Fluoride in Drinking Water in 31 Provinces of Iran

Hydrogeochemical evaluation with emphasis on nitrate and fluoride in urban and rural drinking water resources in western Isfahan province, central Iran

Nitrate (NO3-) and fluoride (F-) are two major potential contaminants found in the groundwater of Iran. These contaminants are highly dangerous to humans if consumed more than the safe limit prescribed by the WHO. Therefore, in this study, the urban and rural drinking water resources of Isfahan province (central Iran) were investigated to evaluate the quality of groundwater from the perspective of NO3- and F-. The calculated saturation index (SI) shows that the majority of samples are mainly undersaturated or in equilibrium with respect to potential minerals. The most likely interpretation for undersaturation with respect to most minerals is either that the minerals are not present if they are reactive or if they are present, then they are not reactive. This study reveals that the majority of the groundwater samples belong to the Ca-Mg-HCO3 water type. Further, in this study, potential physicochemical variables have been used to calculate entropy weighted water quality index (EWQI). The EWQI reveals that the majority of the groundwater in the area is of good quality. Results show that the water chemistry in the area is largely governed by the water-rock interaction. This study based on large data sets reveals that the majority of drinking water resources are uncontaminated by F-. However, the groundwater is found to be largely contaminated by NO3-. The bivariate plot suggests that the unscientific farming practices and overuse of manures and fertilizers are largely responsible for high content of NO3-. Therefore, emphasis should be given on the cost-effective environmentally friendly fertilizers. The findings from this study will aid the governing authorities and concerned stakeholders to understand the hydrogeochemical evolution of groundwater in this region. The results will help formulate policies in the area for sustainable water supply.

Effect of Beverage Consumption Frequency on DMFT Index among Iranian Adult Population: An AZAR Cohort Study

Background

Given the effect of oral and dental condition on emotional and physical health and the different effects of beverage consumption on decayed, missing, and filled teeth (DMFT) as one of the indicators of oral health in different populations, this study aimed to investigate the effect of beverage consumption and its frequency on DMFT among Iranian adult population.

Materials and Methods

The data of this cross-sectional study were obtained from AZAR (Azerbaijan) cohort, conducted on 15,006 adults aged 35 to 70 years old in Shabestar County, Iran. Demographic and nutritional data were collected by nutritionists through the "Food Frequency Questionnaire," and DMFT index by general practitioners trained by a dentist according to the World Health Organization (WHO) guidelines. Beverages including milk, doogh, natural fruit juice, black tea, nonalcoholic beer, coffee, sugar-sweetened beverages, and artificial fruit juice were studied.

Results

A total of 14,966 adults with the mean age of 49.64 ± 9.28 were enrolled. The participants' mean DMFT value was 21.27 ± 8.95. Weekly consumption of tea and coffee beverages resulted in 13% (95% confidence interval: 3% to 22%) lower DMFT compared to daily consumption (p=0.01). However, there was no association between DMFT and other beverages.

Conclusion

The higher DMFT values with the daily consumption of tea and coffee beverages showed that a part of adults' oral health is affected by beverages; therefore, this should be considered by healthcare authorities in order to manage carries development in the communities.

Relationship of fluoride in drinking water with blood pressure and essential hypertension prevalence: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Previous studies showed controversial results of the relationship between fluoride exposure through drinking water and elevated blood pressure. We conducted a systematic review and meta-analysis to assess the direct relationship of drinking water fluoride exposure with blood pressure and essential hypertension prevalence in general populations.

METHODS

We conducted a systematic search in databases including Web of Knowledge, PubMed, Scopus, and Embase by MeSH and non-MeSH terms for relevant studies with any design published until August 2019, with no limitation in time and language. The pooled effect measure was calculated within a 95% confidence interval (CI).

RESULTS

Our search retrieved 630 journal articles, six of which were eligible for data extraction. The random-effects model found significantly higher systolic blood pressure (mean difference = 6.49 mmHg; 95% CI 3.73-9.25; p value < 0.01) and diastolic blood pressure (mean difference = 4.33 mmHg; 95% CI 1.39-7.26; p value < 0.01) in groups exposed to high-fluoride drinking water than in groups exposed to normal/low-fluoride drinking water. A significant relationship was also found between high-fluoride drinking water and essential hypertension (odds ratio = 2.14; 95% CI 1.02-4.49; p value = 0.045).

