ABSTRACT
Initial results from 11 of the 18 countries involved in an ongoing regional study are presented. The levels of flouride in various water sources in the Caribbean were hitherto unknown. This study provides the first comprehensive documentation of the regional distribution of natural flouride levels in water by spatial location, source and approximate population coverage. The aim is to discuss the public health implications as well as the significance in caries-prevention. A total of 594 water samples were collected from 9 different sources in 11 countries during the dry and wet seasons using a standard protocol. Flouride levels were determined using the ion-selective electrode. Duplicate analysis was conducted on 25 percent randomly selected samples in each batch. Detectable levels were classified in mg/ based on a five-point ordinal scale as flouride-free (< 0.1); low (>0.1-0.3); sub-optimal (0.3-0.6); optimal (> 0.6-0.7); and high (> 0.7), respectively. Flouride levels ranged from 0.01 to 2.9 mg/l. Most samples (61.3 percent) were flouride-free while 16.2 percent and 9.64 percent contained optimal and high levels, respectively. Areas with levels above 0.7 mg/l were recorded in 7 countries while trace amounts of flouride were recorded for all samples obtained from Cayman Islands, Monsterrat and St. Vincent. The significant variations in flouride levels recorded in samples obtained from the same location underscore the need for routine flouride analysis, especially in areas with high levels. Natural flouride levels in regional water sources are generally below the optimal required for maximum caries reduction with minimal prevalence of enamel flourosis in tropical environments. Localized deflouridation of water supplies should be considered in areas with flouride levels in excess of 2 mg/l if a high prevalence of moderate and severe enamel flourosis is detected among residents. Given the current water sources, supply and distribution systems and respective populations served, the findings of this study indicate that water flouridation is not a feasible or cost-effective option for caries prevention in the region. Further research on the availability of non-dairy flouride sources is required. (AU)