SciELO - Scientific Electronic Library Online

 
vol.17 issue3Yeasts from the oral cavity of children with AIDS: exoenzyme production and antifungal resistanceEffect of a 0.5% chlorhexidine gel on dental plaque superinfecting microorganisms in mentally handicapped patients author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

  • English (pdf)
  • Article in xml format
  • How to cite this article
  • SciELO Analytics
  • Curriculum ScienTI
  • Automatic translation

Indicators

Related links

Share


Pesquisa Odontológica Brasileira

Print version ISSN 1517-7491

Pesqui. Odontol. Bras. vol.17 no.3 São Paulo July/Sept. 2003

http://dx.doi.org/10.1590/S1517-74912003000300005 

BIOCHEMISTRY

 

Fluorine content of several brands of chocolate bars and chocolate cookies found in Brazil

 

Conteúdo de flúor em diversas marcas de chocolate e bolachas de chocolate encontradas no Brasil

 

 

Marília Afonso Rabelo BuzalafI; José Mauro GranjeiroI; Vanessa Eid da Silva CardosoII; Thelma Lopes da SilvaIV; Kelly Polido Kaneshiro OlympioIII

IAssociate Professors, Department of Biological Sciences
IIGraduate Student
IIIGraduate Student, Department of Community Health – Bauru Dental School, University of São Paulo
IVResearch Assistant

 

 


ABSTRACT

Chocolate bars and chocolate cookies are foodstuffs highly appreciated by children. The possibility of having fluorine (F) among their components, associated with an excessive consumption, may make them decisive contributors to the total daily F intake. Thus, they could participate in the establishment of dental fluorosis. The aim of this study was to analyze the fluorine concentration [F] of the chocolates bars (CB) Baton, Confeti, Garoto Ball, Kinder Ovo, M&M’s, Milkybar, Nescau, Nescau Ball, Surpresa, Surpresa Bichos, Tortuguita; and of the chocolate cookies (CC) Danyt’s, Hipopó, Nescau, Passatempo, Pokémon, Sítio do Pica-Pau Amarelo and Trakinas. Samples were purchased in Bauru, São Paulo, Brazil. Three grams of each product were previously ashed at 525°C (CB and cookies fillings) and at 550°C (cookies dough), during 4 hours. Fluorine was separated from the ash by hexamethyldisiloxane (HMDS)-facilitated diffusion. Fluorine analysis was carried out with the specific electrode. Mean [F]s ± SD and amplitude (unit mg/g) were: CB = 0.30 ± 0.45 (0.07 – 1.60, n = 12) and CC = 1.08 ± 2.64 (0.04 – 7.10, n = 7). It was concluded that some of the analyzed foods may be important contributors to the total daily F intake. As for the product that had the highest [F] (Danyt’s), when only 3 units are consumed just once a day, they may supply up to 40% of the maximum recommended daily F intake (0.07 mg/kg body weight) for a 2-year-old child (12 kg). The [F] in these products should be informed on their labels.

Descriptors: Chocolate; Fluorine; Fluorosis, dental; Child.


RESUMO

Chocolates em barra e bolachas de chocolate são guloseimas altamente apreciadas pelas crianças. A possibilidade de conter flúor (F) em seus componentes, associada a seu excessivo consumo podem torná-los contribuintes decisivos para a ingestão diária total de F. Assim, eles poderiam participar no estabelecimento da fluorose dental. O objetivo deste estudo foi analisar a concentração de flúor [F] dos chocolates em barra (CB) Baton, Confeti, Garoto Ball, Kinder Ovo, M&M’s, Milkybar, Nescau, Nescau Ball, Surpresa, Surpresa Bichos, Tortuguita; e das bolachas de chocolate (CC) Danyt’s, Hipopó, Nescau, Passatempo, Pokémon, Sítio do Pica-Pau Amarelo e Trakinas. Os produtos foram adquiridos em Bauru, São Paulo, Brasil. Três gramas de cada produto foram previamente calcinadas a uma temperatura de 525°C (CB e recheio das bolachas), e de 550°C (massas das bolachas), durante 4 horas. O F foi separado das cinzas por difusão facilitada por hexametildisiloxano (HMDS). As análises de F foram feitas com o eletrodo específico. As [F]s médias ± DP e amplitude (mg/g) foram: CB = 0,30 ± 0,45 (0,07 – 1,60, n = 12) e CC = 1,08 ± 2,64 (0,04 – 7,10, n = 7). Concluiu-se que alguns dos alimentos analisados podem ser importantes contribuintes para a ingestão diária total de F. No caso do produto que apresentou a maior [F] (Danyt’s), quando apenas 3 unidades são consumidas uma única vez ao dia, elas podem fornecer mais de 40% da ingestão diária máxima de F recomendada (0,07 mg/kg peso corporal) para uma criança de 2 anos de idade (12 kg). A [F] presente nesses produtos deveria ser informada em seus rótulos.

