Risk assessment of fluoride exposure in drinking water of Tunisia

Integrating deep learning and regression models for accurate prediction of groundwater fluoride contamination in old city in Bitlis province, Eastern Anatolia Region, Türkiye

Groundwater resources in Bitlis province and its surroundings in Türkiye's Eastern Anatolia Region are pivotal for drinking water, yet they face a significant threat from fluoride contamination, compounded by the region's volcanic rock structure. To address this concern, fluoride levels were meticulously measured at 30 points in June 2019 dry period and September 2019 rainy period. Despite the accuracy of present measurement techniques, their time-consuming nature renders them economically unviable. Therefore, this study aims to assess the distribution of probable geogenic contamination of groundwater and develop a robust prediction model by analyzing the relationship between predictive variables and target contaminants. In this pursuit, various machine learning techniques and regression models, including Linear Regression, Random Forest, Decision Tree, K-Neighbors, and XGBoost, as well as deep learning models such as ANN, DNN, CNN, and LSTM, were employed. Elements such as aluminum (Al), boron (B), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), phosphorus (Pb), lead (Pb), and zinc (Zn) were utilized as features to predict fluoride levels. The SelectKbest feature selection method was used to improve the accuracy of the prediction model. This method identifies important features in the dataset for different values of k and increases model efficiency. The models were able to produce more accurate predictions by selecting the most important variables. The findings highlight the superior performance of the XGBoost regressor and CNN in predicting groundwater quality, with XGBoost consistently outperforming other models, exhibiting the lowest values for evaluation metrics like mean squared error (MSE), mean absolute error (MAE), and root mean squared error (RMSE) across different k values. For instance, when considering all features, XGBoost attained an MSE of 0.07, an MAE of 0.22, an RMSE of 0.27, a MAPE of 9.25%, and an NSE of 0.75. Conversely, the Decision Tree regressor consistently displayed inferior performance, with its maximum MSE reaching 0.11 (k = 5) and maximum RMSE of 0.33 (k = 5). Furthermore, feature selection analysis revealed the consistent significance of boron (B) and cadmium (Cd) across all datasets, underscoring their pivotal roles in groundwater contamination. Notably, in the machine learning framework evaluation, the XGBoost regressor excelled in modeling both the "all" and "rainy season" datasets, while the convolutional neural network (CNN) outperformed in the "dry season" dataset. This study emphasizes the potential of XGBoost regressor and CNN for accurate groundwater quality prediction and recommends their utilization, while acknowledging the limitations of the Decision Tree Regressor.

Aluminum-Crosslinked Nanocellulose Scaffolds for Fluoride Removal

Anionic carboxylated cellulose nanofibers (CNF) are effective media to remove cationic contaminants from water. In this study, sustainable cationic CNF-based adsorbents capable of removing anionic contaminants were demonstrated using a simple approach. Specifically, the zero-waste nitro-oxidization process was used to produce carboxylated CNF (NOCNF), which was subsequently converted into a cationic scaffold by crosslinking with aluminum ions. The system, termed Al-CNF, is found to be effective for the removal of fluoride ions from water. Using the Langmuir isotherm model, the fluoride adsorption study indicates that Al-CNF has a maximum adsorption capacity of 43.3 mg/g, which is significantly higher than that of alumina-based adsorbents such as activated alumina (16.3 mg/g). The selectivity of fluoride adsorption in the presence of other anionic species (nitrate or sulfate) by Al-CNF at different pH values was also evaluated. The results indicate that Al-CNF can maintain a relatively high selectivity towards the adsorption of fluoride. Finally, the sequential applicability of using spent Al-CNF after the fluoride adsorption to further remove cationic contaminant such as Basic Red 2 dye was demonstrated. The low cost and relatively high adsorption capacity of Al-CNF make it suitable for practical applications in fluoride removal from water.

Health risk assessment in an area of dental fluorosis disease from high fluoride drinking water: a case study from southeastern Türkiye

This study focuses on identifying fluoride (F‒) concentrations and its health risk assessment (HRA) in drinking water sources in south-eastern Türkiye. Groundwater quality was assessed using some graphical approaches such as Schoeller and Piper diagrams and GIS mapping. Average daily exposure dosages through oral and dermal contact exposure routes were considered to determine the potential health risk of F‒ in groundwater. Groundwater samples were taken from 53 points in spring, summer, autumn, and winter seasons. The results showed that the average annual F‒ concentrations in water resources in the study area were 0.26‒3.62 mg/L. According to the HRA results, the highest F‒ health risk in this region was observed in children, followed by teenagers and adults. This study indicated that there is a strong relationship between the high health risk (4.28 > 3.5) in children and dental fluorosis caused by high F‒ concentration in groundwater.

Investigation of fluoride concentrations, water quality, and non-carcinogenic health risks of borehole water in bongo district, northern Ghana

Access to potable water is a significant concern due to the increasing global threat posed by fluoride contamination in groundwater sources. This study investigated the concentrations of fluoride (F-), the suitability of groundwater for human consumption, the physicochemical characteristics affecting the water quality, and non-carcinogenic adverse health risks to both children and adults in the Bongo district in Northern Ghana. The findings revealed that the groundwater had a mean pH, salinity, TDS, conductivity, and turbidity below the WHO guideline values with a mean fluoride concentration of 1.76 mg/L above the guideline limit of 1.5 mg/L. The study also found that there was no strong relationship between fluoride and the measured water parameters, which may be attributed to poor control of distribution, transport mechanisms, and sources. The WQI scores ranged from 42.62% to 70.72%, indicating that all borehole water samples were of good and excellent quality. The average chronic daily intake showed that children are often more exposed to the harmful impact of fluoride than adults. The average HQ > 1 indicates the probability of dental and skeletal fluorosis after continuous exposure over time in adults and children. The study recommends taking immediate action to mitigate high groundwater fluoride concentrations, implementing appropriate water management strategies, and raising public awareness of the health risks. These measures can guide future groundwater management practices and help policymakers address contamination and protect local communities.

Prevalence of Skeletal Fluorosis in Northern Tanzania: A Follow-Up Study

OBJECTIVES

Skeletal fluorosis is a metabolic bone disease caused by excessive exposure to fluoride, predominantly through contamination of drinking water. This study aimed to identify all cases of skeletal fluorosis in Tindigani village situated in Northern Tanzania. This was done following changes in drinking water sources after a previous prevalence study in 2009 in this population.

METHODS

In a door-to-door cross-sectional study of Tindigani village, a sample of residents was assessed for skeletal fluorosis and dental fluorosis. Diagnosis of skeletal fluorosis was based on pre-defined angles of deformity of the lower limbs. Dental fluorosis was diagnosed and graded using the Thylstrup and Fejerskov Index. Samples from current drinking water sources underwent fluoride analysis.

RESULTS

Tindigani village had a population of 1,944 individuals. Of the 1,532 individuals who were screened, 45 had skeletal fluorosis, giving a prevalence of 3.3% (95% CI=2.4, 4.3). Dental fluorosis was present in 82.5% of those examined (95% CI=79.8, 85.3). Dental fluorosis was present in all individuals with skeletal fluorosis and at higher grades than in the rest of the population. Drinking water samples were collected from 28 sources. These included piped, surface, well, and borehole water sources. Fluoride concentrations ranged from 0.45-38.59 mg/L of fluoride.

CONCLUSIONS

Skeletal fluorosis is an ongoing but preventable health problem in the current population. The delivery of sustainable low fluoride piped water to this community would be of clear health benefit. This has been addressed at a local level.

