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.     

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.

     

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.     

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.     

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.     

Fluorides in groundwater and its impact on health

Fluoride is a naturally occurring toxic mineral present in drinking water and causes yellowing of teeth, tooth problems etc. Fluorspar, Cryolite and Fluorapatite are the naturally occurring minerals, from which fluoride finds its path to groundwater through infiltration. In the present study two groundwater samples, Station I and Station II at Hyderabad megacity, the capital of Andhra Pradesh were investigated for one year from January 2001 to December 2001. The average fluoride values were 1.37 mg/l at Station I and 0.91 mg/l at Station II. The permissible limit given by BIS (1983) 0.6-1.2 mg/l and WHO (1984) 1.5 mg/l for fluoride in drinking water. The groundwaters at Station I exceeded the limit while at Station II it was within the limits. The study indicated that fluoride content of 0.5 mg/l is sufficient to cause yellowing of teeth and dental problems.     

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.     

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.     

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.     

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.     

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.     

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.     

Worldwide contamination of water by fluoride

Fluoride contamination in water is a major problem across the globe, with health hazards such as dental and skeletal fluorosis. Most earlier studies are confined to local or regional scales. As the problem has serious socioeconomic implications, there is a need for a global perspective. Thus, here we review worldwide research for nearly a century on fluoride contamination in water. We investigated the distribution of fluoride contamination in water, its sources, mobilization and association. The major findings are: (1) Anomalous fluoride concentration in groundwater is mainly confined to arid and semiarid regions of Asia and North Africa. (2) The geogenic sources of fluoride in water are mainly fluorine-bearing minerals in rocks and sediments, whereas anthropogenic sources of fluoride in water are mainly pesticides and industrial waste. (3) Fluoride mobilization from geogenic sources is mainly controlled by alkalinity and temperature. (4) Fluoride occurrence in water is associated with ions such as sodium, arsenic chloride and bicarbonate. There are few associations of fluoride in water with calcium and magnesium.     

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 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.     

Dental caries in fluorine exposure areas in China

In this study, fluorine concentrations in drinking water and in urine of residents from a fluorine exposure area in China were tested. DMFT (average number of decayed, missing and filled teeth) of local residents in four age groups were also determined. The results of the study indicate that in fluorine exposure areas, there is a strictly positive correlation between fluorine content in urine and the fluorine content in drinking water. Effect of dental caries by high fluorine content drinking water is different for the different age groups. High fluorine content drinking water is more dangerous for 15-and 18-year-old groups than 5- and 12-year-old groups.     

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.     

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.