Effect of excess fluoride ingestion on human thyroid function in Gaya region,Bihar, India

Fluoride (F) is mainly ingested through drinking water and food. In addition to producing dental and skeletal fluorosis, excess fluoride may affect the functioning of many organs including the thyroid gland. The present study investigated the thyroid function of subjects with dental fluorosis from F-endemic areas of Gaya region, Bihar, India and compared it with control individuals from Bodh Gaya. The mean F concentration in groundwater of F-endemic area was 2.82 ± 0.18 mg/L (range 0.62–7.2 mg/L), while that of control area was 0.49 ± 0.04 mg/L (range 0.21–0.76 mg/L). Abnormal levels of T3, T4, and TSH were found in the study subjects from both control and F-endemic areas.     

Fluoride contamination in groundwater of central Rajasthan,India and its toxicity in rural habitants

This study was carried out to assess fluoride (Fl) concentration in groundwater in some villages of central Rajasthan, India, where groundwater is the main source of drinking water. Water samples collected from deep aquifer-based hand pumps were analyzed for Fl content. Fluoride in groundwater of 121 habitations of Bhilwara tehsil of Bhilwara district of Rajasthan was determined to examine the potential Fl-induced toxicity in rural locations. Fluoride concentrations in the tehsil ranged from 0.5 to 5.8 mg/l. In the tehsil, 69 villages (57%) were found to have Fl concentration beyond the maximum desirable limit recommended in Bureau of Indian Standards (BIS), 10500, 1991. Fifty-eight percent population of these villages was under the threat of fluorosis. One percent population of tehsil living in two villages ingested more than 5 mg/l Fl in each liter of drinking water and at maximal risk for dental and skeletal fluorosis. 142 individuals of these villages were examined for fluorosis. Data indicated that only four individuals (2.82%) did not exhibit dental fluorosis. Most individuals were found to suffer from mild (34.51% or 49 individuals) and moderate (31.69% or 45 individuals) fluorosis. Severe dental fluorosis was recorded in only 16 individuals (11.27%). In 104 individuals above 21 years of age examined for the prevalence of skeletal fluorosis, 66 were positive for skeletal fluorosis with a maximum 36.5% with grade I skeletal fluorosis. Grade II skeletal fluorosis was recorded in 28 individuals (26.9%). Data in this study demonstrate that there is a need to take ameliorative steps in this region to prevent fluorosis.     

A review of global outlook on fluoride contamination in groundwater with prominence on the Pakistan current situation

Several million people are exposed to fluoride (F^?) via drinking water in the world. Current review emphasized the elevated level of fluoride concentrations in the groundwater and associated potential health risk globally with a special focus on Pakistan. Millions of people are deeply dependent on groundwater from different countries of the world encompassing with an elevated level of fluoride. The latest estimates suggest that around 200 million people, from among 25 nations the world over, are under the dreadful fate of fluorosis. India and China, the two most populous countries of the world, are the worst affected. In Pakistan, fluoride data of 29 major cities are reviewed and 34% of the cities show fluoride levels with a mean value greater than 1.5 mg/L where Lahore, Quetta and Tehsil Mailsi are having the maximum values of 23.60, 24.48, > 5.5 mg/L, respectively. In recent years, however, other countries have minimized, even eliminated its use due to health issues. High concentration of fluoride for extended time period causes adverse effects of health such as skin lesions, discoloration, cardiovascular disorders, dental fluorosis and crippling skeletal fluorosis. This review deliberates comprehensive strategy of drinking water quality in the global scenario of fluoride contamination, especially in Pakistan with prominence on major pollutants, mitigation technologies, sources of pollution and ensuing health problems. Considering these verities, health authorities urgently need to establish alternative means of water decontamination in order to prevent associated health problems.     

Fluoride content and distribution pattern in groundwater of eastern Yunnan and western Guizhou, China

For study, the fluoride (F) content and distribution pattern in groundwater of eastern Yunnan and western Guizhou fluorosis area in southwestern China, the F content of 93 water samples [groundwater (fissure water, cool spring, and hot springs), rivers water] and 60 rock samples were measured. The result shows the F content of the fissure water and cold spring water is 0.027–0.47 mg/L, and river water is 0.048–0.224 mg/L. The F content of hot spring water is 1.02–6.907 mg/L. The drinking water supplied for local resident is mainly from fissure water, cool spring, and river water. And the F content in all of them is much lower than the Chinese National Standard (1.0 mg/L), which is the safe intake of F in drinking water. The infected people in eastern Yunnan and western Guizhou fluorosis area have very little F intake from the drinking water. The hot spring water in fluorosis area of eastern Yunnan and western Guizhou, southwest China has high F content, which is not suitable for drinking.     

