A review on the potential sources and health implications of fluoride in groundwater of Sub-Saharan Africa

Spatial distribution, geochemical processes of high-content fluoride and nitrate groundwater, and an associated probabilistic human health risk appraisal in the Republic of Djibouti

In the northern East African Rift System, the Republic of Djibouti relies exclusively on groundwater, with levels of fluoride (up to 14 mg/L) and nitrate (up to 256 mg/L) posing potential health risks. To address this, 362 samples were considered, including 133 shallow groundwater samples, along with new and previously published data dating back to 2012 on deep (88) and thermal (141) groundwater samples. To understand the enrichment mechanisms, dissolved anion and cation constituents, geochemical and thermodynamic tools, and stable isotope ratios, such as δ2H(H2O), δ18O(H2O), δ15N(NO3-), and δ18O(NO3-), were used. In particular, two activity diagrams (Mg2+ vs. Ca2+ and Na+ vs. Ca2+), focused on aqueous and solid fluoride species in an updated thermodynamic dataset of 15 fluoride-bearing minerals, are shown for the first time. The dataset offers new and valuable insights into fluoride geochemistry (classic thermodynamic datasets combined with geochemical codes rely solely on fluorapatite and fluorite F-bearing minerals). Activity diagrams and geochemical modeling indicate that mineral dissolution primarily drives groundwater fluoride enrichment in all water types, whereas the elevated nitrate levels may stem from organic fertilizers like animal manure, as indicated by nitrate isotopes and NO3-/Cl- vs Cl- diagrams. Despite the arid climate and 2H18O enrichment in shallow waters, evaporation seems to play a minor role. Monte Carlo simulations and sensitivity analysis were used to assess the health risks associated with elevated F- and NO3- concentrations. Mapping-related spatial distribution analysis identified regional contamination hotspots using a global Moran's I and GIS tools. One fluoride and three nitrate contamination hotspots were identified at a p-value of 0.05. Groundwater chemistry revealed that 88 % of groundwater being consumed exceeded the permissible levels for fluoride and nitrate, posing potential health risks, particularly for teenagers and children. This study pinpoints specific areas with excessive nitrate and fluoride contamination, highlighting a high non-carcinogenic risk.

Early childhood caries, climate change and the sustainable development goal 13: a scoping review

BACKGROUND

Sustainable development goal 13 centres on calls for urgent action to combat climate change and its impacts. The aim of this scoping review was to map the published literature for existing evidence on the association between the Sustainable Development Goal (SDG) 13 and early childhood caries (ECC).

METHODS

The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In August 2023, a search was conducted in PubMed, Web of Science, and Scopus using search terms related to SDG13 and ECC. Only English language publications were extracted. There was no restriction on the type of publications included in the study. A summary of studies that met the inclusion criteria was conducted highlighting the countries where the studies were conducted, the study designs employed, the journals (dental/non-dental) in which the studies were published, and the findings. In addition, the SDG13 indicators to which the study findings were linked was reported.

RESULTS

The initial search yielded 113 potential publications. After removing 57 duplicated papers, 56 publications underwent title and abstract screening, and two studies went through full paper review. Four additional papers were identified from websites and searching the references of the included studies. Two of the six retrieved articles were from India, and one was China, Japan, the United States, and the United Kingdom respectively. One paper was based on an intervention simulation study, two reported findings from archeologic populations and three papers that were commentaries/opinions. In addition, four studies were linked to SDG 13.1 and they suggested an increased risk for caries with climate change. Two studies were linked to SDG 13.2 and they suggested that the practice of pediatric dentistry contributes negatively to environmental degradation. One study provided evidence on caries prevention management strategies in children that can reduce environmental degradation.

CONCLUSION

The evidence on the links between SDG13 and ECC suggests that climate change may increase the risk for caries, and the management of ECC may increase environmental degradation. However, there are caries prevention strategies that can reduce the negative impact of ECC management on the environment. Context specific and inter-disciplinary research is needed to generate evidence for mitigating the negative bidirectional relationships between SDG13 and ECC.

