BOOK
Fluoride in Drinking-water
John Fawell | K. Bailey | J. Chilton | E. Dahi | Lorna Fewtrell | Y. Magara
(2006)
Additional Information
Book Details
Abstract
Fluoride is known to occur at elevated concentrations in a number of parts of the world where it can be a significant cause of disease. The primary focus of Fluoride in Drinking Water is the prevention of adverse health effects from excessive levels of fluoride in drinking water. The book fills the urgent need, identified for updating the WHO Guidelines for Drinking-water Quality, for information on the occurrence of fluoride, its health effects, ways of reducing excess levels and methods for analysis of fluoride in water. The draft document, produced by a working group of experts convened to consider protection from fluoride and its control, was issued for extensive review and consultation. The resultant book, which incorporates the comments received, was further peer review by experts in developed and developing countries. It is aimed at a wide range of individuals, including health workers and sanitary engineers who may require a broad introduction to the subject with more detailed guidance in some specific areas. Fluoride in Drinking-water will be an invaluable reference source for all those concerned with the management of drinking-water containing fluoride and the health effects arising from its consumption, including water sector managers and practitioners as well as health sector staff at policy and implementation levels. It will also be of interest to researchers, students, and development workers and consultants. Contents        Introduction Environmental occurrence, geochemistry and exposure Human health effects Guidelines and standards Removal of excessive fluoride Analytical methods Country data on dental and skeletal fluorosis associated with exposure to fluoride through drinking water Appendix: Indices of severity of dental fluorosis
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Cover | Cover | ||
| Table of contents | v | ||
| Acknowledgements | ix | ||
| 1:\rIntroduction | 1 | ||
| 1.1 References | 2 | ||
| 2:\rEnvironmental occurrence, geochemistry and exposure | 5 | ||
| 2.1 Fluoride distribution in water | 6 | ||
| 2.2 Exposure | 8 | ||
| 2.2.1 Air | 8 | ||
| 2.2.2 Dental products | 8 | ||
| 2.2.3 Food and beverages other than water | 8 | ||
| 2.2.4 Water | 22 | ||
| 2.2.5 Total fluoride exposure | 24 | ||
| 2.3 References | 24 | ||
| 3:\rHuman health effects | 29 | ||
| 3.1 Fluoride metabolism | 29 | ||
| 3.1.1 Absorption | 29 | ||
| 3.1.2 Distribution | 30 | ||
| 3.1.3 Excretion | 30 | ||
| 3.2 Effects on laboratory animals and in vitro systems | 30 | ||
| 3.2.1 Medium and long-term exposure | 30 | ||
| 3.2.2 Mutagenicity and related end-points | 31 | ||
| 3.2.3 Carcinogenicity | 31 | ||
| 3.2.4 Developmental and reproductive toxicity | 31 | ||
| 3.3 Effects on humans | 31 | ||
| 3.3.1 Effects on teeth | 32 | ||
| 3.3.2 Skeletal effects | 33 | ||
| 3.3.3 Cancer | 34 | ||
| 3.3.4 Other possible health effects | 34 | ||
| 3.3.5 Acute effects | 35 | ||
| 3.4 References | 35 | ||
| 4:\rGuidelines and standards | 37 | ||
