Medical Hyporhe.ws (WYO) 33.

21-22
0 Lon,gman Group UK Ltd I994

The Role of Caffeinated

Fluorosis
J. T.. CHAN,
Department

Beverages

in Dental

T. T. YIP, A. H. JESKE
of Pharmacology,

UTDB-Houston,

P.O. Box 20068, Houston,

Texas 77225, USA

Abstract - Recent studies have demonstrated that the incidence of dental fluorosis has
increased during the past decade. Greater availability and use of fluoride-containing
gels,
mouth rinses, dentifrices, etc., improper prescribing of fluoride supplements and ingestion
of fluoride dentifrice by some children are some of the suggested determinants of dental
fluorosis. However, based on the increase in consumption of tea, coffee, and other
caffeine-containing
beverages by the children, and the augmentative effect of caffeine on
fluoride bioavailability,
we theorize that the rise in incidence of dental fluorosis in North
America is mainly due to the replacement of water intake by caffeine-containing
beverages
among the young population.

Introduction

The importance of fluoride in drinking water in

caries prevention is well documented. The incidence of dental caries is lower in communities
supplied by water with optimal concentration of
fluoride (1). The optimal level of fluoride is obtained by selecting the fluoride level which
provides the greatest protection against caries yet
causes the least amount of dental fluorosis.
Recently, however, several studies have raised
the concern that incidence of dental fluorosis has
increased, even in communities with optimal
levels of fluoride in the drinking water (2). It is
sugg,ested that this may be the result of increased
Date
Date

received
accepted

15 August 1989
21 November
1989

to the wide-spread
exposure
of children
avaiIability and use of fluoride-containing dental
products, such as topical fluoride gels, mouth
rinses, dentifrices, etc. (3). It has been shown
that some children swallow a large portion of
these fluoride-containing products when applied
topically in the oral cavity. The improper
prescription of fluoride supplement by health
care providers has also been suggested as one of
the causes of increased dental fluorosis (4). The
occurrence
of dental fluorosis in optimally
fluoridated or low fluoride communities could
also be due to individual variation in the absorption and disposition of fluoride by the body.
Recently. our laboratory has found that in
Sprague-Dawley rats (5) as well as in human subjects (6). the simultaneous ingestion of fluoride
and caffeine or caffeine-containing
beverages
21

MEDICAL HYPOTHESES

22
such as tea, coffee and cola drinks resulted in significantly greater bioavailability of fluoride when
plasma flurode concentration was followed. In
chronic experiments, rats that were fed fluoride
and caffeine simultaneously also demonstrated a
higher plasma fluoride level when compared to
control rats that were fed fluoride only.
Several reports have suggested that soft drinks,
beverages and juices are being consumed in
greater quantities instead of water (7), especially
among children and teenagers. Fluoride is known
to be present in beverages and its concentration
depends on the water used to prepare the
beverage. Daily consumption of as much as
2600 ml of carbonated beverages, or 1300 ml of
tea or- ISdo ml of coffee by sixth grade children
was revealed in a recent Canadian study (8). In
individual cases, beverages became the sole
source of fluoride intake by the children. The
range of fluoride available through beverage consumption contributes further complication in the
prescription of fluoride supplements and the
prevention of dental fluorosis. The augmentative
effect of caffeine present in these beverages on
fluoride bioavailability will further increase the
risk of dental fluorosis in children whose fluid intake is largely composed of caffeine-containing
cola, tea or coffee.
Conclusion

Considering

the

results

reported

in previous

studies on source of fluoride intake in young

children, the augmentative effect of caffeine on
fluoride, and narrowness of the safety range of
fluoride, we theorize that an increase in consumption of caffeinated beverages by children is
a major contributing factor to the increase in incidence of dental fluorosis.

References
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E R.
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J G, Qiu C. Effect
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C J. Fluoride intake from beverage consump8. Hargreaves
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