|Year : 2014 | Volume
| Issue : 5 | Page : 9-12
Evaluation of the influence of serum and salivary fluoride levels on periodontal disease status in endemic fluorosis patients
Harinath Reddy Singam, Uttam Akula, Sunil Kumar Palakuru, Raja Babu Palaparthi, Vidya Sagar Sisinty, Vikram Reddy Guntakalla
Department of Periodontics & Implantology, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Andhra Pradesh, India
|Date of Web Publication||10-Mar-2014|
Harinath Reddy Singam
Department of Periodontics & Implantology, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally - 508 254, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: The major determinant of the prevalence and severity of dental fluorosis has been shown to be the concentration fluoride in the water consumed, but limited studies are available evaluating the effects of fluoride concentration on periodontal disease status.
Aims: The aim of this study is to estimate the levels of fluoride in saliva, serum and in ground water of the villages where the subjects hail from and to correlate the levels of fluoride in serum and saliva to the periodontal disease severity.
Materials and Methods: A total number of 120 subjects selected for the study are divided into two groups. Group A (test group) consisted of dental subjects diagnosed with dental fluorosis and periodontitis. Group B (control group) consisted of 20 non-fluorosed subjects. Assesment of fluoride in saliva and serum has been done by ion selective electrode method. The periodontal status was measured using the community periodontal index and clinical attachment level? Scores and were compared between the groups.
Statistical Analysis Used: Correlation of altered fluoride levels in serum and saliva to the periodontal disease severity was done using the Pearson correlation coefficient and one-way analysis of variance was used for inter group comparison.
Results and Conclusions: No correlation was found between salivary and fluoride levels and the periodontal disease severity. However, mean salivary fluoride levels were found to significantly influence the dental fluorosis severity.
Keywords: Dental fluorosis, periodontitis, saliva, serum
|How to cite this article:|
Singam HR, Akula U, Palakuru SK, Palaparthi RB, Sisinty VS, Guntakalla VR. Evaluation of the influence of serum and salivary fluoride levels on periodontal disease status in endemic fluorosis patients. J NTR Univ Health Sci 2014;3, Suppl S1:9-12
|How to cite this URL:|
Singam HR, Akula U, Palakuru SK, Palaparthi RB, Sisinty VS, Guntakalla VR. Evaluation of the influence of serum and salivary fluoride levels on periodontal disease status in endemic fluorosis patients. J NTR Univ Health Sci [serial online] 2014 [cited 2020 Mar 31];3, Suppl S1:9-12. Available from: http://www.jdrntruhs.org/text.asp?2014/3/5/9/128483
| Introduction|| |
Periodontal disease is one of the most common chronic disease affecting large parts of the population. In the dental plaque biofilm, bacterial growth is the primary factor that governs the relative abundance of different bacteria.  Reports are cited on the distribution of fluorine compounds in the environment, routes of penetration into living organisms and analytical methods for the quantitative determinations of fluorine content in the air, water, soil and foods. Important contributions have been made by Polish researchers on the role and patterns of fluorides in body fluids and soft and hard tissues, which remain in direct relationship to accumulation and elimination of fluorine. Worthy of mention are reports on mechanisms of action of fluorine compounds on the cellular and subcellular level. 
Periodontitis is multifactorial in nature. The various determinants of periodontal disease are age, sex, race, socio-economic status and risk factors including tobacco usage and oral hygiene status. However, there are inconsistent epidemiological data on the periodontal status of subjects living in high-fluoride areas. Groundwater is a major and preferred source of drinking water in the rural population of India. Owing to various ecological factors, natural and/or anthropogenic, the groundwater is getting increasingly polluted.
With regard to fluoride uptake by root tissues Banting and Stamm  found that the mean fluoride concentrations in the outer layers of the tooth root were higher in teeth from a fluoridated area compared with a non-fluoridated area.
The degree of fluorosis appears to relate to the timing, duration and dose of fluoride exposure. Both the animal and human studies, which have been reviewed indicate that the transition/early maturation stage is particularly susceptible to fluoride. Exposure to high levels of fluoride during the secretary stage may also increase the risk of fluorosis by increasing the fluoride concentration locally during the enamel development. This same risk of exposure at the secretory stage does not appear to occur at lower levels of fluoride exposure, such as in water fluoridation. 
| Materials and Methods|| |
A total number of 100 periodontitis subjects having dental fluorosis were selected from four regions of Nalgonda district and were categorized into four groups according to modified dean's fluoride index, 20 from each group. A total of 20 subjects without dental fluorosis were taken as a control, which were divided into two groups, 10 subjects having periodontitis and 10 periodontally healthy subjects.
The nature and purpose of the study was explained to the patient and an informed consent was obtained. A brief case history was recorded in a specially prepared proforma, which included information regarding the patient's overall medical status/general health, oral status and well-being.
Group A (test group) consisted of 100 subjects within the age group of 35-55 years with probing depths ≥5 mm, systemically healthy and no periodontal treatment was rendered in last 6 months. According to the modified deans fluoride index they were categorized into four groups with 20 from each group were included. Group B (control group) consisted of 20 subjects within the age group of 35-55 years with no dental fluorosis and among them 10 subjects with periodontitis and 10 without periodontitis were included. Systemically compromised, history of periodontal therapy 6 months preceding the study, aggressive periodontitis and patients using fluoridated toothpaste since 6 months were excluded.
Community periodontal index (CPI) score and clinical attachment levels (CAL) were recorded and assessed for subjects in all the groups. The unstimulated saliva samples were obtained by expectorating into polypropylene tubes and were immediately subjected for analysis. Venous blood samples were collected and centrifuged at 3000 rpm for 15 min and the supernatant serum is collected and was immediately subjected for fluoride analysis.
