Fluoride levels in drinking water in the Central Province of Saudi Arabia

Fluoride levels in Almadinah Almunawwarah bottled water

Objectives

This research aimed to determine the fluoride levels in commercially available bottled waters and assess the accuracy of the fluoride levels labels on the bottles.

Methods

We obtained the labels from 28 water bottles from markets in Almadinah Almunawwarah. Water samples were diluted with an equal volume of total ionic strength adjustment buffer at the General Administration for Water Services. The electrode potential of each sample was then directly compared to standard fluoride solutions. For each sample, two readings were taken, and the average was recorded. Fluoride-ion levels were determined using a fluoride-ion-selective electrode and a digital readout ion meter.

Results

On average, the mean fluoride levels in the labelled bottles were 0.94 ± 0.14 PPM. The level of the actual fluoride content was 1.13 ± 0.31 PPM. Inconsistencies between the brand labels and true levels of fluoride were detected. Only one brand of bottled water was comparable in terms of the fluoride levels on the labels and the analysed fluoride levels. Only 85.71% of the brands tested had fluoride levels within the permissible fluoride range (0.6-1.5 PPM), 10.71% had fluoride levels above the permissible fluoride range, and 3.57% had fluoride levels below the permissible fluoride range.

Conclusions

In the KSA, most brands of bottled waters had fluoride levels above the ideal levels that are vital to the prevention of dental caries. There were differences in the fluoride levels recorded on the labels and the true levels determined in the laboratory. Fluoride levels must be accurately reported if we are to achieve necessary aesthetic and cosmetic benefits. Bottled water must meet critical quality standards to avoid the negative consequences of higher fluoride levels. Dentists and parents should be aware of this discrepancy.

Prevalence of Caries among School Children in Saudi Arabia: A Meta-Analysis

Introduction

Children's dental health has become the primary concern, because of the increase in the prevalence of caries amongst school children in Saudi Arabia. Therefore, a meta-analysis was conducted to assess the prevalence and severity of dental caries among school children in Saudi Arabia.

Method

A systematic search of Scopus, ISI Web of Science, EMBASE, Saudi digital library, Google Scholar, and MEDLINE via Ovid for cross-sectional studies with healthy participants between 5and –15 years. Two authors independently extracted the prevalence of caries. With 95% confidence intervals (CIs) using a random-effects model, we calculated caries prevalence.

Results

Dental caries prevalence data were extracted from 18 cross-sectional studies (n = 56,327 children). The pooled estimate for the caries prevalence among 5–7 years' children was 84% (95% CI: 0.81–0.87%; I² = 91%) while among 12–15 years' children was 72% (95% CI: 0.63–0.79; I² = 96.2%). Discussion. In this systematic review, the summary estimate of the prevalence of dental caries among children of 5–7 years and 12–15 years were 84% and 72%, respectively. Further research is required to identify approaches for preventing and treating dental caries in schoolchildren.

Caries prevalence and severity in association with sociodemographic characteristics of 9-to-12-year-old school children in Al-Madinah, Saudi Arabia

Aim

This study was conducted to estimate the prevalence and severity of dental caries in 9-to-12-year-old schoolchildren in Al-Madinah, Saudi Arabia (SA); to compare its expression by mean of decayed, missing and filled teeth (dmft/DMFT) and the Significant Caries Index (SiC Index); to examine the association between caries experience and sociodemographic factors; and to determine whether schoolchildren in Al-Madinah are at greater risk for high levels of dental caries.

Materials and methods

Data of 1,000 schoolchildren aged 9–12 years old from a cross-sectional oral health survey in Al-Madinah, SA was obtained and analysed. Dental caries was measured using dmft/DMFT and the SiC Index which was computed into two groups: highest 30% DMFT scores (SiC³⁰) and highest 10% DMFT scores (SiC¹⁰). Sociodemographic variables included age, gender, nationality, school type (public or private) and family income. Descriptive and inferential were calculated to estimate caries prevalence and severity and its association with sociodemographic factors.

Results

Caries prevalence in primary or permanent teeth was 85.1%, with untreated caries of 76.1%. The mean dmft was 2.66 ± 2.63 while the mean DMFT was 1.43 ± 1.73. Caries severity was significantly higher among males, Saudis, those from low-income families and those from public schools (p < 0.05). The mean values of SiC³⁰ (3.52 ± 1.57) and SiC¹⁰ (4.98 ± 1.77) were considerably higher than the overall average DMFT value.