Poor oral health and the risk of esophageal squamous cell carcinoma in Malawi

Esophageal squamous cell carcinoma (ESCC) is the second most common cancer in Malawi. Risk factors for this cancer in Malawi are poorly understood. Poor oral health has previously been linked to increased ESCC risk in other high-incidence regions, including parts of Eastern and Southern Africa. We assessed the relationship between oral health and ESCC risk in a sex, age and location frequency-matched case-control study based at two hospitals in Lilongwe, Malawi from 2017 to 2020. Trained interviewers used a structured questionnaire and direct observation to collect data on demographics; behaviors; oral hygiene habits; the sum of decayed, missing or filled teeth (DMFT score); oral mucosa status; lip depigmentation and dental fluorosis via a visual scale. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI), adjusted for known and suspected ESCC risk factors. During the study period, 300 cases and 300 controls were enrolled. Subjects in the highest tertile of DMFT score (≥7) had an increased risk of ESCC with an adjusted OR of 1.96 (95% CI: 1.16-3.36) compared to those with a DMFT score of 0. Severe dental fluorosis was associated with a statistically nonsignificant increased risk of ESCC (adjusted OR = 2.24, 95% CI: 0.97-5.49) compared to individuals with no fluorosis. Associations with oral mucosa status, lip depigmentation and toothbrushing method and frequency were mostly null or uncertain. Poor oral health, indicated by a higher DMFT score, was associated with increased ESCC risk in Malawi. Dental fluorosis is another possible risk factor in this population, but further evaluation is necessary to clarify any effects of fluorosis on ESCC risk.

The fluorosis conundrum: bridging the gap between science and public health

Fluorosis, a chronic condition brought on by excessive fluoride ingestion which, has drawn much scientific attention and public health concern. It is a complex and multifaceted issue that affects millions of people worldwide. Despite decades of scientific research elucidating the causes, mechanisms, and prevention strategies for fluorosis, there remains a significant gap between scientific understanding and public health implementation. While the scientific community has made significant strides in understanding the etiology and prevention of fluorosis, effectively translating this knowledge into public health policies and practices remains challenging. This review explores the gap between scientific research on fluorosis and its practical implementation in public health initiatives. It suggests developing evidence-based guidelines for fluoride exposure and recommends comprehensive educational campaigns targeting the public and healthcare providers. Furthermore, it emphasizes the need for further research to fill the existing knowledge gaps and promote evidence-based decision-making. By fostering collaboration, communication, and evidence-based practices, policymakers, healthcare professionals, and the public can work together to implement preventive measures and mitigate the burden of fluorosis on affected communities. This review highlighted several vital strategies to bridge the gap between science and public health in the context of fluorosis. It emphasizes the importance of translating scientific evidence into actionable guidelines, raising public awareness about fluoride consumption, and promoting preventive measures at individual and community levels.

Water quality, geochemistry and human health risk of groundwater in the Vyeboom region, Limpopo province, South Africa

This study focuses on the evaluation of trace metals as well as microbial contamination of groundwater. Groundwater samples were collected from 17 boreholes. The microbial quality was tested using membrane filtration method. Higher levels of contamination for both E. coli and total coliform was recorded in the wet season. Majority of the boreholes had nitrate levels above the regulatory guideline value of the World health Organisation and the South African National Standards. The water type was established by Piper plot which showed the predominance of a magnesium bicarbonate water type, with alkaline earth metals dominating the alkali metals, as well as the weaker acids (bicarbonates) dominating the stronger ones (Sulphates and chlorides). Most of the trace metals detected were in compliance with the regulatory standard except for aluminium (0.41-0.88 mg/L). The hazard quotient and Hazard indice exceeded 1 mostly for children in both season which implies a possible non-carcinogenic health risk is associated with the continuous consumption of the water resource. The estimations of carcinogenic risk (CRing) for Cr and Pb exceeded the carcinogenic indices of 10-6 and 10-4 which could pose adverse effects on human health for both children and adults. Therefore, it is recommended that measures should be implemented to reduce the risk.