| 4.1 Application of the WHO guideline value to local conditions | 37 | ||
| 4.2 References | 39 | ||
| 5:\rRemoval of excessive fluoride | 41 | ||
| 5.1 Method characterization | 44 | ||
| 5.1.1 Scale and decentralization | 44 | ||
| 5.1.2 Set-up and flow | 45 | ||
| 5.1.3 Media and process | 46 | ||
| 5.2 Bone charcoal | 47 | ||
| 5.2.1 Description | 47 | ||
| 5.2.2 Preparation | 47 | ||
| 5.2.3 Technical configuration | 49 | ||
| 5.2.4 Regeneration | 51 | ||
| 5.2.5 Design criteria | 51 | ||
| 5.2.6 Cost | 52 | ||
| 5.2.7 Experience | 52 | ||
| 5.2.8 Local customs and beliefs | 53 | ||
| 5.3 Contact precipitation | 53 | ||
| 5.3.1 Description | 53 | ||
| 5.3.2 Technical configuration | 56 | ||
| Chemicals in stock solutions | 57 | ||
| Operation of the domestic unit | 59 | ||
| Operation of the community plant | 59 | ||
| 5.3.3 Design criteria | 59 | ||
| 5.3.4 Cost | 62 | ||
| 5.3.5 Experience | 62 | ||
| 5.4 Nalgonda | 62 | ||
| 5.4.1 Description | 62 | ||
| 5.4.2 Technical configuration | 64 | ||
| 5.4.3 Design criteria | 64 | ||
| 5.4.4 Cost | 65 | ||
| 5.4.5 Sludge disposal | 65 | ||
| 5.4.6 Experience | 65 | ||
| 5.5 Activated alumina | 69 | ||
| 5.5.1 Description | 69 | ||
| 5.5.2 Technical configuration | 69 | ||
| 5.5.3 Regeneration | 70 | ||
| 5.5.4 Design criteria | 70 | ||
| 5.5.5 Cost | 71 | ||
| 5.5.6 Experience | 71 | ||
| 5.6 Clay | 72 | ||
| 5.6.1 Description | 72 | ||
| 5.6.2 Technical configuration | 72 | ||
| 5.6.3 Regeneration | 73 | ||
| 5.6.4 Design criteria | 73 | ||
| 5.6.5 Hygienic precautions | 74 | ||
| 5.6.6 Cost | 75 | ||
| 5.6.7 Experience | 75 | ||
| 5.7 Evaluation and selection of method | 75 | ||
| 5.8 References | 79 | ||
| 6:\rAnalytical methods | 83 | ||
| 6.1 Ion-chromatography with chemical suppression of eluent conductivity | 84 | ||
| Method and performance characteristics | 84 | ||
| Interference and matrix effects | 84 | ||
| Sample size | 86 | ||
| Equipment and consumable requirements | 86 | ||
| Throughput | 86 | ||
| Sample collection, preservation and storage | 86 | ||
| 6.2 Ion-selective electrode method | 86 | ||
| Method performance | 87 | ||
| Interference and matrix effects | 87 | ||
| Sample size | 88 | ||
| Equipment and consumables requirements | 88 | ||
| Throughput | 88 | ||
| Sample collection, preservation and storage | 88 | ||
| 6.3 Complexone method 1 (laboratory test) | 89 | ||
| Method performance | 89 | ||
| Interferences and matrix effects | 90 | ||
| Sample size | 90 | ||
| Equipment and consumable requirements | 90 | ||
| Throughput | 91 | ||
| Sample collection, preservation and storage | 91 | ||
| 6.4 Complexone method 2 (field test) | 91 | ||
| Method performance | 91 | ||
| Interference and matrix effects | 92 | ||
| Sample size | 92 | ||
| Equipment and consumable requirements | 92 | ||
| Throughput | 92 | ||
| 6.5 SPADNS method | 93 | ||
| Method performance | 94 | ||
| Interference and matrix effects | 94 | ||
| Sample size | 95 | ||
| Equipment and consumable requirements | 95 | ||
| Throughput | 95 | ||
| Sample collection, preservation and storage | 95 | ||
| 6.6 References | 95 | ||
