Introduction and objective:
Health hazards caused by environmental exposure to lead is of concern in many places in the world. Lead is particularly harmful to young children who could be also exposed to lead in-utero through exposure of their mothers before pregnancy. There is no level of exposure to lead that is known to be without harmful effects to the organism. Identifying local sources of lead in the environment is a very important part of preventing exposure as there is no cure for lead poisoning. The usefulness of children's primary teeth and the permanent teeth of adults as an indicator of chronic environmental exposure to lead in polluted area have been studied.

The aim of the study was to assess the usefulness of teeth as an indicator of chronic environmental exposure to lead of children and adults in the Silesia Province (Poland), as a particularly polluted area.

Material and methods:
A total of 71 primary teeth from children and 85 permanent teeth from adults were analyzed for lead content. The material was collected as a result of planned tooth extractions for medical reasons.

The primary teeth were characterized by significantly higher concentrations of lead than the teeth collected from adults. The amount of lead in the teeth of adults varied depending on gender, but did not differ much from the place of residence. The lead content in the teeth was higher in the group of younger than older children, which may be an indication of prenatal exposure.

Children's primary teeth are more useful bioindicator than adult teeth for determining environmental exposure to lead, and may also indicate the cumulative exposure to lead of their mothers.

The authors express their thanks to the patients who consented to their teeth being collected for the study. In the case of juvenile patients, consent was given by the parents or legal guardians. The study was funded by the Medical University of Silesia in Katowice, Poland (Grant No. KNW-2–229/D/7/K).
Briffa J, Sinagra E, Blundell R. Heavy metal pollution in the environment and their toxicological effects on humans. Heliyon. 2020; 6(9): e04691. doi: 10.1016/j.heliyon.2020.e04691.
Obeng-Gyasi E. Sources of lead exposure in various countries. Rev Environ Health. 2019; 34(1): 25–34. doi: 10.1515/reveh-2018-0037.
Piekut A, Gut K, Ćwieląg-Drabek M, et al. The relationship between children's non-nutrient exposure to cadmium, lead and zinc and the location of recreational areas – Based on the Upper Silesia region case (Poland). Chemosphere. 2019; 223: 544–550. doi: 10.1016/j.chemosphere.2019.02.085.
Naranjo VI, Hendricks M, Jones KS. Lead Toxicity in Children: An Unremitting Public Health Problem. Pediatr Neurol. 2020; 113: 51–55. doi: 10.1016/j.pediatrneurol.2020.08.005.
Tchounwou PB, Yedjou CG, Patlolla AK, et al. Heavy Metals Toxicity and the Environment. In: Luch A, (editor). Molecular, Clinical and Environmental Toxicology. Experientia Supplementum, Springer, Basel. 2012; 101: 133–164. doi: 10.1007/978-3-7643-8340-4_6.
Nieć J, Baranowska R, Dziubanek G, et al. Children's exposure to heavy metals in the soils of playgrounds, sports fields, sandpits and kindergarten grounds in the region of Upper Silesia. J Ecol Health. 2013; 2(17): 55–62 [in Polish].
WHO. World Health Organization. Lead poisoning and health. Key facts. 2019. URL:
Rădulescu A, Lundgren S. A pharmacokinetic model of lead absorption and calcium competitive dynamics. Sci Rep. 2019; 9(1): 14225. doi: 10.1038/s41598-019-50654-7.
Wani AL, Ara A, Usmani JA. Lead toxicity: a review. Interdiscip Toxicol. 2015; 8(2): 55–64. doi: 10.1515/intox-2015-0009.
UNICEF, Pure Earth. The Toxic Truth: Children's Exposure to Lead Pollution Undermines a Generation of Future Potential. 2020. URL:
Hauptman M, Bruccoleri R, Woolf AD. An Update on Childhood Lead Poisoning. Clin Pediatr Emerg Med. 2017; 18(3): 181–192. doi: 10.1016/j.cpem.2017.07.010.
IHME. Institute for Health Metrics and Evaluation. GBD Compare – Data Visualizations. 2019. URL:
Havens D, Pham MH, Karr CJ, et al. Blood Lead Levels and Risk Factors for Lead Exposure in a Pediatric Population in Ho Chi Minh City, Vietnam. Int J Environ Res Public Health. 2018; 15(1): 93. doi: 10.3390/ijerph15010093.
Johnston JE, Franklin M, Roh H, et al. Lead and Arsenic in Shed Deciduous Teeth of Children Living Near a Lead-Acid Battery Smelter. Environ Sci Technol. 2019; 53(10): 6000–6006. doi: 10.1021/acs.est.9b00429.
López-Costas O, Kylander M, Mattielli N, et al. Human bones tell the story of atmospheric mercury and lead exposure at the edge of Roman World. Sci Total Environ. 2020; 710: 136319. doi: 10.1016/j.scitotenv.2019.136319.
Dziubanek G, Baranowska R, Oleksiuk K. Heavy metals in the soils of Upper Silesia – a problem from the past or a present hazard? J Ecol Health. 2012; 16(4): 169–176.