Distribution, sources, and potential health risks of fluoride, total iodine, and nitrate in rural drinking water sources of North and East China

Small-scale water sources serving villages and towns are the main source of drinking water in rural areas. Compared to centralized water sources, rural water sources are less frequently monitored for water quality and have poor post-treatment facilities, making them vulnerable to drinking health risks. To reveal the hydrochemical characteristics, contaminant sources, and health risks in rural water sources, 189 water samples were collected from lakes and reservoirs, rivers, and groundwater in North and East China for major ions, nutrient salts, microelements, and stable isotope analysis. Statistical analysis and isotopic tracing were performed, as well as human health risk assessment. The exceeding threshold rates for fluoride (F-) and nitrate (NO3-) in surface water were 1.8 % and 9.1 %, respectively. For groundwater, the exceeding threshold rates were 20.9 % for F-, 15.7 % for total iodine (TI), and 4.5 % for NO3-. F- and TI were mainly derived from the leaching of fluoride- and iodine-containing minerals by cationic exchange, and NO3- is mainly derived from nitrogen in the soil (31.7-43.9 %), the use of ammonia fertilizers (24.3-36.1 %), and the discharge of manure and sewage (19.4-31.9 %). Nitrogen in the soil can be an important source of nitrate in the aquatic environment, and soils with higher clay content have a greater retention effect on the migration of nitrogen pollutants from the surface to the groundwater. F- in water sources contributes most to human health risks for drinking, followed by NO3- and TI, and a higher proportion of groundwater (37 %) present health risks for drinking than surface water (14 %) for children. Authorities should give high priority to optimizing the choice of water sources and technology for water treatment, and rational measures should be taken to protect water sources from the threats of anthropogenic pollution.

Modeling, quality assessment, and Sobol sensitivity of water resources and distribution system in Shiraz: A probabilistic human health risk assessment

Given water's vital role in supporting life and ecosystems, global climate change and human activities have significantly diminished its availability and quality. This study explores the health risks of drinking water consumption in the shiraz county water resources and distribution system. The result showed that the water was slightly alkaline. However, the average pH values during the study were within the permissible range. The area's abundance of total hardness and calcium was due to the high concentration of minerals in rocks and soils. The nitrate and fluoride concentrations in drinking groundwater varied from 0.02 to 116.70 mg/L and 0.10-1.85 mg/L, respectively. Although the water quality index indicated that 52.63, 45.03, and 20.3 percent of samples were of excellent, good, and poor quality in 2020, those percentages obtained 46.05, 52.09, and 14.0 percent in 2021. The regression values of training, testing, validation, and the proposed artificial neural network model were 0.93, 0.92, 0.85, and 0.92. The maximum levels of hazard quotient of nitrate and fluoride (except for adults) were higher than 1 in all age groups, indicating a high non-carcinogenic risk by exposure to nitrate. Furthermore, according to the Monte Carlo simulation, the 95th percentile hazard index in all groups was more than 1. Children and infants were more inclined towards risk than teens and adults based on the intake of nitrate and fluoride from drinking water. The Sobol sensitivity reflected that the nitrate concentration and ingestion rate are vital parameters that influence the outcome of the oral exposure model for all age groups. The interaction of ingestion rate with a concentration of nitrate and fluoride is an important parameter affecting the health risk assessment. In conclusion, these findings suggest that precise measures can reduce health risks and guarantee safe drinking water for residents of Shiraz County.

Hydrogeochemical and multivariate statistical approaches to investigate the characteristics of groundwater quality in fluoride-enriched hard rock region in Tirupathur district of Tamil Nadu, India

Fluoride pollution is a major issue worldwide, posing health risks such as dental and skeletal fluorosis. This study was conducted in fluoride enrichment hard rock regions of Vaniyambadi and Ambur talks in Tirupathur district, Tamil Nadu. Four hundred eighty groundwater samples were collected from May 2021 to April 2022 and grouped as summer, southwest monsoon (SWM), northeast monsoon (NEM), and winter. Maximum concentration of fluoride was found to be 4 mg/L in the summer season in Vellakuttai region of Vaniyambadi taluk. The study aims to investigate the hydrogeochemical process and mechanism influencing groundwater chemistry and it also provides the confirmation of exploratory data analysis in groundwater quality using structural equation modeling. The Piper and Gibbs diagrams illustrate the rock-water interaction and anthropogenic sources that contribute to the NaHCO3 and NaCl-type waters, respectively. Multivariate statistical analysis such as hierarchical cluster analysis (HCA), principal component analysis (PCA), multiple linear regression (MLR), and structural equation modeling (SEM) has been carried out to determine the groundwater quality. HCA manifests the nature and sources of groundwater, whereas PCA divides all the physicochemical parameters into two PC loadings, accounting for 97.46%, 99.46%, 99.18%, and 98.93% of cumulative % of variance during the summer, SWM, NEM, and winter seasons, respectively. PC1 has a higher loading factor to Cl, Ca, and Mg, whereas PC2 has a higher loading factor to Na, HCO3, SO4, and NO3. The results of the MLR model provide higher accuracy in detecting the contamination factors associated with the environment and natural rocks. SEM revealed the goodness-of-fit indices 0.993, 0.999, 1.000, and 0.999 in summer, SWM, NEM, and winter, respectively. Hence, this study provides insight view of variation of fluoride concentration in groundwater in different seasons and also mentions the factors that influence fluoride concentration in Vaniyambadi and Ambur taluk.

Temporal groundwater quality, health risks and source point management zonation of multi-aquifers in Jilin Qian'an, Northeastern China

Jilin Qian'an, located in Northeastern China's Songnen Plain, relies almost exclusively on groundwater for drinking. The quaternary phreatic aquifer (Q3) is distinguished by high geogenic fluoride and arsenic concentrations, which necessitates reliance on quaternary confined (Q1) and neogene confined (N) aquifers (deeper aquifers) as source point management (SPM) alternatives. However, deeper aquifers are contaminated, necessitating temporal monitoring and unique management strategies. Using 165 samples, this study investigated the appropriateness of deeper restricted aquifers as a continuous SPM alternative by assessing the spatiotemporal groundwater quality and human health risk of the multi-aquifers in Jilin Qian'an from the 1980s to the 2010s. In addition, a source point management zonation (SPMZ) was implemented to define the specific intervention necessary in various portions of the study area. Results indicate water quality parameters were within recommended limits for most samples except fluoride, while arsenic was the most significant heavy metal pollutant. Mean groundwater mineralization in all the aquifers increased with time. Deeper aquifers are still a better alternative to the shallow phreatic aquifer as groundwater quality in the study is of the order N > Q1 > Q3 in the respective aquifers. Cancer risk assessment (CR) shows increases from 2001 to the 2010s in all aquifers except in Q3. SPMZ delineated: High As and high F zones; high As and low F zones; high As zones; high F zones; low F zones; and safe zones. Localized intervention based on SPMZ is recommended, along with the use of alternative water sources.

Spatial variation in groundwater quality and health risk assessment for fluoride and nitrate in Chhotanagpur Plateau, India

The evaluation of groundwater quality is vital to assess the risk to human health. The present study assesses groundwater quality for drinking purposes and human health risks due to ingestion of fluoride and nitrate through drinking water in Chhotanagpur Plateau, India, using geoinformation techniques. For drinking water quality assessment, analyzed parameters were compared with World Health Organization (WHO) standards, and water quality index (WQI) was used. Results reveal that most of the samples come within the desired limit suggested by WHO. In a few samples, conductivity, hardness, chloride, sulfate, and calcium are higher than the desirable limit, whereas fluoride and nitrate are beyond the permissible limit in 70% and 27% of the samples, respectively. WQI highlights that poor to very poor water is present in 25% of the samples. Anthropogenic activities have played a critical role in deteriorating groundwater quality, resulting in harmful impacts on human health. To assess non-carcinogenic health risks, the hazard quotient (HQ) and total hazard index (THI) were computed. THI ranges from 0.01 to 7.46, 0.01 to 7.05, and 0.01 to 9.05 for males, females, and children, respectively. THI is greater than the allowable limit in 84%, 78%, and 89% of the samples for males, females, and children, respectively, indicating high risk to human health, particularly children. The study advocates proper water management strategies. Knowledge of spatial variation and anomalous concentration is vital for groundwater management as well as health risk assessment. The findings of this study will be helpful to government officials, policy planners, and local communities.