Descritores: Chocolate; Flúor; Fluorose dentária; Criança.


 

 

INTRODUCTION

It has been suggested that the incidence and severity of dental fluorosis has become greater in the last decade in both optimally fluoridated and nonfluoridated areas in many countries, as well as in Brazil5,11,18,23. This has been attributed to an increase in the fluoride level of foods and beverages through processing with fluoridated water, to the inadvertent ingestion of fluoride toothpaste, and to the inappropriate use of dietary supplements19.

During infancy and childhood, the main sources of fluoride are considered to be commercially available beverages and foods. This period coincides with the calcification of different stages of the developing permanent teeth crowns. This is also a critical time for ensuring that the optimal levels of ingested fluoride are not exceeded. Several previous studies have determined the fluoride content of children foods, such as milk1,3,14,15,26,30, dinners and desserts6,12,21,22,25,31 and beverages1,13,16. However, these studies have been limited mainly to products manufactured in North America.

Little information is available on products from Brazil4,10,24. The available studies were limited to a very small number of infant foods.

Chocolate bars and chocolate cookies are foodstuffs highly appreciated by children. Thus, the aim of the present study was to analyze the fluoride concentration [F] of chocolate bars and chocolate cookies commercially available in Brazil.

 

MATERIALS AND METHODS

Twelve product samples of chocolate bars (CB) and seven of chocolate cookies (CC) from different brands (Table 1) were purchased in Bauru, São Paulo, Brazil. The products were chosen because they are the most consumed by infants and young children. Foodstuff type, brand name, manufacturer’s name and production site were recorded for each studied product.

 

 

Preparation and fluoride analysis

The products’ packages were opened on the day of the analysis. CBs were frozen and then grated. Their fillings, when present, were separated. As for the CCs, the baked dough was separated from the fillings and ground. After this preparation, 3 g of each product was ashed for four hours, at 525°C for the CBs and fillings, and at 550°C for the dough of the CCs.

The ashes were dissolved in 3 ml of deionized water. Fluoride determinations were carried out after overnight hexamethyldisiloxane (HMDS)-facilitated diffusion using the ion-specific electrode (model 9609, Orion Research, Cambridge, MA, USA)27. A set of standards (ranging between 0.200-6.400 mg F/ml) was prepared, using serial dilution from a 100 ppm NaF stock solution (Orion #940907) and diffused in triplicate in the same way as the samples. The millivoltage potentials were converted to mg F using a standard curve with a coefficient correlation of r > 0.99. All samples were analyzed in duplicate. The mean reproducibility of the readings, based on the duplicate samples, was 94 percent.

 

RESULTS

Table 1 shows all the products analyzed, as well as the manufacturer. Table 2 shows the [F] determined for all the products. Fluorine concentration is expressed as mg/g. Mean [F] ± SD (amplitude, n) were 0.30 ± 0.45 (0.07 – 1.60, n = 12) and 1.08 ± 2.64 (0.04 – 7.06, n = 7) for the CBs and CCs, respectively. Most of the products had low [F], except one brand of CB (M&M’s Minis) and one brand of CC (Danyt’s) that had mean [F] of 1.60 and 7.06 mg/g, respectively.

