Nutritional status and dental fluorosis among schoolchildren in communities with different drinking water fluoride concentrations in a central region in Mexico

Association between fluoride exposure and psychiatric disorders in adults

To explore the association between fluoride exposure and depression / anxiety in adults, the 1,169 participants were recruited. The demographic information of participants was obtained through questionnaire survey and physical measurements. Morning urine samples were collected, and urinary fluoride (UF) level was determined. Changes in depression and anxiety levels were evaluated using the Patient Health Questionnaire-2 and General Anxiety Disorder-2 scales. The association between psychiatric disorders and UF levels was analyzed. In the total population, the prevalence of depression and anxiety were 3.17% and 4.19%, respectively. These results showed no significant association between depression / anxiety scale scores and UF levels. Logistic regression suggested no significant association between depression / anxiety levels, and UF levels, but there was an interaction between UF and income on depression. Our findings highlighted the interaction between fluoride exposure and monthly income, which may affect depression in adults.

Molar-Incisor Hypomineralization Is Associated with the Prevalence of Thinness among Schoolchildren in Communities with Different Fluoride Levels in the Drinking Water

Objective

To examine the association between molar-incisor hypomineralization (MIH) and the prevalence of thinness among Mexican schoolchildren in communities with different fluoride levels in the drinking water.

Methods

A cross-sectional study on Mexican children (n = 488) selected from two communities presenting different concentrations of fluoride in the drinking water (1.0-1.40 ppm/F). The World Health Organization (WHO) growth standards were used to calculate BMI-for-age z-scores, with BMI z-score cutoff points of <-2.0, >+1.0, >+2.0 recommended for defining thinness, being overweight, and obesity. The presence and severity of MIH were evaluated using the European Academy of Paediatric Dentistry (EAPD) criteria. Multiple logistic regression analyses were used to assess the association, adjusting for confounders.

Results

The proportion of children presenting thinness, being overweight, and obesity was 8.2%, 23.6%, and 28.7%, respectively, while 21.5% of the schoolchildren had MIH, classified, by severity, as 9.6% mild, 6.4% moderate, and 5.5% severe. Of those schoolchildren presenting thinness, 16.2% had MIH, and only 6.0% did not (p  < 0.001). Finally, schoolchildren presenting thinness were more likely to present MIH (OR = 2.76 (CI 95% 1.33-5.73); p=0.006) than children with a normal BMI.

Conclusion

The present study found a relationship between thinness and the presence of MIH in schoolchildren, indicating the need for strategies and interventions aimed at preventing and controlling micronutrient deficiencies in the child population.

Unraveling gene expression and genetic instability in dental fluorosis: Investigating the impact of chronic fluoride exposure

Chronic fluoride exposure, even in small quantities, when continuously ingested by the human population, can lead to a significant public health concern known as fluorosis. Our understanding of the effects of fluoride on human health, as well as its potential to impact DNA, is limited. The present study aimed to assess genetic instability in 20 individuals diagnosed with dental fluorosis and 20 individuals without the condition from the state of Rio Grande do Sul, Brazil. The participants' dental fluorosis was evaluated using the Thylstrup-Fejerskov index (TF). To further evaluate genetic instability, several assays were conducted, including the alkaline and modified (+FPG) comet assay (using a visual score, VS), the buccal micronucleus (MN) cytome (BMCyt) assay, the cytokinesis-block MN (CBMN-Cyt) assay, and the measurement of telomere length (TL). In addition, the study utilized tools from Systems Biology to gain insights into the effects of fluoride exposure on humans, which aided in the selection and evaluation of mRNA expression levels of specific genes, namely PPA1 (inorganic pyrophosphatase 1), AQP5 (Aquaporin 5), and MT-ATP6 (Mitochondrially Encoded Adenosine Triphosphate Synthase Membrane Subunit 6). Furthermore, fluoride levels in the blood and urine were assessed using an ion-selective electrode, along with the evaluation of the inflammatory response in serum. The group with dental fluorosis exhibited 2.18 times higher MN frequencies specifically when assessed using the CBMN-Cyt assay, in comparison with individuals without fluorosis. Findings from the enzyme-modified comet assay indicated oxidative damage to purines in DNA. Furthermore, a decrease in TL was observed, along with elevated expression patterns of the PPA1 and AQP5 genes, and significant alterations in cytokine release. Significant correlations were identified between the TF and age, as well as the levels of necrotic cells. Additionally, noteworthy correlations were established between fluoride levels and the levels of MN, VS, and MT-ATP6. Although dental fluorosis results from fluoride exposure, our research highlights the potential influence of this condition on genomic instability and gene expression. Consequently, our findings stress the importance of continuously monitoring populations with a high incidence of dental fluorosis to enhance our comprehension of how genomic instability might correlate with the origins and consequences of health problems in these individuals.

A Systematic Review on Water Fluoride Levels Causing Dental Fluorosis

Dental fluorosis is a long-existing public health issue resulting from inequitable access to potable water. Socially disadvantaged rural communities in fluoride-endemic areas, where a conventional irrigation system is absent and groundwater containing natural fluoride is the predominant source of drinking water, face a significant oral public health threat. This study aimed to determine the association between water fluoride levels and dental fluorosis. A systematic review aligned with PRISMA principles was conducted using the SPIDER search methodology and relevant keywords on many search engines, such as Google Scholar, PubMed, Elsevier, Sage, Web of Science, Cochrane, and Scopus. This review sought to ascertain the PICO model’s application as a search strategy tool. The reviewers gathered and assessed 1164 papers from January 2010 to January 2023. In total, 24 research papers from diverse databases were included. Using the Newcastle–Ottawa Scale, grades resulting from several data screens were evaluated. According to a previous systematic review, there may be publication bias in studies examining the association between fluoride in drinking water and dental fluorosis. The findings of this systematic review indicate that subpar fluoride is detrimental to human health. The author outlines legislative tools and technological advancements that might reduce fluoride levels.

