Assessment of NIR-triggered PEG-coated NaGdF4:Tm3+/Yb3+bio-compatible upconversion nanoparticles for contrast enhancement in OCT imaging and optical thermometry.

In this investigation, we embarked on the synthesis of polyethylene glycol coated NaGdF4:Tm3+/Yb3+upconversion nanoparticles (UCNPs), aiming to assess their utility in enhancing image contrast within the context of swept source optical coherence tomography (OCT) and photo-thermal OCT imaging. Our research unveiled the remarkable UC emissions stemming from the transitions of Tm3+ions, specifically the1G4→3H6transitions, yielding vibrant blue emissions at 472 nm. We delved further into the UC mechanism, meticulously scrutinizing decay times and the nanoparticles' capacity to convert radiation into heat. Notably, these nanoparticles exhibited an impressive photo-thermal conversion efficiency of 37.5%. Furthermore, our investigations into their bio-compatibility revealed a promising outcome, with more than 90% cell survival after 24 h of incubation with HeLa cells treated with UCNPs. The nanoparticles demonstrated a notable thermal sensitivity of 4.7 × 10-3K-1at 300 K, signifying their potential for precise temperature monitoring at the cellular level.

Arsenic and fluoride in groundwater triggering a high risk: Probabilistic results using Monte Carlo simulation and species sensitivity distribution.

The widespread presence of arsenic (As) and fluoride (F-) in groundwater poses substantial risks to human health on a global scale. These elements have been identified as the most prevalent geogenic contaminants in groundwater in northern Mexico. Consequently, this study aimed to evaluate the human health and ecological risks associated with the content of As and F- in the Meoqui-Delicias aquifer, which is in one of Mexico's most emblematic irrigation districts. Concentrations of As and F- were measured in 38 groundwater samples using ICP-MS and ion chromatography, respectively. Overall, these elements showed a similar trend across the aquifer, revealing a positive correlation between them and pH. The concentration of As and F- in the groundwater ranged from 5.3 µg/L to 303 µg/L and from 0.5 mg/L to 8.8 mg/L, respectively. Additionally, the levels of As and F- surpassed the established national standards for safe drinking water in 92% and 97% of samples, respectively. Given that groundwater is used for both agricultural purposes and human activities, this study also assessed the associated human health and ecological risks posed by these elements using Monte Carlo simulation and Species Sensitivity Distribution. The findings disclosed a significant noncarcinogenic health risk associated with exposure to As and F-, as well as an unacceptable carcinogenic health risk to As through water consumption for both adults and children. Furthermore, a high ecological risk to aquatic species was identified for F- and high to medium risks for As in the sampling sites. Therefore, the findings in this study provide valuable information for Mexican authorities and international organizations (e.g., WHO) about the adverse effects that any exposure without treatment to groundwater from this region represents for human health.

Comprehensive risk assessment and interactions of fluoride and boron ions in the water-sediments interface: The Red Sea, Egypt.

This study presents a baseline evaluation of the distribution, human and ecotoxicological risk, and the potential interactions of fluoride and boron in the water-sediment interface in 25 locations from incredible Red Sea tourist destinations. Results showed comparable levels of B and F in the water and sediments with previous literature. Significant positive correlation was found between B and F (r = 0.57; P<0.01). Based on the sediment/liquid partition coefficient (Kd), F is more likely to be released from the sediment into seawater (logKd< 3) than B (3< logKd< 4). pH and alkalinity may affect water-sediment interactions of B and F, respectively, while SO42- and Cl- ions had no significant effect on adsorption ability of F and B. The majority of minerals had average saturation Index (SI) > 1 referring to the over saturation of seawater with these minerals and their inability to dissolve. The formation of CF, FAP, and CFAP may be related to the high correlation between Fw (r = 0.928, P< 0.01; r = 0.527, P< 0.01; r = 0.608, P< 0.01) and Bw (r = 0.38, P< 0.05; r = 0.38, P< 0.05; r = 0.397, P< 0.05). Total hazard quotient (THQ) for children and adults were <1, revealing no health risks from exposure to B and F through ingestion and skin contact while swimming. The risk characterization ratio; RCRmix(MEC/PNEC) showed high short-term risks to aquatic organisms. Further investigations might emphasis on emerging mitigation strategies to address these concerns.