 

 

DISCUSSION

Due to the increase in the prevalence and severity of dental fluorosis in both optimally fluoridated and non-fluoridated areas in many countries, as well as in Brazil, the increase in the consumption of fluoride from many sources, including foods and beverages, causes preoccupation. Many studies have demonstrated that it is necessary to know the fluorine concentration of infant foods, foodstuffs and beverages to estimate the total fluorine ingestion by children12,13,17. Although it is difficult to precisely determine the total fluorine intake from the diet, it is clear that there is substantial variation in the intake of different foods, foodstuffs and beverages, and in the fluorine content of these products. Since products are not required to have their fluorine content displayed, only through a fluorine assay it is possible to determine dietary fluorine intake.

It is considered that the optimal range of fluorine intake is 0.05 – 0.07 mg F/kg body weight/day2,11. Most of the foodstuffs analyzed revealed no concentrations in excess of 0.40 mg F/g so that these sources of fluorine appear to be acceptable, at least at present (Table 2). This is in reasonable agreement with the findings of Vlachou et al.31 who found fluorine concentrations between 0.01 and 0.31 mg F/g for dairy products. However, high fluorine concentrations were found in CB M&M’s Minis (1.60 mg F/g) and in CC Danyt’s (7.06 mg F/g). We cannot rule out the possibility that the high fluorine concentrations found in these products may make them considerable contributors to the total daily fluorine intake. When 215 g of M&M’s or 3 units of Danyt’s, which contain approximately 0.210 mg of F, are consumed just once a day, they may provide up to 40% of the upper limit of the ranges believed to be associated with increased risk of enamel fluorosis (0.07 mg F/kg body weight/day) for a 2 year-old child, weighing around 12 kg2,11.

Another possibility that must be considered is the concomitant ingestion of these foodstuffs with other fluorine-rich products. This is the case of a ready-to-drink chocolate milk (Toddynho, Quaker, Guarulhos, SP, Brazil), which contains fluorine levels between 1.08 and 1.28 ppm4. Soymilk or even powdered or liquid concentrate infant formulas appear to have the same problem. In this situation, the total fluorine intake will be higher.

Buzalaf et al.4 tested two commercial brands of ready-to-drink chocolate milk. In one of them (Nescau, Nestlé, Caçapava, SP, Brazil), fluorine concentrations ranging between 0.150 and 0.170 ppm were found while in the other (Toddynho, Quaker, Guarulhos, SP, Brazil), fluorine levels between 1.08 and 1.28 ppm were observed. Both products were produced in optimally fluoridated areas. The authors had previously detected high fluorine concentrations in Toddynho24. However, they were not able to identify the possible source of the fluorine. They found low fluorine concentrations (ranging between 0.05 and 0.09 mg F/g) in powdered chocolate. This may support the exclusion of cocoa as the possible fluorine source in foodstuffs that have chocolate among their components.

The bioavailability of fluorine from fluorine-rich products is an important issue to be considered. Trautner, Siebert29 compared the bioavailability of fluorine from dietary sources and observed low bioavailability for most solid foods, such as fish and algal flour and for mammalian fish bones. The authors attributed this to the high calcium content of these products. The CC that showed the highest fluorine concentration in this study is calcium-rich. Thus, it is possible that this product may contribute little to dietary fluorine intake. This should be tested in bioavailability experiments in humans, ideally, or in vitro, simulating the gastric conditions.

Another factor that should be taken into account is that the presence of food bolus when fluorine is ingested may increase the degree of fluorine absorption by the stomach by increasing the residence time28. There is also some evidence that high dietary fat levels may increase the absorption of ingested fluorine20. High level of fat in the duodenum reduces the rate of gastric emptying, increasing fluorine absorption. Chocolate foodstuffs contain fat among their components and may, therefore, increase the degree of fluorine absorption. Hence, the degree of absorption of fluorine may be reduced if it is ingested simultaneously with foods containing appreciable amounts of divalent or trivalent cations, because insoluble complexes or precipitates are formed.

