Fluoridation Status Research Articles

Flawed MIREC fluoride and intelligence quotient publications: A failed attempt to undermine community water fluoridation.

To assess the evidence presented in a set of articles that use the Canadian Maternal-Infant Research on Environmental Chemicals (MIREC) study database to claim that community water fluoridation (CWF) is associated with harm to foetal and infant cognitive development. Critical appraisal of measurements and processes in the MIREC database, and articles derived therefrom. MIREC's cohort is approximately 2000 pregnant women recruited in 10 centres across Canada, 2008-2011, leading to measuring 512 children aged 3-6 years in six cities. Fluoride exposure was measured by city fluoridation status, self-reports and maternal spot urine samples. Intelligence Quotient (IQ) was measured using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) by different assessors in each city. MIREC's fluoride and IQ measurements are invalid and therefore cannot support the claim that CWF is associated with IQ decline in children. The MIREC fluoride-IQ articles' results should be considered unacceptable for legal and policy purposes; other water fluoridation studies and systematic reviews show no effect of fluoridation on cognition.

Status of Fluoride in Groundwaters of Haryana: A Review

Status of Fluoride in Groundwaters of Haryana: A Review

Hydrogeochemical characteristics and fluoride status of groundwater in dry drone region of Virudhunagar district, Tamilnadu, India

Hydrogeochemical characteristics and fluoride status of groundwater in dry drone region of Virudhunagar district, Tamilnadu, India

Contamination Status and Ecological Security Thresholds of Fluoride in Farmland around a Phosphorus Chemical Plant in a Karst Area of Southwestern China.

The phosphorus chemical plant (PCP) production process leads to the substantial discharge of fluoride into the surrounding environment. However, there is limited research data regarding the pollution levels and ecological safety thresholds of farmland fluoride around PCPs in karst areas. This study evaluates the local contamination status and health risks by determining the fluoride content in farmland and vegetables in vicinity of a PCP in a karst area of Southwestern China. Farmland ecological security threshold was derived based on the species sensitivity distribution (SSD) model. Results showed that the fluoride contents in the soil ranged from 529.36 to 1496.02 mg kg-1, with the median value of 823.93 mg kg-1, which was higher than the national background value in China (478 mg kg-1) by 172.37%. Fluoride contents in vegetables ranged from 0.01 to 25.21 mg kg-1, with the median value of 1.29 mg kg-1, which was higher than the limits of contaminants in food (1 mg kg-1) by 129.00%, and 53.85% of vegetable samples were contaminated. Leafy vegetables showed a higher tendency of fluoride enrichment compared to non-leafy vegetables. Despite there being no significant health risk to the residents via the intake of vegetables overall, there may be potential health risks from the intake of sweet potato leaves. Based on the SSD model, the ecological safety thresholds of fluoride in local farmland was classified into the suitable for planting category (≤174.13 mg kg-1), safe plant utilization category (174.13-4005.42 mg kg-1), and strict control of planting category (≥4005.42 mg kg-1). These findings will provide valuable insights to facilitate the safe cultivation of local agricultural products and optimize the utilization of soil resources.

Access to community water fluoridation in rural Victoria: Itdepends where you live….

To explore the water fluoridation status of rural Victorian towns over 1000 population and document the oral health profile in the local government areas (LGAs) currently with no water fluoridation. To assist/inform future LGA planning, we describe a case study of a community-based co-design approach to increase access to fluoridated water in rural communities. A descriptive design and a case study. Rural Victorian towns over 1000 population. Twenty-nine LGAs in rural areas. LGA water fluoridation status and oral health profiles. Sixty-six (33%) of the 203 Victorian rural towns with >1000 population, representing 149 251 people, did not have access to fluoridated water. Towns in 29 rural LGAs were included with 62% without water fluoridation with many having higher than the Victorian average of preventable hospital admissions due to dental conditions in children aged 0-9 years. Over 50% of children aged 0-12 years living in these rural nonfluoridated LGAs had above-the-state average rates of decayed, missing and filled teeth (dmft/DMFT). In those aged 0-5 years, this was the highest with 78% above-the-state average. In the case study, meetings were well attended, and the group resolved to lobby for water fluoridation, which was successful. Many Victorian rural towns do not have access to fluoridated water. A community-based co-design approach can dispel ill-informed concerns about dangers of water fluoridation to successfully lobby the state government to fluoridate the local water supply.

