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.

Fuzzy logic-based health risk assessment of fluoride in groundwater used as drinking source in Sira region, Tumkur, India.

Fluoride contamination in drinking water is a serious public health concern across the world, and more than 90 million people in India are affected by health risks associated with fluoride. Though the fatality due to fluoride chronic toxicity is uncommon, the exposure to fluoride at different concentration levels shows various adverse health effects such as dental and skeletal fluorosis, multiorgan failure, cognitive and behavioural effects. Hence, the objectives of the present study are to understand the hydrogeochemistry and drinking water suitability of groundwater of the Sira region, Karnataka, India, and to understand the occurrence of fluoride and its health risks using the United State Environmental Protection Agency (US EPA) method and fuzzy logic concepts. Forty-six samples were collected from each pre and post-monsoon season. The hydrogeochemistry studied through Chadha's diagram and Gibb's diagram indicated that the groundwater in this region is of Na-Cl type and the hydrogeochemistry is majorly controlled by rock-water interaction and followed by evaporative dominance. Water quality parameters were compared with drinking water standards guidelines, and the results showed that around 50% of the samples were contaminated with fluoride. The occurrence of high levels of fluoride in the study region is associated to the presence of granitic rocks and it is influenced by high pH and low calcium dissolution in the groundwater. Based on US EPA method, the order of population group under the risk of dental and skeletal fluorosis, is children > adolescents > adults. A fuzzy inference system model is developed to assess the health risk due to fluoride and its output gives severity levels of each type of health risk, i.e. dental caries, dental fluorosis and skeletal fluorosis. The results of the application of the fuzzy inference system model in the Sira region showed that the children (< 8 Yr.) are more susceptible to the moderate risk of dental caries, dental fluorosis and skeletal fluorosis. Whereas adolescents (8-18 Yr.) and adults (> 18 Yr.) are less susceptible to low-very low risk. Hence, health risks associated with fluoride can be better addressed with the help of a fuzzy inference system model which can be used for more reliable and grounded results to improve the quality of decision-making.

Fluoride concentrations in drinking water and health risk assessment in the south of Algeria.

Drinking water is the primary source of fluoride intake by humans worldwide. Algeria, Africa's largest country, has been reported to have moderate to high fluoride levels in the water, particularly in the Southern and Saharan regions. In the south of Algeria, dental fluorosis is considered an epidemic that is spreading within the population by health professionals. This study aimed to determine fluoride concentrations in drinking water consumed by Ouargla population (south-east of Algeria) in 2021, assess non-carcinogenic health risk via daily human intake, and calculate the upper acceptable fluoride concentration in drinking water by Galgan and Vermillion formula. Forty-two water samples were collected during the spring season. The fluoride was measured using a validated spectrophotometric method. Hazard quotient of fluoride (HQ) and estimated daily intake (EDI) were calculated. The results reveal a mean fluoride level of 1.07 ± 0.38 mg/L, below WHO recommendation. Fluoride concentrations in water were higher in rural areas than in the central city (p = 0.05). HQ values were less than one for adults but greater than 1 for infants and children, suggesting health risks associated with water consumption for these vulnerable groups (p = 0.007). The main contribution of this study is the establishment of a database concerning fluoride levels and hazard quotient in the south of Algeria. Monitoring drinking water and control fluorosis is essential to avoid potential health risks.

Fluoride Exposure through Different Drinking Water Sources in a Contaminated Basin in Guanajuato, Mexico: A Deterministic Human Health Risk Assessment.

Water fluoride levels above the World Health Organization's guideline (1.5 mg/L), common in overexploited aquifers, represent a health hazard. Our objective was to assess the health risks posed by exposure to fluoride in different drinking water sources in a contaminated basin in Mexico. Fluoride was measured in mutual drinking water sources and in the urine of 39 children and women. Risks were estimated through hazard quotient (HQ) by drinking water source. Dental fluorosis was assessed in the children. Mean fluoride water concentrations (mg/L) were: well, 4.2; waterhole, 2.7; bottled, 2.1; rainwater, 0.4. The mean urinary fluoride concentrations (specific gravity adjusted) were 2.1 mg/L and 3.2 mg/L in children and women, respectively. Our multiple linear regression model showed children's urinary fluoride concentrations increased 0.96 mg/L for every 1 mg/L increase in water fluoride (p < 0.001). Dental fluorosis was diagnosed in 82% of the children, and their HQ according to drinking water source was: well, 1.5; waterhole, 1.1; bottled, 0.8; harvested rainwater, 0.3. The pervasive dental fluorosis indicates a toxic past fluoride exposure; urinary fluoride levels and HQs indicate high exposure and current health risks for most children. Drinking harvested rainwater will likely prevent most of the local fluoride exposure.