Relationships between dental fluorosis and fluoride concentrations in bottled water and groundwater in low-income children in Mexico

Introduction

The aim of the current study was to investigate associations between dental fluorosis in children living in low socioeconomic areas in Mexico, and fluoride concentrations in tap water, fluoride concentrations and in bottled water, and body mass index (BMI).

Methods

A cross-sectional study involving 585 schoolchildren aged 8-12 years was conducted in communities in a southern state of Mexico with >0.7 parts per million (ppm) fluoride in the groundwater. The Thylstrup and Fejerskov index (TFI) was used to evaluate dental fluorosis, and the World Health Organization growth standards were used to calculate age-adjusted and sex-adjusted BMI Z-scores. A BMI Z-score ≤ -1 SD was used as the cut-off point for thinness, and multiple logistic regression models for dental fluorosis (TFI ≥ 4) were constructed.

Results

The mean fluoride concentration in tap water was 1.39 ppm (SD 0.66), and the mean fluoride concentration in bottled water was 0.32 ppm (SD 0.23). Eighty-four children (14.39%) had a BMI Z-score ≤ -1 SD. More than half (56.1%) of the children presented with dental fluorosis in TFI categories ≥ 4. Children living in areas with higher fluoride concentrations in the tap water [odds ratio (OR) 1.57, p = 0.002] and bottled water (OR 3.03, p < .001) were more likely to have dental fluorosis in the severe categories (TFI ≥ 4). BMI Z-score was associated with the probability of dental fluorosis (TFI ≥ 4; OR 2.11, p < 0.001), and the effect size was 29.3%.

Discussion

A low BMI Z-score was associated with a higher prevalence of dental fluorosis in the severe category. Awareness of the fluoride concentrations in bottled water may help prevent dental fluorosis, particularly in children exposed to several high fluoride content sources. Children with a low BMI may be more vulnerable to dental fluorosis.

Fluoride presence in drinking water along the southeastern part of El Bajío Guanajuatense, Guanajuato, Mexico: sources and health effects

Drinking water with a high natural concentration of fluoride (F^-) has serious consequences for the health of the rural population in the state of Guanajuato, Mexico, where the water contains levels of F^- that are not allowed by national and international regulations (1.5 mg/L). This health problem is very common in multiple states throughout Mexico where drinking water is generally extracted from aquifers that are hosted in fractured volcanic rocks of the Tertiary. These aquifers show similar geological characteristics: deep basins that formed as a result of felsic eruptive events and the extensional deformation of the Basin and Range and are now filled with unconsolidated sediments. In this study, we assessed the occurrence of F in volcanic rocks collected at 11 sampling sites along the Sierra de Codornices in Guanajuato (ranging between 0.01299 and 0.146 wt%, average 0.039 wt%, and SD = 0.039 wt%; n = 10), a region where both rural and urban communities consume drinking water with a high F^- content (up to 7.1 (mg/L). The F content is dispersed in volcanic rocks, and the highest levels are present in felsic rocks. The statistical and hydrogeochemical results of a sampling campaign of 32 wells in the Juventino Rosas (JR) and Villagran (Vill) municipalities in 2019 suggest that F^- mobilization in groundwater is the product of silicate weathering and the dissolution of volcanic glass, alkaline desorption in the surfaces of F-containing minerals, and possibly ion exchange of minerals and clays or deep fluids enriched with F^-, in addition to the precipitation of carbonates that decrease the Ca²⁺ concentration in groundwater. All of these processes can be accelerated by groundwater geothermal characteristics within the study area. The hydrogeochemical, fluoride exposure risk, and fluoride pollution index (FPI) results, as well as the epidemiological survey, indicate that teenagers and older adults from Praderas de la Venta are at risk of exposure to F^- due to the high concentrations ingested over a long period, the toxicity of the element, and its ability to accumulate in the bones. Extended exposure to elevated levels increases the risk. This work allows us to observe how the populations of JR and Vill can be exposed to high F^- contents in drinking water due to the geological characteristics of the region.

Screening of differentially methylated genes in skeletal fluorosis of rats with different types and involvement of aberrant methylation of Cthrc1

Fluoride is a widespread pollutant in the environment. There is a high risk of developing skeletal fluorosis from excessive fluoride exposure. Skeletal fluorosis has different phenotypes (including osteosclerotic, osteoporotic and osteomalacic) under the same fluoride exposure and depends on dietary nutrition. However, the existing mechanistic hypothesis of skeletal fluorosis cannot well explain the condition's different pathological manifestations and their logical relation with nutritional factors. Recent studies have shown that DNA methylation is involved in the occurrence and development of skeletal fluorosis. DNA methylation is dynamic throughout life and may be affected by nutrition and environmental factors. We speculated that fluoride exposure leads to the abnormal methylation of genes related to bone homeostasis under different nutritional statuses, resulting in different skeletal fluorosis phenotypes. The mRNA-Seq and target bisulfite sequencing (TBS) result showed differentially methylated genes in rats with different skeletal fluorosis types. The role of the differentially methylated gene Cthrc1 in the formation of different skeletal fluorosis types was explored in vivo and in vitro. Under normal nutritional conditions, fluoride exposure led to hypomethylation and high expression of Cthrc1 in osteoblasts through TET2 demethylase, which promoted osteoblast differentiation by activating Wnt3a/β-catenin signalling pathway, and participated in the occurrence of osteosclerotic skeletal fluorosis. Meanwhile, the high CTHRC1 protein expression also inhibited osteoclast differentiation. Under poor dietary conditions, fluoride exposure led to hypermethylation and low expression of Cthrc1 in osteoblasts through DNMT1 methyltransferase, and increased the RANKL/OPG ratio, which promoted the osteoclast differentiation and participated in the occurrence of osteoporotic/osteomalacic skeletal fluorosis. Our study expands the understanding of the role of DNA methylation in regulating the formation of different skeletal fluorosis types and provides insights into new prevention and treatment strategies for patients with skeletal fluorosis.

