year":"1996","journal-title":"J. Dent. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"25","DOI":"10.3389\/fdmed.2020.632534","article-title":"100 Years of Chalky Teeth Research: From Pioneering Histopathology to Social Good","volume":"1","author":"Hubbard","year":"2021","journal-title":"Front. Dent. Med."},{"key":"ref_22","unstructured":"Kim, S.J. (2021). Structural Characterization and Amelotin-Mediated Mineralization of Enamel Lesions in Molar-Incisor Hypomineralization. [Ph.D. Thesis, University of Toronto]."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1177\/08959374890030022301","article-title":"Macroscopic and Scanning Electron Microscopic Appearance and Hardness Values of Developmental Defects in Human Permanent Tooth Enamel","volume":"3","author":"Suckling","year":"1989","journal-title":"Adv. Dent. Res."},{"key":"ref_24","unstructured":"(2022, June 02). Spo\u0142ecze\u0144stwo|Wielkopolskie Regionalne Obserwatorium Terytorialne. Available online: https:\/\/wrot.umww.pl\/kapital-ludzki-i-spoleczny\/."},{"key":"ref_25","unstructured":"(2022, April 19). Kalkulator Doboru Pr\u00f3by. Available online: https:\/\/www.naukowiec.org\/dobor.html."},{"key":"ref_26","unstructured":"(2022, May 31). Social Science Statistics. Available online: https:\/\/www.socscistatistics.com\/."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Yonezawa, D., and Yagi, M. (2022). Effect of a School-Based Fluoride Mouth-Rinsing Programme on Dental Caries. Int. Dent. J., in press.","DOI":"10.1016\/j.identj.2021.12.003"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"127","DOI":"10.15171\/joddd.2016.021","article-title":"The Prevalence of Dental Fluorosis and Exposure to Fluoride in Drinking Water: A Systematic Review","volume":"10","author":"Goodarzi","year":"2016","journal-title":"J. Dent. Res. Dent. Clin. Dent. Prospects"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lee, J.M., Koh, D.-C., Chae, G.-T., Kee, W.-S., and Ko, K.-S. (2021). Integrated Assessment of Major Element Geochemistry and Geological Setting of Traditional Natural Mineral Water Sources in South Korea at the National Scale. J. Hydrol., 598.","DOI":"10.1016\/j.jhydrol.2021.126249"},{"key":"ref_30","first-page":"e823","article-title":"Prevalence of Dental Fluorosis among 12\u201315 Years Old School Children in Zeway, Oromia Region, Ethiopia","volume":"2","author":"Gebretsadik","year":"2021","journal-title":"Orapuh J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"53","DOI":"10.32811\/25954482-2021v4n2p53","article-title":"Assessment of Public Water Supply Fluoridation of the 15th Regional Health of Paran\u00e1","volume":"4","author":"Ferreira","year":"2021","journal-title":"R. Sa\u00fade P\u00fabl. Paran\u00e1"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1007\/s00784-021-04046-9","article-title":"Caries Lesion Transition Patterns of Schoolchildren in a Fluoridated Community in Brazil","volume":"26","author":"Cabral","year":"2022","journal-title":"Clin. Oral Investig."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1034\/j.1600-0528.2002.300110.x","article-title":"A Blind Caries and Fluorosis Prevalence Study of School-Children in Naturally Fluoridated and Nonfluoridated Townships of Morayshire, Scotland","volume":"30","author":"Stephen","year":"2002","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/j.1600-0528.1997.tb01729.x","article-title":"Risk Factors Associated with Fluorosis in a Non-Fluoridated Population in Norway","volume":"25","author":"Wang","year":"1997","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1038\/s41405-021-00087-0","article-title":"Comparison of a Full Arch Digital Photographic Assessment of Caries Prevalence in 5-Year-Old Children to an Established Visual Assessment Method: A Cross-Sectional Study","volume":"7","author":"Thomas","year":"2021","journal-title":"BDJ Open"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s42522-021-00054-7","article-title":"Dental Fluorosis among People and Livestock Living on Gihaya Island in Lake Kivu, Rwanda","volume":"3","author":"Habiyakare","year":"2021","journal-title":"One Health Outlook"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1177\/0022034515590377","article-title":"Diet and Dental Caries: The Pivotal Role of Free Sugars Reemphasized","volume":"94","author":"Sheiham","year":"2015","journal-title":"J. Dent. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1038\/sj.bdj.4800726","article-title":"Dental Fluorosis in Permanent Incisor Teeth in Relation to Water Fluoridation, Social Deprivation and Toothpaste Use in Infancy","volume":"189","author":"Tabari","year":"2000","journal-title":"Br. Dent. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.14219\/jada.archive.2002.0057","article-title":"Fluorosis: Is It Really a Problem?","volume":"133","author":"Bowen","year":"2002","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1080\/00016350600931217","article-title":"Dental Fluorosis in Children in Areas with Fluoride-Polluted Air, High-Fluoride Water, and Low-Fluoride Water as Well as Low-Fluoride Air: A Study of Deciduous and Permanent Teeth in the Shaanxi Province, China","volume":"65","author":"Ruan","year":"2007","journal-title":"Acta Odontol. Scand."