An assessment of compliance with optimal fluoride levels for oral health benefit by New Zealand drinking water suppliers.

Community water fluoridation (CWF) has proven oral health benefits. We investigated whether drinking water suppliers are meeting New Zealand CWF targets (0.7-1.0ppm) to ensure these benefits. We retrieved fluoride testing data from 25 supplies serving 2,059,000 people (82% of people on a fluoridated supply), for the years 1992-2022 (22,220 weekly observations). We descriptively assessed compliance with fluoride targets in this convenience sample. The mean fluoride level was 0.66 ppm (SD 0.28). Water suppliers achieved fluoride targets 54.1% of the time (range 4.2%-77.9%). Fluoride concentration fell short of the target in 42.2% of observations, exceeded but under the maximum acceptable value (MAV) in 3.6%, and in excess of the MAV in 0.1%. The percentage of compliant observations was greater in larger than smaller supplies. Noncompliance with CWF targets was common. Epidemiological studies that rely on fluoridation status as their exposure may underestimate the oral health benefits of CWF. Our results highlight future challenges with the feasibility of expanding CWF under new legislation as well as the weaknesses in drinking water surveillance.

Public attitudes to water fluoridation in Scotland.

Introduction Currently, no-one in Scotland benefits from artificial water fluoridation and there have been no recent reports published about public opinion on this issue. We conducted a robust public survey consultation on community water fluoridation to address this absence.Aims To gauge public attitudes in three urban areas of Scotland to determine respondents' sources of information, awareness of the current fluoridation status of their local water supply and attitude to community water fluoridation.Methods A face-to-face quota sample with proportions set for age and sex using six closed questions, plus demographics. The questions and sample size were based on earlier similar studies.Results A random on-street survey of 410 people was completed. The vast majority (88%, n = 360) of the total sample had not read or heard anything about water fluoridation in the previous 12 months. A minority (36%) believed, incorrectly, that their water supply was already fluoridated compared to 47% who did not know and a smaller minority of 17% who correctly said no. Of those who answered either 'yes' or 'no' to the question 'do you think fluoride should be added to water if it can reduce tooth decay?' (n = 292), 88% were in favour of adding fluoride to water to reduce tooth decay, with 12% stating that they were not in favour of water fluoridation. When people who recorded they don't know were included (n = 410), 63% said 'yes', 28% stated 'don't know' and 9% said 'no'.Conclusion Public opinion in Scotland, gauged through a random on-street representative survey, remains strongly in favour of community water fluoridation. Monitoring public opinion should be conducted on a regular basis by individual health boards and the Scottish Government to allow them to take forward this effective and safe public health measure within the existing permissive water fluoridation legislation.

Fluoride Status and Cardiometabolic Health: Findings from a Representative Survey among Children and Adolescents.

There is preliminary evidence to suggest a positive association between fluoride exposure and higher blood pressure among children, but population-based biomarker studies are lacking. Thus, data from the 2013/2014 and 2015/2016 cycles of the US-based National Health and Nutrition Examination Survey (NHANES) were analysed to evaluate the association between plasma fluoride concentrations and blood pressure among children and adolescents aged 8 to 19 years. Secondary analyses were carried out on fluoride status in relation to further markers of cardio-metabolic health, i.e., anthropometric indices, biomarkers of lipid and sugar metabolism, and C-reactive protein levels. There was a positive correlation between water fluoride content and plasma fluoride concentrations (Spearman’s r = 0.41, p < 0.01). However, multivariable linear regression models did not show significant differences in adjusted mean values of systolic and diastolic blood pressure across increasing quartiles of fluoride concentrations. Further markers of cardio-metabolic health were not associated with fluoride status, with the exception of a weak inverse association between plasma fluoride and HbA1c levels. Higher plasma fluoride may not be a risk factor for increased blood pressure or impaired cardio-metabolic health among children in the USA, a non-fluoride endemic country, with wide-spread water fluoridation.