Necessity to Pay Attention to the Effects of Low Fluoride on Human Health: an Overview of Skeletal and Non-skeletal Damages in Epidemiologic Investigations and Laboratory Studies

Due to the implementation of water improvement and fluoride reduction plans supported by central and local governments in recent years, areas with high fluoride exposure are being gradually decreased. Therefore, it is of practical importance to study the effect of low fluoride on human health. Epidemiologic investigations and in vivo and in vitro studies based on low fluoride have also confirmed that fluoride not only causes skeletal damage, such as dental fluorosis, but also causes non-skeletal damage involving the cardiovascular system, nervous system, hepatic and renal function, reproductive system, thyroid function, blood glucose homeostasis, and the immune system. This article summarizes the effects of low fluoride on human and animal skeletal and non-skeletal systems. A preliminary exploration of corresponding mechanisms that will help to fully understand the harm of low fluoride on human health was undertaken to provide the basis for establishing new water fluoride standards and help to implement individual guidance.

Plaster board waste (PBW) - A potential fluoride leaching source in soil/water environments and, fluoride immobilization studies using soils

Plaster board waste generated from industries, usually contains major proportion of calcium as calcium sulfate. In addition, fluoride is remarkably one among the constituents of this waste material which leaches off into the soil and aquatic environments and causes fluoride pollution. In order to simulate how the dumping of PBW causes fluoride contamination in soil and water sources, shaking and stirring based batch-mode leaching studies were conducted. These studies explored the leaching of fluoride as a function of particle size, agitation time, pH of the leaching solvent (distilled water), L/S (water: PBW) ratio, temperature and electrolytes. It was explored that 1 g of plaster board waste contains18.54 mg F per gram of PBP. High leaching of 3.72 mg F per liter was studied at pH 6.02 with Ca²⁺ and TDS contents of 1050 mg L^-1 and1640 mg L^-1 respectively. The influence of sodium electrolytes such as chloride, nitrate, hydrogen carbonate, carbonate, sulfate, borate, phosphate and acetate on the leaching of fluoride from PBW was studied. The influence of fluoride leaching by sodium phosphate recorded a high value of 12.75 mg L^-1 with no detectable amount of calcium ions. The influence of eight electrolytic mixtures each containing five sodium electrolytes on fluoride leaching corroborated the highest leaching in mixtures containing phosphate followed by hydrogen carbonate/carbonate. Solutions of calcium and aluminium chloride and their mixture were used to measure the rate of leachable fluoride in solution. Furthermore, the fluoride leaching at different temperatures and acids was studied. Naturally occurring soils when blended with PBW were observed to immobilize fluoride and lessened the amount of leaching fluoride in water. Various characterization studies such as FTIR, Raman, FESEM (with EDS), XRD and XPS were carried out for PBW and its treated samples using different electrolytes. Fluoride leaching proportionate to the precipitation of carbonate and phosphate was recorded in the case of appropriate electrolyte and mixtures.

L-arginine and lisinopril supplementation protects against sodium fluoride-induced nephrotoxicity and hypertension by suppressing mineralocorticoid receptor and angiotensin-converting enzyme 3 activity

Sodium fluoride (NaF) is one of the neglected environmental toxicants that has continued to silently cause toxicity to both humans and animals. NaF is universally present in water, soil, and atmosphere. The persistent and alarming rate of increase in cardiovascular and renal diseases caused by chemicals such as NaF in mammalian tissues has led to the use of various drugs for the treatment of these diseases. The present study aimed at evaluating the renoprotective and antihypertensive effects of L-arginine against NaF-induced nephrotoxicity. Thirty male Wistar rats (150-180 g) were used in this study. The rats were randomly divided into five groups of six rats each as follows: Control, NaF (300 ppm), NaF + L-arginine (100 mg/kg), NaF + L-arginine (200 mg/kg), and NaF + lisinopril (10 mg/kg). Histopathological examination and immunohistochemistry of renal angiotensin-converting enzyme (ACE) and mineralocorticoid receptor (MCR) were performed. Markers of renal damage, oxidative stress, antioxidant defense system, and blood pressure parameters were determined. L-arginine and lisinopril significantly (P < 0.05) ameliorated the hypertensive effects of NaF. The systolic, diastolic, and mean arterial blood pressure of the treated groups were significantly (P < 0.05) reduced compared with the hypertensive group. This finding was concurrent with significantly increased serum bioavailability of nitric oxide in the hypertensive rats treated with L-arginine and lisinopril. Also, there was a significant reduction in the level of blood urea nitrogen and creatinine of hypertensive rats treated with L-arginine and lisinopril. There was a significant (P < 0.05) reduction in markers of oxidative stress such as malondialdehyde and protein carbonyl and concurrent increase in the levels of antioxidant enzymes in the kidney of hypertensive rats treated with L-arginine and lisinopril. The results of this study suggest that L-arginine and lisinopril normalized blood pressure, reduced oxidative stress, and the expression of renal ACE and mineralocorticoid receptor, and improved nitric oxide production. Thus, L-arginine holds promise as a potential therapy against hypertension and renal damage.

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.