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1111\/j.1600-0722.2008.00600.x","article-title":"Prevalence and Extent of Dental Caries, Dental Fluorosis, and Developmental Enamel Defects in Lithuanian Teenage Populations with Different Fluoride Exposures","volume":"117","author":"Machiulskiene","year":"2009","journal-title":"Eur. J. Oral Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3132","DOI":"10.3390\/ijerph110303132","article-title":"Reducing Exposure to High Fluoride Drinking Water in Estonia-a Countrywide Study","volume":"11","author":"Indermitte","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Waugh, D.T., Potter, W., Limeback, H., and Godfrey, M. (2016). Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and Its Implications for Public Health and Water Fluoridation. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13030259"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1177\/00220345211007747","article-title":"Excess Risk of Dental Caries from Higher Free Sugars Intake Combined with Low Exposure to Water Fluoridation","volume":"100","author":"Ha","year":"2021","journal-title":"J. Dent. Res."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Stangvaltaite-Mouhat, L., Puriene, A., Stankeviciene, I., and Aleksej\u016bnien\u0117, J. (2021). Fluoride in the Drinking Water and Dental Caries Experience by Tooth Surface Susceptibility among Adults. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01598-w"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Jairoun, A.A., Al-Hemyari, S.S., Shahwan, M., Jairoun, O., and Zyoud, S.H. (2021). Analysis of Fluoride Concentration in Toothpastes in the United Arab Emirates: Closing the Gap between Local Regulation and Practice. Cosmetics, 8.","DOI":"10.3390\/cosmetics8040113"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1111\/cdoe.12606","article-title":"The Impact of Different Determinants on the Dental Caries Experience of Children Living in Australia Rural and Urban Areas","volume":"49","author":"Ha","year":"2021","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s10971-021-05668-x","article-title":"Fluorides-Foundation for Healthy Teeth: A Dental Perspectives","volume":"100","author":"Haider","year":"2021","journal-title":"J. Sol-Gel Sci. Technol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1159\/000107929","article-title":"Prevalence of Dental Fluorosis in German Schoolchildren in Areas with Different Preventive Programmes","volume":"41","author":"Momeni","year":"2007","journal-title":"Caries Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1034\/j.1600-0528.2003.00035.x","article-title":"Fluoride Intake by Brazilian Children from Two Communities with Fluoridated Water","volume":"31","author":"Paiva","year":"2003","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0140-6736(07)60031-2","article-title":"Dental Caries","volume":"369","author":"Selwitz","year":"2007","journal-title":"Lancet"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Butera, A., Pascadopoli, M., Gallo, S., Lelli, M., Tarterini, F., Giglia, F., and Scribante, A. (2021). SEM\/EDS Evaluation of the Mineral Deposition on a Polymeric Composite Resin of a Toothpaste Containing Biomimetic Zn-Carbonate Hydroxyapatite (MicroRepair\u00ae) in Oral Environment: A Randomized Clinical Trial. Polymers, 13.","DOI":"10.3390\/polym13162740"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Saldarriaga, A., Rojas-Gualdr\u00f3n, D.F., Restrepo, M., Bussaneli, D.G., Fragelli, C., de C\u00e1ssia Loiola Cordeiro, R., Santos-Pinto, L., and Jeremias, F. (2021). Clinical Changes in the Severity of Dental Fluorosis: A Longitudinal Evaluation. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01729-3"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Dong, H., Yang, X., Zhang, S., Wang, X., Guo, C., Zhang, X., Ma, J., Niu, P., and Chen, T. (2021). Associations of Low Level of Fluoride Exposure with Dental Fluorosis among U.S. Children and Adolescents, NHANES 2015\u20132016. Ecotoxicol. Environ. Saf., 221.","DOI":"10.1016\/j.ecoenv.2021.112439"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Jullien, S. (2021). Prophylaxis of Caries with Fluoride for Children under Five Years. BMC Pediatr., 21.","DOI":"10.1186\/s12887-021-02702-3"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1007\/s00204-017-2135-2","article-title":"Sirt1 Overexpression Suppresses Fluoride-Induced P53 Acetylation to Alleviate Fluoride Toxicity in Ameloblasts Responsible for Enamel Formation","volume":"92","author":"Suzuki","year":"2018","journal-title":"Arch. Toxicol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1002\/tox.20724","article-title":"Excessive Fluoride Induces Endoplasmic Reticulum Stress and Interferes Enamel Proteinases Secretion","volume":"28","author":"Wei","year":"2013","journal-title":"Environ. Toxicol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000512483","article-title":"Epidemiology of Erosive Tooth Wear, Dental Fluorosis and Molar Incisor Hypomineralization in the American Continent","volume":"55","author":"Martignon","year":"2021","journal-title":"Caries Res."