Conclusion

Dental caries persists as a public health challenge among schoolchildren in Al-Madinah, SA, with a very high prevalence and severity among schoolchildren. The use of the SiC Index highlighted the subgroups with more severe caries experience.

Comparison of oral health indicators between two places of endemic dental fluorosis in Jordan

INTRODUCTION

Excessive fluoride intake during tooth development causes dental fluorosis.

AIM

This study aimed to (1) determine the prevalence of dental fluorosis in association with fluoride concentrations in drinking water, (2) explore the effects of altitude on the severity of fluorosis in two towns with high fluoride levels in the drinking water, and (3) assess decayed, missing, and filled teeth (DMFT) and oral hygiene practices among participants.

MATERIAL AND METHODS

The sample consisted of 100 and 141 schoolchildren, aged 15.3 ± 1.4 and 16.1 ± 1.3 years, living in Ruwaished and Kuraymah, respectively. Oral examinations were carried out, and dental fluorosis was assessed using the Dean's index. The DMFT index was also used for assessment. Samples of drinking water were analyzed using a fluoride-ion selective electrode. SPSS was used to analyze the data.

RESULTS

Two-thirds (68.8%) of adults from Kuraymah had moderate to severe fluorosis, with only 7% being unaffected. In Ruwaished, 50% of the sample had severe fluorosis, 22% showed moderate fluorosis, and none were unaffected. The average DMFT scores were 3.18 ± 1.81 and 3.81 ± 1.41 for Kuraymah and Ruwaished, respectively. In both towns, males had significantly higher caries scores than females. Oral hygiene was poor, as 64% and 57% of the participants from Kuraymah and Ruwaished, respectively, did not brush their teeth. A significant correlation was found between poor oral hygiene and increased DMFT scores.

CONCLUSIONS

This study concluded that higher fluorosis incidence and severity were present in the higher-altitude location (Ruwaished). Moreover, this study also indicated that fluorosed teeth are not immune to caries, and the preventive management of dental fluorosis should be directed to de-fluoridation of drinking water in endemic areas.

Effect of Fluoride Concentration in Drinking Water on Dental Fluorosis in Southwest Saudi Arabia

This study was intended to evaluate the fluoride concentration in drinking water and its effect on dental fluorosis in Southwest Saudi Arabia. Water samples were gathered rom wells, filtration plants and commercial brands (bottled water) in distinct urban and rural areas of Asir region of the Kingdom of Saudi Arabia (KSA). Overall, 63 water samples were collected from 12 locations and 9 brands of bottled water. ExStik^® FL700Fluoridemeter was used in the analysis of water samples for fluoride levels. The total number of screened patients for dental fluorosis, aged between 9 and 50 years, was 1150; among them, 609 were males and 541 were females. Dean's index criteria were used to examine the patients for dental fluorosis. The results revealed that fluoride levels varied between 0.03 and 3.8 ppm. People who drank well water displayed increased fluoride levels (>0.81 ppm). The prevalence of dental fluorosis was established to be 20.43% among the total number of examined patients. The findings of this study show very mild to moderate dental fluorosis prevail among the patients who consume well water in the Asir region.

Potential risk factors for dental caries in Type 2 diabetic patients

BACKGROUND

Diabetic patients are known to be at higher risk for dental caries. However, the role of potential risk factors such as blood glucose, salivary glucose and glycaemic control in the occurrence of dental caries in type 2 diabetes (T2D) is not clearly understood so far, and therefore, it was evaluated in this study.

MATERIALS AND METHODS

This cross-sectional study was conducted on 100 T2D patients from Saudi Arabia. The caries risk assessment was evaluated using the guidelines of Caries Management by Risk Assessment (CAMBRA). Cariogenic bacteria load in saliva was determined by a chair-side test kit. The levels of fasting blood glucose (FBG), salivary glucose and HbA1c were analysed.

RESULTS

Majority of the patients had dental caries (84%), exposed root surfaces (92%) and heavy plaque (73%), whereas 66% of patients suffered from xerostomia. The frequency of patients with high counts of Streptococcus mutans and Lactobacilli (LB) were 78% and 42%, respectively. There were significant associations between dental caries risk and FBG, HbA1c and salivary glucose. After categorizing the patients into 3 categories of glycaemic control, we observed a significant association between glycaemic control and dental caries risk.