CONCLUSION

The risk of elevated blood pressure increases in the general population of fluoride endemic areas. However, more research is needed to make a firm conclusion about the adverse effects of excess fluoride intake on the cardiovascular system at the individual level.

Health risk assessment of nitrate and fluoride in bottled water: a case study of Iran

Bottled water use has become widespread in recent years. Many Iranian cities are located in regions with a hot and semi-hot climate, and the quality of drinking water is low in most of these areas. Nitrate and fluoride are chemical constituents of drinking water with significant health concerns since they can be harmful in concentrations higher than drinking water standards. This study aims to determine nitrate and fluoride concentrations in different bottled water brands in the study region; evaluate the non-carcinogenic health risks posed by nitrate and fluoride exposure via the ingestion of bottled water; and compare the measured nitrate and fluoride concentrations with the amounts reported on the bottle labels. Twenty bottled water brands were sampled, and their nitrate and fluoride amounts were determined using the spectrophotometry method. The results revealed that 100% of nitrate and 70% of fluoride in samples had concentrations greater than the levels reported on bottle labels. Minimum, maximum, and mean concentrations for nitrate were, respectively, 1.1, 28, and 8.37 mg/L, and for fluoride were 0.014, 2.36, and 0.63 mg/L. The hazard quotient (HQ) values due to nitrate intake were > 1 in 10% of the samples (n = 2) for both infants and children, indicating potential adverse non-carcinogenic health effects upon consumption. For fluoride intake, the potential adverse health effects (HQ > 1) for infants, children, teenagers, and adults were respectively high in 30, 20, 10, and 10% of the samples. For nitrate, the 95th centile for infants was 1.547, and for fluoride, it was 2.62, 2.19, 1.15, and 1 for infants, children, teenagers, and adults, respectively.

Geochemical evaluation of fluoride contamination in groundwater from Shanmuganadhi River basin, South India: implication on human health

In order to assess the geochemical mechanism liable for fluoride contamination in groundwater and its health effects on the people of the Shanmuganadhi River basin, Tamil Nadu, India, 61 groundwater samples were collected during post- and pre-monsoon seasons from the wells used for drinking purposes. Collected samples were analysed for various physico-chemical parameters. The parameters estimated in the present study are hydrogen ion concentration (pH), total dissolved solids, electrical conductivity, calcium (Ca²⁺), magnesium (Mg²⁺), sodium (Na⁺), potassium (K⁺), bicarbonate (HCO₃^-), chloride (Cl^-), sulphate (SO₄^2-), nitrate (NO₃^-), phosphate (PO₄^3-) and fluoride (F^-). The fluoride ion concentration in the groundwater samples of this region varied from 0.01 to 2.50 mg/l and 0.01 to 3.30 mg/l during post- and pre-monsoon seasons, respectively. Out of 61 groundwater samples, 14 samples of post-monsoon season and 16 samples of pre-monsoon season represented high, very high and extremely high classes of fluoride, which cause dental fluorosis in this region. The fluoride-bearing minerals in the granitic and gneissic rocks such as apatite, hornblende, muscovite, biotite and amphiboles are the major sources for fluoride contamination in this area. In addition to the geogenic sources, applications of synthetic fertilizers in the agricultural fields also contribute significant amount of fluoride ions to groundwater. The spatial distribution of fluoride in different geological formations clearly indicate that the wells located in charnockite terrain were possessing very low fluoride concentration when compare with the wells located in the hornblende-biotite gneiss formation. Therefore, dental fluorosis risks are mostly associated with rock types in this region. People living over the basement rock comprising of hornblende-biotite gneiss are prone for fluorosis. Fluoride exhibited good positive correlation with bicarbonate in groundwater. As fluoridated endemic regions normally acquire lot of bicarbonate in groundwater samples, Shanmuganadhi basin falls under fluoride endemic category. The present study identified 26 villages in Shanmuganadhi basin as probable fluorosis risk areas where attention should be given to treat the fluoride-rich groundwater before drinking water supply. The groundwater level fluctuation study also designates that rise in water level reduces the concentration of fluoride due to dilution mechanism. Therefore, recharge of groundwater by artificial methods will definitely improve the present scenario.