Level of natural fluoride in public water supply: geographical and meteorological factors in Brazil's Northeast

This study analyzed the relationships between the concentration of natural fluoride in public water supply and meteorological and hydrographic factors in a northeastern region of Brazil. This was a descriptive, analytical, ecological, longitudinal, and field study conducted by collecting water in 23 municipalities (2019 to 2020) of four macroregions of Paraíba (Brazil): coast (1), borborema (2), agreste (3), and outback (4). Four collection sites were selected per municipality: two near and two distant from the water treatment plant. Fluoride concentration was determined using a combined ion-specific electrode and classified according to the Collaborating Center of the Ministry of Health in Oral Health Surveillance. Meteorological, hydrographic, and population characteristics were also collected. All analyzed samples showed natural fluoride; macroregions 2 and 4 showed the highest mean fluoride concentration, macroregion 4 presented the highest mean temperature, and all macroregions showed a similar pattern of precipitation. The mean fluoride concentration of the four macroregions was below the appropriate value to prevent caries. An increase in precipitation would decrease the fluoride concentration in water. In conclusion, the concentration of natural fluoride varied according to meteorological and hydrographic factors. The concentration in surface waters increased during periods of low precipitation. Therefore, this study provided important information to support implementation of community water fluoridation in this region.

Microstructural Analysis of Cancellous Bone in Fluorosis Rats

Skeletal fluorosis likely alters bone structural properties on the cortical and cancellous tissue levels in view that fluorine ion replaces bone mineral composition. Our previous study showed high bone turnover occurred in cortical bone of skeletal fluorosis. Therefore, this study further analyzed the microstructure of cancellous bone in fluorosis rats. Rats were randomly assigned into three groups: the control, low-dose fluoride group (10 mgF-/kg·day), and high-dose fluoride group (20 mgF-/kg·day). Rats were orally administered with fluoride for 1, 2, and 3 months of periods. The trabecular bone parameters of tibia were detected with micro CT and analyzed with software. The activities of glutathione peroxidase (GPX), superoxide dismutase (SOD), and the content of malondialdehyde (MDA) in serum were measured. Results showed that severity of dental fluorosis rose with the increase of dose and prolongation of fluoride exposure. Meantime, the poorer connectivity and less trabecular bone network were observed in cancellous bone of rats treated with fluoride. Data analysis indicated that fluoride treatment significantly decreased bone volume and connectivity degree, but amplified trabecular space in 1 and 2 months of periods. Intriguingly, trabecular thickness significantly decreased in 1-month high-dose fluoride group, but returned to the control in 3 months of period. Fluoride treatment mainly inhibited the GPX activity and increased the MDA level to activate oxidative stress. This study confirmed that excessive fluoride impaired cancellous bone and caused redox imbalance.

Reutilization of carbon of waste filter cartridge after its surface modification for the fluoride removal from water by continuous flow process

In the present study, the waste carbon cartridge of the water filter was modified and reutilized for defluoridation of water. The modified carbon was characterized by particle size analysis (PSA), Fourier transformed infrared spectroscopy (FTIR), zeta potential, pHzpc, energy-dispersive X-ray (EDS), scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), and X-ray crystallography (XRD). The adsorptive nature of modified carbon was investigated with pH (4-10), dose (1-5 g/L), contact time (0-180 min), temperature (25-55 °C), fluoride concentration (5-20 mg/L), and the effect of the competitive ions. Adsorption isotherm, kinetics, thermodynamics, and breakthrough studies were evaluated for fluoride uptake on surface-modified carbon (SM*C). Fluoride adsorption on the carbon accepted Langmuir model (R2 = 0.983) and pseudo-second-order kinetic (R2 = 0.956). The presence of HCO3- in the solution reduced the elimination of fluoride. The carbon was regenerated and reused four times; the removal percentage was decreased from 92 to 31.7%. This adsorption phenomenon showed exothermic behavior. The maximum fluoride uptake capacity of SM*C achieved 2.97 mg/g at 20 mg/L of initial concentration. The modified carbon cartridge of the water filter was successfully employed for fluoride removal from water.

