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    "en": "Fluoride - Excess or inadequate intake"
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    "en": "Fluoride is a naturally occurring mineral to which the public are often exposed via drinking-water. Depending on dose intake fluoride may have both beneficial effects (reducing the incidence of dental caries) or negative effects (causing tooth enamel and skeletal fluorosis following prolonged high exposure) (adapted from NCBI, 2020 and WHO, no date). <br /> <p>NCBI, 2020. <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/fluoride\">PubChem Fluoride Compound Summary for CID 19800730. National Center for Biotechnology Information (NCBI)</a>. Accessed 8 October 2020.</p>"
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      "Fluoride can be released into the environment in several ways: (i) natural activities, such as volcanic emissions, weathering of minerals and dissolution, particularly into groundwater; (ii) human activities, such as the production and use of phosphate fertilisers; manufacture and use of hydrofluoric acid and production of aluminium, steel and oil; and (iii) remobilisation of historic sources, such as water flow and sediment movement from aluminium production plants. It is estimated that caries of the permanent teeth is the most prevalent of all conditions assessed, with 2.4 billion people globally suffering from caries of permanent teeth and 486 million children from caries of primary teeth. Public health actions are needed to provide sufficient fluoride intake in areas where this is lacking, so as to minimise tooth decay. This can be done through drinking-water fluoridation or, when this is not possible, through salt or milk fluoridation or use of dental care products containing fluoride, and by advocating a low-sugar diet (WHO, no date). Excessive fluoride intake usually occurs through the consumption of groundwater naturally rich in fluoride, particularly in warm climates where water consumption is greater, or where high-fluoride water is used in food preparation or crop irrigation. Such exposure may lead to dental fluorosis or crippling skeletal fluorosis, which is associated with osteosclerosis, calcification of tendons and ligaments, and bone deformities. While the global prevalence of dental and skeletal fluorosis is not entirely clear, it is estimated that excessive fluoride concentrations in drinking water have caused tens of millions of dental and skeletal fluorosis cases worldwide. Although removal of excessive fluoride from drinking water may be difficult and expensive, low-cost solutions that can be applied at a local level do exist (WHO, no date). The range in intakes producing detrimental or beneficial effects are not far apart (WHO, no date). Public health actions are needed to provide sufficient fluoride intake in areas where this is lacking, so as to minimise tooth decay. This can be done through drinking-water fluoridation or, when this is not possible, through salt or milk fluoridation or use of dental care products containing fluoride. Excessive fluoride intake usually occurs through the consumption of groundwater naturally rich in fluoride, particularly in warm climates where water consumption is greater, or where high-fluoride water is used in food preparation or irrigation of crops such as rice. In these areas, means should be sought to manage intakes by providing drinking-water with a moderate (i.e., safe) fluoride level or using alternative sources of water for drinking, cooking or irrigation. Although removal of excessive fluoride from drinking-water may be difficult and expensive, low-cost solutions that can be applied at a local level do exist. The preparation of food using fluoride-rich coal also contributes to excessive fluoride intake via ingestion and inhalation (WHO, 2019)."
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