Monitoring salt fluoridation programs through urinary excretion studies

This paper reviews problems associated with urinary collection for the estimation of fluoride exposure and recent findings in this context. After intake of a salted meal at noon, children aged 9 to 14 excreted on average 45 microgF/h. Morning and nocturnal excretions were only 16 microgF/h with the exception of those children who ate bread made with fluoridated salt (25 microF/h). Fluoride excretions in children consuming drinking water with 0.6 to 0.8 ppmF were similar, but the variations within the 24 h period were smaller. When it is not feasible to obtain reliable 24 h urinary collections, fairly precise extrapolations of 24 h excretions can be obtained from three separate collections lasting about 16 hours, which should cover morning, early afternoon and the whole night. Three- to six-year-old children benefitting from optimal fluoride supply through water or milk excreted approximately 0.35 to 0.40 mgF/24 h; this range seems to correspond to an optimal usage of fluorides. Studies on urinary fluoride excretion, like those on total fluoride intake, cannot be carried out on random samples. Due to the necessity of close cooperation of parents and children, such studies were done with "convenience" samples. In westernized countries with now low caries prevalence, intermittent high urinary excretions occur frequently. Possible sources are fluoride intake from concentrated oral care products (fluoride gels, fluoride chewing gums) or from dentifrices (containing 1000 to 1500 ppmF), mineral waters, industrial tea preparation or fluoride tablets (or other supplements). These problems do not affect the amount of fluoride in fingernail clippings which appear to be suitable for the routine monitoring of fluoride exposure.