Reducing Exposure to High Fluoride Drinking Water in Estonia—A Countrywide Study

Ene Indermitte,Enn Karro,Astrid Saava

doi:10.3390/ijerph110303132

Abstract

Fluoride is a naturally occurring contaminant in groundwater in Estonia. There are several regions in Estonia with fluoride contents in public water supplies as high as 7 mg/L. Long-term exposure to high-fluoride drinking water may have several adverse health effects, primarily dental fluorosis. The opportunities for exposure reduction rely highly on water treatment technologies. Since 2004 public water suppliers in Estonia have made efforts to diminish fluoride content in drinking water systems. A follow-up study on a country level was carried out in 2004–2012 to analyze the changes in population exposure to excessive (over 1.5 mg/L) fluoride in drinking water and to get information about the reduction methods applied by public water supplies (PWS) to optimize the fluoride levels in public water system. The results showed that bigger PWS have been more effective in fluoride reduction measures than small PWS. The main methods used to lower the fluoride content were reverse osmosis technology and replacement of water sources with new ones (new drilled wells). As a result of all the measures taken the overall high-fluoride exposure has been reduced substantially (82%).

Highlights

IntroductionElevated levels of fluoride in drinking water (i.e., levels above the World Health Organization guideline value of 1.5 mg/L) have been identified in numerous countries around the World [1,2], including Estonia [3]
Elevated levels of fluoride in drinking water have been identified in numerous countries around the World [1,2], including Estonia [3]
The results of this study give an overview of reduction of excessive exposure to drinking water fluoride among Estonian population on a country level and implemented measures during 2004–2012

Summary

Introduction

Elevated levels of fluoride in drinking water (i.e., levels above the World Health Organization guideline value of 1.5 mg/L) have been identified in numerous countries around the World [1,2], including Estonia [3]. In Estonia elevated levels of fluoride (up to 7 mg/L) are found in the Silurian-Ordovician aquifer system, which is an important and often the only source of drinking water in central and western. Chronic excessive consumption of fluoride may lead to skeletal fluorosis [10] and hip fractures among the elderly [11]. Fewtrell et al have estimated that high fluoride concentrations in drinking water have caused about 47 million of dental fluorosis cases and 20 million skeletal fluorosis cases in 17 countries [12].

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Results

Discussion

Conclusion