Distribution and Risk Assessment of Fluoride in Drinking Water in the West Plain Region of Jilin Province, China

The west plain region of Jilin province of northeast China is one of the typical endemic fluorosis areas caused by drinking water for many years. Investigations of hydrogeological and ecoenvironmental conditions as well as endemic fluorosis were conducted in 1998. Results show that the ground water, especially, the water in the unconfined aquifer is the main source of drinking water for local residents. The fluoride concentration in groundwater in the unconfined aquifers is higher than that in the confined aquifer in the west plain of Jilin province. The fluoride concentration in the unconfined aquifer can be used to classify the plain into fluoride deficient area, optimum area and excess area, which trend from west to east. High fluoride (>1.0 mg L(-1)) in drinking water resulted in dental and skeletal fluorosis in local residents (children and pregnant women). There exists a positive correlation between fluoride concentration in the drinking water and the morbidities of endemic fluorosis disease (r1 = 0.781, r2 = 0.872). Health risks associated with fluoride concentration in drinking water are assessed. It has been determined that fluoride concentration in excess of 1.0 mg L(-1) exposes residents to high health risks based on risk identification. The study area is classified into five health risk classes as shown in Figure 4. The risk indexes of this area more than 1.0 are accounted for 68% of the total west plain region.     

Geochemical provenance and spatial distribution of fluoride in groundwater of Mayo Tsanaga River Basin, Far North Region, Cameroon: implications for incidence of fluorosis and optimal consumption dose

The 500,000 inhabitants of Mayo Tsanaga River Basin are vulnerable to a “silent” fluorosis from groundwater consumption. For the first time, the groundwater is investigated for the purpose of identifying the provenance of fluoride and estimating an optimal dose of fluoride in the study area. Based on the fluoride content of groundwater, fluorine and major oxides abundances in rocks from the study area, mean annual atmospheric temperature, and on-site diagnosis of fluorosis in children, the following results and conclusions are obtained: Fluoride concentration in groundwater ranges from 0.19 to 15.2 mg/l. Samples with fluoride content of <1.5 mg/l show Ca–HCO₃ signatures, while those with fluoride >1.5 mg/l show a tendency towards Na-HCO₃ type. Fluor-apatite and micas in the granites were identified as the main provenance of fluoride in the groundwater through water-rock interactions in an alkaline medium. The optimal fluoride dose in drinking water of the study area should be 0.7 mg/l, and could be adjusted downward to a level of 0.6 mg/l due to the high consumption rate of groundwater, especially during drier periods.     

Occurrence and problems of high fluoride waters in Turkey: an overview

Endemic dental fluorosis was first observed in Turkey in Isparta Province, located in the SW of Anatolia, with mottled enamel related to the high levels of fluoride (1.5–4.0 ppm) in drinking waters, about 55 years ago. The origin of fluoride was attributed to the contents of minerals in volcanic rocks, consisting of pyroxene, hornblende, biotite, fluorapatite and glassy groundmass minerals. It was also reported about 35 years ago that severe dental and skeletal fluorosis has been observed in human beings and livestock in Dogubeyaz?t and Caldiran areas, located around Tendurek Volcano in eastern Turkey, where natural waters contained fluoride levels between 2.5 and 12.5 ppm. It was hypothesised that fluoride, which might be transported by fumaroles or escaped from devitrified lavas, could be held on the surface of some minerals and then exchanged with OH^- in ground waters with high pH at the foothills of the young Tendurek Volcano. Endemic dental and skeletal fluorosis was also observed in the inhabitants in Kizilcaoren Village of Beylikova Town in Eski?ehir Province situated in the midwest of Turkey, where the fluoride content of the drinking waters ranged from 3.9 to 4.8 ppm. The origin of high fluoride in the natural waters was related to the fluorspar deposits, occurring in the catchment area near the village. During the survey in the Güllü Village of Esme-Usak, located in south-midwest of Turkey, it was observed that most of the inhabitants born and raised in the village and aged between 10 and 30 years, showed mild to moderate levels of mottled enamel. The fluoride contents of the deep well waters used for drinking in the village, varied from 0.7 to 2.0 ppm. Amorphous microscopic fluorite existing in the Pliocene lake limestones was considered as a possible origin of fluoride in the waters.     