Arsenic and fluoride co-exposure through drinking water and their impacts on intelligence and oxidative stress among rural school-aged children of Lahore and Kasur districts, Pakistan

Arsenic (As), and fluoride (F^-) are potent contaminants with established carcinogenic and non-carcinogenic impacts on the exposed populations globally. Despite elevated groundwater As and F^- levels being reported from various regions of Pakistan no biomonitoring study has been reported yet to address the co-exposure impact of As and F^- among school children. We aimed to investigate the effects of these two contaminants on dental fluorosis and intelligence quotient (IQ) along with the induction of oxidative stress in rural children under co-exposed conditions. A total of 148 children (5 to 16 years old) from the exposed and control group were recruited in the current study from endemic rural areas of Lahore and Kasur districts, Pakistan having elevated As and F^- levels in drinking water than permissible limits. We monitored malondialdehyde and its probable association with antioxidants activity (SOD, CAT, and GR) as a biomarker of oxidative stress. GSTM1/T1 polymorphisms were measured to find the impact of As on health parameters. Mean urinary concentrations of As (2.70 vs. 0.016 µg/L, P < 0.000) and F^- (3.27 vs. 0.24 mg/L, P < 0.000) as well as the frequency of dental fluorosis were found elevated among the exposed group. The cases of children with lower IQ were observed high in the exposed group. Additionally, lower concentrations of antioxidants (SOD, CAT, and GR) were found suggesting high susceptibility to F^- toxicity. The findings suggest that F^- accounted for high variations in health parameters of children under the co-exposure conditions with As.

Urinary fluoride and micronutrients intake in children from San Luis Potosi, Mexico

To assess the relationship between urinary fluoride and micronutrients intake we recruited 121 schoolchildren from San Luis Potosí. We evaluated fluoride concentrations in drinking water and urine with the ion-selective electrode method and estimated calcium, magnesium, and phosphorus intakes with a validated consumption frequency questionnaire. About 72% of the population used tap water for drinking and cooking. Fluoride concentrations were 2.36 ± 0.02 mg/L in tap water, 0.14 ± 0.04 mg/L in bottled water and 2.05 ± 0.62 mg/L in urine. Urinary fluoride was higher in children with a consumption <50% of the Recommended Daily Intake (RDI) of calcium (2.20 v/s 1.96 mg/L; p < 0.05), <50% RDI of magnesium (2.58 v/s 1.96 and 1.90 mg/L; p < 0.05) and >150% RDI of phosphorus (2.43 v/s 1.82 mg/L; p < 0.05). These data indicated that fluoride concentration in tap water is higher than bottled water and estimated micronutrients intake is related to urinary fluoride.

Fluoride levels in river water from the volcanic regions of Cauca (Colombia)

Fluoride concentrations of 0.5 mg/L in drinking water are considered useful for dental caries prevention. However, fluoride concentrations higher than 1.2 mg/L in water can pose a risk of dental fluorosis due to high exposure to fluoride. The objective is to determine the fluoride concentration in water from aqueducts of different Colombian municipalities of Cauca (Popayán, Coconuco, and Puracé) to assess the fluoride dietary intake from the consumption of this water. A total of 66 water samples have been taken from Popayán, Coconuco, and Puracé. Fluoride content was determined by fluoride ion-selective electrode (ISE) potentiometry. The fluoride concentrations recorded in Coconuco and Puracé water were ≤ 0.002 mg/L. The mean fluoride content recorded in the Popayán water was 0.42 mg/L, with its highest concentration in Cauca River water (0.83 mg/L). Considering the admissible intake values, the water from Popayán confers remarkable fluoride intakes, especially in children with high percentages of contribution to the admissible daily intake (46.7% to 7- to 12-month children and 41.5% to 1- to 3-year children). The fluoride content in the water of Coconuco and Puracé does not reach an optimal value (< 0.5 mg/L) for the protective effect against dental caries, while the water of the main Cauca River basin does reach the optimal value. Likewise, the intake of fluoride from the consumption of the analyzed water does not confer any health risk. However, the implementation of monitoring systems for fluoride levels is recommended in order to safeguard the consumer's health.

Comparison of Water Defluoridation Using Different Techniques

Fluoride pollution in subsurface water is a significant problem for different nations across the world because of the intake of excessive fluoride caused by the drinking of the contaminated subsurface. Water pollution by flouride can be attributed to the natural and human-made agents. Increased levels of fluoride in drinking water may result in the irretrievable demineralization of bone and tooth tissues, a situation called fluorosis, and other disorders. There has long been a need for fluoride removal from drinking water to make it safe for human use. Among the various fluoride removal methods, adsorption is the method most popularly used due to its cheap cost, ease of utilization, and being a scalable and simple physical technique. According to the findings of this study, the highest concentration of fluoride (0.1–15.0 mg/L) was found in Sweden and the lowest (0.03–1.14 mg/L) in Italy. We collected the values of adsorption capacities and fluoride removal efficiencies of various types of adsorbents from valuable released data accessible in the literature and exhibited tables. There is still a need to find the actual possibility of using biosorbents and adsorbents on a commercial scale and to define the reusability of adsorbents to decrease price and the waste generated from the adsorption method. This article reviews the currently available methods and approaches to fluoride removal of water.