Groundwater vulnerability to fluoride pollution and health risk assessment in the western part of Odisha, India.

The fluoride dynamics of the Dharmagarh Block of Kalahandi District, Odisha, India, and associated health risk assessment have been studied. Complex data matrices were evaluated using groundwater quality index, fluoride pollution index, and principal component analysis to understand the geological evolution and identify potential sources for fluoride pollution. The study region comprises granite, granitic gneiss, and khondalite of hard and compact rock of Precambrian Eon, which supplies mostly the fluoride-bearing minerals. Altogether thirty-four (34) groundwater samples across the entire study area were collected and subjected to various physico-chemical analyses. The majority of the groundwater in the proposed region is hard to very hard type with Mg-HCO3 and Na-HCO3 being the two dominant facies. Groundwater contains fluoride in concentrations ranging from 0.21 to 2.26 mg/L. The statistical analysis of the quality parameters reveals the moderate positive correlation of fluoride with sodium (0.392) and pH (0.313) and week positive correlation with EC, TDS, TH, TA, Mg2+, and HCO3-, which directly depicts the initiation of fluoride problem within the study area. Based on the water quality index, 23.53% samples are good, 73.53% are poor, and 2.94% are very poor in nature. With respect to fluoride pollution index, 5.88% samples show high pollution, 55.88% samples show medium pollution, and 38.24% of samples show low pollution index. Human health risk assessment has also been carried out using the hazard quotient of fluoride. Altogether 70.59% of samples show Total Hazard Index (THI) values < 1 suggesting low risk of cancer and within the permissible range, whereas 29.41% of samples show THI > 1 suggesting the non-carcinogenic risk of pollutants, which exceeds the allowable limit for all the classes of male, female and children.

Groundwater chemical evolution characteristics and human health risk assessment in Shicheng County, Jiangxi Province.

Groundwater plays a pivotal role in the water resources of Shicheng County; however, the issue of excessive fluoride content in groundwater and its associated health risks often goes unnoticed. Groundwater assumes a crucial role in the hydrological dynamics of Shicheng County; nevertheless, the matter concerning elevated levels of fluoride within groundwater and its accompanying health hazards frequently evades attention. The hydrogeochemical analysis, obscure comprehensive water quality assessment based on cloud model, and probabilistic human health risk assessment using Monte Carlo simulation were conducted on 34 collected water samples. The findings indicate that the predominant groundwater hydrochemical types are SO4·Cl-Na and HCO3-Na. The processes of rock weathering and cation exchange play crucial roles in influencing water chemistry. Groundwater samples generally exhibit elevated concentrations of F-, surpassing the drinking water standard, primarily attributed to mineral dissolution. The concentrations of F- in more than 52.94% and 23.53% of the groundwater samples exceeded the acceptable non-carcinogenic risk limits for children and adults, respectively. Considering the inherent uncertainty in model parameters, it is anticipated that both children and adults will have a probability exceeding 49.36% and 30.50%, respectively, of being exposed to elevated levels of F ions in groundwater. The utilization of stochastic simulations, in contrast to deterministic methods, enables a more precise depiction of health risks. The outcomes derived from this investigation possess the potential to assist policymakers in formulating strategies aimed at ensuring the provision of secure domestic water supplies.

Salivary and urinary assessment of fluoride and silver ion concentrations after silver diamine fluoride application in children: a prospective cohort study.

PURPOSE: The purpose of the study was to determine the fluoride (F) and silver (Ag) ions levels in the saliva and urine of healthy children after silver diamine fluoride (SDF) application on dental carious lesions. METHODS: Sixty children (4-6 years with ≥ 3 caries lesions) were recruited from the outpatient department of Pediatric Dentistry. From each child, 3 ml unstimulated saliva samples were collected at baseline, one hour, and 24 h after SDF application. Similarly, 3 ml urine samples were collected prior to and after 24 h of SDF application. F and Ag ion concentrations were determined by fluoride ion-selective electrode (ISE) and inductively coupled plasma mass spectrometry (ICPMS), respectively. RESULTS: The mean ± standard deviation (SD) baseline, 1-h, and 24-h salivary F concentrations (ppm) were 0.07 ± 0.07, 0.93 ± 0.48, and 0.19 ± 0.19, respectively, while the mean baseline and 24-h urinary F concentrations (ppm) were 0.33 ± 0.20 ppm and 0.43 ± 0.25 ppm, respectively. The mean baseline, 1-h, and 24-h salivary Ag concentrations (ppb) were 4.22 ± 3.15, 4198 ± 350, and 56.93 ± 37, respectively. The mean baseline and 24-h urinary Ag concentrations (ppb) were 2.80 ± 2.93 ppb and 4.72 ± 4.0 ppb, respectively. There were statistically elevated F and Ag ion concentrations at 1 h and 24 h after SDF application as compared to the baseline. CONCLUSION: Salivary and urinary F and Ag ions concentrations elevated significantly at 24 h following SDF applications in children. A significant high recovery of these ions in urine indicates minimal systemic absorption, thus intermittent topical application of 38% SDF has a minimal risk of toxicity.