Health risk assessment in children living in an urban area with hydrofluorosis: San Luis Potosí Mexico case study.

BACKGROUND: Fluoride is an inorganic element, which can be found in high concentrations in groundwater. Its consumption and exposure have consequences on human health. The objective of this study was to evaluate fluoride exposure and develop a health risk assessment in children from an urban area with hydrofluorosis in Mexico. METHODS: Water fluoride levels in active wells were provided by the Water State Agency and divided into three zones: agriculture zone (Zone A), metallurgical zone (Zone B), and industrial zone (Zone C). Urinary fluoride levels were determined by potentiometric method using an ion-selective electrode. Health risk assessment was performed through Monte Carlo model analysis and hazard quotient was calculated. RESULTS: According to fluoride well concentration, all zones have high concentration especially Zone B (2.55 ± 0.98 mg/L). Urinary fluoride concentrations were highest in children in Zone B (1.42 ± 0.8 mg/L). The estimated median daily intake dose of fluoride was 0.084 mg/Kg-day for the children living in zone B. The highest mean HQ value was to Zone B (1.400 ± 0.980), followed by Zone C (0.626 ± 0.443). CONCLUSION: The levels of fluoride exposure registered are a potential risk to generate adverse health effects in children in the San Luis Potosi metropolitan area.

Fluoride in Drinking Water and Skeletal Fluorosis: a Review of the Global Impact.

When safe and adequate exposure of an essential trace element is exceeded it becomes potentially toxic. Fluoride is one classic example of such a double edged sword which both plays a fundamental role in the normal growth and development of the body for example the consumption of levels between 0.5-1.0 ppm via drinking water is beneficial for prevention of dental caries but its excessive consumption leads to development of fluorosis. PURPOSE OF REVIEW: The abundance of fluorine in the environment as well as in drinking water sources are the major contributors to fluorosis. It is a serious public health concern as it is a noteworthy medical problem in 24 nations including India yet the threat of fluorosis has not been rooted out. The review focuses on recent findings related to skeletal fluorosis and role of oxidative stress in its development. The fluoride mitigation strategies adopted in recent years are also discussed. RECENT FINDINGS BASED ON CASE STUDIES: Recent findings revealed that consumption of fluoride at concentrations of 1.5 ppm is majorly responsible for skeletal fluorosis. The sampling from rural areas showed that 80% villages are having fluoride concentrations more than the WHO permissible limits and people residing in such areas are affected by the skeletal fluorosis and also in the regions of Africa and Asia endemic fluorosis have been accounted in the majority of the region affecting approximately 100 million people. Various mitigation programmes and strategies have been conducted all over the world using defluoridation. Fluorosis is a slow and progressive malady affecting our body and a serious concern to be taken into consideration and to be dealt with effectively. The fluoride toxicity although reversible, is a slow process and the side effects lack treatment options. The treatment options available are either not approachable or affordable in the rural areas commonly suffering from the fluoride toxicity. No specific treatments are available to date to treat skeletal fluorosis affectively; therefore, prevention is one of most safest and best approach to fight fluorosis. The current review lays emphasis on the skeletal fluorosis and its prevalence in recent years. It also includes the recent findings as well as the current strategies related to combat skeletal fluorosis and provides findings that might be helpful to promote the research in the field of effective treatment for fluorosis as well as development of easy and affordable methods of fluoride removal from water.

The association between the prevalence of dental fluorosis and the socio-economic status and area of residence of 12-year-old students in Uruguay.