Fluoride Adsorption from Aqueous Solution by Modified Zeolite-Kinetic and Isotherm Studies

Fluorine is a very common element in the Earth's crust and is present in the air, food, and in natural waters. It never meets in the free state in nature due to its high reactivity, and it comes in the form of fluorides. Depending on the concentration of fluorine absorbed, it may be beneficial or harmful to human health. Similar to any trace element, fluoride ion is beneficial for the human body at low levels, but as soon as its concentration becomes too high, it is toxic, inducing dental and bone fluorosis. The lowering of fluoride concentrations that exceed the recommended standards in drinking water is practiced in various ways around the world. The adsorption process has been classified as one of the most efficient methods for the removal of fluoride from water as it is environmentally friendly, easy to operate, and cost-effective. The present study deals with fluoride ion adsorption on modified zeolite. There are several influential parameters, such as zeolite particle size, stirring rate, solution pH, initial concentration of fluoride, contact time, and solution temperature. The maximum removal efficiency of the modified zeolite adsorbent was 94% at 5 mg/L fluoride initial concentration, pH 6.3, and 0.5 g modified zeolite mass. The adsorption rate increases accordingly with increases in the stirring rate and pH value and decreases when the initial fluoride concentration is increased. The evaluation was enhanced by the study of adsorption isotherms using the Langmuir and Freundlich models. The Langmuir isotherm corresponds with the experimental results of the fluoride ions adsorption with a correlation value of 0.994. The kinetic analysis results of the fluoride ions adsorption on modified zeolite allowed us to demonstrate that the process primarily follows a pseudo-second-order and then, in the next step, follows a pseudo-first-order model. Thermodynamic parameters were calculated, and the ΔG° value is found to be in the range of -0.266 kJ/mol up to 1.613 kJ/mol amidst an increase in temperature from 298.2 to 331.7 K. The negative values of the free enthalpy ΔG° mean that the adsorption of fluoride ions on the modified zeolite is spontaneous, and the positive value of the enthalpy ∆H° shows that the adsorption process is endothermic. The ∆S° values of entropy indicate the fluoride adsorption randomness characteristics at the zeolite-solution interface.

Effects of elevated arsenic and nitrate concentrations on groundwater resources in deltaic region of Sundarban Ramsar site, Indo-Bangladesh region

An attempt has been adopted to predict the As and NO₃^- concentration in groundwater (GW) in fast-growing coastal Ramsar region in eastern India. This study is focused to evaluate the As and NO₃^- vulnerable areas of coastal belts of the Indo-Bangladesh Ramsar site a hydro-geostrategic region of the world by using advanced ensemble ML techniques including NB-RF, NB-SVM and NB-Bagging. A total of 199 samples were collected from the entire study area for utilizing the 12 GWQ conditioning factors. The predicted results are certified that NB-Bagging the most suitable and preferable model in this current research. The vulnerability of As and NO₃^- concentration shows that most of the areas are highly vulnerable to As and low to moderately vulnerable to NO₃. The reliable findings of this present study will help the management authorities and policymakers in taking preventive measures in reducing the vulnerability of water resources and corresponding health risks.

Re-evaluating fluoride intake from food and drinking water: Effect of boiling and fluoride adsorption on food

Although drinking water is the main source of fluoride intake, recent studies reported that fluoride intake from foods could also be high, depending on cooking methods. In this study, we quantified the fluoride accumulation in foods soaked or boiled in fluoride-containing water and assessed the fluoride intake in different age groups from food and drinking water. We observed that, in the case of rice soaked in fluoride-containing water, more fluoride was accumulated in the rice than previously estimated. Fluoride interferes with the iodine staining process of rice, indicating fluoride adsorption. Fluoride accumulation in rice and vegetables increased when the soaking temperature was raised to 100 °C due to the gelatinization of rice grains and softening of vegetables. Ingesting foods boiled in fluoride-containing water increased the fluoride intake per body weight of infants more significantly than that in children and adults due to their low body weight. These results indicate that soaking and boiling foods in fluoride-containing water significantly increases fluoride intake compared to previous estimations. Therefore, it is necessary to re-evaluate the fluoride intake from food and drinking water considering the methods used for cooking food in each country and region.

Water quality and probabilistic non-carcinogenic health risk of groundwater: a half decadal scenario change in Vadodara

Groundwater is essential to secure the safety of water supply in Vadodara, Gujarat. In this study, groundwater samples were collected from various part of the city which separated in 12 wards. The present study contains analyses of 720 groundwater samples gathered from various tube and open wells and analyzed for fluoride and other physicochemical parameters during 2014 and 2019. The results indicated that fluoride and TDS were high and the overall water quality was poor in the study area. Gastrointestinal and other health-related issues increased due to higher TDS in east, north and northeast regions. Likewise, hierarchical cluster analysis also indicated that TDS and chloride-rich water. Fluoride concentration was observed in the range of 0.66-1.61 mg/l (2014) and 0.86-1.77 mg/l (2019) which indicates that 62% samples are unfit for drinking purpose, which could cause dental and skeletal fluorosis. The water quality index (WQI) indicated lack of excellent water in the studied area in the last half-decade. As per WQI calculation suggest that 82.12% (2014) and 69.00% (2019) of groundwater samples represent poor, very poor and unsuitable categories, whereas remaining 17.85% (2014) and 31.00% (2019) of the samples represent good category for drinking purposes in entire Vadodara, Gujarat. Marginal improvement in the groundwater quality is reported due to good rainfall in 2019. Health risks associated with high fluoride drinking water were assessed for various age groups of inhabitants such as children, infants and adults. The non-carcinogenic hazard quotient estimated by oral intake was 1.38-3.36 (2014) and 1.79-3.70 (2019) for infants; 0.69-1.68 (2014) and 0.90-1.85 (2019) for children, whereas 0.07-0.18 (2014) and 0.10-0.20 (2019) for adults. Therefore, infant and children are relatively at higher health risk due to the intake of fluoride-rich drinking water than adult in the studied region. Both indices were indicated contaminated water or closer to contamination which induced non-carcinogenic health risk on citizens. Thus, the comprehensive results of present study can be used as a baseline data and valuable tool for government authorities for long-term monitoring, health monitoring and sustainable development of Vadodara, Gujarat.

State-of-the-art of research progress on adsorptive removal of fluoride-contaminated water using biochar-based materials: Practical feasibility through reusability and column transport studies

Fluoride (F^-) is one of the essential elements found in soil and water released from geogenic sources and several anthropogenic activities. Fluoride causes fluorosis, dental and skeletal growth problems, teeth mottling, and neurological damage due to prolonged consumption, affecting millions worldwide. Adsorption is an extensively implemented technique in water and wastewater treatment for fluoride, with significant potential due to efficiency, cost-effectiveness, ease of operation, and reusability. This review highlights the current state of knowledge for fluoride adsorption using biochar-based materials and the limitations of biochar for fluoride-contaminated groundwater and industrial wastewater treatment. Biochar materials have shown significant adsorption capacities for fluoride under the influence of low pH, biochar dose, initial concentration, temperature, and co-existing ions. Modified biochar possesses various functional groups (-OH, -CC, -C-O, -CONH, -C-OH, X-OH), in which enhanced hydroxyl (-OH) groups onto the surface plays a significant role in fluoride adsorption via electrostatic attraction and ion exchange. Regeneration and reusability of biochar sorbents need to be performed to a greater extent to improve removal efficiency and reusability in field conditions. Furthermore, the present investigation identifies the limitations of biochar materials in treating fluoride-contaminated drinking groundwater and industrial effluents. The fluoride removal using biochar-based materials at an industrial scale for understanding the practical feasibility is yet to be documented. This review work recommend the feasibility of biochar-based materials in column studies for fluoride remediation in the future.

Systematic impacts of fluoride exposure on the metabolomics of rats

Fluoride is widely present in the environment. Excessive fluoride exposure leads to fluorosis, which has become a global public health problem and will cause damage to various organs and tissues. Only a few studies focus on serum metabolomics, and there is still a lack of systematic metabolomics associated with fluorosis within the main organs. Therefore, in the current study, a non-targeted metabolomics method using gas chromatography-mass spectrometry (GC-MS) was used to research the effects of fluoride exposure on metabolites in different organs, to uncover potential biomarkers and study whether the affected metabolic pathways are related to the mechanism of fluorosis. Male Sprague-Dawley rats were randomly divided into two groups: a control group and a fluoride exposure group. GC-MS technology was used to identify metabolites. Multivariate statistical analysis identified 16, 24, 20, 20, 24, 13, 7, and 13 differential metabolites in the serum, liver, kidney, heart, hippocampus, cortex, kidney fat, and brown fat, respectively, in the two groups of rats. Fifteen metabolic pathways were affected, involving toxic mechanisms such as oxidative stress, mitochondrial damage, inflammation, and fatty acid, amino acid and energy metabolism disorders. This study provides a new perspective on the understanding of the mechanism of toxicity associated with sodium fluoride, contributing to the prevention and treatment of fluorosis.