Another crucial factor when the association between fluorosis and infant foods is considered is the critical period of fluorine exposure for the development of fluorosis. Enamel fluorosis can occur following either an acute or chronic exposure to fluorine during tooth formation7. Fluorosed enamel is characterized by retention of amelogenins in the early-maturation stage of development and by the formation of a more porous enamel with subsurface hypomineralization. Secretory enamel is believed to be more susceptible to acute fluorine exposure, and the transition/early maturation stage of enamel formation is the most susceptible to chronic fluorine ingestion above the threshold levels. Evans, Stamm9 determined the occurrence of fluorosis in Hong Kong when the fluorine level in the drinking water was reduced from 1.0 to 0.7 ppm. The susceptibility of developing enamel in the various birth cohorts to the change in water fluorine concentration indicated that the permanent maxillary central incisors were most susceptible to fluorosis during a critical period of twenty-two to twenty-six months of age. For the permanent incisors, fluorine exposure during the months before this period carried less risk than did continued exposure for up to thirty-six months beyond this critical time that corresponds to the maturation phase of permanent incisor development. In a subsequent report concerning the same population, Evans, Darvell8 refined the estimate of the critical period for susceptibility to enamel fluorosis in permanent maxillary central incisors. The authors concluded that the maxillary central incisor, as a whole, appears mostly at risk of fluorosis from dietary fluorine between the ages of fifteen and twenty-four months for males, and between the ages of twenty-one and thirty months for females. Hence, the critical period for the anterior permanent teeth would be after the first twelve months of life. At this time, there is a high fluorine intake from infant foods and beverages.

 

CONCLUSION

This work showed that some chocolate bars and chocolate cookies may be important contributors to the total daily fluorine intake, especially when combined with other fluorine sources. Thus, their consumption by children who are in the period of tooth formation, and consequently are in risk of developing dental fluorosis, should be controlled. The product labels should provide information on their fluorine content in order to permit pediatric dentists and doctors to advise about their consumption by patients.

 

REFERENCES

1. Adair SM, Wei HY. Supplemental fluoride recommendations for infants based on dietary fluoride intake. Caries Res 1978;12:76-82.        [ Links ]

2. Burt BA. The changing patterns of systemic fluoride intake. J Dent Res 1992;71:1228-37.        [ Links ]

3. Buzalaf MAR, Granjeiro JM, Damante CA, Ornelas F. Fluoride content of infant formulas prepared with deionized, bottled mineral and fluoridated drink water. J Dent Child 2001;68:37-41.        [ Links ]

4. Buzalaf MAR, Granjeiro JM, Duarte JL, Taga ML. Fluoride content of infant foods in Brazil and risk of dental fluorosis. ASDC J Dent Child 2002;69:196-200.        [ Links ]

5. Correia Sampaio F, Ramm von der Fehr F, Arnberg P, Petrucci Gigante D, Hatloy A. Dental fluorosis and nutritional status of 6- to 11-year-old children living in rural areas of Paraiba, Brazil. Caries Res 1999;33:66-73.        [ Links ]

6. Dabeka RW, McKenzie AD, Conacher HBS, Kirkpatrick DC. Determination of fluoride intakes by infants. Can J Public Health 1982;73:188-91.        [ Links ]

7. DenBesten PK, Thariani H. Biological mechanisms of fluorosis and level and timing of systemic exposure to fluoride with respect to fluorosis. J Dent Res 1992;71:1238-43.        [ Links ]

8. Evans RW, Darvell BW. Refining the estimate of the critical period for susceptibility to enamel fluorosis in human maxillary central incisors. J Public Health Dent 1995; 55:238-49.        [ Links ]

9. Evans RW, Stamm JW. An epidemiological estimate of the critical period during which human maxillary central incisors are most susceptible to fluorosis. J Public Health Dent 1991;51:251-9.        [ Links ]

10. Fernandes DRM, Tabchoury CM, Cury JA. Concentração de flúor em alimentos infantis e risco de fluorose dental [abstract n.1289]. Pesqui Odontol Bras 2000;14 (Suppl):47.        [ Links ]

11. Fomon SJ, Ekstrand J, Ziegler EE. Fluoride intake and prevalence of dental fluorosis: trends in fluoride intake with special attention to infants. J Public Health Dent 2000;60:131-9.        [ Links ]