A health risk assessment for fluoride in Central Europe

Like many elements, fluorine (which generally occurs in nature as fluoride) is beneficial to human health in trace amounts, but can be toxic in excess. The links between low intakes of fluoride and dental protection are well known; however, fluoride is a powerful calcium-seeking element and can interfere with the calcified structure of bones and teeth in the human body at higher concentrations causing dental or skeletal fluorosis. One of the main exposure routes is via drinking water and the World Health Organisation currently sets water quality guidelines for the element. In Central Europe, groundwater resources that exceed the guideline value of 1.5 mg l⁻¹ are widespread and effects on health of high fluoride in water have been reported. The aim of the current project was to develop a geographic information system (GIS) to aid the identification of areas where high-fluoride waters and fluorosis may be a problem; hence, where water treatment technologies should be targeted. The development of the GIS was based upon the collation and digitisation of existing information relevant to fluoride risk in Ukraine, Moldova, Hungary and Slovakia assembled for the first time in a readily accessible form. In addition, geochemistry and health studies to examine in more detail the relationships between high-fluoride drinking waters and health effects in the population were carried out in Moldova and Ukraine demonstrating dental fluorosis prevalence rates of 60–90% in adolescents consuming water containing 2–7 mg l⁻¹ fluoride.     

Monitoring,mapping and health risk assessment of fluoride in drinking water supplies in rural areas of Maku and Poldasht,Iran

The aim of this study was to investigate and determine fluoride concentrations in drinking water supplies in rural areas of Maku and Poldasht in West Azerbaijan Province, the northwest of Iran. Fluorosis risk assessment and characterization was also investigated. Fluoride concentrations mapping was accomplished by using the GIS system. Totally, 356 water samples, including one sample in each season, were collected from 89 water supplies providing water for 95 and 61 rural areas of Maku and Poldasht, respectively. According to the results, in Maku and Poldasht, 25 and 30 rural areas had contaminated water sources, respectively. Average annual fluoride concentrations ranged from 3.04 to 7.31 mg/l in the contaminated villages of Maku, which is about 2–4.8 times higher than the maximum standard level of the Iranian drinking water standard, and 4.52–8.21 mg/l in the contaminated areas of Poldasht, which is about 3–5.47 times higher than the maximum standard level. The maximum fluoride level was determined 11.12 mg/l and 10.98 mg/l in one of villages of Maku and Poldasht Counties in summer, respectively. Neither in Maku nor in Poldasht, water resources showed dental cavity risk, while dental fluorosis risk and skeletal fluorosis risk were very significant in some villages of both cities. Children were at most risk of fluorosis. New alternative water supplies for the contaminated villages if possible, consumption of bottled water and application of reverse osmosis are recommended as remedial actions in the contaminated areas.

     

Daily dietary fluoride intake in rural villages of the Ethiopian Rift Valley

Dental and skeletal fluorosis is widespread in the Ethiopian Rift Valley region. Drinking water has been considered the main reason for the development of fluorosis, but dietary intake may also be a contributor in areas with high concentration of fluoride in water, soil, and biota. The purpose of this study is to assess the total daily dietary fluoride intake by adults in a rural part of the Ethiopian Rift Valley. The food, beverage, and water samples were collected from selected households of three neighboring villages with similar dietary pattern, but with different fluoride content in their water sources. Village A uses water with 1.0 mg L^?1 fluoride, village B uses water with 3.0 mg L^?1 fluoride, and village C uses water with 11.5 mg L^?1 fluoride both for food preparation and for drinking. The level of fluoride was determined in all food ingredients, in the prepared food, beverages, and in the water used for food preparation and drinking. Recipe and food frequency questionnaires were used to gather household food preparation and consumption patterns. An alkali fusion method was used for digestion of food samples and for subsequent determination of fluoride with ion-selective electrode. The daily fluoride intake varied depending on its concentration in the water used for cooking and drinking. In households using water with 1 mg L^?1, 3 mg L^?1, and 11.5 mg L^?1 fluoride, the total personal intake was found to be 10.5, 16.6, and 35.3 mg d^?1, respectively. Contribution of the water to the daily fluoride intake was 33%, 58%, and 86%, respectively. Even in households using water containing fluoride at a concentration of 1 mg L^?1, the daily intake was higher than the recommended safe intake of 1.5–4.0 mg d^?1 for adults, which indicates that the fluoride intake through food may cause health risks. Minimizing the fluoride concentration in water to the lowest possible level will greatly reduce the daily intake. The form of fluorine (organic or inorganic) in the food items and the associated health risk factors need further investigation.     

