Fluoride content of mineral waters on the Belgian market and a case report of fluorosis induced by mineral water use

Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation

The Republic of Ireland (RoI) is the only European Country with a mandatory national legislation requiring artificial fluoridation of drinking water and has the highest per capita consumption of black tea in the world. Tea is a hyperaccumulator of fluoride and chronic fluoride intake is associated with multiple negative health outcomes. In this study, fifty four brands of the commercially available black tea bag products were purchased and the fluoride level in tea infusions tested by an ion-selective electrode method. The fluoride content in all brands tested ranged from 1.6 to 6.1 mg/L, with a mean value of 3.3 mg/L. According to our risk assessment it is evident that the general population in the RoI is at a high risk of chronic fluoride exposure and associated adverse health effects based on established reference values. We conclude that the culture of habitual tea drinking in the RoI indicates that the total cumulative dietary fluoride intake in the general population could readily exceed the levels known to cause chronic fluoride intoxication. Evidence suggests that excessive fluoride intake may be contributing to a wide range of adverse health effects. Therefore from a public health perspective, it would seem prudent and sensible that risk reduction measures be implemented to reduce the total body burden of fluoride in the population.

[Fluoride content of bottled natural mineral waters in Spain and prevention of dental caries]

AIM

The aim of the study was to determine the concentration of fluoride in natural mineral waters marketed in Spain in order to prevent tooth decay without the risk of causing dental fluorosis

DESIGN

Descriptive and cross-sectional study during 2012.

LOCATION

Natural mineral waters marketed in Spain.

PARTICIPANTS

Three bottles with different bottling dates of 109 natural mineral waters (97 Spanish and 12 imported brands).

MAIN MEASURES

Determination of fluoride by ion chromatography

RESULTS

Median fluoride concentrations of the natural mineral waters bottled in Spain was 0.22 (range 0.00-4.16; interquartile range:0.37). Most samples (61 brands, 62%) contained less than 0.3mg/L. There are 19 Spanish brands with more than 0.6 mg/L. The median level in imported brands was 0.35 (range 0.10-1.21; interquartile range: 0.23). Only 28 of the 109 brands examined (25.6%) specified the fluoride content on the label. Good correlation was observed between the concentrations indicated and those determined.

CONCLUSIONS

Fluoride concentrations in natural mineral waters showed high variation. Given the growing consumption of natural mineral waters in Spain, this type of information is important to make proper use of fluoride in the primary prevention of dental caries.

Fluoride intake through consumption of tap water and bottled water in Belgium

There is a tendency to align higher levels of fluoride in natural mineral water with the existing higher levels in tap water. Treatment of natural mineral waters could harm the preservation of their natural character. In this study fluoride intake through bottled and tap water consumption in the Belgian adult population was assessed, taking into account regional differences. A deterministic approach was used whereby consumption quantities of tap water and different brands of bottled water were linked with their respective fluoride concentrations. Data from the national food consumption survey (2004) were used and the Nusser methodology was applied to obtain usual intake estimates.

Mean intake of fluoride through total water consumption in Flanders was 1.4±0.7 mg/day (97.5^th percentile: 3.1 mg/day), while in the Walloon region it was on average 0.9±0.6 mg/day (97.5^th percentile: 2.4 mg/day). The probability of exceeding the UL of 7 mg per day via a normal diet was estimated to be low. Consequently, there is no need to revise the existing norms, but higher fluoride concentrations should be more clearly indicated on the labels. Reliable data about total dietary fluoride intake in children, including intake of fluoride via tooth paste and food supplements, are needed.