Oral health of adolescents in West Africa: prioritizing its social determinants

Oral health is a major public health issue in West Africa, yet it has gotten little attention. Individual and group disparities in health status are influenced by social determinants of health (SDH), which also affect oral health. Adolescence is a significant transition into adulthood, a time when the SDH can contribute to lifelong health status. This article explored the SDH associated with oral health behaviour, perception, and oral health development amongst adolescents in West Africa. This article engaged articles published in peer-reviewed journals relating to adolescents' oral health and West Africa. The authors undertook this desk review to determine the social determinants of adolescents' oral health in West Africa. The literacy levels and oral health awareness of adolescents, family and social circle influences, socioeconomic status, nutritional levels, and cultural and environmental factors have been identified as important social determinants. Adequate policy implementation with the integration of oral health in schools' curriculum, health systems reorientation with the adoption of oral health delivery in primary health care and expansion in oral health research with the assessment of cultural influences on oral health development have been recommended as interventions to reduce oral health inequalities in West Africa.

Relationships between dental fluorosis and fluoride concentrations in bottled water and groundwater in low-income children in Mexico

Introduction

The aim of the current study was to investigate associations between dental fluorosis in children living in low socioeconomic areas in Mexico, and fluoride concentrations in tap water, fluoride concentrations and in bottled water, and body mass index (BMI).

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.

Fluoride presence in drinking water along the southeastern part of El Bajío Guanajuatense, Guanajuato, Mexico: sources and health effects

Drinking water with a high natural concentration of fluoride (F^-) has serious consequences for the health of the rural population in the state of Guanajuato, Mexico, where the water contains levels of F^- that are not allowed by national and international regulations (1.5 mg/L). This health problem is very common in multiple states throughout Mexico where drinking water is generally extracted from aquifers that are hosted in fractured volcanic rocks of the Tertiary. These aquifers show similar geological characteristics: deep basins that formed as a result of felsic eruptive events and the extensional deformation of the Basin and Range and are now filled with unconsolidated sediments. In this study, we assessed the occurrence of F in volcanic rocks collected at 11 sampling sites along the Sierra de Codornices in Guanajuato (ranging between 0.01299 and 0.146 wt%, average 0.039 wt%, and SD = 0.039 wt%; n = 10), a region where both rural and urban communities consume drinking water with a high F^- content (up to 7.1 (mg/L). The F content is dispersed in volcanic rocks, and the highest levels are present in felsic rocks. The statistical and hydrogeochemical results of a sampling campaign of 32 wells in the Juventino Rosas (JR) and Villagran (Vill) municipalities in 2019 suggest that F^- mobilization in groundwater is the product of silicate weathering and the dissolution of volcanic glass, alkaline desorption in the surfaces of F-containing minerals, and possibly ion exchange of minerals and clays or deep fluids enriched with F^-, in addition to the precipitation of carbonates that decrease the Ca²⁺ concentration in groundwater. All of these processes can be accelerated by groundwater geothermal characteristics within the study area. The hydrogeochemical, fluoride exposure risk, and fluoride pollution index (FPI) results, as well as the epidemiological survey, indicate that teenagers and older adults from Praderas de la Venta are at risk of exposure to F^- due to the high concentrations ingested over a long period, the toxicity of the element, and its ability to accumulate in the bones. Extended exposure to elevated levels increases the risk. This work allows us to observe how the populations of JR and Vill can be exposed to high F^- contents in drinking water due to the geological characteristics of the region.

