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.     

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 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.     

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.

     

Utility of check dams in dilution of fluoride concentration in ground water and the resultant analysis of blood serum and urine of villagers,Anantapur District,Andhra Pradesh,India

High levels of fluoride (beyond 1.5 ppm) in ground water as source of drinking water are common in many parts of Andhra Pradesh, India, causing fluorosis. The study carried out in endemic Nalgonda District, Andhra Pradesh, has indicated that the fluoride-rich ground water present in the wells located down stream and close to the surface water bodies is getting diluted by the low-fluoride surface water. Encouraged by this result, check dams were constructed upstream of the identified marginally high fluoride bearing ground water zones in Anantapur District to reduce fluoride levels as an alternate solution for safe drinking water.In this paper, an attempt is made to study the utility and effect of these check dams in dilution of fluoride concentration in drinking water and its resultant impact on the health aspects of certain villagers of Anantapur District through the analysis of their blood serum and urine. Ground water samples from three fluoride-affected villages, blood and urine of males and females from the same villages were collected and analyzed for fluoride using ion selective electrode method. The results indicated that the fluoride levels in blood serum and urine of males in the age group of 5–11 years are found to be the highest. The concentration of fluoride in ground water is directly proportional to the concentration of fluoride in blood serum and urine. The concentration of fluoride in ground water with depth of the aquifer is a function of lithology, amount and duration of rainfall, rate of infiltration, level of ground water exploitation in the area etc. The construction of check dams upstream of the identified marginally high fluoride waters will not only cause additional recharge of ground water but also reduces the fluoride concentration eventually improving the health of the villagers.     

Dental fluorosis linked to degassing of Ambrym volcano, Vanuatu: a novel exposure pathway

Ambrym in Vanuatu is a persistently degassing island volcano whose inhabitants harvest rainwater for their potable water needs. The findings from this study indicate that dental fluorosis is prevalent in the population due to fluoride contamination of rainwater by the volcanic plume. A dental survey was undertaken of 835 children aged 6–18 years using the Dean’s Index of Fluorosis. Prevalence of dental fluorosis was found to be 96% in the target area of West Ambrym, 71% in North Ambrym, and 61% in Southeast Ambrym. This spatial distribution appears to reflect the prevailing winds and rainfall patterns on the island. Severe cases were predominantly in West Ambrym, the most arid part of the island, and the most commonly affected by the volcanic plume. Over 50 km downwind, on a portion of Malakula Island, the dental fluorosis prevalence was 85%, with 36% prevalence on Tongoa Island, an area rarely affected by volcanic emissions. Drinking water samples from West Ambrym contained fluoride levels from 0.7 to 9.5 ppm F (average 4.2 ppm F, n = 158) with 99% exceeding the recommended concentration of 1.0 ppm F. The pathway of fluoride-enriched rainwater impacting upon human health as identified in this study has not previously been recognised in the aetiology of fluorosis. This is an important consideration for populations in the vicinity of degassing volcanoes, particularly where rainwater comprises the primary potable water supply for humans or animals.     

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.     

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.     

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.     

Inferring the fluoride hydrogeochemistry and effect of consuming fluoride-contaminated drinking water on human health in some endemic areas of Birbhum district,West Bengal

This research work is carried out to evaluate fluoride (F) hydrogeochemistry and its effect on the population of two endemic villages of Birbhum district, West Bengal. Fluoride concentration in drinking water varies from 0.33 to 18.08 mg/L. Hydrogeochemical evolution suggests that ion-exchange mechanism is the major controlling factor for releasing F in the groundwater. Most of the groundwater samples are undersaturated with respect to calcite and fluorite. Health survey shows that out of 235 people, 142 people suffer from dental fluorosis. According to fluoride impact severity, almost 80 and 94 % people in an age group of 11–20 and 41–50 suffer from dental and skeletal fluorosis, respectively. Statistically drinking water F has a positive correlation with dental and skeletal fluorosis. Bone mineral density test reveals that 33 and 45 % of the studied population suffer from osteopenic and osteoporosis disease. IQ test also signifies that F has a bearing on the intelligence development of the study area school children. The existence of significant linear relationship (R ² = 0.77) between drinking water F and urinary F suggests that consumption of F-contaminated drinking water has a major control over urinary F (0.39–20.1 mg/L) excretion.     

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.     

Dental fluorosis in bovine of Nayagarh district of Orissa

Chronic fluoride toxicity in the form of dental fluorosis was observed in cattle from nine (9) villages under two (2) blocks of Nayagarh district of Orissa. Out of 1117 cattle, 221 (18.09%) showed the signs of dental fluorosis. In all affected villages, the prevalence of dental fluorosis in calves (< 1 year age) was greater than adults. There was significant difference in prevalence in respect to age. The commonly observed signs of dental fluorosis were brown discoloration, mottling, attrition or uneven wearing of teeth with or without pitting. None of the affected animals showed characteristic signs of osteofluorosis. The mean serum and urine fluoride concentration of affected animals were significantly (P < 0.05) higher than those of control animals. Fluoride levels (mean) of ground water and surface water in two blocks were 1.30 +/- 0.16 ppm, 0. 66 +/- 0.08 ppm and 1.12 +/- 0.19 ppm, 0. 48 +/- 0.05 ppm respectively. The fluoride content of grass samples of affected and control (non-endemic) area was comparable. There was a highly positive correlation (r = + 0.664) between prevalence of dental fluorosis and fluoride content of ground water. It was concluded that fluoride intake through the water especially ground water contributed to the development of fluorosis in cattle.     

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.     

