Abstract
Compared to the general United States (U.S.) population, Arizona counties along the U.S.-Mexico border have a higher prevalence of dental caries, which can be reduced with adequate fluoride exposure. Because of concern regarding local tap water quality, fluoride-free bottled water consumption is common in this region, raising concern that families are not receiving adequate fluoride to promote dental health. To evaluate the levels of fluoride in tap and bottled water as well as the use of fluoride supplements in an Arizona border community. Low-income Latino households (n = 90) who report use of bottled water as their primary source of water intake were recruited. Participants completed a questionnaire about their and their children's dental histories and use of fluoride supplements. Water samples (bottled and tap) were collected from a subset of households (n = 30) for analysis of fluoride. Fluoride detection levels were significantly greater (p = 0.02, Fisher's exact test) in tap water (average = 0.49 mg/dL) than in bottled water, yet, the majority (22/30) were below the range for optimal dental health (0.7-1.2 mg/L). Concentration of fluoride in the majority (29/30) of bottled water samples was below the quantitative detection limit of 0.4 mg/L. Children were significantly less likely to have dental caries if they received fluoride varnishing treatments (p = 0.01, Fisher's exact test), lived in households that reported using fluoridated mouthwash (p < 0.001, Fisher's exact test), their parents received fluoride education (p = 0.01, Fisher's exact test), and their parents reported visiting a dentist yearly (p < 0.001, Fisher's exact test). Furthermore, none of the participants reported receiving recommendations from health-care providers about fluoride supplementation or variance in content by the type of water consumed. Although fluoride was significantly more likely to be detected in tap than bottled water, neither water source in this border community is likely to provide enough fluoride for optimal dental health. Low-income children in this region may benefit from regular access to fluoride varnishing treatments and/or use of fluoridated mouthwash, interventions that could be tested in future well-designed trials.
Highlights
Dental caries remain a public health problem for many developing countries and for underserved populations in developed countries [1, 2]
Tap water collected from homes supplied by water purveyor A had detectable levels of fluoride, whereas samples collected from homes supplied by water purveyors B and C were below the limit of detection of 0.4 mg/L (Table 1)
In tap water samples where fluoride was detected, only 53% (8/15) contained fluoride levels within the recommended American Dental Association (ADA) range for optimal dental health indicating that 73% (22/30) of the tap water samples collected in Nogales do not meet the ADA recommendations (Table 1)
Summary
Dental caries remain a public health problem for many developing countries and for underserved populations in developed countries [1, 2]. Exposure to fluoride can reduce dental caries and enhance remineralization of early carious lesions [3]. The American Dental Association (ADA) recommends that fluoride levels in drinking water should be between 0.7 and 1.2 mg/L for optimal dental health. Fluoridation of municipal tap water began over six decades ago in the United States (U.S.) and approximately 60% of the population has access to optimally fluoridated water (i.e., 0.7–1.2 mg/L) [5]. Compared to the general United States (U.S.) population, Arizona counties along the U.S.–Mexico border have a higher prevalence of dental caries, which can be reduced with adequate fluoride exposure. Because of concern regarding local tap water quality, fluoride-free bottled water consumption is common in this region, raising concern that families are not receiving adequate fluoride to promote dental health
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