Fluoride induces hypomethylation of BMP2 and activates osteoblasts through the Wnt/β-catenin signaling pathway

BACKGROUND

Skeletal fluorosis has become a public health issue in recent years as its serious impact on patients' life expectancy. Bone morphogenetic protein 2 (BMP2) plays a key role in promoting osteogenesis. However, the mechanism of BMP2-Wnt/β-catenin axis in skeletal fluorosis needs further exploration.

METHODS

The RT-qPCR and western blot assay were carried out to examine the mRNA and protein levels. Cell viability was measured by MTT assay. A commercial ALP assay kit was used to detect ALP activities. Alizarin Red staining was performed to measure the formation of mineralized nodules. Methylation-specific PCR (MSP) was performed to measure the methylation level of BMP2.

RESULTS

Fluoride promoted the expression of osteogenic marker genes (OPN, OCN, OSX and RUNX2) and induced the proliferation and differentiation of MC3T3-E1 cells. Fluoride induced hypomethylation and high expression of BMP2. Furthermore, knockdown of BMP2 reversed the promoting effect of fluoride on osteogenic differentiation of MC3T3-E1. The expression of β-catenin, glycogen synthase kinase 3β (GSK3β), wingless/integrated 3α (Wnt3α), low-density lipoprotein receptor-related protein 5 (LRP5) and dishevelled 1 (Dv1) were increased in osteoblasts treated with fluoride, however, knockdown of BMP2 reversed this phenomenon. Simultaneous knockdown of BMP2 and β-catenin significantly inhibited the differentiation of osteoblasts induced by fluoride.

CONCLUSION

Fluoride contributed to proliferation and differentiation of osteoblasts through BMP2-Wnt/β-catenin axis, providing a feasible theoretical basis for the treatment of skeletal fluorosis.

Exploring a variance decomposition approach integrated with the Monte Carlo method to evaluate groundwater fluoride exposure on the residents of a typical fluorosis endemic semi-arid tract of India

This study appraised the groundwater fluoride (F^-) endemicity and the exposure levels under the Central Tendency Exposure (CTE) condition and the Reasonable Maximum Exposure (RME) condition on the residents of the semi-arid parts of the Birbhum district of Peninsular India using a Variance Decomposition (Sobol Sensitivity Indices) approach combined with Monte Carlo Simulations. The study finds the national scale drinking water standard limit for F^- (1.5 mg L^-1) is inappropriate for the present survey area where F^- concentration in groundwater varied between 0.26 and 11.82 mg L^-1 and ~54.5% of the samples (N = 400) exceeded this limit. Therefore, estimated the optimum F^- concentration of 0.733 mg L^-1 for the region using the method recommended by the World Health Organization (WHO) to calculate the optimum F^- limit at a regional scale. The average value of F^- concentrations for this region (1.71 mg L^-1) is considerably higher than the estimated optimum concentration or even the maximum permissible limits recommended for the subtropical regions (0.5-0.7 mg L^-1). The exposure analysis revealed the infants and children as potentially vulnerable populations compared to adolescents and adults of the study area for CTE and RME scenarios. The multi-exposure pathways indicated oral intake as the main exposure pathway whereas exposure through dermal contact was insignificant for the residents of all age groups of this region. Based on the first, second and total order Sobol Sensitivity Indices, F^- concentration (C) in groundwater, the groundwater ingestion rate and their combined interaction are the greatest significant parameters for the oral exposure model whereas C and its interaction effects with the proportion of the skin surface area in contact with groundwater as the utmost sensitive variables for the dermal health risks assessment model. The present study insists the inhabitants to intake defluoridated groundwater.

Health risk assessment in children living in an urban area with hydrofluorosis: San Luis Potosí Mexico case study

BACKGROUND

Fluoride is an inorganic element, which can be found in high concentrations in groundwater. Its consumption and exposure have consequences on human health. The objective of this study was to evaluate fluoride exposure and develop a health risk assessment in children from an urban area with hydrofluorosis in Mexico.

METHODS

Water fluoride levels in active wells were provided by the Water State Agency and divided into three zones: agriculture zone (Zone A), metallurgical zone (Zone B), and industrial zone (Zone C). Urinary fluoride levels were determined by potentiometric method using an ion-selective electrode. Health risk assessment was performed through Monte Carlo model analysis and hazard quotient was calculated.

RESULTS

According to fluoride well concentration, all zones have high concentration especially Zone B (2.55 ± 0.98 mg/L). Urinary fluoride concentrations were highest in children in Zone B (1.42 ± 0.8 mg/L). The estimated median daily intake dose of fluoride was 0.084 mg/Kg-day for the children living in zone B. The highest mean HQ value was to Zone B (1.400 ± 0.980), followed by Zone C (0.626 ± 0.443).

CONCLUSION

The levels of fluoride exposure registered are a potential risk to generate adverse health effects in children in the San Luis Potosi metropolitan area.

Identifying fluoride endemic areas and exposure pathways for assessment of non-carcinogenic human health risk associated with groundwater fluoride for Gujarat state, India

Analytical data of fluoride concentration in groundwater collected from various geological formations in Gujarat, India, have been studied to assess their spatial distribution characteristics and related potential chronic health risks. Decadal analysis of groundwater was attempted for precise quantification and a realistic ground representation of fluoride concentration in the entire state. This exercise involved collection of 6407 samples over a period of 10 years (2009-2018), from 641 representative locations, distributed evenly throughout the state (6407 = 641 locations × 10 years). The analytical results indicate that 19% of the sample locations have fluoride concentration higher than the permissible limit and 42% of the locations have fluoride concentration much below the desirable limit, thereby exposing children to a higher risk of associated dental morbidities. Monte Carlo simulation integrated with sensitivity and uncertainty analysis was applied for an accurate and realistic assessment of the non-carcinogenic health risk. Model results indicated that groundwater fluoride exposure through consumption is way higher than the exposure due to dermal absorption pathway. It is inferred that 94 locations (15%) have total hazard index greater than the unity value for all population groups, thereby increasing the vulnerability of the local populace to dental and skeletal fluorosis. Total hazard index in 210 locations (36%) and 188 locations (29%) are beyond the permissible limit for the population comprising infants and children. Populaces living in these locations are susceptible to health hazards that stems from high fluoride concentration. Children and infants are at greater risk due to groundwater fluoride toxicity when compared to the adult populace. The order of the geographic stratification of vulnerability is Mainland regions > Saurashtra region > Kachchh region. Ingestion rate and fluoride concentration are the sensitive parameters with high impact and residents of these vulnerable locations should be advised to abstain from direct intake of groundwater and resort to defluoridised groundwater.

Fluoride levels in deep aquifers of Makurdi, North-central, Nigeria: an appraisal based on multivariate statistics and human health risk analysis

Fluoride enrichment of groundwater has been adjudged to be a global environmental challenge in the past decade as most humans depend on groundwater for their domestic needs. This study was conducted to investigate the ionic and fluoride concentrations in borehole water and its associated health risk potentials to residents of Makurdi town and its environs, Benue state, Nigeria. Multivariate statistical techniques were for the first time used to explain the mechanisms of fluoride occurrence in groundwater in the study area. An aggregate of sixty-three (63) groundwater samples were retrieved from boreholes in twenty-one (21) diverse points within the study area and assessed for its physico-chemical composition with emphasis on fluoride content and health risk potentials following standard field and laboratory procedures. It was observed that fluoride content in the sampled water exceeded the stipulated safe limit of 1.5 mg/L in about 33.33% of the total samples and ranged from 0.34 to 2.06 mg/L with an average of 1.26 ± 0.41 mg/L. Moderate affirmative relationships were observed to exist between F^- and TDS, F^- and EC, F^- and Cl^-, and F^- and NO₃^- in the water samples indicative of a common source pollution. Principal component analysis (PCA) revealed that high fluoride content in the water samples was associated with the dissolutions from quartzite and shale into the underlying deep aquifers as well as from contributions from anthropogenic activities including fertilizer and pesticide uses. Fluoride risk assessment indicated that the hazard quotient (HQ) for ingestion of fluoride laden water exceeded the threshold value in 66.7, 71.4, 52.4, and 9.5% of the samples for infants, children, teenagers, and adults respectively. It was found that multivariate statistical procedures such as PCA and correlation analysis (CA) are capable of establishing the relationship among groundwater pollutants, while hierarchical cluster analysis (HCA) was found suitable for explaining the likely sources/processes of pollutant enrichment in the groundwater. It is recommended that the findings of this study would serve as a basis for policy makers and regulatory bodies towards ameliorating the menace of groundwater contamination within the study area.