Objective: This study investigates the association between the prevalence and severity of dental fluorosis, the socio-economic status (SES) and area of residence among 12-year-old schoolchildren in Uruguay.Material and methods: The study was descriptive, cross-sectional, explanatory and observational. Subjects considered eligible were born in 1999 and had their parents' or guardian's prior consent. A questionnaire was used to identify SES according to Centro de Investigaciones Económicas Institute on four levels. Dental fluorosis was determined using the Thylstrup-Fejerskov (TF) index.Results: Of the 1544 students examined, 45.0% showed dental fluorosis. A TF index 1-2 was recorded in 29.3% of the subjects, TF 3 in 20.9%, TF 4 in 6.7% and TF 5-9 in 2.1%. In area 1 (the capital Montevideo city), 84.8% of the subjects had dental fluorosis, a value that was significantly higher than in the inland region (area 2, 24.4%) and border departments (area 3, 22.5%) (x2 = 27.92, p < .0001). Students from families with a low socio-economic level showed less prevalence of dental fluorosis than those with a high level (x2 = 14.58, p = .002).Conclusion: Significant differences exist in the prevalence of dental fluorosis in relation to place of residence and socio-economic level.

Spatial distribution of fluoride in drinking water and health risk assessment of children in typical fluorosis areas in north China.

China has been suffering from endemic fluorosis for the past 30 years. This study investigated fluoride concentrations in 10 districts of Tianjin, China, to illustrate their spatial distribution characteristics and potential human health risks. The results showed fluoride concentration of 0.01-6.30 mg L-1 with a mean value of 0.99 mg L-1, and 78.82% of water fluoride reaches the standard for drinking water (1.5 mg L-1). Higher fluoride levels were recorded in deep well pumps supply zones, and more potential changes in fluoride occurred was positively correlated with pH in groundwater. Mean value of fluoride in drinking water in 10 districts followed the order of WQ > BC > JZ > NH > BD > BH > JN > JH > DL > XQ. Estimations of non-carcinogenic risk for drinking water indicated that mean hazard quotient values of fluoride for combined pathways (i.e., oral ingestion and dermal absorption) were >1.0 for all age groups of WQ and BC. The results also showed that the estimated risk primarily came from the ingestion pathway. Risk levels for children varied obviously, generally in the order of 1-4y > 4-7y > 7-9y (years old). In the central tendency center and reasonable maximum exposure conditions, estimated risks were 1.25, 1.12, 0.771 and 3.66, 3.29, 2.27, respectively. The results supply material information for health authorities in fluorosis areas to put forward more efficient policies to control the endemic diseases. Attention should be paid to the formulation of health promotion strategies and measures to reduce fluoride intake in order to protect the health of residents.

Fluoride contamination, health problems and remediation methods in Asian groundwater: A comprehensive review.

In low concentration, fluoride is considered a necessary compound for human health. Exposure to high concentrations of fluoride is the reason for a serious disease called fluorosis. Fluorosis is categorized as Skeletal and Dental fluorosis. Several Asian countries, such as India, face contamination of water resources with fluoride. In this study, a comprehensive overview on fluoride contamination in Asian water resources has been presented. Since water contamination with fluoride in India is higher than other Asian countries, a separate section was dedicated to review published articles on fluoride contamination in this country. The status of health effects in Asian countries was another topic that was reviewed in this study. The effects of fluoride on human organs/systems such as urinary, renal, endocrine, gastrointestinal, cardiovascular, brain, and reproductive systems were another topic that was reviewed in this study. Different methods to remove fluoride from water such as reverse osmosis, electrocoagulation, nanofiltration, adsorption, ion-exchange and precipitation/coagulation were introduced in this study. Although several studies have been carried out on contamination of water resources with fluoride, the situation of water contamination with fluoride and newly developed technology to remove fluoride from water in Asian countries has not been reviewed. Therefore, this review is focused on these issues: 1) The status of fluoride contamination in Asian countries, 2) health effects of fluoride contamination in drinking water in Asia, and 3) the existing current technologies for defluoridation in Asia.

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.

Spatial Distribution Variation and Probabilistic Risk Assessment of Exposure to Fluoride in Ground Water Supplies: A Case Study in an Endemic Fluorosis Region of Northwest Iran.