Cell viability assessment and ion release profiles of GICs modified with TiO2- and Mg-doped hydroxyapatite nanoparticles.

OBJECTIVES: To assess and compare the cell viability and ion release profiles of two conventional glass ionomer cements (GICs), Fuji IX and Ketac Molar EasyMix, modified with TiO2 and Mg-doped-HAp nanoparticles (NPs). METHODS: TiO2 NPs, synthesized via a sol-gel method, and Mg-doped hydroxyapatite, synthesized via a hydrothermal process, were incorporated into GICs at a concentration of 5 wt.%. The biocompatibility of prepared materials was assessed by evaluating their effects on the viability of dental pulp stem cells (DPSCs), together with monitoring ion release profiles. Statistical analysis was performed using One-way analysis of variance, with significance level p < 0.05. RESULTS: The addition of NPs did not significantly affect the biocompatibility of GICs, as evidenced by comparable decreased levels in cell viability to their original formulations. Distinct variations in cell viability were observed among Fuji IX and Ketac Molar, including their respective modifications. FUJI IX and its modification with TiO2 exhibited moderate decrease in cell viability, while other groups exhibited severe negative effects. While slight differences in ion release profiles were observed among the groups, significant variations compared to original cements were not achieved. Fluoride release exhibited an initial "burst release" within the initial 24 h in all samples, stabilizing over subsequent days. CONCLUSIONS: The addition of NPs did not compromise biocompatibility, nor anticariogenic potential of tested GICs. However, observed differences among FUJI IX and Ketac Molar, including their respective modifications, as well as induced low viability of DPSC by all tested groups, suggest the need for careful consideration of cement composition in their biological assessments. CLINICAL SIGNIFICANCE: The findings contribute to understanding the complex interaction between NPs and GIC matrices. However, the results should be interpreted recognizing the inherent limitations associated with in vitro studies. Further research avenues could explore long-term effects, in vivo performance, and potential clinical applications.

Identification of groundwater pollution sources and health risk assessment in the Fengshui mining area of Central Shandong, China.

The crux of groundwater protection lies in a profound understanding of the sources of pollutants and their impacts on human health. This study selected 47 groundwater samples from the Fengshui mining area in central Shandong Province, China, employing advanced hydrogeochemical techniques, positive matrix factorization (PMF), and Monte Carlo analysis methods, aimed at unveiling the characteristics, origins, and health risks of water pollutants. The results indicated that the majority of samples exhibited a slightly alkaline nature. Notably, the concentrations of fluoride (F-) and nitrate (NO3-) exceeded China's safety standards in 40.43% and 23.40% of the samples, respectively. Moreover, a water quality index (WQI) below 50 was observed in approximately 68.09% of the sites, suggesting that the water quality in these areas generally met acceptable levels. However, regions with higher WQI values were predominantly located in the northern and southern parts of the mining area. PMF analysis revealed that regional geological and industrial activities were the primary factors affecting water quality, followed by mining discharges, fundamental geological and agricultural processes, and leachate enrichment activities. The health risk assessment highlighted the heightened sensitivity of the youth demographic to fluoride, with a more pronounced non-carcinogenic risk compared to nitrate, affecting about 31.89% of the youth population. Hence, it is imperative for local authorities and relevant departments to take prompt actions to remediate groundwater contamination to minimize public health risks.

Associations between school-based fluoride mouth-rinse program, medical-dental expense subsidy policy, and children's oral health in Japan: an ecological study.