The Contribution of Drinking Water towards Dental Fluorosis: A case study of Njoro Division, Nakuru District, Kenya

This study was carried out to measure the fluoride levels of water consumed in the Njoro division of Nakuru district, Kenya. The sources of drinking water, methods of water storage and utilisation, as well as the perceptions of the local community towards dental fluorosis and the percentage of children with moderate to severe dental fluorosis were also determined. Rainwater had mean fluoride levels of 0.5 mg L^-1, dams 2.4 mg L^-1, wells 4.1 mg L^-1, springs 5.5 mg L^-1, and boreholes 6.6 mg L^-1. Water stored in plastic and cement containers did not show appreciable reduction in fluoride content with storage time; water stored in metal containers reduced fluoride by up to 8.2%; water stored in clay pots had the highest reduction in fluoride content, ranging between 34.3 and 64.7%;. Forty eight point three percent of children observed in the area had moderate to severe dental fluorosis, even though most people in the area did not know the cause of the problem.There is need to educate the community on the causes of fluorosis, and to lay strategies for addressing the issue, such as encouraging more rainwater harvesting, treating drinking water with alum, or using clay pots for storage of drinking water.     

Fluoride distribution in groundwater and survey of dental fluorosis among school children in the villages of the Jhajjar District of Haryana,India

Fluoride concentration of groundwater reserves occurs in many places in the world. A critical area for such contamination in India is alluvial soil of the plain region, consisting of five blocks (Jhajjar, Bahadurgarh, Beri, Matanhail, and Sahalawas) of the Jhajjar District adjacent to the National Capital Territory of India, New Delhi. The purpose of this study was to assess the association between water fluoride levels and prevalence of dental fluorosis among school children of the Jhajjar District of Haryana, India. The fluoride content in underground drinking water sources was found to vary in villages. Hence, the villages were categorized as high-fluoride villages (1.52–4.0 mg F/l) and low/normal-fluoride villages (0.30–1.0 mg F/l). The source of dental fluorosis data was school-going children (7–15 years) showing different stages and types of fluorosis who were permanent resident of these villages. The fraction of dental fluorosis-affected children varied from 30% to 94.85% in the high-fluoride villages and from 8.80% to 28.20% in the low/normal-fluoride villages. The results of the present study revealed that there existed a significant positive correlation between fluoride concentration in drinking water and dental fluorosis in high-fluoride villages (r = 0.508; p < 0.001) and insignificant correlation in low-fluoride villages.     

Hydrogeochemistry and statistical analysis applied to understand fluoride provenance in the Guarani Aquifer System, Southern Brazil

High fluoride concentrations (up to 11 mg/L) have been reported in the groundwater of the Guarani Aquifer System (Santa Maria Formation) in the central region of the state of Rio Grande do Sul, Southern Brazil. In this area, dental fluorosis is an endemic disease. This paper presents the geochemical data and the combination of statistical analysis (Principal components and cluster analyses) and geochemical modeling to achieve the hydrogeochemistry of the groundwater and discusses the possible fluoride origin. The groundwater from the Santa Maria Formation is comprised of four different geochemical groups. The first group corresponds to a sodium chloride groundwater which evolves to sodium bicarbonate, the second one, both containing fluoride anomalies. The third group is represented by calcium bicarbonate groundwater, and in the fourth, magnesium is the distinctive parameter. The statistical and geochemical analyses supported by isotopic measurements indicated that groundwater may have originated from mixtures of deeper aquifers and the fluoride concentrations could be derived from rock/water interactions (e.g., desorption from clay minerals).     