Application of Water Quality Index (WQI) for groundwater quality assessment of Biratnagar, Nepal

This present hydrological study assessed the groundwater quality of Biratnagar Metropolitan by the application of Water Quality Index (WQI). It has been determined on the basis of analyzed groundwater samples for some important physicochemical parameters such as pH, turbidity, electrical conductivity (EC), dissolved oxygen (DO), free carbon-dioxide (FCO2), bicarbonate (HCO3), total hardness (TH), phosphate (PO4-P), nitrate-N (NO3-N), arsenic (As), and fluoride (Fl) collected from 110 representative tube wells during post-monsoon period of 2015. The status of fluoride was below detectable level (BDL) in all the analyzed groundwater samples. The WQI for these samples ranged from 84.54 to 403.14. The high value of WQI has been found mainly due to the higher values of turbidity, FCO2 and arsenic in the groundwater. The results of study have been used to recommend models for predicting water quality. The classification of water quality on the basis of WQI value have been found to be good water (18.18%), poor water (59.09%), very poor water (13.64%) and unsuitable for drinking (9.09%). The result of the study suggests that the groundwater of the area needs some degree of treatment before consumption, and it also needs to be protected from the threat of contamination. The groundwater is one of the major source of drinking water as well as for irrigation in study area.

Fluoride Prescribing Behaviors for Medicaid-Enrolled Children in Oregon

This study aims to examine physician and dentist fluoride prescription patterns and identify the factors associated with fluoride prescriptions for Medicaid-enrolled children. The hypothesis is that dentists will be the primary prescribers of fluoride and that caries risk factors will be associated with fluoride prescriptions. Data were analyzed for Oregon children aged 0-17 years enrolled in Medicaid for ≥300 days in both 2016 and 2017. The outcome variable was receiving a fluoride prescription in 2017. A 2-tailed chi-square test was used to assess fluoride prescribing differences between physicians and dentists. Multivariable logistic regression models were used to examine the likelihood of receiving a fluoride prescription in 2017 and to generate ORs. Model covariates included child's age, sex, race, ethnicity, Medicaid plan type, previous fluoride prescription, previous restorative dental treatment, and water fluoridation status. Of 200,169 Medicaid-enrolled children, 6.7% (n=13,337) received fluoride prescriptions. Physicians were >3 times as likely to prescribe fluoride as dentists (73.4% vs 23.0%, p<0.001). Children with a history of fluoride prescriptions (OR=14.30, p<0.001) and any restorative dental treatment (OR=1.58, p<0.001) were significantly more likely to receive a fluoride prescription, whereas children living in areas with water fluoridation were significantly less likely (OR=0.50, p=0.01). Physicians play an important role in prescribing fluoride to Medicaid-enrolled children, especially those at increased dental caries risk. Additional research is needed on strategies to ensure that all high-risk children have an opportunity to benefit from prescription fluoride.