Monitoring of Fluoride Content in Drinking Water by Ion Chromatography: A Case Study in the Suzhou Urban Area, China

BACKGROUND

Both deficient and excessive intake of fluoride can lead to adverse health problems.

OBJECTIVE

The aim of this study is to investigate the fluoride content in three types of drinking water in Suzhou urban area.

METHOD

Ion chromatography was employed to conduct the validation of analysis of fluoride ion in water and the method was applied to analyze the concentration of fluoride in 22 drinking water samples, including tap water, purified water, and commercially available bottled water, collected from five municipal districts of Suzhou urban area.

RESULTS

The used method was validated in the range of 0.05 and 2.00 mg/L with good repeatability and accuracy. Results of water analysis indicated that fluoride content in tap water ranged from 0.267 to 0.336 mg/L (average 0.304 mg/L), and the levels of fluoride in purified water and bottled water were 0.068-0.317 mg/L (average 0.134 mg/L) and 0-0.120 mg/L (average 0.080 mg/L), respectively.

CONCLUSION

The amount of fluoride in all samples analyzed were lower than the limit set for fluoride in drinking water according to the China standard (1.0 mg/L). The low fluoride exposure for the population in the studied area was observed, and the replacement of tap water with purified and bottled water could further aggravate the deficient of fluoride intake for local residents.

HIGHLIGHTS

The present study carried out is the first to characterize the fluoride content in these three types of drinking water in Suzhou urban area by ion chromatography.

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.

Groundwater fluoride chemistry and health risk assessment of multi-aquifers in Jilin Qianan, Northeastern China

Groundwater from deep confined aquifers is often recommended for use because of it's low fluoride health risk. Thus, this study appraised groundwater fluoride hydrochemistry in a multi-aquifer system in Jilin Qianan to determine the non-carcinogenic health risk liable from exploiting the respective aquifers. 124 samples collected from the tertiary confined aquifer (N), quaternary confined aquifer (Q₁), and quaternary phreatic aquifer (Q₃) during surveys in 2001 and 2017 was analyzed using hydrochemical, statistical, spatial, and health risk assessment methods. Results show that the dominant water facies in the respective aquifer layers was Na+K-HCO₃+CO₃ except in Q_1, where Ca+Mg - HCO₃ + CO₃ was marginally dominant. Fluoride concentrations outside the recommended guideline occurred in all the aquifers except N, where concentrations were optimum. The mean fluoride concentration of groundwater in the aquifers was of the order Q₃ (2017) > Q₃ (2001) > Q₁ > N ( mean 2.09, 2.03, 1.41 and 0.75 mg/L with 51.85%, 57.44%, 36.36% and 0% occurring beyond recommended guideline values respectively). Silicate weathering, cation exchange, and fluorite dissolution in an alkaline environment were the significant fluoride contributing processes. Evaporation and MgF⁺ complex additionally influenced Q₁ and Q₃ (2017). The total hazard quotient (THQ) from oral and dermal pathways shows fluoride health risks in the order: infant > children > adult. The associated risks likely from using water in the respective aquifer layers is of the order Q₃ (2017) > Q₃ (2001) > Q₁ > N. The mean groundwater fluoride in 2017 was marginally higher than that of 2001 ( 2.09>2.03 mg/L respectively) although the percentage of age group members disposed to fluoride risk from using water from Q₃ decreased from 2001 to 2017. Knowledge of local hydrogeology in exploiting deep groundwater free of fluoride pollution and on-site defluoridation treatment of groundwater was recommended in the study area and other areas with similar characteristics.

Groundwater Pollution and Human Health Risks in an Industrialized Region of Southern India: Impacts of the COVID-19 Lockdown and the Monsoon Seasonal Cycles

Samples of groundwater were collected during a post-monsoon period (January) and a pre-monsoon period (May) in 2020 from 30 locations in the rapidly developing industrial and residential area of the Coimbatore region in southern India. These sampling periods coincided with times before and during the lockdown in industrial activity and reduced agricultural activity that occurred in the region due to the COVID-19 pandemic. This provided a unique opportunity to evaluate the effects of reduced anthropogenic activity on groundwater quality. Approximately 17% of the wells affected by high fluoride concentrations in the post-monsoon period returned to levels suitable for human consumption in samples collected in the pre-monsoon period. This was probably due to ion exchange processes, infiltration of rainwater during the seasonal monsoon that diluted concentrations of ions including geogenic fluoride, as well as a reduction in anthropogenic inputs during the lockdown. The total hazard index for fluoride in the post-monsoon samples calculated for children, adult women, and adult men indicated that 73%, 60%, and 50% of the groundwater samples, respectively, had fluoride levels higher than the permissible limit. In this study, nitrate pollution declined by 33.4% by the pre-monsoon period relative to the post-monsoon period. The chemical facies of groundwater reverted from the Na-HCO3-Cl and Na-Cl to the Ca-HCO3 type in pre-monsoon samples. Various geogenic indicators like molar ratios, inter-ionic relations along with graphical tools demonstrated that plagioclase mineral weathering, carbonate dissolution, reverse ion exchange, and anthropogenic inputs are influencing the groundwater chemistry of this region. These findings were further supported by the saturation index assessed for the post- and pre-monsoon samples. COVID-19 lockdown considerably reduced groundwater pollution by Na+, K+, Cl-, NO3¯, and F- ions due to shutdown of industries and reduced agricultural activities. Further groundwater quality improvement during lockdown period there is evidence that the COVID-19 lockdown by increased HCO3¯ ion concentration. Overall results illustrate the positive benefits to groundwater quality that could occur as a result of measures to control anthropogenic inputs of pollutants.

Using water quality and isotope studies to inform research in chronic kidney disease of unknown aetiology endemic areas in Sri Lanka

Chronic Kidney Disease of unknown aetiology (CKDu) is a major public health concern in dry climatic, agricultural regions of Sri Lanka. The chemistry of groundwater (the main source of drinking water) in the area has been studied extensively, in relation to the occurrence of CKDu. This paper investigates water quality studies published in CKDu affected areas of Sri Lanka and also presents a new data set of 27 hydrochemical and isotopic samples collected from groundwater wells in selected CKDu endemic areas in Sri Lanka. The study outcomes do not provide evidence of pollutants such as heavy metals in groundwater. However, the study identifies elevated concentrations of silica which requires further investigation. Two groups of groundwater have been identified based on the isotopic results suggesting different sources or origins. The available water quality data, including the data from this study, is not sufficient to answer questions on whether the chemistry of groundwater is related to the CKDu occurrence. However, this study identifies the importance of detailed investigation into degradation products of agrochemicals, the organic matter content and the influence of elevate silica concentration in groundwater. The study also provides research directions in the form of isotopic tracers and the frequency of sampling that is needed to capture potential pollutants in future groundwater quality studies in CKDu endemic areas in Sri Lanka.

Probabilistic human health risk assessment associated with fluoride and arsenic co-occurrence in drinking water from the metropolitan area of San Luis Potosí, Mexico

A major public health concern in Mexico is the natural contamination of groundwater with fluoride and arsenic. Therefore, this work aimed to evaluate the magnitude of human health risk after determining fluoride and arsenic concentrations in groundwater samples (n = 50) from the Metropolitan area of the city of San Luis Potosi, Mexico. Fluoride levels in water were determined via a potentiometric method using an ion-selective electrode. Arsenic concentrations in water samples were determined with an Atomic Absorption technique. Subsequently, a probabilistic health risk assessment was developed (Monte Carlo Analysis). Fluoride levels in water ranged from 0.20 to 3.50 mg/L. For arsenic, the mean level found in the assessed water samples was 15.5 ± 5.50 μg/L (range: 2.50-30.0 μg/L). In addition, when the probabilistic health risk assessment was completed, a mean HI (cumulative hazardous index) of higher than 1 was detected, indicating a high NCR (non-carcinogenic risk) for children and adults. According to the results found in this study, exposure protection campaigns are imperative in the Metropolitan area of the city of San Luis Potosí, Mexico, to successfully diminish exposure to arsenic and fluoride and, as a consequence, decrease the NCR in the population living in that region of Mexico.