12. Heilman JR, Kiritsy MC, Levy SM, Wefel JS. Fluoride concentrations of infant foods. J Am Dent Asssoc 1997; 128:857-63.        [ Links ]

13. Heilman JR, Kiritsy MC, Levy SM, Wefel JS. Assessing fluoride levels of carbonated soft drinks. J Am Dent Assoc 1999;130(11):1593-9.        [ Links ]

14. Howat AP, Nunn JN. Fluoride levels in milk formulations. Br Dent J 1981;150:276-8.        [ Links ]

15. Johnson J Jr, Bawden JW. The fluoride content of infant formulas available in 1985. Pediatr Dent 1987;9:33-7.        [ Links ]

16. Kiritsy MC, Levy SM, Warren JJ, Guha-Chowdhury N, Heilman JR, Marshall T. Assessing fluoride concentrations of juices and juice-flavored drinks. J Am Dent Assoc 1996;127:895-902.        [ Links ]

17. Levy SM, Kiritsy MC, Warren JJ. Sources of fluoride intake in children. J Public Health Dent 1995;55:39-52.        [ Links ]

18. Levy SM, Warren JJ, Davis CS, Kirchner HL, Kanellis MJ, Wefel JS. Patterns of fluoride intake from birth to 36 months. J Public Health Dent 2001;61:70-7.        [ Links ]

19. Mascarenhas AK. Risk factors for dental fluorosis: a review of the recent literature. Pediatr Dent 2000;22:269-77.        [ Links ]

20. Miller RF, Phillips PH. The enhancement of the toxicity of sodium fluoride in the rat by hight dietary fat. J Nutr 1955;56:447-54.        [ Links ]

21. Ophaug RH, Singer L, Harland BF. Estimated fluoride intake for 6-month-old infants in four dietary regions of the United States. Am J Clin Nutr 1980;33:324-7.        [ Links ]

22. Ophaug RH, Singer L, Harland BF. Dietary fluoride intake of 6-month and 2-year-old children in four dietary regions of the United States. Am J Clin Nutr 1985;42:701-7.        [ Links ]

23. Pereira AC, da Cunha FL, Meneghim Md, Werner CW. Dental caries and dental fluorosis prevalence study in a nonfluoridated Brazilian community: trend analysis and toothpaste association. ASDC J Dent Child 2000;67:132-5.        [ Links ]

24. Pin MLG, Oliveira FS, Silva MSB, Buzalaf MAR, Machado MAM, Granjeiro JM. Concentração de flúor no leite, sucos, refrigerantes e alimentos infantis [abstract B231]. Pesqui Odontol Bras 2000;14(Suppl):136.        [ Links ]

25. Rojas-Sanchez F, Kelly SA, Drake KM, Eckert GJ, Stookey GK, Dunipace AJ. Fluoride intake from foods, beverages and dentifrice by young children in communities with negligibly and optimally fluoridated water: a pilot study. Community Dent Oral Epidemiol 1999;27:288-97.        [ Links ]

26. Silva M, Reynolds EC. Fluoride content of infant formulae in Australia. Aust Dent J 1996;41:37-42.        [ Links ]

27. Taves DR. Separation of fluoride by rapid diffusion using hexamethyldisiloxane. Talanta 1968;15:969-74.        [ Links ]

28. Trautner K, Einwag J. Influence of milk and food on fluoride bioavailability from NaF and Na2FPO3 in man. J Dent Res 1989;68:72-7.        [ Links ]

29. Trautner K, Siebert G. An experimental study of bio-availability of fluoride from dietary sources in man. Arch Oral Biol 1986;31:223-8.        [ Links ]

30. van Winkle S, Levy SM, Kiritsy MC. Water and formula fluoride concentrations: significance for infants fed formula. Pediatr Dent 1995;17:305-10.        [ Links ]

31. Vlachou A, Drummond BK, Curzon MEJ. Fluoride concentrations of infant foods and drinks in the United Kingdom. Caries Res 1992;26:29-32.        [ Links ]

 

 

Recebido para publicação em 27/06/02
Enviado para reformulação em 25/02/03
Aceito para publicação em 09/04/03

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License