Removal of fluoride ion from aqueous solutions by titania-grafted β-cyclodextrin nanocomposite

TiO₂-grafted β-cyclodextrin nanocomposite was synthesized by treating the triazole modified β-cyclodextrin with the amino functionalized titanium dioxide nanoparticles, and applied for removal of fluoride ion from aqueous media by batch technique. The structural changes of nanocomposite before and after fluoride sorption were characterized using BET, BJH, AFM, and elemental mapping based on EDX analyses. The adsorption parameters including pH, adsorbent dosage, contact time, temperature, initial fluoride ion concentration, and coexisting anions have been investigated to determine the optimal adsorption conditions. The experimental data were evaluated by the Langmuir, Freundlich, and Temkin isotherms, and the pseudo-first order, pseudo-second order, and intraparticle diffusion kinetic models. Evaluation of experimental data with adsorption isotherms, Langmuire (R² = 0.9988 and Q_max = 48.78 mg g^-1), Temkin (R² = 0.9939), and Freundlich (n_F = 2.73) reveals the high adsorption efficiency of nanocomposite and suggests a monolayer chemical adsorption for fluoride ions. The adsorption experimental data fitted well with the pseudo-second order kinetic model, suggesting that a chemical sorption is involved in the rate-determining step. Thermodynamic parameters (ΔG° < 0, ΔH° > 0 and ΔS° > 0) confirmed the spontaneity, feasibility, and endothermic nature of fluoride sorption. The nanoadsorbent was regenerated in NaOH solution and reused for three adsorption-desorption cycles. The adsorption results represented the nanocomposite as a potential adsorbent for the fluoride ions removal from aqueous solutions.

Elucidating various geochemical mechanisms drive fluoride contamination in unconfined aquifers along the major rivers in Sindh and Punjab, Pakistan

The present study aims to investigate the spatial distribution and associated various geochemical mechanisms responsible for fluoride (F⁻) contamination in groundwater of unconfined aquifer system along major rivers in Sindh and Punjab, Pakistan. The concentration of F⁻ in groundwater samples ranged from 0.1 to 3.9 mg/L (mean = 1.0 mg/L) in Sindh and 0.1-10.3 mg/L (mean = 1.0 mg/L) in Punjab, respectively with 28.9% and 26.6% of samples exhibited F⁻ contamination beyond WHO permissible limit value (1.5 mg/L). The geochemical processes regulated F⁻ concentration in unconfined aquifer mainly in Sindh and Punjab were categorized as follows: 1) minerals weathering that observed as the key process to control groundwater chemistry in the study areas, 2) the strong correlation between F⁻ and alkaline pH, which provided favorable environmental conditions to promote F⁻ leaching through desperation or by ion exchange process, 3) the 72.6% of samples from Sindh and Punjab were dominated by Na⁺- Cl⁻ type of water, confirmed that the halite dissolution process was the major contributor for F⁻ enrichment in groundwater, 4) dolomite dissolution was main process frequently observed in Sindh, compared with Punjab, 5) the arid climatic conditions promote evaporation process or dissolution of evaporites or both were contributing to the formation of saline groundwater in the study area, 6) the positive correlation observed between elevated F⁻ and fluorite also suggested that the fluorite dissolution also played significant role for leaching of F⁻ in groundwater from sediments, and 7) calcite controlled Ca²⁺ level and enhanced the dissolution of F-bearing minerals and drive F⁻ concentration in groundwater. In a nut shell, this study revealed the worst scenarios of F⁻ contamination via various possible geochemical mechanisms in groundwater along major rivers in Sindh and Punjab, Pakistan, which need immediate attention of regulatory authorities to avoid future hazardous implications.

