Kjell Bjorvatn

Drinking water quality in the Ethiopian section of the East African Rift Valley I—data and health aspects

Drinking water samples were collected throughout the Ethiopian part of the Rift Valley, separated into water drawn from deep wells (deeper than 60 m), shallow wells (<60 m deep), hot springs (T>36 degrees C), springs (T<32 degrees C) and rivers. A total of 138 samples were analysed for 70 parameters (Ag, Al, As, B, Ba, Be, Bi, Br, Ca, Cd, Ce, Cl, Co, Cr, Cs, Cu, Dy, Er, Eu, F, Fe, Ga, Gd, Ge, Hf, Hg, Ho, I, In, K, La, Li, Lu, Mg, Mn, Mo, Na, Nb, Nd, Ni, NO(2), NO(3), Pb, Pr, Rb, Sb, Se, Si, Sm, Sn, SO(4), Sr, Ta, Tb, Te, Th, Ti, Tl, Tm, U, V, W, Y, Yb, Zn, Zr, temperature, pH, conductivity and alkalinity) with ion chromatography (anions), spectrometry (ICP-OES and ICP-MS, cations) and parameter-specific (e.g. titration) techniques. In terms of European water directives and WHO guidelines, 86% of all wells yield water that fails to pass the quality standards set for drinking water. The most problematic element is fluoride (F), for which 33% of all samples returned values above 1.5 mg/l and up to 11.6 mg/l. The incidence of dental and skeletal fluorosis is well documented in the Rift Valley. Another problematic element may be uranium (U)-47% of all wells yield water with concentrations above the newly suggested WHO maximum acceptable concentration (MAC) of 2 microg/l. Fortunately, only 7% of the collected samples are above the 10 microg/l EU-MAC for As in drinking water.

Determination of fluoride in food by the use of alkali fusion and fluoride ion-selective electrode

A simple, rapid, and reliable method was developed for determination of fluoride in biological samples. Fluoride was determined by alkali fusion and fluoride ion-selective electrode. The influence of concentration and volume of sodium hydroxide as ashing aid, sample weight, lifetime of the electrode and storage time of the sample solutions on analytical results were studied. Fluoride contents of various marine biological samples and certified reference material were determined.

Radon, fluoride and 62 elements as determined by ICP-MS in 145 Norwegian hard rock groundwater samples

Hard rock groundwater (145) samples collected from private drinking water wells in the environs of Oslo and Bergen were analysed for their radon and fluoride contents. A further 62 elements were determined by inductively coupled plasma mass spectrometry (ICP-MS). For 59 elements, more than 50% of all concentration values were above the detection limit. Characteristic differences between the Oslo- and Bergen-dataset can be shown to be related to host rock lithology. Variation in element contents generally spans 2-6 orders of magnitude. Concentrations of several elements (e.g. Ba, F, Fe, Mn, Na, Rn) exceed current drinking water action levels in a significant number of cases. High levels of other parameters such as Be, Mo, Th and U, which could have an impact on health, were observed. There are no Norwegian action levels currently defined for these elements. The economic and toxicological impacts of these findings require urgent assessment.

ALTITUDE AS A RISK INDICATOR OF DENTAL FLUOROSIS IN CHILDREN RESIDING IN AREAS WITH 0.5 AND 2.5 MG FLUORIDE PER LITRE IN DRINKING WATER

The purpose of this study was to assess the association between altitude and dental fluorisis among Ugandan children in two fluoride (F) districts while controlling for other factors related to fluorosis. A random sample of 481 children aged 10–14 years was examined for fluorosis using the Thylstrup and Fejerskov (TF) index. The prevalence and severity of dental fluorosis increased significantly with increase in altitude (900 vs. 2,200 m in the low– and 1,750 vs. 2,800 m in the high–F district) and in F concentration in the drinking water. In bivariate correlation analyses, F exposure from liquid (FEL), altitude, infant formula, vegetarianism and storing of drinking water in earthenware pots were significantly associated with the tooth prevalence of fluorosis (TPF), i.e. at a severity of TF score ≥1 (p<0.05); age and gender were not. The stepwise multiple linear regression explained 35 and 55% of the variance in TPF within the low– and high–F districts, respectively. The change in R2 due to FEL was 28 and 51% points compared with 5 and 4% points due to altitude. The significant effect of FEL and altitude was confirmed by multiple logistic regression analyses. Thus, although most of the variation in the prevalence and severity of dental fluorosis was explained by the F intake from liquid, altitude was a significant risk indicator after controlling for potential confounders.