Fluoride occurrence in environment, regulations, and remediation methods for soil: A comprehensive review

Fluoride, a naturally occurring chemical element, is largely insoluble in soils. More than 90% of the fluoride in soil is bound to soil particles and is unable to be dissolved. As part of the soil, fluoride is predominantly located in the colloid or clay fraction of the soil, and the movement of fluoride is strongly affected by the sorption capacity of the soil, which is affected by pH, the type of soil sorbent present, and the salinity. The Canadian Council of Ministers of the Environment soil quality guideline for fluoride in soils under a residential/parkland land use scenario is 400 mg/kg. In this review, we focus on fluoride contamination in soil and subsurface environments, and the various sources of fluorides are discussed in detail. The average fluoride concentration in soil in different countries and their regulations for soil and water are comprehensively reviewed. In this article, the latest advances in defluoridation methods are highlighted and the importance of further research addressing efficient and cost-effective methods to remediate fluoride contamination in soil is critically discussed. Methods used to mitigate fluoride risks by removing fluoride from the soil are presented. We strongly recommend that regulators and soil chemists in all countries explore opportunities to improve defluoridation methods and consider adopting more stringent regulations for fluoride in soil depending on geologic conditions.

A Systematic Review and Meta-Analysis of the Relationship Between the Severity of Dental Fluorosis and Fluoride Biomarkers in Endemic Areas

The intake of high concentrations of fluoride, mainly through drinking water, diet and fluoridated dentifrices, produces fluorosis, which in its early stages is manifested as dental fluorosis (DF). To recognize exposure to fluoride in endemic areas and to evaluate the risk of developing health impairment, the WHO has established several biomarkers that are used to determine systemic fluorine (F^-) exposure. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the relationship between the severity of DF and fluoride biomarkers in endemic areas. The protocol of this study was previously registered as CRD42021244974. A digital search was carried out in PubMed/Medline, SpringerLink, Scopus, Cochrane and Google Scholar by employing the keywords "urine", "nails", "hair", "plasma", "saliva" and "dental fluorosis" for the original studies with content associated with F^- for the biomarkers and DF. The mean difference was established as the effect measure for the meta-analysis. Seven studies fulfilled the eligibility criteria, among which five assessed urine and two employed nails as fluoride biomarkers. A positive significant difference was found between the biomarkers and the severity of DF (0.27, p < 0.001) and individually for each biomarker (urine: 0.14, p = 0.001; nails: 0.88, p < 0.05). The F^- concentration in urine and nails is correlated with the severity of DF, with the most evident differences between healthy individuals and those with mild severity. Both biomarkers are adequate to assess this relationship in endemic areas of fluoride and DF.

Excessive Lysosomal Stress Response and Consequently Impaired Autophagy Contribute to Fluoride-Induced Developmental Neurotoxicity

Fluoride can cause developmental neurotoxicity; however, the precise mechanism has yet to be determined. We aimed to explore the possible role and mechanism of fluoride-induced developmental neurotoxicity, specifically the significance of the lysosomal stress response. As an in vivo model, Sprague Dawley rats were exposed to sodium fluoride (NaF) from embryo to 2 months of age. We found that NaF caused autophagic flux blockage and apoptosis in the rat hippocampus. These results were validated in human neuroblastoma (SH-SY5Y) cells in vitro. In addition, in SH-SY5Y cells, NaF hindered autophagosome-lysosome fusion, decreased lysosomal degradation, and elevated lysosomal pH, which is the most prominent hallmark of a lysosomal stress response. Interestingly, rapamycin promoted autophagosome-lysosome fusion, effectively restoring autophagic flux and reducing apoptosis. Notably, bafilomycin A1, a lysosomal lumen alkalizer, unsurprisingly exacerbated the NaF-induced increase in lysosomal pH and decreased lysosomal degradability, as well as enhanced apoptosis of SH-SY5Y cells. In conclusion, our results suggest that NaF exposure initiates excessive lysosomal stress response, resulting in elevated lysosomal pH, decreased lysosomal degradation, and blocked autophagic flux, which leads to neuronal apoptosis. Thus, the lysosomal stress response may be a promising target for the prevention and treatment of fluoride-induced developmental neurotoxicity.