EPA. Environmental Protection Agency. Learn about Lead. 2020. URL:
Shepherd TJ, Dirks W, Manmee C, Hodgson S, Banks DA, Averley P, Pless-Mulloli T. Reconstructing the life-time lead exposure in children using dentine in deciduous teeth. Sci Total Environ. 2012; 425: 214–222. doi: 10.1016/j.scitotenv.2012.03.022.
Kamberi B, Koçani F, Dragusha E. Teeth as Indicators of Environmental Pollution with Lead. J Environment Analytic Toxicol. 2012; 2(1): 1000118. doi: 10.4172/2161-0525.1000118.
Abdullah MM, Ly AR, Goldberg WA, et al. Heavy metal in children's tooth enamel: related to autism and disruptive behaviors? J Autism Dev Disord. 2012; 42(6): 929–936. doi: 10.1007/s10803-011-1318-6.
Jaishankar M, Tseten T, Anbalagan N, et al. Toxicity, mechanism and health effects of some heavy metals. Interdiscip Toxicol. 2014; 7(2): 60–72. doi:10.2478/intox-2014-0009.
Genuis SJ, Birkholz D, Rodushkin I, et al. Blood, urine, and sweat (BUS) study: monitoring and elimination of bioaccumulated toxic elements. Arch Environ Contam Toxicol. 2011; 61(2): 344–357. doi: 10.1007/s00244-010-9611-5.
Noguchi T, Itai T, Kawaguchi M, Takahashi S, Tanabe S. Applicability of Human Hair as a Bioindicator for Trace Elements Exposure. In: Interdisciplinary Studies on Environmental Chemistry – Environmental Pollution and Ecotoxicology. 2012: 73–77.
Ahmeda AS, Elgharabawy RM, Ahmed HA, Barghash SS. Human hair and nails as bio-indicator of heavy metals contamination by hair dye exposure among population in Saudi Arabia. WJPMR. 2016; 2(6): 130–137.
Barton HJ. Advantages of the Use of Deciduous Teeth, Hair, and Blood Analysis for Lead and Cadmium Bio-Monitoring in Children. A Study of 6-Year-Old Children from Kraków (Poland). Biol Trace Elem Res. 2011; 143(2): 637–658. doi: 10.1007/s12011-010-8896-6.
Asaduzzaman K, Khandaker MU, Baharudin NAB, et al. Heavy metals in human teeth dentine: A bio-indicator of metals exposure and environmental pollution. Chemosphere. 2017; 176: 221–230. doi: 10.1016/j.chemosphere.2017.02.114.
Piekut A, Moskalenko O, Gut K. Can primary teeth be an indicator of the environmental exposure of children to heavy metals? Med Srod. 2018; 21(4): 18–23 [in Polish]. doi: 0.19243/2018402.
Rahman A, Yousuf FA. Lead levels in primary teeth of children in Karachi. Ann Trop Paediatr. 2002; 22(1): 79–83. doi: 10.1179/027249302125000201.
Orłowska J, Pelc W, Machoń-Grecka A, Dobrakowski M, Pawlas N, Krzemień P, Cisowska-Babraj M, Kasperczyk S. The role of selected dietary and hygiene habits in environmental lead exposure children. Med Srod. 2018; 21(4): 31–38. doi: 10.19243/2018404.
Kowalska M, Kulka E, Jarosz W, Kowalski M. The determinants of lead and cadmium blood levels for preschool children from industrially contaminated sites in Poland. IJOMEH. 2018; 31(3): 1–9. doi:10.13075/ijomeh.1896.01153.
Ben Said A, Telmoudi C, Louati K, et al. Evaluation of the reliability of human teeth matrix used as a biomarker for fluoride environmental pollution. Ann Pharm Fr. 2020; 78(1): 21–33. doi: 10.1016/j.pharma.2019.10.006.
Malara P, Fischer A, Malara B. Selected toxic and essential heavy metals in impacted teeth and the surrounding mandibular bones of people exposed to heavy metals in the environment. J Occup Med Toxicol. 2016; 11: 56. doi: 10.1186/s12995-016-0146-1.
Kamberi B, Kqiku L, Hoxha V, et al. Lead concentrations in teeth from people living in Kosovo and Austria. Coll Antropol. 2011; 35(1): 79–82.
Al-Qattan SI, Elfawal MA. Significance of teeth lead accumulation in age estimation. J Forensic Leg Med. 2010; 17(6): 325–328. doi: 10.1016/j.jflm.2010.05.001.
Fernández-Escudero AC, Legaz I, Prieto-Bonete G, et al. Aging and trace elements in human coronal tooth dentine. Sci Rep. 2020; 10: 9964. doi: 10.1038/s41598-020-66472-1.
Amr MA. Trace elements in Egyptian teeth. Int J Phys Sci. 2011; 6(27): 6241–6245. doi: 10.5897/IJPS09.307.
Johnston JE, Franklin M, Roh H, Austin C, Arora M. Lead and Arsenic in Shed Deciduous Teeth of Children Living Near a Lead-Acid Battery Smelter. Environ Sci Technol. 2019; 53(10): 6000–6006. doi: 10.1021/acs.est.9b00429.
Tvinnereim HM, Eide R, Riise T. Heavy metals in human primary teeth: some factors influencing the metal concentrations. Sci Total Environ. 2000; 255(1–3): 21–27. doi: 10.1016/S0048-9697(00)00436-8.
IQAir, World's most polluted cities 2019 (PM2.5). URL:
Karahalil B, Aykanat B, Ertaş N. Dental lead levels in children from two different urban and suburban areas of Turkey. Int J Hyg Environ Health. 2007; 210(2): 107–112. doi: 10.1016/j.ijheh.2006.08.009.
Alomary A, Al-Momani IF, Obeidat SM, et al. Levels of lead, cadmium, copper, iron, and zinc in deciduous teeth of children living in Irbid, Jordan by ICP-OES: some factors affecting their concentrations. Environ Monit Assess. 2013; 185(4): 3283–3295. doi: 10.1007/s10661-012-2790-y.