Variability in fluoride content of subsurface water reservoirs

Groundwater may contain high concentrations of fluoride. In most countries, however, information on the fluoride content is scarce and anecdotal. The aim of the present study was to make a comprehensive assessment of F- in the groundwater of a representative area of Norway, thereby establishing a more solid basis for appropriate health counseling. Relevant technical information was collected, together with water samples from 1063 underground water sources in 31 municipalities in the county of Hordaland. One thousand and two water samples were analyzed for F- and pH with an F(-)-selective electrode and a pH electrode, respectively. Mean F- was 0.30 mg/l (range, < 0.02-9.48). Fourteen per cent of the wells contained water with F- levels > or = 0.50 mg/l. In three municipalities well water had a mean F- concentration > 0.07 mg/l; in one instance the mean was as high as 1.45 mg/l. In 10 municipalities maximum F- values were > 1.50 mg/l. F- values showed a positive correlation with the pH of the water and the depth of the wells (P < 0.01) and a negative correlation with the age of the well (P < 0.05). The results indicated that low-capacity wells deliver water with a higher F- value than high-capacity wells. This trend, however, was not statistically significant. The results show that high-F groundwater is prevalent and emphasize that information on domestic water supply must be available before supplementary fluoride is prescribed for caries prophylactic purpose.

Dental fluorosis among persons exposed to high- and low-fluoride drinking water in western Norway

The aim of this project was to study the prevalence and severity of dental fluorosis among persons exposed to moderate- to high- or low-fluoride drinking water in western Norway, and to assess the risk factors involved. Subjects aged 5 to 18 years who had been lifelong consumers of moderate- to high-fluoride groundwater (> or = 0.50 mg F/L) were selected for the study (n = 113). A comparison group (n = 105) was chosen among consumers of low-fluoride surface water (approximately 0.10 mg F/L) in the same district. The Thylstrup-Fejerskov (TF) Index was used to score dental fluorosis. A questionnaire was used to obtain information on fluoride exposure and other relevant factors. Among the consumers of low-fluoride water 14.3% showed dental fluorosis (TF score 1-2) as compared to 78.8% in the group consuming moderate- to high-fluoride water (TF scores 1-7). Premolars were most frequently affected, but severe cases (TF scores 3-7) were equally prevalent in maxillary central incisors and first molars. In logistic regression analysis with TF score 0 or TF score > or = 1 as the dependent variable, only fluoride concentration in the drinking water was associated with a statistically increased risk of dental fluorosis (odds ratio: 18.9; 95% CI: 8.85-40.44). In the study area, which was characterised by multiple fluoride sources, uncontrolled groundwater with moderate to high fluoride content was the most important factor in the development of dental fluorosis. In order to prevent dental fluorosis, groundwater wells should routinely be analysed for fluoride.

Age as a determinant of severity of dental fluorosis in children residing in areas with 0.5 and 2.5 mg fluoride per liter in drinking water

Abstract The purpose of this study was to investigate the influence of age on the severity of dental fluorosis in children exposed to drinking water with either low or high fluoride concentrations. The children selected for this study were aged 10–14 years, with 28 permanent teeth and at least 1 tooth pair with fluorosis. The children were permanent residents of districts in western Uganda with either 0.5 mg (n=33) or 2.5 mg fluoride/l in drinking water (n=186). All vestibular tooth surfaces were examined for fluorosis using the modified Thylstrup and Fejerskov (TF) index. In the high fluoride community, the proportion of teeth per child with TF scores ≥4, and ≥5 was significantly higher among children aged 13–14 years compared to those aged 10–12 years. Children’s chronological age correlated positively and significantly with the median TF scores for all teeth, including early erupting (first molars and incisors) and late erupting teeth (canines, premolars and second molars). In linear regression analyses, the median TF score for all teeth, as well as for early erupting and late erupting teeth, increased significantly with age. On the other hand, in the low fluoride community there was no significant association between age and the severity of fluorosis. This study showed a significant increase in the severity of fluorosis with increasing age in a high fluoride community, whereas no change in severity with age was observed in a low fluoride community.