Detection of fluoride in saliva and serum has been done by ion selective electrode method.
The ion selective electrode method used by fluoride meter is used in this study. The instrument is calibrated by using fluoride stock in which known concentration of fluoride is estimated. Using 0.1 ppm 1 ml is pipetted into a plastic beaker with a long neck and diluted until a graduation common for three such estimations. Then 1.0 ppm 1 ml, 10 ppm of 1 ml fluoride concentrations are pipetted respectively and diluted until a common graduation on the beaker. Following the dilution, these solutions are poured into corresponding beaker and the fluoride meter is used for estimation of fluoride. Each time the fluoride meter is used the reading on the meter should be calibrated to "UR," which stands for unrecorded.
Calibration of the instrument is done for every twenty saliva and serum sample analysis. After estimation of fluoride in each saliva or serum sample, the fluoride meter is washed with distilled water and cleaned wiped with a tissue blotting paper.
The fluoride levels in saliva are directly estimated from the plastic saliva container, but the serum sample is extracted from the blood sample collected from the subjects after subjecting the blood sample containing test tube to centrifuge at 3000 rpm for 10 min. Then the serum is separated and poured into 3 ml sterilized vials and estimation of fluoride is done.
The calibration of fluoride meter is performed for every 20 samples to keep track of the proper function of the fluoride meter.
| Results|| |
The objective of this study being correlation of altered fluoride levels in serum and saliva to the periodontal disease severity in the above groups. Statistical Package for the Social Sciences software has been used (version-11.5) the descriptive analysis of the data using the Pearson correlation coefficient has been done and one-way analysis of variance (ANOVA) was used for inter group comparison.
The means of fluoride in saliva between the groups are calculated and checked for any significant variation in the intragroup mean values by ANOVA test. As the fluoride scores increased, there was a significant difference between the control group and severe fluoride score group. This indicates that there is some significant relation between the salivary fluoride levels and increase in severity of the dental fluorosis scores [Table 1]. However, the mean serum fluoride levels when compared to fluorosis scores showed no significant difference between the groups [Table 2].
|Table 1: Comparision of mean salivary fluoride levels with dental fluorosis severity|
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|Table 2: Comparision of mean serum fluoride levels with dental fluorosis severity|
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The mean fluoride levels in saliva score when correlated to the mean CPI score in [Table 3]. The coefficient value is 0.40, which does not indicate any correlation between them. The comparison of mean fluoride levels in serum CPI scores indicated that there is no correlation between the mean of serum fluoride and CPI scores [Table 4].
|Table 3: Correlation of mean saliva fluoride scores to the mean cpi scores|
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|Table 4: Correlation of mean serum fluoride scores to the mean cpi scores|
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The mean fluoride levels in saliva as well as serum was calculated and compared with mean CAL scores, which did not signify any correlation [Table 5] and [Table 6].
|Table 5: Correlation of mean saliva fluoride scores to the mean cal scores|
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|Table 6: Correlation of mean serum fluoride scores to the mean cal scores|
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| Discussion|| |
The aim of the study is to correlate the altered fluoride levels of saliva and serum to the periodontal disease severity. The study was aimed at estimating the levels of fluoride levels in saliva and serum samples (240) in all the 120 subjects and correlating these levels to the periodontal disease severity which was measured by calculating CPI and CAL scores.
The present study has shown that as the salivary fluoride scores increased there was a significant difference between the control group and severe fluorosis score group. This indicates that there is some significant relation between the salivary fluoride levels and increase in severity of the dental fluorosis scores. However, similar relation was not found between the serum fluoride levels and the fluorosis scores.
Vandana et al. assessed the periodontal status of patient in endemic fluorosed area (Davangere) by recording the simplified oral hygiene index and community periodontal index of treatment needs (CPITN) indices. They found a strong association of occurrence of periodontal disease in high fluorosed areas.  In contrast to the above mentioned study, this particular study the correlation of altered fluoride levels in saliva and serum to periodontal disease severity shows no correlation between the life-long exposure of fluoride in drinking on the periodontal status of the subjects with dental fluorosis, which are in correlation with earlier studies.  The mean fluoride levels in saliva and serum when correlated to the mean CPI score did not indicate any correlation showing no significant attachment loss due to fluorosis.
The direct evidence of toxic effect of fluoride in the medical literature theoretically convinces the possibility of toxic effect such as cemental necrosis, osteosclerosis and calcification of ligament in human periodontal region as a consequence of lifetime exposure to high-fluoride water levels.  However, little or no direct effect of fluoride on periodontal destruction was reported. , The exact role of fluoride in initiation or progression of periodontal disease is not clearly understood. The relation between fluorosis root changes including the irregular, rough and heavy deposits of calcified marks and periodontal status remains to be proved. In the present study, there was no significance of shallow pockets in fluorosed patients who have been residing in areas with high fluoride levels in drinking water ranging from 2.5 ppm to 7.2 ppm. These findings are similar to the study conducted by Kumar and John in Ennore, Chennai, using CPITN who concluded that lower prevalence of shallow pockets in the study area, where the fluoride level in the drinking water ranges from 1.83 to 2.01 ppm, indicates that the use of fluoride in water is beneficial to the periodontal tissues. 
The effect of salivary fluoride levels on plaque microbial populations is not clearly understood.  Lowe plaque scores were reported in endemic fluorosis areas,  but however, in the present study no significant influence of the same was found on periodontal disease status.
| Conclusion|| |
Considering the limitations of this study, the following conclusions were made: There was no correlation between salivary and fluoride levels and the periodontal disease severity. However, mean salivary fluoride levels were found to significantly influence the dental fluorosis severity.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]