Fluoride in Iranian Drinking Water Resources: a Systematic Review, Meta-analysis and Non-carcinogenic Risk Assessment

A systematic review, meta-analysis, and non-carcinogenic risk considering fluoride content of drinking water resources of 31 provinces of Iran among some international databases such as Science Direct, Scopus, PubMed, and national databases including SID and Irandoc (2011 to July 2017) were conducted. In this context, 10 articles (40 studies) with 1706 samples were included in meta-analyses and risk assessment studies. The pooled concentration of fluoride in the cold, mild, and warm weather provinces were calculated as 0.39 mg/L (95% CI 0.32-0.48 mg/L), 0.52 (95% CI 0.43-0.61 mg/L), and 0.75 (95% CI 0.56-0.94 mg/L), respectively. The pooled concentration of fluoride in Iranian drinking water resources was 0.51 (95% CI 0.45-0.57 mg/L). The minimum and maximum concentrations of fluoride content were related to Kermanshah (0.19 mg/L) and Kerman (1.13 mg/L) provinces, respectively. The HQ of fluoride in the children and adults were 0.462 and 0.077, respectively as children are more vulnerable than adults. The HQ for children and adults was lower than 1 value. Therefore, there is no considerable non-carcinogenic risk for consumers due to drinking water in Iran. Although the non-carcinogenic of fluoride in drinking water was not significant, fluoride entry from other sources, such as food or inhalation, could endanger the health of the residents of Kerman and Bushehr provinces.

Oral health of 6-7 year-old children according to the Caries Assessment Spectrum and Treatment (CAST) index

Background

The index of Caries Assessment Spectrum and Treatment (CAST) reveals a range of caries development from a non-cavitated status to advanced lesions. The aim of the present study was to explore the oral health status of 6- to 7-year-old children based on the CAST index in relation to oral health knowledge and background determinants.

Methods

A multi-stage cluster random sampling method was applied and after ethical clearance, clinical examination was performed (Kappa = 0.89). The status of caries and oral hygiene was recorded according to the CAST index and OHI-Simplified (OHI-S) index, respectively. A self-administered questionnaire was used to collect the data of parental knowledge of oral health. SPSS version 22.0 was used for data analysis and p-value less than 0.05 were considered significant.

Results

Seven hundred and thirty-nine children and their parents in 24 schools participated in this study (88%), of whom 48.6% were boys and the rest were girls. In permanent molars, a healthy status (code 0–2) was observed in 89.3–93.7% of the teeth. In primary molar teeth, dentinal lesions ranged from 25.3 to 31.2%, the prevalence of pulp involvement was between 2.9 and 10.5%, and less than 1% had abscess/fistula. Serious morbidity (codes 6 and 7) were more common in the first primary molars than the second ones. Multi-variable logistic regression analysis indicated that children with a low level of father’s education were 2.45 times more likely to have a CAST score of 3 and higher (95% CI 1.35–4.46, p = 0.003) compared to children whose fathers had academic education. For each one-unit increment of OHI_S, the likelihood of a CAST score 3 and higher in primary dentition increased by 1.77 times (OR = 1.77; 95% CI 1.08–2.93, p = 0.02).

Conclusion

The consequences of dental caries including abscess and fistula were more prevalent in the first and second primary teeth. There was a significant correlation between a CAST score of 3 and higher with father’s education (as an indicator of social rank) and oral hygiene status. The CAST index is a useful and practical index in epidemiological surveys.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0709-x) contains supplementary material, which is available to authorized users.

Correlation between drinking water fluoride and TSH hormone by ANNs and ANFIS

Background

Artificial neural networks (ANNs) and adaptive neural-fuzzy Inference system (ANFIS) are the best solutions to finding the correlation between some water parameters and human hormones. The correlation between thyroid stimulating hormone (TSH) and drinking water fluoride studied by ANN_S and ANFIS models in Yazd city.

Method

In this study, eighty people with thyroid gland disorder and 213 healthy people invited. Their thyroid hormones and fluoride drinking water analyzed.

Results

The result of ANFIS showed R² = 0.81 for test and R² = 0.85 for train in all cases and controls data. This results were R² = 0.73 and R² = 0.81 for ANNs respectively.