BACKGROUND: Dental caries are a common non-communicable disease among children. As a public health measure at the prefectural level, school-based fluoride mouth-rinse (S-FMR) program, medical/dental expense subsidy policies, and other factors may reduce the incidence of dental caries and tooth loss. Prefectures focusing on promoting oral health policies may promote both, but the interaction effect of implementing both subsidy policies and S-FMR at the prefectural level on caries prevention has not yet been examined. METHODS: We conducted an ecological study using two-wave panel data, prefecture-level aggregated data in Japan for 2016 and 2018. Coefficient and 95% confidence intervals (CI) were calculated for the dependent variables for oral health using mixed-effects linear regression analysis adjusted for possible confounders. Two dependent variables were used; the standardized claim ratio (SCR) of deciduous tooth extraction and 12-year-olds' decayed, missing, or filled permanent teeth (DMFT). Four independent variables were S-FMR, the SCR of dental sealants, prefectural income per person, and subsidy policy in three models: co-payment until children enter elementary school (n = 23), no co-payment until children enter elementary school (n = 7), and co-payment continuing beyond elementary school (n = 17). The effects of six interaction terms, each representing a unique pairing from the four independent variables, were individually calculated. RESULTS: S-FMR was negatively associated with the SCR of deciduous tooth extractions and DMFT (coefficient = -0.11, 95% CI -0.20; -0.01 and coefficient = -0.003, 95% CI -0.005; -0.001, respectively). No co-payment until children enter elementary school was positively associated with the SCR of deciduous tooth extraction compared to co-payment until children enter elementary school(coefficient = 11.42, 95% CI 3.29; 19.55). SCR of dental sealants was positively associated with the SCR of deciduous tooth extractions (coefficient = 0.12, 95% CI 0.06; 0.19) but negatively associated with DMFT (coefficient = -0.001, 95% CI -0.003; -0.0001). Per capita prefectural income was positively associated with the SCR of deciduous tooth extractions(coefficient = 0.01, 95% CI 0.001; 0.02). No interaction was found between S-FMR and the subsidy policy at both outcomes. CONCLUSION: High S-FMR utilization and no co-payment until children enter elementary school were associated with fewer deciduous tooth extractions. Also, S-FMR and dental sealant were associated with decreased DMFT.

Laser fluorescence assessment of dental caries arrest with two silver fluoride agents in patients with special needs- a preliminary report.

PURPOSE: While silver diamine fluoride has been used extensively for caries arrest and desensitising, silver fluoride (AgF) at neutral pH may also have value as a minimally invasive dental caries treatment. This study explored the effectiveness of two AgF products (AgF/KI and AgF/SnF2) when used in adult patients with special needs (SN) who had high caries risk and salivary gland hypofunction. METHODS: This split-mouth clinical study, over two appointments 3-months apart, compared the impact of a single application of AgF/KI (Riva Star Aqua, SDI) and AgF/SnF2 (Creighton Dental CSDS, Whiteley) on matched carious lesions in the same arch, by clinical visual-tactile (cVT) assessment of caries status and laser fluorescence (LF, DIAGNOdent) evaluation of bacterial load in the lesions, using repeated measures analysis. RESULTS: Twelve participants were recruited in the study. A total of 56 teeth (28 pairs) were included. Both AgF products gave a significant decrease in caries activity as measured by cVT (P < 0.0001) and LF (P = 0.0027). There were no statistically significant differences between the two AgF treatments, with response rates for improvements in active lesions of 92% in the AgF/KI arm, and 96% in the AgF/SnF2 arm. There was no effect of tooth type, lesion type, arch type, plaque metabolism and plaque area at the site level on outcomes, nor was there a clustering effect of sites in a patient level analysis. Overall, LF was superior to cVT for detecting lesions that still progressed despite treatment (P = 0.0027). CONCLUSION: A single application of AgF/KI or AgF/SnF2 has high predictability (over 90%) for achieving arrest in active caries lesions in adult patients with SN and high caries risk. Clinical assessment should use visual-tactile examination combined with LF readings to detect lesions that are still progressing and that require additional treatments. Future studies should compare these AgF modalities with SDF and explore factors such as time between applications and the need for repeated applications. TRIAL REGISTRATION: The study was registered with the Australian Clinical Trials Registry (ACTRN12621001139864p) on 23/08/2021.

