It is important to maintain confidence in the risk and benefit balance of major caries-preventive programs using fluoride. The ongoing debate about potential effects of early-life exposures to fluoride on cognitive neurodevelopment requires high-quality scientific evidence. This study aimed to investigate the potential effects of fluoride exposure on cognitive neurodevelopment assessed with the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV) in an Australian population-based sample. The sample was selected from the National Child Oral Health Study (NCOHS) 2012–2014. NCOHS collected data on socioeconomic factors, oral health behaviors, and residential history to estimate percentage lifetime exposure to fluoridated water during the first 5 y of life (%LEFW). NCOHS children were also examined by trained and calibrated examiners to assess dental fluorosis (a reliable and valid individual biomarker of total fluoride intake during early childhood). The sample was followed up in 2022–2023 to collect data on cognitive neurodevelopment (intelligence quotient [IQ]) using the WAIS-IV, which was administered by trained and calibrated qualified psychologists. Multivariable regression models were generated to investigate associations between the 2 exposure measurements (%LEFW and dental fluorosis) with full-scale IQ (FSIQ) scores, controlling for important confounding effects. Hypotheses of noninferiority were also tested, contrasting different levels of exposure to fluoride. Some 357 participants aged 16 to 26 y completed the WAIS-IV, with a mean FSIQ score of 109.2 (95% confidence interval [CI]: 107.8–110.5). The estimates of the multivariable regression models demonstrated slightly higher FSIQ scores among the exposed than the nonexposed. The adjusted β of 100%LEFW versus 0%LEFW was 1.07 (95% CI: −2.86, 5.01) and of having dental fluorosis versus no fluorosis was 0.28 (95% CI: −3.00, 3.57). The hypothesis of noninferiority tests found that FSIQ scores of those exposed and nonexposed to fluoride were equivalent. The study provided consistent evidence that early childhood exposure to fluoride does not have effects on cognitive neurodevelopment.

中文翻译：

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儿童早期接触氟化物和认知神经发育：一项基于人群的纵向研究


对使用氟化物的主要龋齿预防计划的风险和收益平衡保持信心非常重要。关于早期接触氟化物对认知神经发育的潜在影响的持续争论需要高质量的科学证据。本研究旨在调查氟化物暴露对澳大利亚人群样本中第 4 版 （WAIS-IV） 评估的氟化物暴露对认知神经发育的潜在影响。该样本选自 2012-2014 年全国儿童口腔健康研究 （NCOHS）。NCOHS 收集有关社会经济因素、口腔健康行为和居住史的数据，以估计出生后前 5 年终生接触氟化水的百分比 （%LEFW）。NCOHS 儿童还由经过培训和校准的检查员进行检查，以评估氟斑牙（儿童早期总氟化物摄入量的可靠且有效的个体生物标志物）。该样本在 2022-2023 年进行了随访，以使用 WAIS-IV 收集认知神经发育（智商 [IQ]）的数据，该数据由经过培训和校准的合格心理学家管理。生成多变量回归模型以研究 2 种暴露测量值 （%LEFW 和氟牙） 与全面 IQ （FSIQ） 评分之间的关联，控制重要的混杂效应。还测试了非劣效性的假设，对比了不同水平的氟化物暴露。约 357 名年龄在 16 至 26 岁之间的参与者完成了 WAIS-IV，平均 FSIQ 评分为 109.2 （95% 置信区间 [CI]：107.8-110.5）。多变量回归模型的估计表明，暴露者的 FSIQ 分数略高于未暴露者。 100% LEFW 与 0% LEFW 的校正β为 1.07 （95% CI： -2.86， 5.01），氟牙与无氟斑牙的校正为 0.28 （95% CI： -3.00， 3.57）。非劣效性检验的假设发现，暴露于氟化物和未暴露于氟化物的人的 FSIQ 分数是相等的。该研究提供了一致的证据表明，儿童早期接触氟化物对认知神经发育没有影响。