Fluoride exposure duringintrauterine and lactation periods promotes changes in the offspring rats' alveolar bone

The importance of fluoride (F) for oral health is well established in the literature. However, evidence suggests that excessive exposure to this mineral is associated with adverse effects at different life stages and may affect many biological systems, especially mineralized tissues. The purpose of this study was to investigate the effects of F exposure during pregnancy and breastfeeding on the alveolar bone of the offspring since the alveolar bone is one of the supporting components of the dental elements. For this, the progeny rats were divided into three groups: control, 10 mg F/L, and 50 mg F/L for 42 (gestational and lactation periods). Analysis of the quantification of F levels in the alveolar bone by particle-induced gamma emission; Raman spectroscopy to investigate the physicochemical aspects and mineral components; computed microtomography to evaluate the alveolar bone microstructure and analyses were performed to evaluate osteocyte density and collagen quantification using polarized light microscopy. The results showed an increase in F levels in the alveolar bone, promoted changes in the chemical components in the bone of the 50 mg F/L animals (p < 0.001), and had repercussions on the microstructure of the alveolar bone, evidenced in the 10 mg F/L and 50 mg F/L groups (p < 0.001). Furthermore, F was able to modulate the content of organic bone matrix, mainly collagen; thus, this damage possibly reduced the amount of bone tissue and consequently increased the root exposure area of the exposed groups in comparison to a control group (p < 0.001). Our findings reveal that Fcan modulate the physicochemical and microstructural dimensions and reduction of alveolar bone height, increasing the exposed root region of the offspring during the prenatal and postnatal period. These findings suggest that F can modulate alveolar bone mechanical strength and force dissipation functionality.

Health risk assessment of fluoride exposure due to groundwater consumption in Romania

Fluoride has both beneficial and detrimental effects on human health. Concentrations of fluoride less than 1.0 mg/L in ingested water are beneficial for the rate of tooth decay, especially in children. The aims of the paper are as follows: (i) to monitor fluoride concentrations in drinking water samples (well water and tap water from the rural district of Valea Râmnicului, Romania); (ii) to study and select the optimal buffer solution and the optimal volume used in the analyses and (iii) to validate the potentiometric method for determining fluoride ions with a selective ion electrode. The values of fluoride ion concentrations in the groundwater samples and in tap water varied from 0.01 to 0.138 mg^/L. The values for the hazard quotient for the studied samples varied from 0.01 to 0.13.

Fluoride concentration in bottled drinking water from a fluoride endemic area: A market-based survey

Drinking water is the primary source of fluoride intake for humans around the world. In southern Algeria, dental fluorosis is considered an epidemic that is spreading among the population by health professionals. Thus, the consumption of bottled water is important because it is considered safer for health.

OBJECTIVES

This study aims to determine the fluoride concentrations of bottled water commercially available in southern Algeria and report the non-carcinogenic health risk via daily human intake.

MATERIAL AND METHODS

By 2021, 28 commercial brands were obtained from different supermarkets in Ouargla, Algeria. Fluoride was measured using a validated spectrophotometric method. The fluoride risk quotient (HQ) and the estimated daily intake (EDI) were calculated.

RESULTS

All the brands did not mention the fluoride content on the label. The mean level was 0.40 ± 0.42 mg/L, and a wide range was found [0.00-1.65 mg/L]. The average was below the WHO standard. Most samples (75%, n = 21) contained less than 0.50 mg/L, which can cause dental caries. The HQ values average were less than 1, suggesting no health risk associated with drinking bottled water.