Unravelling groundwater contamination and health-related implications in semi-arid and cold regions of India.

Groundwater, a vital global resource, is essential for sustaining life and various human activities. However, its quality and availability face increasing threats from both natural and human-induced factors. Widespread contamination, arising from both natural origins and human activities such as agriculture, industry, mining, improper waste disposal, and wastewater release, poses significant risks to human health and water security. India, known for its dense population and pronounced groundwater challenges, serves as a prominent case study. Notably, in most of its regions, groundwater resources have been found to be severely contaminated by various chemical, biological, and radioactive contaminants. This review presents an examination of contamination disparities across various states of semi-arid and cold regions, encompassing diverse assessment methods. The studies conducted in semi-arid regions of North, South, West, and East India highlight the consistent presence of fluorides and nitrates majorly, as well as heavy metals in some areas, with values exceeding the permissible limits recommended by both the Bureau of Indian Standards (BIS) and the World Health Organization (WHO). These contaminants pose skeletal and dental threats, methemoglobinemia, and even cancer. Similarly, in cold regions, nitrate exposure and pesticide residues, reportedly exceeding BIS and WHO parameters, pose gastrointestinal and other waterborne health concerns. The findings also indicated that the recommended limits of several quality parameters, including pH, electrical conductivity, total dissolved solids (TDS), total hardness, and total alkalinity majorly surpassed. Emphasising the reported values of the various contaminant levels simultaneously with addressing the challenges and future perspectives, the review unravels the complex landscape of groundwater contamination and its health-related implications in semi-arid and cold regions of India.

Fluoride and caries prevention: a scoping review of public health policies.

Background: Dental caries is the most common infectious disease, affecting approximately 60 to 90% of the world population, especially young children, and disadvantaged communities. Due to the extremely high prevalence and the significant negative impact on general health, well-being, and quality of life it is considered a global public health problem. Despite the improvement of policies to promote oral health care in the past decades, dental caries is still a healthcare challenge, characterized by increasing disparities among different social groups between and within countries. Fluoride-based prevention of dental caries is a cost-effective approach, that has been implemented since 1940's. It includes systemic and topical administrations, through community-based or individual programs. Preventive interventions should be tailored to individual and community caries risk assessment and estimate of cumulative fluoride intake, in order to maximize the preventive effect and avoid the risk of potential adverse effects associated with excessive fluoride exposure. Regulation of public health policies plays a major role in this context. Study design: Scoping review. Methods: The aim of this scoping review was to report an overview of current guidelines regarding fluoride-based preventive strategies for dental caries and relevant policies on the matter, as well as to address current issues related to public health aspects of dental caries prevention. We searched for the relevant literature on the matter, focusing on policy documents, such as recommendations, position papers and guidelines, issued from the major scientific and regulatory institutions involved in oral health promotion and on publications concerning relevant aspects of public health law. Results: Prevention of dental caries through fluoride can rely on topical fluorides for home-use (toothpastes and mouthrinses), professionally applied topical fluorides (gels, varnishes, silver diamine fluoride, fluoride-releasing restorative materials and sealants), fluoride supplements (tablets and drops), and community-based strategies (community water fluoridation, fluoridated salt and milk). Current relevant guidelines for all these preventive aids are outlined in the paper. A significantly greater preventive effect of topical fluorides has been widely established in the recent past, as compared to systemic effects. Furthermore, increasing concerns have emerged on potential adverse effects on general health associated with early and excessive systemic exposure to fluoride, especially for children, supported by recent meta-analyses. Also, community water fluoridation has raised significant aspects of relevance for health law and policies. In a public health perspective, healthcare policymakers should tackle social iniquities by promoting information and oral health literacy, through community and school-based programs, ensuring access to early dental visits and basic dental care and improving availability and affordability of fluoride topical products. Conclusions. Fluoride-based prevention can provide a simple and cost-effective approach to reduce the incidence of dental caries and the associated social burden. Among fluoride-based preventive strategies, systemic community-based administration of fluoride should be considered with great caution, due to the unfavorable risk-benefit ratio currently established. Topical fluoridated pro-ducts are generally preferred, given the optimal risk-benefit ratio. Further efforts must be made to identify and tackle the barriers to dental caries prevention and related social iniquities from a public health perspective. Policies and laws on oral health should promote access to caries prevention with targeted comprehensive strategies.