Geochemical occurrences of arsenic and fluoride in bedrock groundwater: a case study in Geumsan County,Korea

Bedrock groundwaters in Geumsan County, Korea, were surveyed to investigate the distribution and geochemical behaviors of arsenic and fluoride, mobilized through geogenic processes. The concentrations were enriched up to 113 μg/L for arsenic and 7.54 mg/L for fluoride, and 16% of 150 samples exceeded World Health Organization drinking water guidelines for each element. Simple Ca-HCO₃ groundwater types and positive correlations with pH, Ca, SO₄, and HCO₃ were characteristics of high (>10 μg/L) As groundwaters. The oxidation reaction of sulfide minerals in metasedimentary rocks and locally mineralized zones seems to be ultimately responsible for the existence of arsenic in groundwater. Desorption process under high pH conditions may also control the arsenic mobility in the study area. High (>1.5 mg/L) F groundwaters were found in the Na-HCO₃ type and with greater depth. Fluoride seemed to be enriched by deep groundwater interaction with granitic rocks, and continuous supply to shallow Ca-HCO₃-type groundwater kept the concentration high. In the study area, drinking water management should include periodic As and F monitoring in groundwater.

     

Health risk assessment of groundwater arsenic pollution in southern Taiwan

Residents of the Pingtung Plain, Taiwan, use groundwater for drinking. However, monitoring results showed that a considerable portion of groundwater has an As concentration higher than the safe drinking water regulation of 10 μg/L. Considering residents of the Pingtung Plain continue to use groundwater for drinking, this study attempted to evaluate the exposure and health risk from drinking groundwater. The health risk from drinking groundwater was evaluated based on the hazard quotient (HQ) and target risk (TR) established by the US Environmental Protection Agency. The results showed that the 95th percentile of HQ exceeded 1 and TR was above the safe value of threshold value of 10^?6. To illustrate significant variability of the drinking water consumption rate and body weight of each individual, health risk assessments were also performed using a spectrum of daily water intake rate and body weight to reasonably and conservatively assess the exposure and health risk for the specific subgroups of population of the Pingtung Plain. The assessment results showed that 0.01–7.50 % of the population’s HQ levels are higher than 1 and as much as 77.7–93.3 % of the population being in high cancer risk category and having a TR value >10^?6. The TR estimation results implied that groundwater use for drinking purpose places people at risk of As exposure. The government must make great efforts to provide safe drinking water for residents of the Pingtung Plain.     

Influence of climate on groundwater fluoride in different climatic domains in a hard rock terrain of Sri Lanka: implications to community health

Health risks associated with excessive intake of fluoride through drinking water are one of the geoenvironmental health problems observed in many parts of the world, mainly in countries of the humid tropical belt, including Sri Lanka. Fluoride-related health problems are widespread in the dry climatic region compared to the wet climatic zone of Sri Lanka. The potential health risks of fluoride for communities in a river basin which drains through two climatic zones, viz. wet and dry zones, were investigated in this study. Sixty-three groundwater samples were collected from wells in the Walawe river basin during pre- and post-monsoon periods. From collected samples, ten selected samples were analyzed for their tritium (³H) levels to find out the approximate resident time of groundwater. In the river basin, the dry zone segment is characterized by elevated levels of fluoride (>?1.0 mg/L) in groundwater. Groundwater fluoride in the region was primarily of geogenic origin. The tritium values showed older groundwater contained higher fluoride levels, showing a increased dissolution of fluoride-bearing minerals. The hazard quotient (HQ_fluoride) showed that about 45% of pre- and 55% of post-monsoon groundwater samples in the dry zone area were unsuitable for drinking purposes for school children who are vulnerable to non-carcinogenic risks and dental fluorosis. This study emphasizes the need for continuous water quality monitoring and mitigation measures to ensure the health of residents.

