Evaluation of Fluoride Concentration in Commercially Available Bottled Water in Romania—A Potential Risk Factor for Dental Fluorosis

Abstract

Fluoride (F) ions actively participate in the dental enamel remineralisation process and inhibit the activity of cariogenic bacteria of the oral biofilm. However, increased systemic intake of F during critical periods of amelogenesis can lead to dental fluorosis (DF). The necessity of our study stemmed from the growing consumption of bottled water, as water is one of the primary sources of F in humans, and labelling F concentration is optional. Our aim was to evaluate the F concentration in bottled natural mineral or spring still waters available on the market in Iasi, Romania. We purchased forty different brands of still bottled water from the major grocery stores and tested them using an ion-selective electrode method. The reliability of the data was assessed by the intraclass correlation coefficient (ICC), while the differences between the obtained and labelled F values were examined using a paired samples t-test. The tested F levels ranged between 0.0338 and 4.6262 milligrams per litter (mg/L). The majority of the samples, around 85% recorded F values ranging from 0.232 to 0.0338 mg/L, offering slight or no benefit in caries prevention. Another 10% of the samples had F values ranging between 0.3 and 0.4 mg/L and could provide a dental health benefit. A percentage of 5% of the tested samples recorded F levels above the optimal level of 0.7 mg/L, as set by the American Dental Association (ADA) and the United States Department of Health and Human Services (U.S. HHS). This elevated F concentration poses a potential risk for DF in infants and toddlers, indicating that regular consumption of these samples may be unsafe.

Keywords

• fluoride
• bottled water
• dental fluorosis
• paediatric dentistry
• oral health