Water fluoridation between public health and public law: an assessment of regulations across countries and their preventive medicine implications.

Background: Among health professionals and health policymakers concern is growing as to the difficulty of balancing the prevention of dental caries through cost-effective interventions and the need to limit unnecessary exposure of the population, and especially children, to environmental chemicals. In this respect, the use of water fluoridation to prevent tooth decay epitomizes the dilemma by raising questions relevant to both public health and public law, ranging from the balance of public health and medical self-determination, the division of powers between local or national authorities over water fluoridation, and the need to avoid the adverse effects of socioeconomic inequalities as well as both under- and over-exposure. Study design: We carried out a narrative review by searching the relevant literature about the laws and rules related to drinking water fluoridation at the community level in the US, UK, and Europe, in order to discuss how the issue is handled from both a public health and public law perspective. Methods: Sources of data for this review were the biomedical and legal literature retrieved by searching online databases, and websites of public health and legal institutions. Results and Conclusions: We found that water fluoridation is still largely adopted throughout the US, while in the UK and particularly in the European Union only a minor part of the population is subject to it. In addition, the recommended and maximum allowed amounts of fluoride in drinking water are being adapted to the public health recommendations and the new regulations, within an evolving evaluation of the epidemiologic evidence and the risk assessment currently in progress by two major regulatory agencies, the US National Toxicology Program - NTP and the European Food Safety Authority - EFSA. Under a comparative public law perspective, the three investigated legislations are facing a reassessment of their policies and regulations, to allow for effective and safe public health measures in the field of water fluoridation and more generally for a preferred use of topical fluoride for caries prevention. A consistent trend across these legislations is the choice to centralize at the national level regulatory and management issues related to water fluoridation, and to carefully balance benefits for dental caries prevention in children and the potential risks of systemic overexposure associated with excess fluoride intake, by promptly responding to the evolving indications by the scientific community and the public health professionals.

A GIS approach for groundwater quality evaluation with entropy method and fluoride exposure with health risk assessment.

This study used the entropy water quality index to analyse the suitability of groundwater for human consumption as well as the hazard index to identify the probable non-carcinogenic dangers among children, women, and men in Nawada, Bihar (India). A total of 75 groundwater samples were taken from hand pumps and tube/bore wells in the pre-monsoon of 2017, and they were evaluated for various physicochemical characteristics. The region's groundwater major cations and anions are dominated by Ca2+ > Mg2+ and [Formula: see text] > Cl- > [Formula: see text] > NO3- > F > [Formula: see text]. Fluoride, chloride, and hardness exceeded WHO and BIS safe standards. Calcium, sodium, magnesium, sulphate, and chloride showed positive correlations, indicating water-rock interactions and mineral leaching and dissolution. Ionic cross-plots reveal that the dissolution of carbonate minerals was the primary source of calcium and magnesium in the groundwater. Also, silicate weathering contributed to these ions in the groundwater. The entropy water quality index (EWQI) found that 79% of groundwater samples were drinkable, whereas 21% were not consumable. The eastern, western, and some southern study areas have the worst drinking water quality. The main source of fluoride toxicity in people is groundwater. For all sampling locations, the HQ fluoride was calculated to be in the ranges of 0.04-3.69 (male), 0.04-3.27 (female), and 0.05-4 (children), indicating a considerably greater risk than the permissible levels (> 1). The fluoride-based non-carcinogenic risks are 27%, 20%, and 21% for children, women, and men, respectively. Children have higher risks from polluted water than adults, according to the non-carcinogenic health risk assessment. This study establishes a standard for regional and global scientific studies that help decision-makers and planners determine the quality of groundwater and fluoride risk and management.

Multi-model exploration of groundwater quality and potential health risk assessment in Jajpur district, Eastern India.