Conclusion

This models can be used as an alternative for show correlation between Drinking Water Fluoride and TSH Hormone and R² = 0.85 gained from ANFIS was the best.

Distribution and health risk assessment of natural fluoride of drinking groundwater resources of Isfahan, Iran, using GIS

Fluoride (F) contamination in groundwater can be problematic to human health. This study evaluated the concentration of fluoride in groundwater resources of Isfahan Province, the central plateau of Iran, and its related health issues to the inhabitant populations. For this purpose, 573 drinking groundwater samples were analyzed in 2016 by using the spectrophotometric method. Non-carcinogenic health risks due to F exposure through consumption of drinking water were assessed using the US EPA method. In addition, the associated zoning maps of the obtained results were presented using geographic information system (GIS). The results indicated that F content in drinking water ranged from 0.02 to 2.8 mg/L. The F contents were less than 0.50 mg/L in 63% of the drinking groundwater samples, 0.51-1.5 mg/L in 33.15%, and higher than 1.5 mg/L in 3.85% (Iran and World Health Organization guidelines) of the drinking groundwater samples. The F levels in the west and the south groundwater resources of the study areas were lower than 0.5 mg/L, which is within the recommended values for controlling dental caries (0.50-1.0 mg/L). Therefore, these places require more attention and more research is needed to increase F intake for health benefit. The HQ index for children, teens and male and female adults had health hazards (HQ > 1) in 51, 17, 28, and 18 of samples, respectively. Groundwater resources having a risk of more than one were located in the counties of Nayin, Natanz, and Ardestan. So, in these areas, there are potential risks of dental fluorosis. The most vulnerable groups were children. The F levels must be reduced in this region to decrease endemic fluorosis.

Impact of Drinking Water Fluoride on Human Thyroid Hormones: A Case- Control Study

The elevated fluoride from drinking water impacts on T₃, T₄ and TSH hormones. The aim was study impacts of drinking water fluoride on T₃, T₄ and TSH hormones inYGA (Yazd Greater Area). In this case- control study 198 cases and 213 controls were selected. Fluoride was determined by the SPADNS Colorimetric Method. T₃, T₄ and TSH hormones tested in the Yazd central laboratory by RIA (Radio Immuno Assay) method. The average amount of TSH and T₃ hormones based on the levels of fluoride in two concentration levels 0-0.29 and 0.3-0.5 (mg/L) was statistically significant (P = 0.001 for controls and P = 0.001 for cases). In multivariate regression logistic analysis, independent variable associated with Hypothyroidism were: gender (odds ratio: 2.5, CI 95%: 1.6-3.9), family history of thyroid disease (odds ratio: 2.7, CI 95%: 1.6-4.6), exercise (odds ratio: 5.34, CI 95%: 3.2-9), Diabetes (odds ratio: 3.7, CI 95%: 1.7-8), Hypertension (odds ratio: 3.2, CI 95%: 1.3-8.2), water consumption (odds ratio: 4, CI 95%: 1.2-14). It was found that fluoride has impacts on TSH, T₃ hormones even in the standard concentration of less than 0.5 mg/L. Application of standard household water purification devices was recommended for hypothyroidism.

Calculating fluoride concentrations data using ambient temperatures in drinking water distribution networks in select provinces of Iran

Fluoride concentrations in drinking water were analyzed relative to air temperature data collected in different provinces of Iran. Determining suitable concentrations of fluoride in drinking water is crucial for communities because of the health effects of fluoride on humans. This study analyzed fluoride concentrations in drinking water from selected Iranian provinces. The data were derived mainly from a detailed literature review. The annual mean maximum temperatures (AMMTs) were collected from a popular website that maintains records of daily ambient temperature measurements for the last five years (2012-2016). Using regional ambient temperatures, the optimal value of fluoride in drinking water for each province was calculated by the Galgan and Vermillion formula. These optimal fluoride concentrations in drinking water for different Iranian regions were calculated to be 0.64-1.04 mg F/L. Most of the selected provinces were found to have acceptable concentrations of fluoride, except for Alborz, Khuzestan, and Hormozgan, which reported concentrations of 0.66, 0.66, and 0.64 mg/L, respectively.