Surveillance and monitoring of fluorides in public drinking water: a systematic review

Abstract

Fluoride can harm or protect human dentition according to its concentration in the water. This paper summarizes major methodological features and main findings described in studies of fluoride concentration in public supply water that were published in specialized journals between 2008 and 2012, highlighting their implications for public health surveillance. A systematic review was conducted comprising scientific articles in the databases Embase, Lilacs and PubMed. Thirty-six studies were included: 28 from the Americas, five from Asia, two from Africa and one from Europe. The variability of the studies related to design and methodological procedures was high. Although the studies provided information on the space-temporal distribution of the samples, few publications described the population covered by the investigated supply source. Almost half of the studies were cross-sectional and no dispersion or variation measure was associated to the mean value. The electrometric method and dichotomous classification of the samples were predominately used for evaluating the outcomes. Less than half of the studies were articulated to surveillance as a State action and a lesser number raised hypotheses regarding possible factors related to the findings. There is a major space to be narrowed between the results of these initiatives and the use of that information by public health authorities and to improve methodological procedures in future studies. The interaction between researchers and water quality control organizations should be increased.