The presence of fluoride and nitrate is a serious groundwater quality issue in India impacting human health. In the present study, 14 different hydrochemical parameters for 76 groundwater samples collected from the Jajpur district of Odisha, India, were evaluated. Entropy-weighted water quality index (EWQI), fixed-weight groundwater quality index (GWQI), principal component analysis (PCA), and rotated factor loading-based water quality index (PCWQI) were employed to assess groundwater quality. About 65.79 ± 4.68%, 33.55 ± 3.95%, and 0.66 ± 0.76% of the samples were rated as "excellent," "good," or "medium" quality, respectively, across the four different water quality indices, with a nominal rating discrepancy of 13.15%. Though 86% of samples consistently received excellent or good ratings across all WQI frameworks, concentrations of F- and NO3- in 36.8% and 11.84% of the samples exceeded the WHO permissible limit. In health risk assessment, about 38.15% of samples surpassed the F- hazard quotient (HQ > 1) posing non-carcinogenic health risks for children. The non-carcinogenic health risks due to NO3- were evident in 55.26% and 11.84% of samples for children and adults, respectively. The higher concentration of NO3- in some of the water samples, together with its positive correlation with HCO3-, may worsen groundwater pollution. The moderate correlation between Ca2+ and HCO3- (r = 0.410) and the insignificant correlation between Mg2+ and HCO3- (r = 0.234) suggests calcite dissolution is far more common than dolomite.

Hydro-chemical based assessment of groundwater vulnerability in the Holocene multi-aquifers of Ganges delta.

Determining the degree of high groundwater arsenic (As) and fluoride (F-) risk is crucial for successful groundwater management and protection of public health, as elevated contamination in groundwater poses a risk to the environment and human health. It is a fact that several non-point sources of pollutants contaminate the groundwater of the multi-aquifers of the Ganges delta. This study used logistic regression (LR), random forest (RF) and artificial neural network (ANN) machine learning algorithm to evaluate groundwater vulnerability in the Holocene multi-layered aquifers of Ganges delta, which is part of the Indo-Bangladesh region. Fifteen hydro-chemical data were used for modelling purposes and sophisticated statistical tests were carried out to check the dataset regarding their dependent relationships. ANN performed best with an AUC of 0.902 in the validation dataset and prepared a groundwater vulnerability map accordingly. The spatial distribution of the vulnerability map indicates that eastern and some isolated south-eastern and central middle portions are very vulnerable in terms of As and F- concentration. The overall prediction demonstrates that 29% of the areal coverage of the Ganges delta is very vulnerable to As and F- contents. Finally, this study discusses major contamination categories, rising security issues, and problems related to groundwater quality globally. Henceforth, groundwater quality monitoring must be significantly improved to successfully detect and reduce hazards to groundwater from past, present, and future contamination.

Regional and racial/ethnic inequalities in public drinking water fluoride concentrations across the US.

BACKGROUND: Although the US Centers for Disease Control and Prevention (CDC) considers fluoridation of community water systems (CWSs) to be a major public health achievement responsible for reducing dental disease, recent epidemiologic evidence suggests that chronic exposure to population-relevant levels of fluoride may also be associated with adverse child neurodevelopmental outcomes. To our knowledge, a nationally representative database of CWS fluoride concentration estimates that can be readily linked to US epidemiologic cohorts for further study is not publicly available. Our objectives were to evaluate broad regional and sociodemographic inequalities in CWS fluoride concentrations across the US, and to determine if county-level racial/ethnic composition was associated with county-level CWS fluoride. METHODS: We generated CWS-level (N = 32,495) and population weighted county-level (N = 2152) fluoride concentration estimates using over 250,000 routine compliance monitoring records collected from the US Environmental Protection Agency's (EPA) Third Six Year Review (2006-2011). We compared CWS-level fluoride distributions across subgroups including region, population size served, and county sociodemographic characteristics. In county-level spatial error models, we also evaluated geometric mean ratios (GMRs) of CWS fluoride per 10% higher proportion of residents belonging to a given racial/ethnic subgroup. RESULTS: 4.5% of CWSs (serving >2.9 million residents) reported mean 2006-2011 fluoride concentrations ≥1500 µg/L (the World Health Organization's guideline for drinking water quality). Arithmetic mean, 90th, and 95th percentile contaminant concentrations were greatest in CWSs reliant on groundwater, located in the Southwest and Eastern Midwest, and serving Semi-Urban, Hispanic communities. In fully adjusted spatial error models, the GMR (95% CI) of CWS fluoride per a 10% higher proportion of county residents that were Hispanic/Latino was 1.16 (1.10, 1.23). IMPACT STATEMENT: We find that over 2.9 million US residents are served by public water systems with average fluoride concentrations exceeding the World Health Organization's guidance limit. We also find significant inequalities in community water system fluoride concentration estimates (2006-2011) across the US, especially for Hispanic/Latino communities who also experience elevated arsenic and uranium in regulated public drinking water systems. Our fluoride estimates can be leveraged in future epidemiologic studies to assess the potential association between chronic fluoride exposure and related adverse outcomes.

