| A Quantitative Look at Fluorosis, Fluoride Exposure, and Intake in Children Using a Health Risk Assessment Approach Serap Erdal1 and Susan N. Buchanan2 1Division of Environmental and Occupational Health Sciences, School of Public Health, and 2Departments of Occupational Medicine and Family Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA Abstract
The prevalence of dental fluorosis in the United States has increased during the last 30 years. In this study, we used a mathematical model commonly employed by the U.S. Environmental Protection Agency to estimate average daily intake of fluoride via all applicable exposure pathways contributing to fluorosis risk for infants and children living in hypothetical fluoridated and nonfluoridated communities. We also estimated hazard quotients for each exposure pathway and hazard indices for exposure conditions representative of central tendency exposure (CTE) and reasonable maximum exposure (RME) conditions. The exposure pathways considered were uptake of fluoride via fluoridated drinking water, beverages, cow's milk, foods, and fluoride supplements for both age groups. Additionally, consumption of infant formula for infants and inadvertent swallowing of toothpaste while brushing and incidental ingestion of soil for children were also considered. The cumulative daily fluoride intake in fluoridated areas was estimated as 0.20 and 0.11 mg/kg-day for RME and CTE scenarios, respectively, for infants. On the other hand, the RME and CTE estimates for children were 0.23 and 0.06 mg/kg-day, respectively. In areas where municipal water is not fluoridated, our RME and CTE estimates for cumulative daily average intake were, respectively, 0.11 and 0.08 mg/kg-day for infants and 0.21 and 0.06 mg/kg-day for children. Our theoretical estimates are in good agreement with measurement-based estimates reported in the literature. Although CTE estimates were within the optimum range for dental caries prevention, the RME estimates were above the upper tolerable intake limit. This suggests that some children may be at risk for fluorosis. Key words: children, exposure, fluoride, multipathway, risk. Environ Health Perspect 113:111-117 (2005) . doi:10.1289/ehp.7077 available via http://dx.doi.org/ [Online 14 September 2004]
Address correspondence to S. Erdal, Environmental and Occupational Health Sciences, School of Public Health, 2121 West Taylor St., Chicago, IL 60613 USA. Telephone (312) 996-5875. Fax: (312) 413-9898. E-mail: erdal@uic.edu The authors declare they have no competing financial interests. Received 8 March 2004 ; accepted 14 September 2004.
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