title: Deterioration of teeth and alveolar bone loss due to chronic environmental high-level fluoride and low calcium exposure.
abstract: OBJECTIVE
  Health risks due to chronic exposure to highly fluoridated groundwater could be underestimated because fluoride might not only influence the teeth in an aesthetic manner but also seems to led to dentoalveolar structure changes. Therefore, we studied the tooth and alveolar bone structures of Dorper sheep chronically exposed to very highly fluoridated and low calcium groundwater in the Kalahari Desert in comparison to controls consuming groundwater with low fluoride and normal calcium levels within the World Health Organization (WHO) recommended range.
  
  
  METHODS
  Two flocks of Dorper ewes in Namibia were studied. Chemical analyses of water, blood and urine were performed. Mineralized tissue investigations included radiography, HR-pQCT analyses, histomorphometry, energy-dispersive X-ray spectroscopy and X-ray diffraction-analyses.
  
  
  RESULTS
  Fluoride levels were significantly elevated in water, blood and urine samples in the Kalahari group compared to the low fluoride control samples. In addition to high fluoride, low calcium levels were detected in the Kalahari water. Tooth height and mandibular bone quality were significantly decreased in sheep, exposed to very high levels of fluoride and low levels of calcium in drinking water. Particularly, bone volume and cortical thickness of the mandibular bone were significantly reduced in these sheep.
  
  
  CONCLUSIONS
  The current study suggests that chronic environmental fluoride exposure with levels above the recommended limits in combination with low calcium uptake can cause significant attrition of teeth and a significant impaired mandibular bone quality.
  
  
  CONCLUSIONS
  In the presence of high fluoride and low calcium-associated dental changes, deterioration of the mandibular bone and a potential alveolar bone loss needs to be considered regardless whether other signs of systemic skeletal fluorosis are observed or not.
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.|Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Maciej J K
authors.initials: MJK
authors.lastname: Simon
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.|Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Frank Timo
authors.initials: FT
authors.lastname: Beil
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Riedel
authors.affiliation: Materials Sciences Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, CA, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: Lau
authors.affiliation: Materials Sciences Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, CA, USA.
authors.forename: Antoni
authors.initials: A
authors.lastname: Tomsia
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Zimmermann
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.|Department of Orthodontics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Koehne
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.|MW Center for Orthopedics and Sports Medicine, Munich, Dienerstrasse 12, 80331, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Ueblacker
authors.affiliation: Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rüther
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Pia
authors.initials: P
authors.lastname: Pogoda
authors.affiliation: Institute of Orthopaedic Research and Biomechanics, Center of Musculoskeletal Research, University of Ulm, Helmholtzstr. 14, 89081, Ulm, Germany.
authors.forename: Anita
authors.initials: A
authors.lastname: Ignatius
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. amling@uke.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Amling
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Oheim
mesh_terms: D016301:Alveolar Bone Loss / Q000139:chemically induced*; D000818:Animals; D002118:Calcium / Q000032:analysis*; D060766:Drinking Water / Q000737:chemistry*; D004781:Environmental Exposure; D005459:Fluorides / Q000032:analysis*; D009276:Namibia; D012756:Sheep; D012757:Sheep Diseases / Q000139:chemically induced*; D034561:Sheep, Domestic; D013052:Spectrometry, X-Ray Emission; D014076:Tooth Diseases / Q000139:chemically induced*; D014961:X-Ray Diffraction
chemical_list: D060766:Drinking Water; D005459:Fluorides; D002118:Calcium
keywords: Alveolar bone; Fluoride; Fluorosis; HR-pQCT; Histomorphometry; Sheep
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