Prevalence of fluorosis is a worldwide public health issue, especially in the West Azerbaijan province of Iran. The aim of this study was to investigate fluoride concentration in drinking water resources within Maku city, in both the warm and cold seasons, to perform a health risk assessment. Fluoride were measured using UV-visible spectrophotometry. The spatial distribution was calculated by the software ArcGIS and Hazard Quotients (HQs) were calculated according to the US EPA method. The fluoride concentrations ranged between 0.29 to 6.68 and 0.1 to 11.4 mg/L in the cold and warm seasons, respectively. Based on this report, 30.64 and 48.15% of the samples revealed a fluoride level higher than the permissible level in the cold and warm seasons, respectively. Moreover, results showed that the HQ value in the warm season for different age groups was higher than the HQ value in the cold season. In both seasons, the non-carcinogenic risks of fluoride for the four exposed populations varied according to the order: children > teenagers > adults > infants. The HQ values for three age groups (children, teenager and adults) for both seasons were higher than 1 with a high risk of fluorosis. The results of this study, support the requests that government authorities better manage water supplies to improve health quality.

Caries Assessment Spectrum and Treatment: Would It direct Future Epidemiological Surveys?

AIM: To evaluate caries spectrum among 12- and 15-year-old Indian children using the Caries Assessment Spectrum and Treatment (CAST) index. MATERIALS AND METHODS: An epidemiological survey of the schoolchildren was carried out in a district in India. A stratified cluster random sampling method was used to select the sample. The caries prevalence of the surveyed population was obtained by using this CAST tool. Chi-square test was used to verify the association between dental fluorosis, socioeconomic status, and age and caries experience. Mann-Whitney U-test was used to compare the caries experience between the two age groups. RESULTS: A total of 2,610 children were examined. The majority of the schoolchildren (12 years: 74.2%, 15 years: 75.5%) were healthy concerning their caries experience and the prevalence of the other codes was minimal. The prevalence of dentin carious lesions and the percent of restorable teeth was greater among the 15-year-olds. The mean decayed, missing, and filled teeth (DMFT) of 12- and 15-year-old subjects was calculated to be 0.22 and 0.29 respectively. CONCLUSION: The currently surveyed population showed a low caries prevalence and the use of the tool highlighted the caries spectrum in an impressive way. CLINICAL SIGNIFICANCE: A well-designed tool to assess the carious spectrum of an individual or a community, thus enabling the responsible stakeholders to plan an appropriate care that is necessary.

Distribution and health risk assessment of natural fluoride of drinking groundwater resources of Isfahan, Iran, using GIS.

Fluoride (F) contamination in groundwater can be problematic to human health. This study evaluated the concentration of fluoride in groundwater resources of Isfahan Province, the central plateau of Iran, and its related health issues to the inhabitant populations. For this purpose, 573 drinking groundwater samples were analyzed in 2016 by using the spectrophotometric method. Non-carcinogenic health risks due to F exposure through consumption of drinking water were assessed using the US EPA method. In addition, the associated zoning maps of the obtained results were presented using geographic information system (GIS). The results indicated that F content in drinking water ranged from 0.02 to 2.8 mg/L. The F contents were less than 0.50 mg/L in 63% of the drinking groundwater samples, 0.51-1.5 mg/L in 33.15%, and higher than 1.5 mg/L in 3.85% (Iran and World Health Organization guidelines) of the drinking groundwater samples. The F levels in the west and the south groundwater resources of the study areas were lower than 0.5 mg/L, which is within the recommended values for controlling dental caries (0.50-1.0 mg/L). Therefore, these places require more attention and more research is needed to increase F intake for health benefit. The HQ index for children, teens and male and female adults had health hazards (HQ > 1) in 51, 17, 28, and 18 of samples, respectively. Groundwater resources having a risk of more than one were located in the counties of Nayin, Natanz, and Ardestan. So, in these areas, there are potential risks of dental fluorosis. The most vulnerable groups were children. The F levels must be reduced in this region to decrease endemic fluorosis.

Geochemical sources, hydrogeochemical behavior, and health risk assessment of fluoride in an endemic fluorosis area, central Iran.