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Li, Q., Shen, J., Qin, T., Zhou, G., Li, Y., Chen, Z., and Li, M. (2021). A Qualitative and Comprehensive Analysis of Caries Susceptibility for Dental Fluorosis Patients. Antibiotics, 10.","DOI":"10.3390\/antibiotics10091047"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1111\/odi.13700","article-title":"Dental Caries-Related Primary Hypertension in Children and Adolescents: Cross-Sectional Study","volume":"27","author":"Rabiega","year":"2021","journal-title":"Oral Dis."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Jha, P.K., and Tripathi, P. (2021). Arsenic and Fluoride Contamination in Groundwater: A Review of Global Scenarios with Special Reference to India. Groundw. Sustain. Dev., 13.","DOI":"10.1016\/j.gsd.2021.100576"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1177\/154411130201300206","article-title":"Dental Fluorosis: Chemistry and Biology","volume":"13","author":"Aoba","year":"2002","journal-title":"Crit. Rev. Oral Biol. Med."},{"key":"ref_63","unstructured":"(2022, June 01). Public Health. Available online: https:\/\/ec.europa.eu\/health\/index_en."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1159\/000095648","article-title":"Fluoride Intake Levels in Relation to Fluorosis Development in Permanent Maxillary Central Incisors and First Molars","volume":"40","author":"Hong","year":"2006","journal-title":"Caries Res."},{"key":"ref_65","unstructured":"Mohabatpour, F., Chen, X., Papagerakis, S., and Papagerakis, P. (2022). Novel Trends, Challenges and New Perspectives for Enamel Repair and Regeneration to Treat Dental Defects. Biomater. Sci., Available online: https:\/\/pubs.rsc.org\/en\/content\/articlelanding\/2022\/bm\/d2bm00072e\/unauth."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.cis.2019.04.011","article-title":"The Importance of Being Amorphous: Calcium and Magnesium Phosphates in the Human Body","volume":"269","author":"Gelli","year":"2019","journal-title":"Adv. Colloid Interface Sci."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e276","DOI":"10.1016\/j.dental.2021.01.021","article-title":"Impact of Biomineralization on Resin\/Biomineralized Dentin Bond Longevity in a Minimally Invasive Approach: An \u201cin Vitro\u201d 18-Month Follow-Up","volume":"37","author":"Moreira","year":"2021","journal-title":"Dent. Mater."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1177\/0895937409335621","article-title":"Calcium Sodium Phosphosilicate (NovaMin\u00ae): Remineralization Potential","volume":"21","author":"Burwell","year":"2009","journal-title":"Adv. Dent. Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1159\/000493031","article-title":"State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management","volume":"53","author":"Nebu","year":"2019","journal-title":"Caries Res."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Biria, M., Rezvani, Y., Roodgarian, R., Rabbani, A., and Iranparvar, P. (2022). Antibacterial Effect of an Herbal Toothpaste Containing Bamboo Salt: A Randomized Double-Blinded Controlled Clinical Trial. BMC Oral Health, 22.","DOI":"10.1186\/s12903-022-02224-z"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Delbem, A.C.B., and Pessan, J.P. (2019). Alternatives to Enhance the Anticaries Effects of Fluoride. Pediatric Restorative Dentistry, Springer. Available online: https:\/\/link.springer.com\/chapter\/10.1007\/978-3-319-93426-6_6.","DOI":"10.1007\/978-3-319-93426-6_6"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"S158","DOI":"10.5005\/jp-journals-10005-2143","article-title":"A Comparative Evaluation of Remineralizing Potential of Commonly Used Fluoridated Toothpaste, Herbal Toothpaste, Toothpaste with Zinc Hydroxyapatite, and Toothpaste with Calcium Sucrose Phosphate in Children: A Scanning Electronic Microscopic Study","volume":"15","author":"Soneta","year":"2022","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_73","first-page":"20","article-title":"Formulating a Vitamin D Delivery Toothpaste Using a Penetration Promotor","volume":"15","author":"Chang","year":"2020","journal-title":"J. Int. Res. Med. Pharm. Sci."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/12\/7153\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:27:49Z","timestamp":1760138869000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/12\/7153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,10]]},"references-count":73,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["ijerph19127153"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19127153","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,6,10]]}}}