Arsenic levels in rice grain and assessment of daily dietary intake of arsenic from rice in arsenic-contaminated regions of Bangladesh—implications to groundwater irrigation

Chronic exposure to arsenic (As) causes significant human health effects, including various cancers and skin disorders. Naturally elevated concentrations of As have been detected in the groundwater of Bangladesh. Dietary intake and drinking water are the major routes of As exposure for humans. The objectives of this study were to measure As concentrations in rice grain collected from households in As-affected villages of Bangladesh where groundwater is used for agricultural irrigation and to estimate the daily intake of As consumed by the villagers from rice. The median and mean total As contents in 214 rice grain samples were 131 and 143 μg/kg, respectively, with a range of 2–557 μg/kg (dry weight, dw). Arsenic concentrations in control rice samples imported from Pakistan and India and on sale in Australian supermarkets were significantly lower (p < 0.001) than in rice from contaminated areas. Daily dietary intake of As from rice was 56.4 μg for adults (males and females) while the total daily intake of As from rice and from drinking water was 888.4 and 706.4 μg for adult males and adult females, respectively. From our study, it appears that the villagers are consuming a significant amount of As from rice and drinking water. The results suggest that the communities in the villages studied are potentially at risk of suffering from arsenic-related diseases.     

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.

     

Assessment of Iodine Deficiency and Goitre Incidence in Parts of Yewa Area of Ogun State, Southwestern Nigeria

This study was carried out to determine the occurrence, prevalence and contributing factors to the incidence of goitre in Yewa north local government area of Ogun state, southwestern Nigeria. To achieve these objectives, soil, water, and cassava tubers were collected from four villages – Igbogila, Egua, Sawonjo and Imoto and from Lagos (about 250 m to the ocean) as a reference location, in order to determine their iodine concentrations. The results of the analyses indicated a soil mean iodine range of 2.1–5.8 μg g⁻¹; a cassava mean iodine value of 2.3–3.5 μg g⁻¹ and a drinking water mean iodine value of generally <1.0 μg L⁻¹ in all the four villages. These values of iodine in soil and water of the four villages are considered low when compared with the soil iodine value of 7.4 μg g⁻¹ and water iodine value of 6.1 μg L⁻¹ obtained from Lagos. The limestone unit of the study area remains an inhibiting factor in the bioavailability of the iodine because of its alkalinity. Statistical analysis has shown that there was significant difference between iodine concentration in the soils and the drinking water, and a correlation between the soil iodine and organic matter content at p < 0.05. The correlation between soil iodine and granulometric fractions occurred at p < 0.01. Potential goitrogens in the commonly consumed cassava products might also have contributed to the prevalence of goitre in the study area. Both the females and the adults (i.e., less mobile groups) were found to be vulnerable to goitre development in these villages.     

Concentrations of inorganic elements in 20 municipal waters in Sweden before and after treatment – links to human health

The water chemistry of 20 municipal water treatment plants in southern Sweden, representing various bedrock situations, and water qualities, were investigated. Four water samples, raw and treated, were collected from each plant and analyzed by predominantly ICP-OES and ICP-MS at four occasions from June to December, 2001. The concentrations of Ca, Mg, K, Na, HCO₃ and a number of micronutrients, varied considerably in treated waters from the studied plants (ranges; Ca: 9.1–53.7 mg L⁻¹, Mg: 1.4–10.9 mg L⁻¹, K: 1.1–4.8 mg L⁻¹, Na; 5.4–75.6 mg L⁻¹, HCO₃: 27–217 mg L⁻¹). The elimination of Fe and Mn from raw water was efficient in all treatments investigated, giving concentrations in treated waters below the detection limits at some plants. Softening filters gave waters with Ca-concentrations comparable to the softest waters in this study. Adjustment of pH by use of chemicals like lye, soda or lime, modified the consumer water composition significantly, besides raising the pH. It was estimated that drinking water contributed to approximately 2.2–13% of the daily Ca uptake, if the gastrointestinal uptake efficiency from food and water was estimated to be around 50%. The corresponding figures for Mg was 1.0–7% and for F 0–59%. None of the studied elements showed any significant time trends in raw or treated waters during the follow-up period. The concentrations of potentially toxic metals such as Al, Pb and U were low and did not indicate risks for adverse health effects (ranges; Al: 0.5–2.3 μg L⁻¹, Pb: 0–0.3 μg L⁻¹, U: 0.2.5 μg L⁻¹).     

Potential fluoride contamination in the drinking water of Marks Nagar,Unnao district,Uttar Pradesh,India

This study was conducted in the summer season (May, 2007). The fluoride concentration along with other physico-chemical parameters in ground water samples was determined in Marks Nagar of Unnao district, Uttar Pradesh (India), since it is the only source of drinking water for the villagers. The fluoride concentration in the water varied from 0.8 to 13.9 mgl⁻¹ with a mean of 4.02 mgl⁻¹. The correlation analysis revealed that fluoride had a positive correlation with pH, CO₃, HCO₃, and sodium adsorption ratio (SAR), whereas a negative correlation with Ca and Mg was found. A soil profile was also dug in the area to assess depth-wise fluoride content in the soil. The soil samples and underneath calcium carbonate (CaCO₃) concretion were analyzed for fluoride content. The percent of soluble fluoride to total fluoride in the soil varied from 25.15 to 4.76% down the soil profile. The soluble fluoride was found to decrease with the increase in the clay content in the soil. The total leachable fluoride in CaCO₃ concretions was found to be 6.08%. It was inferred from this study that the soil and underneath layer of CaCO₃ concretions may be the potential source of fluoride contamination in the shallow drinking water sources of the area.     

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.     

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.