The present study is the first attempt to put forward the possible source(s) and health risk assessment of fluoride in Bahabad, central Iran. Fluoride concentrations ranged from 0.22 to 2.35 mg/L and 292-355 mg/kg in the groundwater and soil samples, respectively. Geochemical provenance techniques using major and rare earth elements in soils revealed that local shale is the most probable source rock of fluoride in the area. A two-step chemical fractionation method applied on soil samples demonstrated that residual and water-soluble fractions were the most probable modes of fluoride in soil, whereas exchangeable fraction had a minor role. The coefficient of aqueous migration showed that fluoride in the studied soils behaved as a mobile element. Moreover, the relative mobility indicated that soils played a more important role than rocks in releasing fluoride into groundwater. In groundwater medium, chemical weathering, evaporation, and ion exchange acted as the main geochemical controlling factors of fluoride enrichment. Findings of this study signify that the role of NaCl and NaSO4-type waters should be considered more to recognize susceptible areas to fluoride contamination in groundwater. People in the study area are exposed to high levels of fluoride intake through drinking water, thus making dental fluorosis a major public health concern in the area. Scanning electron microscopy of the dentin's enamel showed morphological modifications (e.g., cracks and fissures) in residents' enamel structures. The results of this study may lead to suitable management strategies to mitigate the endemic fluorosis problem.

Assessment of fluoride retention in jowar consuming population: A cross-sectional study.

INTRODUCTION: Dental fluorosis is considered as a serious public health problem in India. Water is usually the major source of fluoride exposure, but this is not the case always as exposure to local factors like diet can be important in some situations. Earlier studies have shown that jowar (a millet) consumption interacts with fluoride in the body and elevate fluorosis. AIM AND OBJECTIVE: To determine the association between jowar consumption and severity of dental fluorosis. MATERIALS AND METHODS: Hundred schoolgoing children of 10-14 years old was selected by random sampling from Wadloor village. Dental fluorosis was measured in children by Thylstrup-Fejerskov index (1988). Twenty-four hours diet recall method was used to know the exposure to jowar of the children. A pretested questionnaire was given to mother or caretaker to record the jowar consumption. Spot urine samples of children were collected in plastic containers (20 ml) and brought to the laboratory in icebox. Ion selective electrode method was used to measure the fluoride level in urine samples of children. RESULTS: On comparison of the quantity of jowar and fluorosis using Pearson Chi-square test, difference among variable was found out to be statistically significant (P = 0.013, P < 0.05). On comparison of quantity jowar consumption and urinary fluoride level using Pearson Chi-square test, the difference among variable was found statistically significant (P < 0.001). CONCLUSION: Jowar consuming population was positively associated with severity of dental fluorosis.

Assessment of potential health risk of fluoride consumption through rice, pulses, and vegetables in addition to consumption of fluoride-contaminated drinking water of West Bengal, India.

A study was conducted in fluoride-affected Bankura and Purulia districts of West Bengal to assess the potential health risk from fluoride exposure among children, teenagers, and adults due to consumption of rice, pulses, and vegetables in addition to drinking water and incidental ingestion of soil by children. Higher mean fluoride contents (13-63 mg/kg dry weight) were observed in radish, carrot, onion bulb, brinjal, potato tuber, cauliflower, cabbage, coriander, and pigeon pea. The combined influence of rice, pulses, and vegetables to cumulative estimated daily intake (EDI) of fluoride for the studied population was found to be 9.5-16%. Results also showed that intake of ivy gourd, broad beans, rice, turnip, fenugreek leaves, mustard, spinach, and amaranth grown in the study area is safe at least for time being. The cumulative EDI values of fluoride (0.06-0.19 mg/kg-day) among different age group of people of the study area were evaluated to be ~104 times higher than those living in the control area; the values for children (0.19 and 0.52 mg/kg-day for CTE and RME scenarios, respectively) were also greater than the "Tolerable Upper Intake Level" value of fluoride. The estimated hazard index (HI) for children (3.2 and 8.7 for CTE and RME scenarios, respectively) living in the two affected districts reveals that they are at high risk of developing dental fluorosis due to the consumption of fluoride-contaminated rice, pulses, and vegetables grown in the study area in addition to the consumption of contaminated drinking water.

Risk assessment of fluoride exposure in drinking water of Tunisia.