Health risk assessment and spatial distribution of nitrate, nitrite, fluoride, and coliform contaminants in drinking water resources of kazerun, Iran

Exposure to nitrate, nitrite, and fluoride through drinking water consumption, especially in arid and semi-arid regions, has been considered by many researchers. Therefore, the present study aimed to investigate the status of nitrate, nitrite, fluoride, and total coliforms in water supply sources of Kazerun located in Fars province, Iran, determine their spatial distribution, and perform health risk assessment in four age groups (infants, children, teenagers, and adults). In this research, the concentration data of 25 groundwater wells were examined. Then, the spatial distribution of the contaminants was determined using the Arc GIS software (v. 10.5) and their health risk assessment was performed via the standard method of the US Environmental Protection Agency. The maximum concentrations of nitrate, nitrite, and fluoride were 25.5, 0.056, and 0.72 mg/l, respectively and their mean concentrations were 13.5, 0.008, and 0.52 mg/l, respectively. In addition, the mean and maximum concentrations of coliforms were 371.21 and 2694.50 CFU/100 ml, respectively. The total coliforms value was higher than the permissible limit in 60 % of the cases. The highest Chronic Daily Intake (CDI) of the studied contaminants was related to nitrate among children (range: 0.21–1.45, with an average value of 0.77 mg/kg-day). Moreover, the Hazard Quotient (HQ) values were below 1 for all contaminants and in all age groups. The highest HQ value (0.9) belonged to nitrate amongst children. Furthermore, the Hazard Index (HI), as a cumulative effect of HQ, was calculated for all three contaminants and the results showed that it was greater than 1 in 56 % of the cases among children, which was considered a serious risk. The findings revealed no significant relationship between nitrate and nitrite concentrations and total coliforms. Overall, nitrate seemed to play a more critical role in the health risk of the exposed age groups in comparison to nitrite and fluoride. Hence, appropriate managerial measures are recommended to be taken.

Public attitudes to water fluoridation in the North East of England.

Introduction Local authorities in the North East of England plan to conduct a public consultation on community water fluoridation. Monitoring public opinion is an important consideration.Aims To measure public attitudes in five areas in the North East of England, to determine respondents' sources of information and their awareness of the current fluoridation status of their local water supply.Methods A face-to-face quota sample with quotas set for age, gender and district using six closed questions plus demographics. The questions and sample size were based on earlier similar studies.Results Just over one-third of respondents (283/761, 37%) had read or heard about fluoridation over the previous 12 months. Their main sources of information were local newspapers followed by dental practices. A substantial minority believed, incorrectly, that their water supply was already fluoridated. Sixty percent of respondents were in favour of adding fluoride to the water supply to prevent dental decay while 16% were opposed.Conclusion and recommendation Public opinion in the North East of England remains favourable to community water fluoridation. Monitoring public opinion should be conducted on a regular basis.

GROUNDWATER QUALITY IN BIRATNAGR OF MORANG DISTRICT, NEPAL

A study was conducted to assess the groundwater quality in Biratnagar of Morang district of Nepal on the basis of some important physicochemical and microbiological analysis. During the study, the elevated value of turbidity ranged from 2.1±2.80 NTU (ward no. 8) to 81.46±44.28 NTU (ward no. 10), free-carbondioxide (FCO2) ranged from 12±2.45 mg /L (ward no. 21) to 17.2±3.03 mg/L (ward no. 8), arsenic ranged from nil (ward no. 3) to 0.17±0.21 mg /L (ward no. 1), iron (Fe) ranged from 0.45 mg/L (ward no. 7) to 3.67 mg/L (ward no. 4), manganese (Mn), ranged from 0.45 mg/L (ward no. 7) to 5.99 mg/L (ward no. 16) and fecal coliform bacteria were found positive in 10 wards (ward nos. 2, 3, 4, 9, 10, 11,14,15,20 and 21) constituting 45.45% of the total samples ranging from 3 to 25 MPN/100 ml . Out of the total analyzed samples, turbidity in 78 samples (70.90%), FCO2, Fe, and Mn in all samples (100%) and arsenic in 37 water samples (33.64 %) were crossed the permissible limit of WHO guideline. However, the value of pH, EC, DO, TH, PO4-P, NO3-N, Cd, Zn, and Pb were below the WHO guideline value. The status of fluoride was below detectable level in all the analyzed groundwater samples.