CONCLUSION

Type 2 diabetes patients are at high risk for dental caries, which is directly associated with FBG, HbA1c and salivary glucose. This is the first study measuring dental caries and its risk factors in T2D patients from Saudi Arabia.

Fluoride Concentration of Water Supply in Eastern Saudi Arabia: A Preliminary Study

BACKGROUND

Community water fluoridation is known to play a significant role in enhancing oral health by reducing the incidence of dental caries. However, the level of fluoride in the supplied public water in the Eastern Province of Saudi Arabia is unknown.

OBJECTIVE

To determine water fluoride levels at the main sources supplying water to households and schools in two major cities (Dammam and Al-Khobar) of the Eastern Province of Saudi Arabia.

METHODS

From the Directorate of Water Agency and Directorate of Education, the following were identified as the main sources of public water supply in Dammam and Al-Khobar: the water agency, public water tanks and four contracted companies. Two samples were collected from each of these six identified water sources at two different time points (in January and July 2016; 2 samples/site/time point; N = 24) using 500 mL polythene bottles. Each sample was analyzed using an ion chromatography system at different detection limits (including the lowest detection limit of 0.065 ppm) to determine the fluoride level.

RESULTS

There was no fluoride detected in any sample even at the lowest detection limit, indicating that fluoride levels in the studied water samples were <0.065 ppm.

CONCLUSION

This study found that in the cities studied, fluoride levels, if any, are considerably below the optimum recommended level for the prevention of dental caries (i.e., 0.7 ppm).

Parental views on fluoride tooth brushing and its impact on oral health: A cross-sectional study

Objective:

This study aimed to describe the current use and knowledge about fluoride toothpaste and children's oral hygiene habits among parents of Saudi children.

Materials and Methods:

In this cross-sectional study, the parents of children aged 7–12 years who visited the undergraduate pediatric dental clinics at the College of Dentistry in Riyadh, Saudi Arabia were interviewed. The interview included questions to assess the parents’ level of fluoride knowledge, the dental appearance of their children, and any general dental health concerns and practices.

Results:

A total of 463 parents (women 55.5%, men 44.5%) were included. Over half (60.3%) of the participants reported that they were unhappy with the appearance of their child's teeth. Only 11.5% received high fluoride knowledge scores. The additive index for the level of fluoride knowledge was significantly lower among mothers than among fathers. The majority of the parents were not able to correctly report whether the toothpaste their children used contained fluoride. Furthermore, the majority of the respondents were unaware of the benefits of fluoride in preventing dental caries.

Conclusions:

There is a need to enhance parental knowledge regarding high fluoride intake and its harmful consequences on children's health. Both mothers and fathers should have higher levels of awareness regarding oral health promotion to maintain optimal oral health in their children.

Knowledge and attitude of Saudi mothers towards their preschool children's oral health

Objectives: To determine knowledge and attitude of Saudi mothers towards their preschool children’s oral health.

Methods: One hundred and one mothers (of children aged 16 to 40 months) attending well-baby clinics at Security Forces Hospital Polyclinics in Makkah Al-Mukarrama participated in the study. A questionnaire was used to collect the required information.

Results: A great majority (92.1%) of the mothers agreed that “baby teeth are important for child’s general health. Similarly, 90.1% of the mothers agreed that “using fluoridated toothpaste helps to prevent tooth decay”. About four in every ten mothers (43.6%) agreed that a child should be allowed to use a bottle at-will when he/she becomes able to hold it. More than half of the mothers (54.5%) agreed that letting baby sleep with bottle still in the mouth was of no harm to teeth. A significantly (p=0.04) higher percentage of high Socioeconomic status (SES) mothers as compared to middle SES mothers (85.9% versus 55.6%) agreed that “frequent feeding with milk or milk formula is of no harm to baby’s teeth”. A significantly (p=003) higher percentage of the middle SES mothers as compared to high SES mothers (66.7% versus 17.4%) agreed that a child should only visit a dentist in case of a dental pain/problem.

Conclusions: The mothers need to be educated in several important areas related to feeding, diet and first dental check-up visit of their children.

