https://www.frontiersin.org/articles/10 ... 87463/full
- NOTES from the study:
- High fluoride content in tap water can cause permanent damage to the enamel of developing teeth, resulting in hypomineralization, staining, and loss of dental structures. Fluorosis is an irreversible condition, and its treatment is expensive. In severe cases of fluorosis, a full crown reconstruction is required, which is a time-consuming and costly procedure that is often beyond the reach of low-income people.
- In Oaxaca—as in several other regions of the country—there are multiple sources of fluoride exposure, including bottled water. Children in the study region can access fluoridated salt containing 200–250 mg fluoride/kg, and most use fluoridated toothpaste.
- Mexican regulations allow a maximum fluoride concentration of 2.0 ppm in natural mineral water and 0.7 ppm in non-mineral water
- 65.3% of the children consumed bottled water as their primary drinking water source, and 34.7% consumed tap water.
- In girls the mean height-for-age was 0.66 (SD 0.99), and in boys it was 0.59 (SD 1.01) (p = 0.460). With respect to the WHO standards, 69.68% of boys and 71.75% of girls fell below the mean.
- The BMI Z-score in girls was 0.25 (SD 1.20), and in boys it was 0.46 (SD 1.28; p = 0.043). BMI Z-scores were significantly lower in 12-year-old girls than in 12-year-old boys (p = 0.028)
- Bottled water with the highest fluoride concentrations was found in areas with higher fluoride in the water wells.
- Most of the children (98.6%) indicated that they brushed their teeth daily, and 89.03% of the children in this group used the same toothpaste brand, which contained 1,450 ppm fluoride.
Methods: A cross-sectional study involving 585 schoolchildren aged 8–12 years was conducted in communities in a southern state of Mexico with >0.7 parts per million (ppm) fluoride in the groundwater. The Thylstrup and Fejerskov index (TFI) was used to evaluate dental fluorosis, and the World Health Organization growth standards were used to calculate age-adjusted and sex-adjusted BMI Z-scores. A BMI Z-score ≤ −1 SD was used as the cut-off point for thinness, and multiple logistic regression models for dental fluorosis (TFI ≥ 4) were constructed.
Results: The mean fluoride concentration in tap water was 1.39 ppm (SD 0.66), and the mean fluoride concentration in bottled water was 0.32 ppm (SD 0.23). Eighty-four children (14.39%) had a BMI Z-score ≤ −1 SD. More than half (56.1%) of the children presented with dental fluorosis in TFI categories ≥ 4. Children living in areas with higher fluoride concentrations in the tap water [odds ratio (OR) 1.57, p = 0.002] and bottled water (OR 3.03, p < .001) were more likely to have dental fluorosis in the severe categories (TFI ≥ 4). BMI Z-score was associated with the probability of dental fluorosis (TFI ≥ 4; OR 2.11, p < 0.001), and the effect size was 29.3%.
Discussion: A low BMI Z-score was associated with a higher prevalence of dental fluorosis in the severe category. Awareness of the fluoride concentrations in bottled water may help prevent dental fluorosis, particularly in children exposed to several high fluoride content sources. Children with a low BMI may be more vulnerable to dental fluorosis.