Skip to main content

A health risk assessment for fluoride in Central Europe

Environmental Geochemistry and Health volume 29, pages 83–102 (2007)Cite this article

Abstract

Like many elements, fluorine (which generally occurs in nature as fluoride) is beneficial to human health in trace amounts, but can be toxic in excess. The links between low intakes of fluoride and dental protection are well known; however, fluoride is a powerful calcium-seeking element and can interfere with the calcified structure of bones and teeth in the human body at higher concentrations causing dental or skeletal fluorosis. One of the main exposure routes is via drinking water and the World Health Organisation currently sets water quality guidelines for the element. In Central Europe, groundwater resources that exceed the guideline value of 1.5 mg l−1 are widespread and effects on health of high fluoride in water have been reported. The aim of the current project was to develop a geographic information system (GIS) to aid the identification of areas where high-fluoride waters and fluorosis may be a problem; hence, where water treatment technologies should be targeted. The development of the GIS was based upon the collation and digitisation of existing information relevant to fluoride risk in Ukraine, Moldova, Hungary and Slovakia assembled for the first time in a readily accessible form. In addition, geochemistry and health studies to examine in more detail the relationships between high-fluoride drinking waters and health effects in the population were carried out in Moldova and Ukraine demonstrating dental fluorosis prevalence rates of 60–90% in adolescents consuming water containing 2–7 mg l−1 fluoride.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  • Apambire, W. B., Boyle, D. R., & Michel, F. A. (1997). Geochemistry, genesis and health implications of fluoriferous groundwaters in the upper regions of Ghana. Environmental Geology, 33(1), 13–24.

    Article  Google Scholar 

  • Bartram, J., & Balance, R. (1996). Water quality monitoring, a practice guide to the design and implementation of freshwater quality studies and monitoring programmes. London: E&F Spon.

    Google Scholar 

  • Biro, G., Antal, M., & Zajkas, G. (1996). Nutrition survey of the Hungarian population in a randomized trial between 1992–1994. European Journal of Clinical Nutrition, 50, 201–208.

    Google Scholar 

  • Brown, W., & Konig, K. G. (1977). Cariostatic mechanism of fluorides. Caries Research, 11(Suppl 1), 1–327.

    Google Scholar 

  • Dean, H., Arnold, F., & Elvove, E. (1942). Domestic water and dental caries. V. Additional studies of the relation of fluoride in domestic waters and dental caries. Public Health Report, 57, 1155–1179.

    Google Scholar 

  • Dissanayake, C. B. (1996). Water quality and dental health in the Dry Zone of Sri Lanka. In J. D. Appleton, R. Fuge, & G. J. H. McCall (Eds.) Environmental geochemistry and health with specific reference to developing countries. London: Geological Society (pp. 131–141) Geological Society Special Publication 113.

    Google Scholar 

  • Dissanayake, C. B., & Chandrajith, R. (1999). Medical geochemistry of tropical environments. Earth Science Reviews, 47(3–4), 219–258.

    Article  Google Scholar 

  • Edmunds, W. M., & Smedley, P. M. (1996). Groundwater geochemistry and health—an overview. In J. D. Appleton, R. Fuge, & G. J. H. McCall (Eds.), Environmental geochemistry and health with specific reference to developing countries London: Geological Society (pp. 91–107). Geological Society Special Publication 113.

    Google Scholar 

  • Fordyce, F. M., & Vrana, K. (Eds.) (2001). Development of a fluoride risk assessment GIS for Central Europe. Final Report: Water Quality Improvements through Fluoride Reduction in Groundwater of Central Europe. Inco-Copernicus 15-CT98-0139.

  • Frencken, J. E., Truin, G. J., Van’t Hof, M. A., Konig, K. G., Mabelya, L., Mulder, J., & Ruiken, H. M. (1990). Prevalence of dental caries in 7–13-yr-old children in Morogoro District, Tanzania, in 1984, 1986, and 1988. Community Dental Oral Epidemiology, 18(1), 2–8.

    Article  Google Scholar 

  • Fuge, R. (1988). Sources of halogens in the environment, influences on human and animal health. Environmental Geochemistry and Health, 10(2), 51–61.