The cholinergic system, intelligence, and dental fluorosis in school-aged children with low-to-moderate fluoride exposure

Disruption of cholinergic neurotransmission can affect cognition, but little is known about whether low-to-moderate fluoride exposure affects cholinergic system and its effect on the prevalence of dental fluorosis (DF) and intelligence quotient (IQ). A cross-sectional study was conducted to explore the associations of moderate fluoride exposure and cholinergic system in relation to children's DF and IQ. We recruited 709 resident children in Tianjin, China. Ion selective electrode method was used to detect fluoride concentrations in water and urine. Cholinergic system was assessed by the detection of choline acetyltransferase (ChAT), acetylcholinesterase (AChE) and acetylcholine (ACh) levels in serum. Compared with children in the first quartile, those in fourth quartile the risk of either developing DF or IQ < 120 increased by 19% and 20% for water and urinary fluoride. The risk of having both increased by 58% and 62% in third and fourth quartile for water fluoride, 52% and 65% for urinary fluoride. Water fluoride concentrations were positively associated with AChE and negatively associated with ChAT and ACh, trends were same for urinary fluoride except for ACh. The risk of either developing DF or having non-high intelligence rose by 22% (95%CI: 1.07%, 1.38%) for the fourth quartile than those in the first quartile of AChE, for having the both, the risk was 1.27 (95%CI: 1.07, 1.50), 1.37 (95%CI: 1.17, 1.62) and 1.44 (95%CI: 1.23, 1.68) in second, third and fourth quartiles. The mediation proportion by AChE between water fluoride and either developing DF or IQ < 120 was 15.7%. For both to exist, the proportion was 6.7% and 7.2% for water and urinary fluoride. Our findings suggest low-to-moderate fluoride exposure was associated with dysfunction of cholinergic system for children. AChE may partly mediate the prevalence of DF and lower probability of having superior and above intelligence.

Modeling and experimental approaches for determining fluoride diffusion kinetics in bone char sorbent and prediction of packed-bed groundwater defluoridator performance

Fluoride (F) in groundwater (GW) in excess of 1.5 mg/L is a globally distributed problem impacting the health of hundreds of millions of people, many of whom cannot access centralized treatment infrastructure. Animal (e.g., cow) bone char has received emerging interest as a low-cost F sorbent for use in decentralized household and community water treatment. Pilot column tests using full-sized granular bone char particles can be used to assess treatment performance of fixed-bed contactors, but are costly, time consuming, and require large amounts of test water. Rapid small-scale column tests (RSSCTs) can be used to simulate F uptake in bone char contactors if the relationship between F intraparticle diffusion kinetics and bone char particle size is known. Two common approaches to the RSSCT assume either constant (CD) or linear proportional (PD) sorbate diffusivity as a function of sorbent particle size. This study used experimentally determined pseudo-equilibrium and kinetic F sorption data in model groundwater as inputs to the homogeneous surface diffusion model (HSDM) to determine F intraparticle diffusion coefficients for different-sized bone char particles, and to fit RSSCT and pilot column breakthrough data to evaluate CD and PD approaches. Results of this study, corroborated by incorporation of additional literature data, indicate approximately linearly proportional diffusivity of F as a function of bone char particle size. Congruently, the PD-RSSCT approach provided a superior simulation of pilot column F breakthrough compared to the CD-RSSCT. PD-RSSCT breakthrough data closely matched pilot breakthrough on a scaled service time basis up to around 500 bed volumes, corresponding to a relative F breakthrough of about 40%, and provided a slightly conservative indicator of F removal thereafter. The PD-RSSCT was compared with a hybrid modeling and empirical workflow using the HSDM with experimentally determined pseudo-equilibrium and kinetic parameter inputs as time-and-cost-saving approaches to evaluating full-sized groundwater treatment system performance. This comparison and a sensitivity analysis of HSDM input parameters used in the hybrid workflow indicated that greater precision can be obtained using the PD-RSSCT.

WITHDRAWN: Co-exposure effects of arsenic and fluoride on intelligence and oxidative stress in school-aged children: A cohort study

This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause.

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.

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.

Bioaccumulation of arsenic and fluoride in vegetables from growing media: health risk assessment among different age groups

The current study was conducted to evaluate the arsenic (As) and fluoride (F^-) concentrations in growing media (stored rainwater and soil), of district Tharparkar, Pakistan. The bioaccumulation/transportation of As and F from growing media to different types of vegetables (wild cucumis, Indian squish and cluster bean) was evaluated. Total concentrations of As and F^- in stored rainwater samples were observed up to 585 μg/L and 32.4 mg/L, respectively, exceeding many folds higher than WHO provisional guideline values. The As and F^- contents in soil samples of nine agricultural sites were found in the range of 121-254 mg/kg and 115-478 mg/kg, respectively. The highest contents of As and F^- were observed in wild cucumis as compared to Indian squish and cluster bean (p < 0.05), grown in the same agricultural field. The bioaccumulation factors of As and F^- were to be > 4.00, indicating the high rate of transportation of As and F^- from growing media to vegetables. A significant positive correlation of As and F^- in vegetables with their concentrations in soil and water was observed (r > 0.60 with p < 0.05). The risk assessment elucidated that the population of different age group consuming local vegetables and drinking water contaminated with As and F^- may have adverse health effects.

Engineered nanomaterials for water decontamination and purification: From lab to products

Clean water is vital for life; it is required not only for drinking but also for the preparation of food and proper hygiene. Unfortunately, more than fifty percent of the world population mainly in China and India face a severe scarcity of water. Around 1.8 billion people inevitably drink water from sources having fecal contamination resulting in the death of about a million children every year. Scientists are developing various economic technologies to decontaminate and purify water. Nanomaterials-based technology offers an economic and effective alternative for water purification and decontamination. As nanomaterials are available globally, have remarkable antimicrobial activity and the ability to effectively remove organic and inorganic pollutants from water. This review discusses the potential role of nanomaterials in the purification of drinking water. As nanomaterials exhibit remarkable antimicrobial and antiparasitic activities against waterborne pathogens and parasites of primary concern like Shigella dysenteriae, Vibrio cholera, and Entamoeba histolytica. Nanomaterials also demonstrate the ability to absorb toxic chemicals like mercury and dyes from polluted water. However, for successful commercialization of the technology, some inherent bottlenecks need to be addressed adequately. These include nanoparticles aggregation, their seepage into drinking water and adverse effects on human health and the environment. Nanocomposites are being developed to overcome these problems and to combine two or more desirable properties for water purification. Widespread and large-scale use of nanomaterials for water purification soon may become a reality. Products containing nanomaterials such as Karofi, Lifestraw, and Tupperware for water purification are already available in the market.