Geoclassification of fluoride‐affected areas of Lucknow, Uttar Pradesh, India

AbstractThe availability and quality of groundwater for drinking purpose is steadily decreasing due to influx of contaminants and high rate of extraction. Fluoride contamination in groundwater is posing serious threat to human health, being a reason of dental and skeletal fluorosis. The present study is aimed to assess the current status of fluoride in groundwater resources of Lucknow, Uttar Pradesh, India, and geoclassify the location on the scale of fluorosis threat. The study was conducted in eight blocks of Lucknow, targeting 190 spots. 82.11% of groundwater samples were found within the permissible limit, while 17.89% samples revealed fluoride concentration higher than the permissible limit (1.5 mg/L) prescribed by WHO in 2011. It was observed that around 81.47% population of Sarojininagar, 62.51% population of Kakori, 43.03% population of Mohanlalganj, 6.16% population of Gosaiganj, and 5.47% population of Chinhat are currently exposed to high fluoride concentration (&gt; 1.5 mg/L) and prone to risk of adverse health effect posed by excess fluoride consumption. If the current scenario continues, the proportion of population vulnerable to fluoride toxicity may increase in the future.

Community water fluoridation exposure and dental caries experience in newly enrolled members of the Canadian Armed Forces 2006-2017.

This cross-sectional study examines the dental caries experience of new Canadian Armed Forces (CAF) members in relation to enrollment from municipalities with and without water fluoridation. The study population consisted of recruits who enrolled in the CAF between 2006 and 2017 with an enrollment address in municipalities with known fluoridation status (n = 24,552). Odontogram statistics from dental examinations were used to calculate the number of decayed, missing, and filled teeth (DMFT) and tooth surfaces (DMFS) for each recruit. The average difference between recruits from municipalities with and without fluoridation was determined using a linear regression model which adjusted for confounding by age and gender and allowed effect modification based on socio-economic status. The average recruit was male, 24years of age, with 5.6 DMFT and 11.6 DMFS. After adjusting for age and gender, recruits residing in municipalities with water fluoridation had lower DMFT by 0.67 (CI - 0.55, - 0.79) points and lower DMFS by 1.77 (- 1.46, - 2.09) points. When allowing for effect modification by median income quintile of the recruits' home census tract, the average reduction in DMFT and DMFS was similar in all income quintiles, with average reductions in DMFT ranging from 0.47 to 1.02 and average reductions in DMFS ranging from 1.33 to 2.70. Residence in a municipality with water fluoridation was associated with reduced caries experience in a national sample of newly enrolled CAF members. The benefits of water fluoridation were uniform across neighbourhood income and military rank classes.

Sedentary behavior, unhealthy food consumption and dental caries in 12-year-old schoolchildren: a population-based study.

This study analyzed the association between sedentary behavior (SB), unhealthy food consumption, and dental caries amongst 12-year-old schoolchildren. An epidemiological survey was carried out in the five largest cities (> 80,000 inhabitants) of the State of Mato Grosso do Sul, Brazil. Data were collected on decayed, missing and filled teeth index (DMFT), sociodemographic characteristics, SB, unhealthy food consumption, and water fluoridation status. The analysis was based on the theoretical framework established by J Sisson. Structural equation models were performed to test the association of dental caries experience with sociodemographic, contextual, and behavioral factors. The mean DMFT index in the five cities was 1.02 (95%CI: 0.39-1.66). Higher sedentary behavior (more than 2 hours/day) [standardized coefficient (SC) = 0.21 95%CI: 0.07-0.39] and higher unhealthy food consumption (more than 4 times/week) [SC = 0.23 (0.10-0.45)] were associated with higher DMFT index than their counterparts. Also, cities with fluoridated water were associated with lower DMFT index [SC = -0.85 (-1.20--0.50)]. Families who had a per capita income above the poverty line had a direct association with unhealthy food consumption [SC = -0.24 (-0.38--0.11)]. Unhealthy food consumption mediated the association of sedentary behavior on DMFT index [SC=0.07 (0.02-0.13)]. Sensitivity analysis confirmed the findings. Sedentary behavior mediated by unhealthy food consumption had a significant association with dental caries experience. Public policies must address transdisciplinary actions to reduce sedentary behavior and unhealthy food consumption and promote water fluoridation.