    Article  Google Scholar 

  • Gabovych, R., & Minkh, A. (1979). Hygienic problems of drinking water fluoridation. Moscow: Meditsina.

    Google Scholar 

  • Gabovych, R., & Ovrutsky, G. (1969). Fluoride in stomatology and hygiene. Kazan: Tatpoligraph.

    Google Scholar 

  • Gnatyuk, P. (1988). Fluorosis and caries of temporal teeth. Stomatology, 67(5), 67–68.

    Google Scholar 

  • Grigoryeva, L., Golovko, N., Nikolishiyn, A., & Pavlyenko, L. (1993). Fluoride influence on prevalence and intensity of stomatological disease in adolescents of Poltava Oblast. In Conference proceedings—fluoride problems of ecology, biology, medicine and hygiene. Poltava, pp. 25–26.

  • Groshikov, M. (1985). Non-caries injuries of dental tissues. Moscow: Meditsina.

    Google Scholar 

  • Health Protection Ministry. (1999). Norms of physiological needs of Ukrainian population in main food nutrients. Kiev: Health Ministry of Ukraine Decree 272.

    Google Scholar 

  • Hem, J. (1992). Study and interpretation of the chemical characteristics of natural water. Reston: US Geological Survey.

    Google Scholar 

  • Jacks, G., Rajagopalan, K., Alveteg, T., & Jonsson, M. (1993). Genesis of high-F groundwaters, southern India. Applied Geochemistry (Suppl 2), 241–244.

  • Jarup, L. (2004). Health and environmental information systems for exposure and disease mapping and risk assessment. Environmental Health Perspectives, 112(9), 995–997.

    Google Scholar 

  • Jenkins, G. (1967). The mechanism of action of fluoride in reducing caries incidence. International Dental Health, 17, 385–390.

    Google Scholar 

  • Jowsey, J., & Riggs, B. (1978). Effects of concurrent calcium ingestion in intestinal absorption of fluoride. Metabolism, 27, 971–974.

    Article  Google Scholar 

  • Kajaba, I., & Bucko, A. (1968). Health and nutritional status of children in an industrialised and agricultural area of Eastern Slovakia. III. Investigations of the lipid metabolism. Reviews of Czech Medicine, 14(3), 180–191.

    Google Scholar 

  • Krishnamachari, K. (1986). Skeletal fluorosis in humans—a review of recent progress in the understanding of the disease. Progress in Food and Nutrition Science, 10(3–4), 279–314.

    Google Scholar 

  • Lahermo, P., Sandstrom, H., & Malisa, E. (1991). The occurrence and geochemistry of fluorides in natural waters in Finland and East Africa with reference to their geomedical implications. Journal of Geochemical Exploration, 41, 65–79.

    Article  Google Scholar 

  • Li, Y., Liang, C. K., Katz, B. P., Niu, S., Cao, S., & Stookey, G. K. (1996). Effect of fluoride exposure and nutrition on skeletal fluorosis. Journal of Dental Research, 75(SISI), 2699.

    Google Scholar 

  • Lukomsky, I. (1955). Anti-caries fluoridation of teeth. Moscow: Meditsina.

    Google Scholar 

  • Ministry of the Environment. (1998). The evaluation of ecological sustainability of the Ziarska Kotlina Basin. Bratislava: Ministry of the Environment.

    Google Scholar 

  • Ortiz, D., Castro, L., Turrubiartes, F., Milan, J., & Diaz-Barriga, F. (1998). Assessment of the exposure to fluoride from drinking water in Durango, Mexico using a geographic information system. Fluoride, 31(4), 183–187.

    Google Scholar 

  • Pashayev, C., Akhmyedov, R., & Halifa-Zade, C. (1990). Fluoride and other biogeochemical factors influence on microstrength of enamel and dentin. Stomatology, 69(6), 10–12.

    Google Scholar 

  • Patrikyeyev, V. (1958). Histological study of dental hard tissue injured by endemic fluorosis. Stomatology, 5, 19–21.