Fluoride contamination in groundwater sources in Southwestern Nigeria: Assessment using multivariate statistical approach and human health risk

The present study investigated the ionic and fluoride concentrations in tap water and its associated health risk to local dwellers of Ogun State (Abeokuta south), Nigeria. 63 samples were collected from twenty-one different locations. Results obtained revealed the mean concentration of fluoride (F^-) as 1.23 mg/L. Other water quality parameters such as total dissolved solids (TDS), electrical conductivity (EC), F^-, Fe^2+, and SO₄^2- surpassed the WHO guidance for drinking water. Strong positive correlation was observed between F^- and TDS; F^- and pH; TDS and EC; TDS and Mg²⁺; TDS and SO₄^2-; TDS and HCO₃^-; EC and HCO₃^-; EC and SO₄^2-; Na⁺ and Cl^-; SO₄^2- and Cl^-. In addition, Empirical Bayesian Kriging (EBK) model was employed to spatially distribute the concentration of the analyzed elements within the study region. The chronic daily dose (CDD) and hazard quotient (HQ) were also used to evaluate the health risk associated with F^-, considering dermal and ingestion as pathways. The results revealed that the associated HQ for infants between the age range of 6-12months within about 91% of the study region surpassed the accepted HQ limit. However, the HQ for age categories 11-16years; >65years; 18-21years; 21years; 16-18years within 95.2%, 90.5%, 80.95% and 100% of the study location were less than 1. Conclusively, the HQ values obtained in this study should serve as a baseline information for water management authorities, policymakers and the society at large towards addressing these pollution issues.

Changing recharge pathways within an intensively pumped aquifer with high fluoride concentrations in Central Mexico

Fluoride (F), naturally found in aquifers around the world at toxic concentrations, causes disease in millions of people. The long-term stability, however, of those concentrations within intensively pumped aquifers is poorly characterized. We assessed long-term stability in the spatial distribution of F concentrations in an intensively pumped aquifer within the semi-arid, inter-montane Independence Basin in central Mexico between 1999 and 2016. Although stable in 16 re-sampled wells, F concentrations increased in some localities across the basin by as much as 4mg/L. Changes in recharge pathways to the deep aquifer were identified by analyzing changes in δ²H, δ¹⁸O and Cl/Br mass ratios. In 1999, δ²H and δ¹⁸O values suggested the aquifer was recharged in the mountains. In 2016, however, substantial increases in δ¹⁸O values in the center of the basin suggest recharge water is derived from rainfall that had experienced increased evaporation. In 1999, the mass ratio Cl/Br in groundwater was slightly enriched over local rainfall, and followed a single mixing line on a plot of Cl. vs. Cl/Br. In 2016, however, three distinct groupings of wells were evident, all following different mixing lines. These changes suggest input from new sources including urban sewage, evaporate dissolution, connate sea water and geothermal waters. Step-wise multiple regression was used to quantify the impact of physical and chemical parameters on F concentrations. In 1999, Li (6.8±1.7) and Na (0.01±0.004) drove F concentrations (R²=0.54). In 2016, Na (0.013±0.0018), HCO₃ (0.004±0.001), Ca (-0.0018±0.00045), and Mg (-0.055±0.023) drove F concentrations (0.78). Irrigation pumping and urban expansion within semi-arid, groundwater-dependent, inter-montane basins drive mixing of disparate groundwater chemistries and introduces new sources of recharge to aquifers inducing changes in aquifer chemistry including increasing concentrations of geogenic toxic elements.

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.

Evaluation of exposure to fluoride in child population of North Argentina

Fluoride is an important element for humans. It inhibits initiation and progression of dental caries and stimulates bone formation. However, excessive intake may lead to the appearance of dental and/or skeletal fluorosis and a decrease in intellectual coefficient in child populations. This study evaluates exposure to fluoride in the child population of Chaco province (Argentina) by analysis of drinking water, food and its bioaccessible fraction (quantity of fluoride solubilised by gastrointestinal digestion and available for intestinal absorption) and urine as a biomarker of internal dose. The concentration of fluoride in drinking water varied between 0.050 and 4.6 mg L^-1, and 80% of the samples exceeded the WHO drinking-water guideline value (1.5 mg L^-1). Fluoride concentrations in food ranged between 0.80 and 3.0 mg kg^-1 fresh weight (fw), being lower in bioaccessible fraction (0.43-1.9 mg kg^-1, fw). On the basis of the consumption data declared for the young child population, fluoride intake varies between 4.1 and 6.5 mg day^-1, greater than the level recommended for this age group. Moreover, in some cases, concentrations of fluoride found in urine (0.62-8.9 mg L^-1) exceeded those reported in areas with declared fluorosis. All data obtained show the worrying situation of child population in this area of Argentina.