Spatial variation and health risk assessment of fluoride in drinking water in the Chongqing urban areas, China

Fluoride is an essential trace element for humans, and its deficiency or excess in the environment could lead to disease. To investigate the spatial distribution and health risk assessment of fluoride (F^-) in drinking water, 302 tap water samples from Chongqing urban areas, China, were collected to analyze F^- using an ion chromatograph. The results showed that (1) F^- concentration in drinking water ranged from 0.100 to 0.503 mg/L, with an average of 0.238 ± 0.045 mg/L. (2) The spatial autocorrelation analysis showed that high-low clusters were mostly located in Dadukou District and Beibei District, while low-low clusters were mainly in southern Banan District. (3) The fluoride average daily doses of children, teens and adults were 0.030, 0.029 and 0.031 mg/(kg day). (4) Hazard quotients of excessive fluoride (HQ_e) of children, teens and adults were 0.51 ± 09, 0.49 ± 0.09 and 0.52 ± 0.10, respectively (inferior to 1.00), whereas hazard quotients of inadequate fluoride (HQ_i) of those groups were 1.21 ± 0.26, 1.23 ± 0.26 and 1.15 ± 0.25, respectively (superior to 1.00). Therefore, average daily fluoride intake of residents with drinking water was inadequate. This could pose dental caries and osteoporosis threats for residents from Chongqing urban areas.

Spatiotemporal distribution of fluoride in drinking water and associated probabilistic human health risk appraisal in the coastal region, Bangladesh

Spatiotemporal distribution of fluoride in drinking water has been posing serious health concerns worldwide. However, in Bangladesh, to date, there is a very limited study reported the probabilistic health risks from fluoride content in drinking water. Therefore, we investigate the spatiotemporal distribution of fluoride concentration in drinking water and associated health risks in the coastal districts of Bangladesh based on randomly collected 840 groundwater samples (Dry-season = 302 and Wet-season = 538). Probabilistic health risk appraisal from fluoride was performed using the Monte-Carlo simulation and sensitivity analysis. Fluoride concentration in 11.89% (Wet-season) and 24.50% (Dry-season) of the samples exceeded the acceptable level of 1.0 mg/L, while 3.90% (Wet-season) and 7.28% (Dry-season) samples surpassed the maximum permissible limit (fluoride: 1.5 mg/L. The deficiency of fluoride content in groundwater (<0.50 mg/L) in Wet-season (60.41%) and in Dry-season (55.63%) was identified from the study area. The seasonality to the spatial change of fluoride concentration in drinking water has been explored. The mean non-carcinogenic risks e.g., hazard quotient (HQ) from the consumption of high fluoride-containing water for infants and children were mostly exceeded the threshold value 1 (HQ > 1) in both seasons. However, the risk of children and infants at the 95th percentile crossed the safe level (SL: 1) in the wet season and the risk of infants, children, teens and adults at the 95th percentile surpassed 1 in the dry season, indicating the potential adverse health effects. Apart from the high exposure, fluoride deficiency might be a severe problem in this region due to the very low concentration of fluoride (<0.50 mg/L) in drinking water. Sensitivity analyses indicate high fluoride-containing drinking water was the most contributing variables affecting the model outcome. Finally, the case-control study should be performed to examine further the health effects from the ingestion of high/low fluoride-bearing groundwater in the study area.

Quantitative assessment of environmental exposure of delivery men in Wuhan

The take out industry is rapidly developing in China, but the environmental exposure of delivery men is neglected. "Ele.Me," an online food ordering platform, is one of the two largest catering online-to-offline platforms in China. From January 2018 to April 2018, data from 16,528 take out shops in Wuhan were crawled by using Python. The data included store name, average delivery time, delivery price, region, and store type. With the use of Baidu map's API batch reverse address resolution, the map locations of the take out shops were identified. Network service area was utilized to obtain the activity space of delivery men along the Wuhan traffic road network. Combined with the data on sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), ozone (O₃), PM2.5, PM10, and noise provided by the Wuhan Environmental Protection Bureau, the spatial interpolation, regional analysis, superposition analysis, and other geographic information system spatial analysis methods were used to study the air and noise pollution within the activity space of delivery men in various take out shops. Results revealed the unbalanced environment faced by Wuhan delivery men. The exposure to NO₂, CO, and PM2.5 was mainly concentrated in the central city, whereas the exposure to SO₂, O₃, and PM10 was mainly noted far from the city. Noise pollution was mainly observed in the districts of Hannan, Caidian, and Dongxihu; and the most serious pollution was recorded in Shamao Street. The weighted comprehensive pollution index model was used to calculate the contribution weight of each evaluation factor to obtain the results of environmental exposure to air pollution. The influence of noise was further considered to obtain the consequences of comprehensive environmental exposure to pollution. The highly polluted regions were those in the central part of the city. Pollution was mainly concentrated in the third loop, whereas Zhucheng Street in the Xinzhou District provided the best environment. The results of this study can serve as a reference for the physical health risk assessment of delivery men.

Skeletal fluorosis: don't miss the diagnosis!

Skeletal fluorosis is a rare toxic osteopathy characterized by massive bone fixation of fluoride. The disease occurs as an endemic problem in some parts of the world and is the result of prolonged ingestion or rarely by inhalation of high amounts of fluoride. Radiographic presentation is mainly characterized by bone changes with osteocondensation and later ossification of many ligaments and interosseous membranes. Skeletal fluorosis is not clinically obvious and can be confused with other rheumatologic disorders. Its severity lies in the development of skeletal deformities and neurological complications. Management of fluorosis generally focuses on symptom treatment.

Geochemical modeling, source apportionment, health risk exposure and control of higher fluoride in groundwater of sub-district Dargai, Pakistan

The present study examined the hydrogeochemical profile of higher fluoride (F^─) in groundwater of mixed industrial and mining areas of Dargai, northern Pakistan. Groundwater samples (n = 75) were collected from three hydrogeochemical environments. The mean concentrations of pH, EC, TDS, Depth and Temperature were (7.6, 1081 μS/cm, 590 mg/L, 75 m, 28.03 °C), for chemical ions viz. NO₃, PO₄, SO₄, Cl, HCO₃, Na, K, Ca and Mg were (18.5, 2.7, 161, 107, 330, 150, 9.76, 33, 52) mg/L respectively. Whereas, the mean concentration of F^─ was 2.0 mg/L. Therefore, 51% groundwater samples exceeded the WHO guideline of F^─ 1.5 mg/L. Additionally, we measured the mean F^─ concentration in rocks, coal and wastewater, which were (670, 98) mg/Kg and 2.3 mg/L respectively. The principal component analysis multilinear regression (PCA─MLR) extracted five significant factors which shows natural, mixed and anthropogenic pollution. Thus, fluorite is the primary source of F^─ contamination in groundwater. While apatite, biotite and muscovite minerals are the secondary sources which occurs in association with quartzite, granite rocks. Under alkaline conditions, F^─ contamination is supported by higher Na⁺, HCO₃^─ and lower Ca⁺⁺ concentrations. The accuracy and reproducibility of the measurement of fluoride was assessed by adopting a standard method of water. The percentage recovery of F^─ was 97% and reproducibility was within ±5% error limit. Lastly, a health risk community fluorosis index (CFI) was calculated through Dean's formula which shows unsuitability of groundwater sources conceiving community fluorosis in the entire study area.

Health risk in children to fluoride exposure in a typical endemic fluorosis area on Loess Plateau, north China, in the last decade

Excessive and inadequate intake of fluoride may cause adverse effects in children, such as dental caries and dental fluorosis. This study reports the results of monitoring fluoride concentrations in drinking water from an endemic fluorosis region during the ten-year period (2008 through 2017). The fluoride concentration had a range of 0.03-9.42 mg L^-1 (mean = 0.55 ± 0.01 mg L^-1). Approximately 10%, 1.3% and 0.06% children are at risk for dental decay, dental fluorosis and skeletal fluorosis, respectively. Probabilistic risks for children were assessed and the fluoride endemic areas were marked by GIS mapping system. On several water consumption points, the hazard quotient (HQ) values for children were higher than 1, indicating potential non-cancer health risks due to fluoride exposure. The results of this study will help governmental agencies to develop better policies for protecting children from exposure to fluoride.