    Google Scholar 

  • Petrovich, Y., Podorozhnaya, R., Dmitriyeva, L., Knavo, O., & Vasyukova, O. (1995). Glutamate and organic phosphates metabolic ferments under fluorosis. Stomatology, 74(2), 26–28.

    Google Scholar 

  • Povoroznuk, V., Zhovinsky, E., Barhanel, I., & Voloh, O. (2001). Impact of increased fluoride concentrations in water on bone tissue functional state and teeth. Ukrainian Medicine Almanac, 1. Kiev.

  • Rapant, S., Vrana, K., & Bodis, D. (1996). Geochemical atlas of Slovakia. I. Groundwater. Bratislava: Geological Survey of the Slovak Republic.

    Google Scholar 

  • Rozier, R. (1999). The prevalence and severity of enamel fluorosis in North American adolescents. Journal of Public Health Dentistry, 59(4), 239–246.

    Google Scholar 

  • Schamschula, R. G., Sugar, E., Un, P. S., Toth, K., Barmes, D. E., & Adkins, B. L. (1985). Physiological indicators of fluoride exposure and utilization: an epidemiological study. Community Dental Oral Epidemiology, 13(2), 104–107.

    Article  Google Scholar 

  • Schamschula, R. G., Sugar, E., Un, P. S., Duppenthaler, J. L., Toth, K., & Barmes, D. E. (1988). The fluoride content of selected foods in relation to the fluoride concentration of water. Acta Physiology Hungary, 72(2), 217–227.

    Google Scholar 

  • Skinner, C. (2000). In praise of phosphates, or why vertebrates chose apatite to mineralise their skeletal elements. International Geology Review, 42, 232–240.

    Article  Google Scholar 

  • Smith, M., Lantz, E., & Smith, H. (1931). The cause of mottled enamel. Science, 74, 244.

    Article  Google Scholar 

  • Susheela, A. K. (1999). Fluorosis management programme in India. Current Science, 77(10), 1250–1256.

    Google Scholar 

  • Tebbutt, T. H. Y. (1983). Relationship between natural water quality and health. Paris: UNESCO.

    Google Scholar 

  • Teotia, M., Teotia, S. P. S., & Singh, K. (1998). Endemic chronic fluoride toxicity and dietary calcium deficiency interaction syndromes of metabolic bone disease and deformities in India: year 2000. Indian Journal of Paediatrics, 65(3), 371–381.

    Google Scholar 

  • Toma, S., Kreidman, J., Vedina, O., & Veliksar, S. (1999). Some observations on fluoride problems in the Moldova Republic. Fluoride, 32(2), 67–70.

    Google Scholar 

  • Toth, G. (1989). Mineral and thermal wells. In M. Pecsi (Eds.), National atlas of Hungary. Budapest: Kartografiai Vallalat, p. 74.

    Google Scholar 

  • Toth, G. (2000). Development of fluoride risk assessment GIS—Phase 2: Dec 1999–Dec 2000, Hungary. In Baker, J. (Ed.), Water quality improvement through fluoride reduction in groundwater of Central Europe Inco-Copernicus Programme Project (IC15-CT98-0139) Technical Annex to Second Annual Report. Amsterdam: Selor.

  • Toth, K., & Sugar, E. (1978). Fluoride content of food and the estimated daily intake from foods. Acta Physiology Hungary, 51(4), 361–369.

    Google Scholar 

  • Vedina, O., & Kreidman, J. (1999). Fluoride distribution in burozems of Moldova. Fluoride, 32(2), 71–73.

    Google Scholar 

  • Voynar, A. (1960). Biological role of microelements in human and animal organism. Moscow: Vysshaya Shokola.

    Google Scholar 

  • Vyeltishchyev, Y. (1995). Ecopathology in childhood. Paediatrics, 4, 26–33.

    Google Scholar 

  • Whitford, G. M. (1997). Determinants and mechanisms of enamel fluorosis. Ciba Foundation Symposium, 205, 226–241.

    Google Scholar 

  • WHO. (1996a). Trace elements in human nutrition and health. Geneva: World Health Organisation.