Fluoride content of bottled drinking waters available in Riyadh, Saudi Arabia

AIMS

This study aimed to examine the fluoride concentration of commercially available bottled water products in Riyadh, Saudi Arabia, and to assess the accuracy of the labeling of fluoride concentration on the tested brands.

METHODS

Fifteen randomly selected commercial brands of bottled water were obtained from supermarkets in Riyadh, Saudi Arabia. Three bottles of each brand were purchased, and fluoride content was measured using a combination fluoride-ion-selective electrode. The average reading for each brand was estimated and also compared with the fluoride content printed on the label.

RESULTS

The mean (±SD) fluoride content of the 12 local bottled water samples was 0.79 (±0.09) mg/L with a range from 0.5 to 0.83 mg/L. The mean fluoride concentration of the three imported brands was 0.67 (±0.02) mg/L with a narrow range of fluoride content (0.65-0.69). All tested samples mention the fluoride content on the label except two imported brands. Five samples showed a significant difference between our evaluation and stated content of fluoride that ranged between +0.46 and -0.2 mg/L.

CONCLUSIONS

Bottled drinking waters available in Riyadh, Saudi Arabia contain differing concentration of fluoride, but within a safe range for use as a source of systemic fluoride. In addition, the manufactures' labeling of fluoride content may be inaccurate.

Accuracy of bottled drinking water label content

The purpose of the study was to compare the accuracy of the concentration of fluoride (F), calcium (Ca), pH, and total dissolved solids (TDS) levels mentioned on the labels of the various brands of bottled drinking water available in Riyadh, Saudi Arabia. Twenty-one different brands of locally produced non-carbonated (still water) bottled drinking water were collected from the supermarkets of Riyadh. The concentration of F, Ca, TDS, and pH values were noted from the labels of the bottles. The samples were analyzed for concentrations in the laboratory using the atomic absorption spectrophotometer. The mean level of F, Ca, and pH were found as 0.86 ppm, 38.47 ppm, and 7.5, respectively, which were significantly higher than the mean concentration of these elements reported in the labels. Whereas, the mean TDS concentration was found 118.87 ppm, which was significantly lower than the mean reported on the labels. In tropical countries like Saudi Arabia, the appropriate level of F concentration in drinking water as recommended by World Health Organization (WHO) should be 0.6-0.7 ppm. Since the level of F was found to be significantly higher than the WHO recommended level, the children exposed to this level could develop objectionable fluorosis. The other findings, like pH value, concentrations of Ca, and TDS, were in the range recommended by the WHO and Saudi standard limits and therefore should have no obvious significant health implications.

Caries prevalence and its relation to water fluoride levels among schoolchildren in Central Province of Saudi Arabia

OBJECTIVE

To determine dental caries prevalence and severity among primary and intermediate schoolchildren in Riyadh and Qaseem Regions, and to determine any correlation between dental caries and fluoride levels in drinking water.

DESIGN

Cross-sectional.

METHODS

1,104 children; 431 (6-7-year-old) primary schoolchildren (249 in Riyadh and 182 in Qaseem) and 673 (12-13-year-old) intermediate schoolchildren (392 in Riyadh and 281 in Qaseem) were examined for dental caries utilising the WHO criteria for diagnosis of dental caries.

RESULTS

In primary schoolchildren the prevalence of caries was 91.2% both in Riyadh and Qaseem. The mean dmft scores were similar in Riyadh (6.53, SD 4.30) and Qaseem (6.35, SD 3.83). Among the intermediate schoolchildren the prevalence of dental caries was slightly higher in Riyadh (92.3%) than Qaseem (87.9%). The mean DMFT score was higher in Riyadh (5.06, SD 3.65) as compared with Qaseem (4.53, SD 3.57) with marginal statistical significance (p = 0.057). Among the primary schoolchildren there was statistically significant (p < 0.05) difference in mean dmft scores at various fluoride levels with lowest dmft scores at the optimum water fluoride level (0.61-0.80ppm) and highest at two extremes i.e. 0.0 to 0.3ppm and > 2.5ppm, while in intermediate schoolchildren no significant difference in overall mean DMFT scores of children at various water fluoride levels could be found.

CONCLUSION

The caries experience among the primary and intermediate schoolchildren in Riyadh and Qaseem was very high, and that there was no linear correlation between water fluoride level and caries experience in these children.