Evaluation of non-carcinogenic risks due to fluoride and nitrate contaminations in a groundwater of an urban part (Coimbatore region) of south India

Groundwater quality investigations were carried out in one of the urban parts of south India for fluoride and nitrate contaminations, with special focus on human health risk assessment for the rapidly growing and increasingly industrialized Coimbatore City. Twenty-five groundwater samples were collected and analyzed for physico-chemical parameters (EC, pH, TDS, Ca²⁺, Mg²⁺, Na⁺, K⁺, Cl^-, SO₄^2-, HCO₃^-, PO₄^3-, NO₃^-, and F^-) and the piper diagram characterized 60% of them as Ca-Mg-Cl type. Analysis of fluoride (0.1 to 2.4 mg/l) shows that 32% of the groundwater samples contain F^- over the permissible limit, affecting a region of 122.10 km². Nitrate (0.1 to 148 mg/l) is over the permissible limit in 44% of the groundwater samples spread over an area of 429.43 km². The total hazard indices (THI) of non-carcinogenic risk for children (0.21 to 4.83), women (0.14 to 3.35), and men (0.12 to 2.90) shows some of the THI values are above the permissible limit of the US Environmental Protection Agency. The THI-based non-carcinogenic risks are 60%, 52%, and 48% for children, women, and men. This investigation suggests higher health risk for children and also recommends that proper management plan should be adopted to improve the drinking water quality in this region in order to avoid major health issues in the near future.

The effects of geochemical processes on groundwater chemistry and the health risks associated with fluoride intake in a semi-arid region of South India

This study attempts to establish the effects of subsurface geochemical processes based on the hydrogeochemical attributes of 61 well samples collected in a semi-arid region of South India. The study also provides the health risks associated with the consumption of fluoride-enriched groundwater by the rural people since groundwater is the major source of water supply in the Shanmuganadhi River basin. In this work, water–rock interaction diagrams, an entropy-weighted water quality index (EWQI), and health risk models as per the United States Environmental Protection Agency (USEPA) were prepared to understand the geochemical mechanism behind the groundwater chemistry and its role in impacting health. About 72% of these samples are of mixed Ca²⁺–Mg²⁺–Cl⁻ water type, representing a transition from freshwater to brackish water, and 36% of them have fluoride above the permissible limit (>1.5 mg l⁻¹). An evaluation of the hydrogeochemical attributes suggests that silicate weathering, carbonate dissolution and reverse ion exchange mostly control the hydrochemistry of the groundwater. The EWQI characterizes about 30% of these samples as unsuitable for drinking and another 49% as of moderate quality. Human health risks were evaluated by dividing the population into seven different age groups and estimating the hazard quotient (HQ) and total hazard index (THI) from intake and dermal contact with fluoride-rich groundwater. The groundwater of this region poses a higher risk for the younger population compared to the adults. About 79% of these groundwater samples pose a health risk to 5–12 month-old infants and only 36% of the samples could be potentially hazardous for adults >23 years old. Our results suggest that the ADD_dermal pathway indicates less risk compared to the ADD_intake estimations.

This study attempts to establish the effects of subsurface geochemical processes based on the hydrogeochemical attributes of 61 well samples collected in a semi-arid region of South India.

Spatial distribution of fluoride in drinking water and health risk assessment of children in typical fluorosis areas in north China

China has been suffering from endemic fluorosis for the past 30 years. This study investigated fluoride concentrations in 10 districts of Tianjin, China, to illustrate their spatial distribution characteristics and potential human health risks. The results showed fluoride concentration of 0.01-6.30 mg L^-1 with a mean value of 0.99 mg L^-1, and 78.82% of water fluoride reaches the standard for drinking water (1.5 mg L^-1). Higher fluoride levels were recorded in deep well pumps supply zones, and more potential changes in fluoride occurred was positively correlated with pH in groundwater. Mean value of fluoride in drinking water in 10 districts followed the order of WQ > BC > JZ > NH > BD > BH > JN > JH > DL > XQ. Estimations of non-carcinogenic risk for drinking water indicated that mean hazard quotient values of fluoride for combined pathways (i.e., oral ingestion and dermal absorption) were >1.0 for all age groups of WQ and BC. The results also showed that the estimated risk primarily came from the ingestion pathway. Risk levels for children varied obviously, generally in the order of 1-4y > 4-7y > 7-9y (years old). In the central tendency center and reasonable maximum exposure conditions, estimated risks were 1.25, 1.12, 0.771 and 3.66, 3.29, 2.27, respectively. The results supply material information for health authorities in fluorosis areas to put forward more efficient policies to control the endemic diseases. Attention should be paid to the formulation of health promotion strategies and measures to reduce fluoride intake in order to protect the health of residents.

Evaluation of the reliability of human teeth matrix used as a biomarker for fluoride environmental pollution

Environmental contamination by heavy metals has been a matter of great concern in many countries for several decades. Human exposure to such elements may cause adverse health effects and young children are particularly at risk. Many matrixes have been used for determination of metal exposure levels. Hard tissues such as teeth and bones have some advantages compared to other matrix. Dental tissues are considered to be suitable for long-term metal exposure due to their stability, resistance to physical and chemical degradation and their good preservation over time. Several studies have analyzed the teeth of animals for assessment the relationship between increased fluoride exposure and dental fluorosis, however few studies have been conducted on human teeth. Thus, the aim of the present study was to assess the reliability of human teeth matrix used as a biomarker for fluoride environmental pollution in Tunisia, and to evaluate the relationship with place of residence, age, dental caries and sex. Teeth samples (n=123) were collected from individuals living in Gafsa (fluoride-polluted area which inhabitants are to a great extent exposed to heavy metals) and Tunis (non polluted area). Samples were analyzed using a potentiometric method. The fluoride concentration was found to be significantly higher in teeth from Gafsa samples than those from Tunis. Their control levels were respectively 6793.1μg/g and 1068.8μg/g. The results indicate that there is a clear relation between fluoride concentration and residence of living. An increased level of dental fluorosis in fluoridated communities has been used to evaluate historical chronic exposure to fluoride in these communities, despite constant fluoride levels in the drinking-water. The fluoride concentration was also observed to be significantly increased in polluted area with age and in carious teeth whereas, no significant difference was observed for sex. Our study confirms well that human teeth used as a bioindicator for environmental pollution provide good chronological information on exposure, and highlighted the risks incurred by consumers living in such polluted area.

Medical Geological assessment of fluoride contaminated groundwater in parts of Indo-Gangetic Alluvial plains

As drinking water is considered as a major pathway of exposure to fluoride in the human body, an endeavor has been made for the assessment of the non-carcinogenic health risk by using hazard quotient (HQ) of fluoride for males, females, and children separately in fluoride affected ground water areas of Indo-Gangetic Alluvial Plains. The study suggests that children groups are more prone to the non-carcinogenic risk of fluoride in the area as HQ for fluoride is more than unitary in 44% (Pre-monsoon) and 38% (Post-monsoon) samples respectively. Field survey conducted in fluoride-affected villagers of the study area portrays cases of mottling of teeth and bone deformities depending on the duration and dosage of fluoride consumption. Petrographic observations of host rocks coupled with molar ratios of chemical species studies exemplify that weathered material developed over the granite-gneiss, mica-schist, amphibolite, granitic intrusive and pegmatite veins due to weathering and extensive water-rock interaction resulting higher concentration of fluoride in groundwater. Likewise, the base exchange index (r1) and meteoric genesis index (r2) advocates that most of the samples belong to Na⁺-HCO₃⁻ type and meteoric origin respectively, and substantiate longer residence time of water along with solute acquisition processes are responsible for elevated fluoride in groundwater. It is, therefore, solar energy-driven electrolytic de-fluoridation technology ought to be provided on a priority basis to the affected inhabitants besides the implementation of rainwater harvesting schemes for mitigation/ dilution of elevated fluoride concentration.