    Google Scholar 

  • WHO. (1996b). Guidelines for drinking water quality. Geneva: World Health Organisation.

    Google Scholar 

  • WHO. (2000). Posting date. Fluoride in Drinking Water. http://www.who.int/environmental_information/Information_resources/htmdocs/Fluoride/fluoride.html.

  • Zaichick, V., Tsyb, A., Matveenko, E., & Chernichenko, I. (1996). Instrumental neutron activation analysis of essential and toxic elements in child and adolescent diets in the Chernobyl disaster territories of Kaluga Region. Science of the Total Environment, 192(3), 269–274.

    Article  Google Scholar 

  • Zhang, B., Hong, M., Zhao, Y., Lin, X., Zhang, X., & Dong, J. (2003). Distribution and risk assessment of fluoride in drinking water in the West Plain region of Jilin Province, China. Environmental Geochemistry and Health, 25(4), 421–431.

    Article  Google Scholar 

  • Zheng, B. S., Dingm, Z. H., Huang, R. G., Zhu, J. M., Yu, X. Y., Wang, A. M., Zhou, D. X., Mao, D. J., & Su, H. C. (1999). Issues of health and disease relating to coal use in southwestern China. International Journal of Coal Geology, 40(2–3), 119–132.

    Article  Google Scholar 

  • Zhovinsky, E. (1979). Geochemistry of fluoride in sedimentary formations of Southwestern East-European Platform. Kiev: Naukova Dumka.

    Google Scholar 

  • Zhovinsky, E., & Povoroznuk, V. (1998). Fluorine in water of Lvov region and relation with bone diseases. Carpathian-Balkan Geological Association. XVI Congress. Austria: University of Vienna, p. 652.

Download references

Acknowledgements

This work was carried out as part of the European Union INCO-COPERNICUS IC15-CT98-0139 “Water Quality Improvement Through Fluoride Reduction in Groundwater of Central Europe” Project, DGXII. The authors gratefully acknowledge permission to use data for this study from the Geological Survey of Slovakia (SGUDS); the Geological Survey of Hungary (MAFI); the Association of State Geologists of Moldova (ASG); the Institute of Geochemistry and Ore Mineral Formation, Ukraine (IGMOF) and the Institute of Gerontology, Ukraine (IGAMS). Dr Chris Johnson and Prof Barry Smith of the British Geological Survey are thanked for their comments on the text. This paper is published with the permission of the Director of the British Geological Survey.

Author information

Affiliations

  1. British Geological Survey, West Mains Road, Edinburgh, EH9 3LA, UK

    F. M. Fordyce & B. C. Hope

  2. HYDEKO-KV, Planckova 4, 851 01, Bratislava, Slovakia

    K. Vrana

  3. Institute of Geochemistry, Mineralogy and Ore Formation, National Academy of Sciences of Ukraine, 3 4 Palladin Prospect, Kiev 142, 252680, Ukraine

    E. Zhovinsky

  4. Institute of Gerontology AMS Ukraine, 67 Vyshgorodska Street, Kiev, 254114, Ukraine

    V. Povoroznuk

  5. Niobium BT, Mimoza ut 14, 1146, Budapest, Hungary

    G. Toth

  6. Association of State Geologists, Moldova, 156 Metropolita Dorofeja Street, Chisinau, Moldova

    U. Iljinsky

  7. Selor eeig, Saffierstraat 101c, 1074 GP, Amsterdam, The Netherlands

    J. Baker

Authors
  1. F. M. Fordyce
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Vrana
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Zhovinsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Povoroznuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Toth
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. C. Hope
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U. Iljinsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. M. Fordyce.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fordyce, F.M., Vrana, K., Zhovinsky, E. et al. A health risk assessment for fluoride in Central Europe. Environ Geochem Health 29, 83–102 (2007). https://doi.org/10.1007/s10653-006-9076-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10653-006-9076-7

Keywords

  • Dental fluorosis
  • Fluoride
  • GIS
  • Hungary
  • Moldova
  • Slovakia
  • Risk assessment
  • Ukraine
  • Water