The presence of fluoride in drinking water is known to reduce dental cavities among consumers, but an excessive intake of this anion might leads to dental and skeletal fluorosis. This study reports a complete survey of the fluoridated tap water taken from 100 water consumption points in Tunisia. The fluoride concentrations in tap water were between 0 and 2.4 mg L-1. Risk assessment of Fluoride exposure was assessed depending on the age of consumers using a four-step method: hazard identification, toxicity reference values selection (TRVs), daily exposure assessment, and risk characterization. Our findings suggest that approximately 75% of the Tunisian population is at risk for dental decay, 25% have a potential dental fluorosis risk, and 20% might have a skeletal fluorosis risk according to the limits of fluoride in drinking water recommended by WHO. More investigations are recommended to assess the exposure risk of fluoride in other sources of drinking water such as bottled water.

Probabilistic risk assessment of Chinese residents' exposure to fluoride in improved drinking water in endemic fluorosis areas.

Studies have yet to evaluate the effects of water improvement on fluoride concentrations in drinking water and the corresponding health risks to Chinese residents in endemic fluorosis areas (EFAs) at a national level. This paper summarized available data in the published literature (2008-2016) on water fluoride from the EFAs in China before and after water quality was improved. Based on these obtained data, health risk assessment of Chinese residents' exposure to fluoride in improved drinking water was performed by means of a probabilistic approach. The uncertainties in the risk estimates were quantified using Monte Carlo simulation and sensitivity analysis. Our results showed that in general, the average fluoride levels (0.10-2.24 mg/L) in the improved drinking water in the EFAs of China were lower than the pre-intervention levels (0.30-15.24 mg/L). The highest fluoride levels were detected in North and Southwest China. The mean non-carcinogenic risks associated with consumption of the improved drinking water for Chinese residents were mostly accepted (hazard quotient < 1), but the non-carcinogenic risk of children in most of the EFAs at the 95th percentile exceeded the safe level of 1, indicating the potential non-cancer-causing health effects on this fluoride-exposed population. Sensitivity analyses indicated that fluoride concentration in drinking water, ingestion rate of water, and the exposure time in the shower were the most relevant variables in the model, therefore, efforts should focus mainly on the definition of their probability distributions for a more accurate risk assessment.

Preliminary human health risk assessment of arsenic and fluoride in tap water from Zacatecas, México.

Zacatecas state is located in the central area of Mexico, where the underground water contains elevated quantities of natural arsenic and fluoride. In order to estimate health risk associated with human exposure to these pollutants, tap water samples from the southern-central region of the state were analyzed. Ninety percent of the samples exceeded the levels of arsenic established by the World Health Organization (WHO) of 0.01 mg/L and 43 % exceeded the limit established by the NOM-127-SSA1(1) of 0.025 mg/L. Forty-three percent of the samples had fluoride levels above the Mexican regulation limit of 1.5 mg/L (NOM-127-SSA1). We used WHO and EPA's health risk assessment method, we estimated 80 % of the inhabitants of sites studied could be exposed to arsenic levels higher than those recommended by EPA and the WHO, 22 % could be exposed to fluoride levels higher than those recommended by EPA, and 16 % of the local population may be in risk of suffering dental fluorosis.

Oral health needs of athletes with intellectual disability in Eastern Europe: Poland, Romania and Slovenia.

OBJECTIVES: The aims of this study were to evaluate the oral condition and treatment needs of Special Olympics (SO) athletes from Poland, Romania and Slovenia. METHODS: A cross-sectional study was performed with data collected through standardised oral screening of athletes who participated in the annual SO events held in Poland, Romania and Slovenia, between 2011 and 2012. The data were compiled and transferred to an SPSS data file for analysis using descriptive statistics. RESULTS: A total of 3,545 athletes participated in the study. Among the main findings, the prevalence of untreated decay was 41% in Poland and 61% in Slovenia, whilst 70% of the Romanian athletes had signs of gingival disease and only 3.8% presented molar fissure sealants. In addition, 47% of Polish athletes were in need of urgent treatment. CONCLUSIONS: Analysis of the results obtained following screening showed comparable oral health needs of athletes with intellectual disability among countries. Exploration of the oral health systems of the countries revealed similar significant co-payments and lack of incentive for dentists to treat patients with special needs. The results from Romania, Poland and Slovenia demonstrated the need for a structured system in which a special population is a target for oral-health-related education programmes and system-included preventive, restorative and maintenance interventions.