Fluoride contamination, health problems and remediation methods in Asian groundwater: A comprehensive review

In low concentration, fluoride is considered a necessary compound for human health. Exposure to high concentrations of fluoride is the reason for a serious disease called fluorosis. Fluorosis is categorized as Skeletal and Dental fluorosis. Several Asian countries, such as India, face contamination of water resources with fluoride. In this study, a comprehensive overview on fluoride contamination in Asian water resources has been presented. Since water contamination with fluoride in India is higher than other Asian countries, a separate section was dedicated to review published articles on fluoride contamination in this country. The status of health effects in Asian countries was another topic that was reviewed in this study. The effects of fluoride on human organs/systems such as urinary, renal, endocrine, gastrointestinal, cardiovascular, brain, and reproductive systems were another topic that was reviewed in this study. Different methods to remove fluoride from water such as reverse osmosis, electrocoagulation, nanofiltration, adsorption, ion-exchange and precipitation/coagulation were introduced in this study. Although several studies have been carried out on contamination of water resources with fluoride, the situation of water contamination with fluoride and newly developed technology to remove fluoride from water in Asian countries has not been reviewed. Therefore, this review is focused on these issues: 1) The status of fluoride contamination in Asian countries, 2) health effects of fluoride contamination in drinking water in Asia, and 3) the existing current technologies for defluoridation in Asia.

The natural radioactivity in drinking water by gross alpha and beta measurements and radiological quality assessment

The aim of this study is to investigate the radiological quality of drinking waters consumed in Nevşehir province which is the most important tourism destination of the Cappadocia region. The activity concentration of gross α- and β-emitting from natural radionuclides (238U, 234U, 230Th, 226Ra, 210Po, 232Th and 210Pb, 228Ra and 40K) in 21 tap water samples supplied by municipal pipelines were analyzed by using a gas proportional α/β counter. The average activity concentrations of the gross α and gross β in tap water samples were found as 88 ± 10 mBq L−1 and 305 ± 32 mBq L−1, respectively. The average natural activity concentrations of α- and β-emitting radionuclides in tap water samples are below the limit values recommended by the Turkish regulation and WHO. For all samples, except for one sample, the gross β activity concentrations are higher than the corresponding gross α concentrations. The average annual effective radiation dose (AERD) due to the ingestion of these water samples was estimated to be 43, 60 and 124 μSv year−1 for infants, children, and adults, respectively. The average of AERD estimated for adults is 24 % higher than the dose limit of 100 μSv year−1. The activity concentration results reveal that tap water samples are acceptable for human consumption in accordance with the Turkish regulation and WHO recommendations for drinking water.

Aberrant DNA methylation of Cyclind-CDK4-p21 is associated with chronic fluoride poisoning

Endemic fluorosis is a serious problem in public health, affecting thousands of people. Abnormal proliferation and activation of osteoblasts in skeletal fluorosis lesions play a leading role and osteoblast proliferation is finely regulated by the cell cycle. There are a few reports on fluoride-induced DNA methylation. However, the role of DNA methylation of the cyclin/cyclin-dependent kinase (CDK)/cyclin-dependent kinase inhibitor (CKI) regulatory network in skeletal fluorosis has not been investigated. We used a population study and in vitro experiment to explore the relationship between the pathogenesis of skeletal fluorosis and methylation of Cyclin d1/CDK4/p21. The results showed a positive relationship between fluoride exposure and expression of Cyclin d1/CDK4, and a negative relationship between fluoride exposure and expression of P21. Hypermethylation of p21 was found in the fluoride-exposed population, and low expression of p21 attributed to promoter hypermethylation was confirmed in vitro. However, no changes in methylation levels of Cyclin d1 and CDK4 genes were observed in the population exposed to fluoride and NaF-treated osteoblasts. These results show that methylation of p21 gene has a significant impact on the proliferation of osteoblasts during the development of skeletal fluorosis. The present study was a first attempt to link the methylation of the Cyclin d1/CDK4/p21 regulatory network with osteoblast proliferation in skeletal fluorosis.

Subchronic exposure to arsenite and fluoride from gestation to puberty induces oxidative stress and disrupts ultrastructure in the kidneys of rat offspring

Underground drinking water is commonly contaminated with arsenite (As) and fluoride (F) associated with chronic kidney diseases in humans; however, the combined renal toxicity of these pollutants and the underlying mechanisms are still unclear. The aim of the present study was to investigate the interaction between As and F regarding toxic effects on the kidney of rat offspring exposed to pollutants during prenatal and postnatal development. Pregnant rats were randomly divided into four groups that received NaAsO₂ (50 mg/L), NaF (100 mg/L), NaAsO₂ (50 mg/L) and NaF (100 mg/L) in drinking water, or clean water, respectively, during gestation and lactation. After weaning, six male pups were randomly selected from each group and continued on the same treatment as their mothers for up to three months. The results revealed that subchronic exposure to high-dose As and/or F decreased the organ coefficient of the kidneys and disrupted kidney ultrastructure, moreover inhibited the activity of antioxidant enzymes and increased the generation of malondialdehyde in the kidney. As exposure alone or combined with F led to an upregulation of nuclear factor erythroid 2-related factor-2 (Nrf2) and its regulatory targets (Ho-1, Gclc, and Nqo1), whereas the effect of F alone was not significant. These results suggest that the renal toxicity of As and F is associated with the induction of mitochondrial damage and oxidative stress, and alters the expression of Nrf2 and its regulatory targets. Furthermore, variance analysis results showed that an interaction between As and F in the toxicity process.

Groundwater fluoride contamination and probabilistic health risk assessment in fluoride endemic areas of the Upper East Region, Ghana

Groundwater fluoride contamination has long been recognized as a water-related health issue in some parts of Ghana. However, the extent of fluoride contamination and the related human health risk to the communities in the fluoride endemic areas are not adequately studied. In this paper, fluoride concentrations in existing and newly drilled wells were assessed. Probabilistic non carcinogenic human health risk assessment, uncertainty and sensitivity analysis for three age groups (Group A: 0-10 years; Group B: 11-20 years; Group C: 21-72 years) was also carried out using Monte Carlo simulation technique. The results showed that, 27.27% and 15.38% of the existing wells in the Bongo and Kassena Nankana West districts have fluoride values above the guideline value 1.5 mg L^-1 respectively. The non-carcinogenic risk of fluoride associated with oral ingestion recorded a mean Hazard Quotient (HQ) > 1 for younger age group (0-10 years) in all the study areas signifying potential health risk to this age group. Additionally, when the upper 95th percentile is used for the HQ, the oral ingestion for all the age categories recorded an HQ > 1. Sensitivity analyses indicated that fluoride concentration in the drinking water and ingestion rate were the most relevant variables in the model to reduce the potential health effect. The study established the basis for a strong advocacy and public awareness on the effect of water quality on human health and proposed some management strategies to guide future groundwater resources management to reduce the potential health risk to the population.

Exploring a multi-exposure-pathway approach to assess human health risk associated with groundwater fluoride exposure in the semi-arid region of east India

Human health risks associated with groundwater fluoride have been assessed using USEPA method in few parts of India, but those assessments were conducted based on a single value for each parameter, which may lead to certain inaccuracy and uncertainties in results. In this study, a higher degree of accuracy in health risk assessment was achieved through Monte Carlo simulations, sensitivity analysis and uncertainty analysis. As fluoride hazards to human health are chronic, a total of 4560 water samples (N = 4560) were collected during consecutive four seasons (2 pre-monsoon and 2 post-monsoon seasons; 1140 samples/season) from the entire Birbhum district, covering all the blocks and geological settings to obtain the spatiotemporal variation of fluoride level. The Empirical Bayesian Kriging geostatistical model was employed to determine fluoride endemic areas. Amongst all blocks, Nalhati-1 had exhibited the highest fluoride level (18.25 mg/L). The study revealed that most of the blocks are vulnerable to groundwater fluoride due to its occurrences in excess level. The average and 95th percentile values of total hazard index indicate that the infants and children populations of the district are more susceptible than the adults and teens. The sensitivity analysis revealed that water ingestion rate and fluoride concentration are the most influential parameters for higher risk of fluoride-related health hazards. Health risks were evaluated through ingestion and dermal exposure routes for infants, children, teens, and adult residents. The exposure was much higher through ingestion than dermal contacts. Ingestion of defluoridated water will reduce the health risks associated with groundwater fluoride exposure.