Perception of dental fluorosis amongst Ethiopian children and their mothers

This study was conducted in three Ethiopian Rift Valley villages known for endemic fluorosis. Three-hundred-and-six adolescents (12-15 years) and 233 mothers participated. The aim was to study dental fluorosis in the youngsters and to assess the extent of agreement between clinical and self-rated discoloration and pitting of teeth, and also the level at which dental fluorosis is perceived as a problem both by children and their mothers. The children (154 M and 152 F) gave a simple self-assessment of tooth-color and quality of their teeth, and were subsequently examined for dental fluorosis. Finally, four color photographs of teeth with dental fluorosis (TF-scores 2, 3, 5, and 7) were used as references during a structured oral interview of the children, as well as their mothers. At TF score S 2, the prevalence of dental fluorosis on maxillary central incisors was 72% and 37% at TF score S 4. The mean TF score was significantly higher among boys than among girls of unemployed fathers compared to children of employed fathers. The likelihood of reporting problems with dental appearance increased with increasing individual TF scores. The child/mother pairs found teeth with TF scores 2 and 3 esthetically acceptable, while teeth with TF scores 5 and 7 were considered unacceptable. Mothers were more critical of severe fluorosis than were their children.

Risk periods in the development of dental fluorosis

Abstract In order to study the age-related susceptibility to dental fluorosis, 40 children who had been lifelong consumers of moderate- to high-fluoride water (0.55–8.48 mg F/l) were examined, as well as a group of older siblings (n = 40) who were born 6 months to 6 years before the fluoride-containing drinking water was introduced to the household. Background information was obtained through a structured questionnaire. Dental fluorosis was scored according to the TF index. Among the 80 children examined, the permanent incisors were erupted in 66, while 67 had permanent first molars present. As compared to their older siblings, the prevalence of dental fluorosis was significantly higher in the children who had consumed moderate- to high-fluoride water throughout their lives. In a multiple regression analysis, the variable “age when introduced to moderate- to high-fluoride water” came out as the only significant risk factor associated with dental fluorosis. This variable was divided into three categories according to the first exposure to moderate- to high-fluoride drinking water (1) 0–12 months of age, (2) 13–24 months of age and (3) after 24 months of age. Category 3 was used as the reference group. Fluoride exposure starting during the 1st year of life showed the highest odds ratio as compared to exposure only after 2 years of age. The findings indicate that early mineralising teeth (central incisors and first molars) are highly susceptible to dental fluorosis if exposed to fluoride from the first and – to a lesser extent – also from the 2nd year of life.

Dental fluorosis and dental caries in permanent teeth: rural schoolchildren in high-fluoride areas in the Shaanxi province, China.

Objectives. To study the dental fluorosis and caries in the permanent teeth of 12 to 13-year-old children in fluorosis-endemic areas; to assess the relationship between fluorosis and the fluoride content of the drinking water and the relationship between caries and the fluoride content of the water; finally, to analyze the effect of fluoride intake and water stored in clay pots on dental fluorosis. Material and methods. 477 children were divided into 5 groups (A to E) according to the fluoride concentration of the waters, i.e. by 0.4, 1.0, 1.8, 3.5, and 5.6 mg F/l, respectively. Dental fluorosis was assessed by TF score and caries by the DMF-T index. A questionnaire was used to obtain information about water storage and other information relevant to childrens fluoride intake. Results. A positive relationship was found between the mean TF scores and the water fluoride concentration. In groups B and D, the TF score was higher in 13-year-olds than in 12-year-olds. Caries prevalence and mean DMF-T ranged from 2.6% and 0.03 (group E) to 22.1% and 0.38 (group A). Storage of water in clay pots seemed to increase the severity of fluorosis slightly, and to decrease the caries prevalence. Conclusions. Defluoridation of drinking water, or—alternatively—the provision of low-fluoride water sources, should be given high priority in the examined Shaanxi rural areas. Fluoride concentration of drinking water should be maximum 0.6 mg/l. Storage of water in the local clay pots may increase the severity of dental fluorosis.