CONCLUSION

With the increasing consumption of bottled water, this work is important for primary prevention programs for dental caries. The main contribution is the constitution of a database concerning the fluoride levels in bottled water marketed in southern Algeria. Labelling of fluoride concentrations by manufacturers should be mandatory.

Bioaccumulation of Fluoride in Plants and Its Microbially Assisted Remediation: A Review of Biological Processes and Technological Performance

Fluoride is widely found in soil–water systems due to anthropogenic and geogenic activities that affect millions worldwide. Fluoride ingestion results in chronic and acute toxicity, including skeletal and dental fluorosis, neurological damage, and bone softening in humans. Therefore, this review paper summarizes biological processes for fluoride remediation, i.e., bioaccumulation in plants and microbially assisted systems. Bioremediation approaches for fluoride removal have recently gained prominence in removing fluoride ions. Plants are vulnerable to fluoride accumulation in soil, and their growth and development can be negatively affected, even with low fluoride content in the soil. The microbial bioremediation processes involve bioaccumulation, biotransformation, and biosorption. Bacterial, fungal, and algal biomass are ecologically efficient bioremediators. Most bioremediation techniques are laboratory-scale based on contaminated solutions; however, treatment of fluoride-contaminated wastewater at an industrial scale is yet to be investigated. Therefore, this review recommends the practical applicability and sustainability of microbial bioremediation of fluoride in different environments.

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.

Hydrogeogenic fluoride in groundwater and dental fluorosis in Thai agrarian communities: a prevalence survey and case-control study

Background

Dental fluorosis can be a disease of social inequity in access to safe drinking water. This dental public health issue becomes prominent in socially disadvantaged agrarian communities in fluoride endemic areas where the standard irrigation system is unavailable and groundwater containing natural fluoride is the major drinking water source. This study aimed to determine the prevalence and severity of dental fluorosis in children and to evaluate its association with fluoride in groundwater in the aforementioned setting in Thailand.

Methods

A cross-sectional survey of 289 children in Nakhon Pathom Province was conducted in 2015. Children with very mild to severe fluorosis were regarded as ‘cases’ while their counterparts were ‘controls’ for a subsequent case–control study. Records of fluoride concentrations in groundwater used for household supply corresponding to resident and number of years by age of each child during 2008–2015 were retrieved. Other exposure variables were measured using a questionnaire. Prevalence ratio (PR), a measure indicating the relative effect of different levels of fluoride on dental fluorosis, was obtained from Poisson regression with robust standard error.

Result

There were 157 children with very mild to moderate dental fluorosis (54.3% prevalence). The univariable analysis revealed that the prevalence of dental fluorosis among children with fluoride concentrations in water sources of 0.7–1.49 (index category 1) and ≥ 1.5 ppm (index category 2) was 1.62 (95% CI; 0.78, 3.34) and 2.75 (95% CI; 1.42, 5.31) times the prevalence among those with fluoride < 0.7 ppm (referent category). After adjusting for all covariates, the adjusted prevalence ratios in both index categories were 1.64 (95% CI; 0.24, 11.24) and 2.85 (95% CI; 0.44, 18.52) which were close to their corresponding crude estimates. Since the magnitude of confounding, measured by (PR_crude–PR_adjusted)/PR_adjusted, were less than 10% for both index categories; this indicated the limited confounding effect of all covariates.

Conclusions

In fluoride endemic areas, groundwater containing natural fluoride utilized for household consumption resulted in high dental fluorosis prevalence, particularly in the groundwater with fluoride concentrations of ≥ 1.5 ppm.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01902-8.