Determination of Fluoride in Organic and Non-organic Wines

Fluorine is an element of great importance to human health, as it is considered to be an essential element. However, both a deficiency and an excess, it can cause various problems. It is for this reason that values have been established regarding the recommended daily intake (RDI) and acceptable daily intake (ADI). The largest source of incorporation of fluoride is water, but it can be found in other foods and beverages, such as vegetables, tea, and wine. The aim of the study was to establish the fluoride concentration in organic and non-organic wines from different appellations of origin of the Canary Islands and mainland Spain, in order to assess the contribution of fluoride and toxic risk. A total of 53 samples of red, white, and rosé wines, both organic and non-organic, from different appellations of origin were analyzed. They were analyzed by potentiometric determination with ion-selective electrode for fluoride using the method of standard addition. The wines analyzed are within the recommended limits set by the International Organisation of Vine and Wine. RDI is not exceeded for adults, taking into account the data provided by the Spanish Agency for Consumer Affairs, Food Safety and Nutrition on the average consumption of "table wines" in Spain. Fluoride intake from wine poses no risk to the health of adults. The fluoride concentration of organic and non-organic wines is within the range of 0.03 to 0.70 mg/L.

Development of an Inner Filter Effects-Based Upconversion Nanoparticles-Curcumin Nanosystem for the Sensitive Sensing of Fluoride Ion

This paper describes a novel ratiometric fluorescence-based sensor for the detection of fluoride ion. Yb³⁺, Er³⁺, and Tm³⁺ codoped NaYF₄ upconversion nanoparticles (UCNPs), which can emit fluorescence at 546, 657, 758, and 812 nm under the 980 nm single wavelength excitation, were synthesized, amino-modified and applied as the fluorescent signal indicator. The natural chemical curcumin served as specific recognition element and mixed with UCNPs to make a nanosystem. In this nanosystem, the absorption peak of curcumin shows a bathochromic shift when F^- was added, causing an upconversion fluorescence quenching at 546 and 657 nm through inner filter effects (IFE), whereas the upconversion emission at 758 and 812 nm remained unchanged. Thus, the fluorescence ratio I₅₄₆/I₇₅₈ was inversely proportional to F^- concentration. Meanwhile, the large absorption bathochromic shift also lead to a color change, based on the colorimetric analysis of F^- by the naked eye. Under the optimized conditions, the developed UCNPs-curcumin mixed system achieved the colorimetric and ratiometric fluorescence sensing toward F^- in the linear range of 25-200 μM and 5-200 μM, with the detection limits as low as 25 μM (ca. 0.48 ppm) and 5 μM (ca. 0.10 ppm), respectively. The developed nanosystem also has high selectivity and antijamming ability. Furthermore, this method showed promising practical applications in spiked real samples (ex., tap water and milk) with recoveries of 79.58% to 134.02% and RSD values in the range of 0.94% to 22.11%, which confirmed its great potential in harmful substance detection.

Histopathological findings of renal tissue induced by oxidative stress due to different concentrations of fluoride

It has been reported that excessive intake of fluoride can induce renal lesions. However, its pathogenesis is still less understood. Therefore, this study was conducted to investigate oxidative damage and the relationships between the oxidative damage and renal lesions in fluoride-treated mice by using the methods of histopathology, biochemistry, flow cytometry and quantitative real-time polymerase chain reaction (qRT-PCR). A total of 240 ICR mice were randomly divided into four equal groups (sodium fluoride was given orally at the dose of 0, 12, 24 and 48 mg/kg body weight for 42 days, respectively). We found that fluoride in excess of 12 mg/kg induced renal oxidative damage, which was characterized by increasing the levels of reactive oxygen species (ROS) production and contents of malondialdehyde (MDA) and protein carbonyls (PC), and decreasing the abilities of anti-superoxide anion (ASA) and anti-hydroxyl radical (AHR), glutathione (GSH) content, as well as activities and mRNA expression levels of superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR) and glutathione peroxidase (GSH-Px). Concurrently, fluoride caused degeneration and necrosis of the tubular cells, renal tubular hyaline casts and glomeruli swelling, which were consistent with the alteration of renal function parameters including elevated contents of serum creatinine (Cr), serum uric acid (UA), blood urea nitrogen (BUN), and the activities of urinary N-acetyl-b-D-glucosaminidase (NAG), renal lactate dehydrogenase (LDH), and reduced activities of sodium-potassium adenosine triphosphatase (Na+/K+-ATPase) and acid phosphatase (ACP) in the kidney. The above-mentioned results showed that fluoride in excess of 12 mg/kg induced renal oxidative damage, which then caused renal lesions and dysfunctions. These findings also clearly demonstrated that oxidative damage is one of the mechanisms of fluoride-induced renal lesions and dysfunctions.

Enzymatic Activity of Glutathione S-Transferase and Dental Fluorosis Among Children Receiving Two Different Levels of Naturally Fluoridated Water

This study was conducted to measure the activity of the enzyme glutathione S-transferase (GST) in saliva and to compare the activity of this enzyme in children with and without dental fluorosis in communities with different concentrations of naturally fluoridated water. A total of 141 schoolchildren participated in this cross-sectional study. Children were selected from two communities: one with a low (0.4 ppm) and the other with a high (1.8 ppm) water fluoride concentration. Dental fluorosis was evaluated by applying the Thylstrup and Fejerskov Index (TFI) criteria. Stimulated saliva was obtained, and fluoride concentration and GST activity were measured. The GST activity was compared among children with different levels of dental fluorosis using multinomial logistic regression models and odds ratios (OR). The mean age of the children was 10.6 (±1.03) years. Approximately half of the children showed dental fluorosis (52.5 %). The average GST activity was 0.5678 (±0.1959) nmol/min/μg. A higher concentration of fluoride in the saliva was detected in children with a higher GST activity (p = 0.039). A multinomial logistic regression model used to evaluate the GST activity and the dental fluorosis score identified a strong association between TFI = 2-3 (OR = 15.44, p = 0.007) and TFI ≥ 4 (OR = 55.40, p = 0.026) and the GST activity level, compared with children showing TFI = 0-1, adjusted for age and sex. Schoolchildren with higher levels of dental fluorosis and a higher fluoride concentration in the saliva showed greater GST activity. The increased GST activity most likely was the result of the body's need to inactivate free radicals produced by exposure to fluoride.