| 7:\rCountry data on dental and skeletal fluorosis associated with exposure to fluoride through drinking-water | 97 | ||
| 7.1 Argentina | 98 | ||
| 7.2 Brazil | 98 | ||
| 7.3 Canada | 99 | ||
| 7.4 China | 99 | ||
| Fluoride-related health effects | 99 | ||
| Dental fluorosis | 99 | ||
| Skeletal fluorosis | 100 | ||
| Exposure and fluoride concentrations | 101 | ||
| Mitigation measures | 102 | ||
| 7.5 Eritrea | 102 | ||
| 7.6 Ethiopia | 103 | ||
| Fluoride-related health effects | 103 | ||
| Dental fluorosis | 103 | ||
| Skeletal fluorosis | 103 | ||
| Exposure and fluoride concentrations | 104 | ||
| Mitigation measures | 104 | ||
| 7.7 Germany | 104 | ||
| 7.8 India | 105 | ||
| Fluoride-related health effects | 105 | ||
| Dental fluorosis | 105 | ||
| Skeletal fluorosis | 105 | ||
| Exposure, fluorosis and fluoride concentrations | 105 | ||
| Mitigation measures | 106 | ||
| 7.9 Indonesia | 107 | ||
| 7.10 Israel | 107 | ||
| 7.11 Japan | 107 | ||
| 7.12 Kenya | 108 | ||
| Fluoride-related health effects | 108 | ||
| Dental fluorosis | 108 | ||
| Skeletal fluorosis | 109 | ||
| Exposure and fluoride concentrations | 109 | ||
| 7.13 Mexico | 109 | ||
| Fluoride-related health effects | 109 | ||
| Dental fluorosis | 109 | ||
| Skeletal fluorosis | 110 | ||
| Exposure and fluoride concentrations | 110 | ||
| 7.14 Niger | 110 | ||
| 7.15 Nigeria | 111 | ||
| 7.16 Norway | 111 | ||
| 7.17 Pakistan | 111 | ||
| 7.18 Saudi Arabia | 112 | ||
| 7.19 Senegal | 112 | ||
| 7.20 South Africa | 112 | ||
| Fluoride-related health effects | 112 | ||
| Dental fluorosis | 113 | ||
| Skeletal fluorosis | 113 | ||
| Exposure and fluoride concentrations | 113 | ||
| 7.21 Spain | 114 | ||
| 7.22 Sri Lanka | 114 | ||
| 7.23 Sudan | 114 | ||
| 7.24 Thailand | 114 | ||
| 7.25 Turkey | 115 | ||
| 7.26 Uganda | 115 | ||
| 7.27 United Republic of Tanzania | 115 | ||
| Fluoride-related health effects | 115 | ||
| Dental fluorosis | 115 | ||
| Skeletal fluorosis | 115 | ||
| Exposure and fluoride concentrations | 116 | ||
| Mitigation measures | 116 | ||
| 7.28 United States of America | 116 | ||
| 7.29 References | 117 | ||
| Appendix:\rIndices of severity of dental fluorosis | 125 | ||
| Dean’s Index | 125 | ||
| 1. Normal\r | 125 | ||
| 2. Questionable | 125 | ||
| 3. Very Mild | 125 | ||
| 4. Mild | 125 | ||
| 5. Moderate | 126 | ||
| 6. Severe | 126 | ||
| DDE (Developmental Defects of Enamel) Index | 126 | ||
| 1. Diffuse opacity | 126 | ||
| 2. Demarcated opacity | 126 | ||
| 3. Hypomineralized enamel | 126 | ||
| 4. Developmental defects of enamel | 126 | ||
| 5. Hypoplasia | 126 | ||
| 6. Opacity | 126 | ||
| Thylstrup and Fejerskov (TF) Index | 126 | ||
| Score 0 | 126 | ||
| Score 1 | 126 | ||
| Score 2 | 127 | ||
| Score 3 | 127 | ||
| Score 4 | 127 | ||
| Score 5 | 127 | ||
| Score 6 | 127 | ||
| Score 7 | 127 | ||
| Score 8 | 127 | ||
| Score 9 | 127 | ||
| TSIF (Tooth Surface Index of Fluorosis) | 128 | ||
| Score 0 | 128 | ||
| Score 1 | 128 | ||
| Score 2 | 128 | ||
| Score 3 | 128 | ||
| Score 4 | 128 | ||
| Score 5 | 128 | ||
| Score 6 | 128 | ||
| Score 7 | 128 | ||
| References | 128 | ||
| Index | 131 |