New WHO Report Addresses Fluoride In Drinking Water

Millions of people are exposed to excessive amounts of fluoride through drinking water contaminated from natural geological sources. As a result, many suffer conditions ranging from mild dental fluorosis to crippling skeletal fluorosis. With the problem continuing to be unrecognized and neglected, guidance is sorely needed, states the World Health Organization (WHO).

On Nov. 21, WHO released a publication, "Fluoride in Drinking-water," that provides the latest scientific evidence on the occurrence of fluoride, its health effects, methods to reduce excess levels and analysis techniques. Guidance is particularly needed because fluoride is found in all natural waters at some concentration, WHO stated. Low concentrations are good for teeth, but excessive concentrations can lead to debilitating disease, such as skeletal fluorosis, which has devastated some communities. In China alone, more than 10 million people are estimated to suffer from skeletal fluorosis.

Clinical dental fluorosis is characterized by staining and pitting of the teeth. In more severe cases, all the enamel may be damaged. In skeletal fluorosis, fluoride accumulates in the bone progressively over many years, leading to stiffness and pain in the joints. In severe cases, it can cause changes to bone structure, calcification of ligaments and crippling effects.

While the global prevalence of dental and skeletal fluorosis is not entirely clear, it is known that water is normally the major source of fluoride exposure, with exposure from diet and from burning high fluoride coal also major contributors in some settings. Fluoride occurs at elevated concentrations in many areas of the world including Africa, the Eastern Mediterranean and southern Asia. One of the best-known areas for high-fluoride levels extends from Turkey through Iraq, Iran, Afghanistan, India, northern Thailand and China. However, there are many other areas with water sources that contain high-fluoride levels and which pose a risk to those drinking the water, notably parts of the rift valley in Africa. Many of these areas are arid and alternative sources of water are not available.

Suffering caused by high levels of fluoride can be prevented, WHO stated. Although removal of excessive fluoride from drinking water may be difficult and expensive, low-cost solutions that can be applied at a local level do exist. Methods outlined in the monograph include: use of crushed clay pots, bone charcoal, contact precipitation or use of activated alumina (absorptive filter). It is important that local authorities consider the causes of fluorosis carefully and choose the best and most appropriate means of dealing with excess fluoride exposure, taking into account the local conditions and sensitivities.

More information about the publication can be accessed at

This article originally appeared in the 11/01/2006 issue of Environmental Protection.

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