     

Groundwater fluoride and dental fluorosis in southwestern Nigeria

This study was carried out to assess the fluoride levels of groundwater from open wells, consumed by the residents of three communities located in two distinct geological terrains of southwestern Nigeria. Fluoride concentration was determined using spectrophotometric technique, while analysis of other parameters like temperature, pH and total dissolve solids followed standard methods. Results of the analysis indicated that groundwater samples from Abeokuta Metropolis (i.e., basement complex terrain) had fluoride content in the range of 0.65?±?0.21 and 1.20?±?0.14. These values were found to be lower than the fluoride contents in the groundwater samples from Ewekoro peri-urban and Lagos metropolis where the values ranged between 1.10?±?0.14-1.45?±?0.07 and 0.15?±?0.07-2.20?±?1.41?mg/l, respectively. The fluoride contents in almost all locations were generally higher than the WHO recommended 0.6?mg/l. Analysis of Duncan multiple range test indicated that there is similarity in the level of significance of fluoride contents between different locations of same geological terrain at p?≤?0.05. It was also observed that fluoride distribution of groundwater samples from the different geological terrain was more dependent on factors like pH and TDS than on temperature. The result of the analyzed social demographic characteristics of the residents indicated that the adults (between the age of 20 and >40?years) showed dental decay than the adolescent (<20?years). This signifies incidence of dental fluorosis by the high fluoride content in the drinking water of the populace. Further investigation on all sources of drinking water and other causes of tooth decay in the area is suggested.     

Dental fluorosis associated with drinking water from hot springs in Choma district in southern province,Zambia

This study was conducted to investigate the high incidence of mottled teeth among residents of an area with hot springs in the Choma District of the Southern Province of Zambia. A survey involving 128 pupils was conducted at a Basic School to collect data on pupil’s backgrounds and their main sources of drinking water between birth and age 7. A dental specialist examined the pupils’ teeth and samples of drinking water were collected from locations where the majority of the pupils lived. It was analysed for fluorides and other drinking water quality parameters. Results of the survey showed a highly significant (P < 0.001) association between pupils’ main sources of drinking water between birth and age 7 and the incidence of discoloured teeth. All (100%) pupils who drank water from hot springs before age 7 had moderate to severe fluorosis, while the majority (96.7%) of the pupils who drank water from other sources had no dental fluorosis. Fluoride concentrations ranged from 5.95 to 10.09 mg/l in water from hot springs, and from 0.03 to 0.6 mg/l in water from other sources. Fluoride levels in water from hot spring water samples exceeded the 1.5 mg/l WHO guideline value for drinking water, while those in water from other sources were significantly (P < 0.05) lower than this. We conclude that the high prevalence of mottled teeth among residents of the study area is a case of endemic dental fluorosis associated with drinking water from hot springs containing high concentrations of fluoride.     

Fluoride in Ceylon tea and its implications to dental health

The purpose of this study was to assess the fluoride content of Ceylon Tea, which is a popular beverage throughout the world. The fluoride content of tea infusions prepared from different grades of tea leaves collected from different parts of the tea-growing regions (25 samples) of Sri Lanka was measured using a fluoride-selective electrode. Fluoride leaching was found to vary from 0.32 to 1.69 mg F/l, but there were no significant differences in terms of fluoride leaching between tea from different tea-growing regions or between tea of different grades. Dental fluorosis is widespread throughout the dry zone of Sri Lanka, and drinking water has traditionally been considered to be the main contributory factor to the development of fluorosis. However, diet, the consumption of tea in particular, may also contribute to the manifestation of dental diseases.     

Chemometric studies of water quality parameters of Sankarankovil block of Tirunelveli, Tamilnadu

The fluoride concentration in ground water was determined in Sankarankovil block of Tirunelveli district of Tamilnadu (India) where it is the only source of drinking water. Various other water quality parameters such as pH, electrical conductivity total hardness and total alkalinity as well as calcium, magnesium, carbonate, bicarbonate and chloride concentrations were also measured. A systematic calculation of correlation coefficient among different physico-chemical parameters was performed. The analytical results indicated considerable variations among the analyzed samples with respect to their chemical composition. Majority of the samples do not comply with Indian as well as WHO water quality standards. The fluoride concentration in the ground water of these villages varied from 0.66 to 3.84 mg l(-1), causes dental fluorosis among people especially children of these villages. The high and low fluoride containing areas were located using isopleth mapping technique. Overall water quality was found unsatisfactory for drinking purposes without any prior treatment except at few locations out of 50 villages.