Health risk assessment in an area of dental fluorosis disease from high fluoride drinking water: a case study from southeastern Türkiye.

This study focuses on identifying fluoride (F‒) concentrations and its health risk assessment (HRA) in drinking water sources in south-eastern Türkiye. Groundwater quality was assessed using some graphical approaches such as Schoeller and Piper diagrams and GIS mapping. Average daily exposure dosages through oral and dermal contact exposure routes were considered to determine the potential health risk of F‒ in groundwater. Groundwater samples were taken from 53 points in spring, summer, autumn, and winter seasons. The results showed that the average annual F‒ concentrations in water resources in the study area were 0.26‒3.62 mg/L. According to the HRA results, the highest F‒ health risk in this region was observed in children, followed by teenagers and adults. This study indicated that there is a strong relationship between the high health risk (4.28 > 3.5) in children and dental fluorosis caused by high F‒ concentration in groundwater.

A Mixed-Methods Study on Topical Fluoride Beliefs and Refusal Behaviors for Caregivers of Children with Special Health Care Needs.

OBJECTIVE: To understand topical fluoride-related beliefs and refusal behaviors for caregivers of children with special health care needs (CSHCN). METHODS: This was an explanatory sequential mixed methods study. For the quantitative analyses, we surveyed 520 caregivers to (a) compare fluoride-related beliefs between caregivers of CSHCN and caregivers of healthy children and (b) evaluate the association between special health care need (SHCN) status and topical fluoride refusal. We used logistic regression models to generate unadjusted odds ratios, confounder-adjusted odds ratios (AOR), and 95% confidence intervals (CI). For the qualitative analyses, we interviewed 56 caregivers who refused or were hesitant about topical fluoride. Data were coded deductively and compared by SHCN status to an existing conceptual model of topical fluoride refusal. RESULTS: In the quantitative analysis, 41.3% of caregivers refused or thought about refusing topical fluoride. There were no significant differences in fluoride beliefs by SHCN status (p-values > 0.05) nor was there a significant association between SHCN status and topical fluoride refusal (AOR: 0.65, 95% CI 0.37-1.14; p = 0.13). In the qualitative analysis, the relative importance of each domain of the conceptual model was similar between the caregiver groups. Two differences were that all caregivers of CSHCN thought fluoride was unnecessary and wanted to keep chemicals out of their child's body. CONCLUSIONS FOR PRACTICE: While caregivers of CSHCN were not more likely to refuse topical fluoride than caregivers of healthy children, there may be important differences in the underlying reasons for refusing topical fluoride.

The impact of bias of underlying literature in guidelines on its recommendations: assessment of the German fluoride guideline.

PURPOSE: The significance of the underlying literature in clinical guidelines can be weakened by the risk of bias, which could negatively affect the recommendations. Especially in controversial matters, such as fluoride use for caries prevention in children, biased results may be not reliable and lead to incorrect conclusions. This study was performed to detect bias in underlying literature of the German guideline for caries prevention using fluoride in children, where no consensus was reached between paediatricians and paediatric dentists. METHODS: Three tools used for risk of bias assessments of different study designs were RoB 2 for RCTs, ROBINS-I for non-randomized studies, and ROBIS for systematic reviews. For each study cited in the guideline two independent risk of bias assessments were performed. Disagreements were resolved by consensus. RESULTS: Out of 58 papers, 48.3% (n = 28) showed high risk of bias, with the majority in sections regarding fluoride tablets, fluoridated toothpaste, and paediatricians' recommendations. 9 out of 20 recommendations and statements were based on studies with high risk of bias, all of which were in these three controversial sections. 13 out of 29 RCTs showed high risk of bias (44.8%), as all 13 non-randomized trials did, while only 2 of 16 (12.5%) systematic reviews had high risk of bias. CONCLUSION: Considering risk of bias of cited studies in clinical guidelines may result in substantial changes in its recommendations and aid in reaching consensus. Efforts should be made to assess risk of bias of underlying literature in future clinical guidelines.