Effect of dietary protein or calcium supplement on the expression of collagen I and dentine phosphoprotein of rats with dental fluorosis

This study aims to assess the roles of dietary protein (Pr) and calcium (Ca) levels associated with excessive fluoride (F) intake and the impact of Pr, Ca, and F on expression of collagen I (COL I) and dentine phosphoprotein (DPP) in rat incisors. Seventy-two rats were randomly allotted to six groups (NC, NC + F, LPrLCa, LPrLCa + F, HPrLCa + F and LPrHCa + F). F, Pr, and Ca were orally administrated to rats for 120 days. The genes and proteins expression levels were quantified. We found that levels of COL1A1 and DSPP gene were respectively decreased by 41.9% and 43.1% in the NC + F group compared with NC group, were respectively decreased by 47.9% and 40.8% in the LPrLCa + F group compared with LPrLCa group, were respectively increased by 71.8% and 39.5% in the HPrLCa + F group and increased by 26.5% and 21.1% in the LPrHCa + F group compared with LPrLCa + F group. Meanwhile, the proteins' expression display with the genes' expression changes were consistent. This study demonstrated that the gene and protein expressions of COL I and DPP were reduced by F both in normal nutrition and malnutrition, and it was reversed by Pr and Ca supplementation, with the effect of Pr being greater than that of Ca.

The prevalence of dental fluorosis and exposure to fluoride in drinking water: A systematic review

Background. Regarding the lack of comprehensive systematic review on the efficacy of water fluoridation and prevalence of dental fluorosis, the aim of the current research was to systematically study the prevalence of dental fluorosis at different levels of water fluoride in the world and lay emphasis on the amount of fluoride in drinking water.

Methods. Studies were searched in PubMed, Scopus, SID, and IranMedex, with regard to inclusion criteria. Study validity was assessed with some checklists, and analyses were performed to ascertain the prevalence of dental fluorosis among individuals categorized in age groups.

Results. Investigation of the heterogeneity and analysis of the subgroups revealed that in the 6-18 year age group, when water fluoride level was less than 0.7 ppm and there was exposure to water fluoride in the first 6-8 years of life, no significant heterogeneity was detected among the studies in this subgroup. Thus, the pooled estimation of dental fluorosis prevalence in this subgroup was 12.9% (95% CI: 7.5-18.3%). Furthermore, meta-regression indicated that the exposure time to fluoride in drinking water, or exposure to fluoride in supplements, diets, air, etc as well as the quality of studies had a significant relation to the difference in the prevalence of dental fluorosis.

Conclusion. The results revealed no heterogeneity in just 2 subgroups, and the results of subgroups could be pooled in them. Furthermore, the number of studies included in this review considerably decreased by considering all the detected confounding factors, whereas other similar systematic reviews mentioned at most 2 factors.

Preliminary human health risk assessment of arsenic and fluoride in tap water from Zacatecas, México

Zacatecas state is located in the central area of Mexico, where the underground water contains elevated quantities of natural arsenic and fluoride. In order to estimate health risk associated with human exposure to these pollutants, tap water samples from the southern-central region of the state were analyzed. Ninety percent of the samples exceeded the levels of arsenic established by the World Health Organization (WHO) of 0.01 mg/L and 43 % exceeded the limit established by the NOM-127-SSA1(1) of 0.025 mg/L. Forty-three percent of the samples had fluoride levels above the Mexican regulation limit of 1.5 mg/L (NOM-127-SSA1). We used WHO and EPA's health risk assessment method, we estimated 80 % of the inhabitants of sites studied could be exposed to arsenic levels higher than those recommended by EPA and the WHO, 22 % could be exposed to fluoride levels higher than those recommended by EPA, and 16 % of the local population may be in risk of suffering dental fluorosis.

Dental fluorosis, fluoride in urine, and nutritional status in adolescent students living in the rural areas of Guanajuato, Mexico

Objective:

The aim of this study was to assess urine fluoride concentration, nutritional status, and dental fluorosis in adolescent students living in the rural areas of Guanajuato, Mexico.

Materials and Methods:

A cross-sectional study was conducted including participants aged 11–20 years. The presence and severity of dental fluorosis was registered according to the Thylstrup and Fejerskov index (TFI) criteria. Anthropometric measures were also recorded. Urine sample of the first morning spot was recollected to assess urine fluoride concentration by using the potentiometric method with an ion-selective electrode. Water samples were also recollected and analyzed. Bivariate tests were performed to compare urine fluoride concentration according to different variables such as sex, body mass index, and TFI. Nonparametric tests were used. A logistic regression model was performed (SPSS® 21.0).

Results:

This study included 307 participants with a mean age of 15.6 ± 1.6; 62.5% of the participants showed normal weight. A total of 91.9% of the participants had dental fluorosis, and 61.6% had TFI > 4. Mean fluoride content in urine ranged between 0.5 and 6.65 mg/L, with a mean of 1.27 ± 1.2 mg/L. Underweight children showed greater urine fluoride concentration. The increment of urine fluoride was a related (OR = 1.40) to having severe dental fluorosis.

Conclusions:

Most of the studied population had moderate or severe dental fluorosis. Urine fluoride concentration was related to fluorosis severity and nutritional status. Underweight children showed greater urine fluoride concentration as well as severe dental fluorosis.