Associations between Household Water Fluoridation Status and Plain Tap or Bottled Water Consumption.

The benefits of community water fluoridation for preventing dental caries are attenuated if people do not consume tap water. We examined associations between household water fluoride content and consuming plain tap or bottled water among US youth. We used National Health and Nutrition Examination Survey data for 2013 to 2016 for 5,193 youth aged 2 to 19 y. Fluoride content in youth's household tap water samples was measured electrometrically with ion-specific electrodes and designated low (<0.6 mg/L) or about optimal (0.6 to 1.2 mg/L). Plain tap and bottled water consumption was obtained from one 24-h dietary recall. We used binomial regression models to estimate adjusted prevalence ratios (APRs) and 95% CIs for consuming plain tap water (including tap only or both tap and bottled) and consuming only bottled water as related to household water fluoride content (low or about optimal) and sociodemographic characteristics. On a given day, 52.6% of youth consumed plain tap water (43.8% exclusively and 8.8% both tap and bottled) and 28%, only bottled water. Neither tap water (APR, 0.96; 95% CI, 0.84 to 1.10) nor only bottled water (APR, 1.03; 95% CI, 0.86 to 1.22) consumption was associated with household water fluoride content. Non-Hispanic Black youth and Hispanic youth were about 30% relatively less likely to consume tap water and 60% to 80% relatively more likely to consume only bottled water than non-Hispanic Whites. Low income, low parental education, and no past-year dental visit were associated with not consuming tap water. Half of youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This study is the first to find that up to 50% of the population served by fluoridated water may not receive its full caries-preventive benefits due to not consuming plain tap water. Half of US youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This finding suggests that up to 50% of the population served by fluoridated water systems may not receive its full caries-preventive benefits due to not consuming plain tap water. Our findings add support for the need to identify and address barriers to tap water consumption and promote health benefits of fluoridation.

Association Between Community Water Fluoridation and Severe Dental Caries Experience in 4-Year-Old New Zealand Children

Robust contemporary epidemiologic evidence for the population-wide efficacy of reticulated community water fluoridation is required. To evaluate whether community water fluoridation is associated with the national rates of severe caries among 4-year-old children in New Zealand after accounting for key sociodemographic characteristics. This was a near whole population-level, natural, geospatial cross-sectional study of 4-year-old children who had a health and development assessment as part of the nationwide B4 School Check screening program conducted in New Zealand between July 1, 2010, and June 30, 2016. The extracted database included 391 677 children. However, geospatial information was missing for 18 558 children, another 32 939 children were unable to be geospatially matched, 5551 children resided in areas with changing fluoridation status, and 58 786 children had no oral health screen recorded, leaving 275 843 (70.4%) eligible children. Data were released in August 2019; statistical analysis was performed from September 2019 to December 2019. Community water fluoridation status from 2011 through 2016. Severe caries experience derived from the "lift the lip" oral health screening. Analyses were adjusted for age, sex, ethnicity, area-level deprivation, and residential location differences. Multilevel mixed-effects logistic regression models were used. Sensitivity analyses based on multiple imputed data were undertaken to measure any differential influence of missing data. In the eligible sample of 275 843 children, the median age was 4.3 years (interquartile range, 4.1-4.6 years), 141 451 children (51.3%) were boys, and 153 670 children (55.7%) resided within fluoridated areas. Severe caries were identified for 24 226 children (15.8%) in fluoridated and 17 135 children (14.0%) in unfluoridated areas, yielding an unadjusted odds ratio of 0.93 (95% CI, 0.90-0.95). However, in the adjusted analyses, children residing in areas without fluoridation had higher odds of severe caries compared with those within fluoridated areas (odds ratio, 1.21; 95% CI, 1.17-1.24). The population attributional fraction associated with unfluoridated community water was 5.6% (95% CI, 4.7%-6.6%) in a complete case analysis. This study finds that community water fluoridation continues to be associated with reduced prevalence of severe caries in the primary dentition of New Zealand's 4-year-old children.