The usage of calcium phosphate systems for onsite defluoridation treatment

Over 200 million people in over 35 countries are affected by excessive fluoride in their waters. For people that do not have access to a centralized water treatment plant, there is a need for an on-site defluoridation system that requires no special operational expertise, does not use hazardous chemicals, and is sustainable by the local population. 8 different calcium phosphate precipitation systems were analyzed and tested for fluoride removal effectiveness. An effective system would have final fluoride concentrations less than 1.5 mg/L and final solutions with pH within drinkable limits. Phosphoric acid with the addition of a calcium carbonate source was found to have a 99.8% fluoride removal rate. Monosodium phosphate with addition of slaked lime was also found to be effective with a 99.98% fluoride removal rate. An optimal slaked lime to monosodium phosphate ratio that achieved effective fluoride removal and neutral pH was found. With 0.45 g of Ca(OH)₂ and 1 g of NaH₂PO₄, initial fluoride concentrations up to 100 mg/L or more could be reduced to near zero concentrations, and a volume of approximately 337 mL of water with a concentration of 5 mg/L F^- could to be reduced to less than 1.5 mg/L F^-.

Geochemical characterization and assessment of fluoride sources in groundwater of Siloam area, Limpopo Province, South Africa

Siloam’s groundwater is reportedly characterized by high fluoride. In response to the reported high incidence of dental fluorosis in the area, sources of elevated fluoride in the groundwater were investigated. Total fluoride (TF) was determined using Ion Chromatograph and Fluoride Ion Selective Electrode. The mineral composition of rocks and soils were determined using X-ray Fluorescence and X-ray diffraction, respectively. Results revealed that groundwater fluoride concentration ranged from 3.92 to 4.95 mg/L. Na-Cl water type was found to be dominant in the water samples. TF content of the rocks and soils ranged from 10 to 2000 mg/L. Leachates were obtained by making a slurry from the samples at a predetermined temperature and time. TF in leachates ranged between 0.27 and 14.88 mg/L and 0.05 to 10.40 mg/L at induced, and non-induced temperatures, respectively. The possible source of fluoride has been previously inferred to be caused by fluorite minerals occurring at greater depth. However, this study proves that fluoride decreases with depth and the elevated fluoride in the groundwater is caused by smectite-kaolinite clay, muscovite and chlorite minerals abundant in the area. Geothermal temperature exhibited by the groundwater in the area is a major factor enhancing the release of fluoride from the clay materials.

Water Quality Assessment and Evaluation of Human Health Risk in Mutangwi River, Limpopo Province, South Africa

Freshwater supply is essential to life on Earth; however, land use activities such as mining and agriculture pose a significant danger to freshwater resources and the wellbeing of aquatic environments. This study temporarily assesses the water quality characteristics of Mutangwi River. Physicochemical parameters (pH, temperature, total dissolved solids (TDS), salinity, electrical conductivity (EC), and turbidity) were determined in situ using an Extech multimeter and turbidity meter. The concentration of the selected metals (Mg, Cr, Fe, Cd, Mn, Pb, Ca, and Na) were analysed using an Atomic Absorption Spectrophotometer. Membrane filtration method was used to analyse microbiological parameters (Escherichia coli and Enterococci). The physicochemical water quality parameters as well as basic anions (fluoride, phosphate, sulfate, nitrate, and chloride) determined complied with the regulatory guideline of the World Health Organization (WHO) and the South Africa National Standards (SANS). Some of the trace metals (Mn, Ca, Fe, and Mg) were found below the guideline values, while others (Pb and Cd) exceeded the threshold limit. The counts for E. coli (814.5-2169 cfu/100 mL) and Enterococci (333-9396 cfu/100 mL) in the study did not comply with the regulatory guidelines. The water quality status using the water quality index (WQI) indicated that on the average, the water quality from Mutangwi River is poor (WQI > 100). The hazard quotient through ingestion exposure did not exceed the threshold limit of 1, for adults and children. This implies that there is no potential non-carcinogenic health risk from trace elements via ingestion of drinking water for children and adults. However, cancer risk for adults and children was computed in relation to Cd and Pb levels and exceeded the threshold limit 10^-4, indicating a possible carcinogenic risk. Water from the river should be adequately treated prior to domestic and agricultural use.