Distribution of fluoride in groundwater around Chagan Lake and its risk assessment under the influence of human activities

Abstract Chagan Lake is located in the area of Western Jilin for which waterways have high fluorine content. Because of the construction of water conservancy projects and agricultural irrigation areas, the groundwater replenishment and drainage conditions there have changed. Groundwater test data were used to analyze the status of groundwater fluoride with this changing hydrodynamic gradient. The paper established a health risk assessment model based on triangular fuzzy number. The results show that the samples of phreatic water and confined water with excessive fluoride content accounted for 68.74% and 29.4%, respectively. Samples that exceeded standards of fluoride content were mainly distributed in the northwest and southwest. The chemistry of phreatic water is more complicated than that of confined water. The water quality categories are mainly poor and very poor. The formation of major anions and cations was mainly controlled by evaporation and rock weathering. It was also found that non-carcinogenic risks of fluoride in phreatic water are greater than those in confined water. The risk indices for children and adults were [1.1, 1.6] and [0.6, 0.9], respectively (α = 0.8). The non-carcinogenic risk assessment model based on triangular fuzzy numbers has a higher reference value than that of traditional models.

Maternal and fetal exposures to fluoride during mid-gestation among pregnant women in northern California

BackgroundPrevious studies have shown a correlation between fluoride concentrations in urine and community water fluoride concentrations. However, there are no studies of the relationship between community water fluoridation, urine, serum, and amniotic fluid fluoride concentrations in pregnant women in the US. The aim of this study was to determine the relationship between maternal urine fluoride (MUF), maternal urine fluoride adjusted for specific gravity (MUFSG), maternal serum fluoride (MSF), amniotic fluid fluoride (AFF) concentrations during pregnancy, and community water fluoridation in Northern California.MethodsArchived samples of urine, serum and amniotic fluid collected from second trimester pregnant women in Northern California from 47 different communities in Northern California and one from Montana (n = 48), were analyzed for fluoride using an ion specific electrode following acid microdiffusion. Women’s addresses were matched to publicly reported water fluoride concentrations. We examined whether fluoride concentrations in biospecimens differed by fluoridation status of the community water, and determined the association between water fluoride concentrations and biospecimen fluoride concentrations using linear regression models adjusted for maternal age, smoking, Body Mass Index (BMI), race/ethnicity, and gestational age at sample collection.ResultsFluoride concentrations in the community water supplies ranged from 0.02 to 1.00 mg/L. MUF, MSF , and AFF concentrations were significantly higher in pregnant women living in communities adhering to the U.S. recommended water fluoride concentration (0.7 mg/L), as compared with communities with less than 0.7 mg/L fluoride in drinking water. When adjusted for maternal age, smoking status, BMI, race/ethnicity, and gestational age at sample collection, a 0.1 mg/L increase in community water fluoride concentration was positively associated with higher concentrations of MUF (B = 0.052, 95% CI:0.019,0.085), MUFSG (B = 0.028, 95% CI: -0.006, 0.062), MSF (B = 0.001, 95% CI: 0.000, 0.003) and AFF (B = 0.001, 95% CI: 0.000, 0.002).ConclusionsWe found universal exposure to fluoride in pregnant women and to the fetus via the amniotic fluid. Fluoride concentrations in urine, serum, and amniotic fluid from women were positively correlated to public records of community water fluoridation. Community water fluoridation remains a major source of fluoride exposure for pregnant women living in Northern California.