Population knowledge regarding the role of fluoride in drinking water and oral health
DOI:
https://doi.org/10.52673/18570461.26.1-80.08Keywords:
Fluoride, drinking water, dental caries, dental fluorosis, oral health, population knowledge level, Republic of MoldovaAbstract
The study examines the relationship between fluoride content of drinking water, dental conditions, and the population’s level of knowledge in the Republic of Moldova. Fluoride has a dual role, providing protection against dental caries but potentially toxic through the occurrence of fluorosis, especially in biogeochemical areas with elevated concentrations. A descriptive cross-sectional study was conducted on a sample of 504 adults using an online questionnaire. Statistical analysis (χ², multinomial logistic regression, ANOVA) assessed the associations between the type of water consumed, living environment, socioeconomic status, and self-reported dental pathology. Although 94% of respondents state that they know what dental caries is, only 6% have heard about dental fluorosis, highlighting a low level of awareness. Dental caries and yellow-brown tooth discoloration were more frequently reported among individuals consuming water from wells and artesian wells, as well as among older age groups. A more favorable socioeconomic status was associated with a lower prevalence of both dental caries and signs of fluorosis. Family doctors and mass media were identified as the most accessible and trusted sources of information regarding oral health and the role of fluoride. The continued use of well water, despite the expansion of water supply networks, maintains the risk of excessive fluoride exposure. The results highlight the need for ongoing water quality monitoring and the implementation of targeted educational programs to prevent dental caries and fluorosis.
References
1. Whelton, H.P.; Spencer, A.J.; Do, L.G.; Rugg-Gunn, A.J. Fluoride Revolution and Dental Caries: Evolution of Policies for Global Use, in: J Dent Res, 2019, 98(8):837-846. https://doi.org/10.1177/0022034519843495
2. Gnatiuc, P.; Terehov, A.L.; Năstase, C. Toxicitatea fluorului în vizorul medicinei moderne, în: Medicina Stomatologică, 2011, 4:35-37, [online] https://repository.usmf.md/bitstream/20.500.12710/23827/1/TOXICITATEA_FLUORULUI_IN_VIZORUL_MEDICINEI_MODERNE.pdf (consultat: 14.10.25).
3. James, P.; Harding, M.; Beecher, T. et al. Impact of Reducing Water Fluoride on Dental Caries and Fluorosis, in: J Dent Res, 2021, 100(5):507-514. https://doi.org/10.1177/0022034520978777
4. Clark, M.B.; Keels, M.A.; Slayton, R.L. Fluoride Use in Caries Prevention in the Primary Care Setting, in: Pediatrics, 2020, 146(6):e2020034637. https://doi.org/10.1542/peds.2020-034637
5. Shavratov, M.; Ferdohleb, E.; Ferdohleb, A. The aesthetic perception of dental fluorosis and relationships with psychosocial aspects/oral health related quality of life, in: Patrimoniul cultural de ieri – implicaţii în dezvoltarea societăţii durabile de mâine, 2023, 220-221, [online] https://ibn.idsi.md/vizualizare_articol/178813 (consultat: 14.10.25).
6. Toumba, K.J.; Twetman, S.; Splieth, C.; Parnell, C.; van Loveren, C.; Lygidakis, N.Α. Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document, in: Eur Arch Paediatr Dent, 2019, 20(6):507-516. https://doi.org/10.1007/s40368-019-00464-2
7. Kumar, S.; Tadakamadla; J.; Johnson, N.W. Effect of community-based oral health interventions on oral health and related behavior of adults: a systematic review, in: J Int Soc Prev Community Dent, 2015, 5(5):406-411.
8. Mukherjee, I.; Singh, U.K. Groundwater fluoride contamination, probable release, and containment mechanisms: a review on Indian context, in: Environ Geochem Health, 2018, 40(6):2259-2301. https://doi.org/10.1007/s10653-018-0096-x
9. Dickinson, J.A.; Guichon, J.; Wadey, W.; Da Silva, K. Family physicians as advocates for community water fluoridation, in: Can Fam Physician, 2023, 69(5):314-318. https://doi.org/10.46747/cfp.6905314
10. Rango, T.; Kravchenko, J.; Atlaw, B. et al. Groundwater quality and its health impact: An assessment of dental fluorosis in rural inhabitants of the Main Ethiopian Rift, in: Environ Int, 2012, 43:37-47. https://doi.org/10.1016/j.envint.2012.03.002
11. Keesari, T.; Pant, D.; Roy, A. et al. Fluoride Geochemistry and Exposure Risk Through Groundwater Sources in Northeastern Parts of Rajasthan, India, in: Arch Environ Contam Toxicol, 2021, 80(1):294-307. https://doi.org/10.1007/s00244-020-00794-z
12. Solanki, Y.S.; Agarwal, M.; Maheshwari, K.; Gupta, S.; Shukla, P.; Gupta, A.B. Removal of fluoride from water by using a coagulant (inorganic polymeric coagulant), in: Environ Sci Pollut Res Int, 2021, 28(4):3897-3905. https://doi.org/10.1007/s11356-020-09579-2
13. Yadav, K.K.; Kumar, S.; Pham, Q.B. et al. Fluoride contamination, health problems and remediation methods in Asian groundwater: A comprehensive review, in: Ecotoxicol Environ Saf, 2019, 182:109362. https://doi.org/10.1016/j.ecotoxicol-env.2019.06.045
14. Bivol, N.; Ciobanu, E. Hygienic analysis of fluoride content in drinking water in some settlements of the Republic of Moldova, in: ArtMed, 2020, 77(4):17-9, [online] https://artamedica.md/index.php/artamedica/article/view/108 (consultat: 25.10.25).
15. Pînzaru, I.; Carp, L.; Bernic, V.; Miron, I.; Bivol, N. Hygienic assessment of fluorine content in drinking water from underground sources of the Republic of Moldova, in: ArtMed, 2020, [online] https://artamedica.md/index.php/artamedica/article/view/126 (consultat: 25.10.25).
16. Horowitz, A.M.; Kleinman, D.V.; Wang, M.Q. What Maryland adults with young children know and do about preventing dental caries, in: Am J Public Health, 2013, 103(6):e69-e76. https://doi.org/10.2105/AJPH.2012.301038
17. U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries, in: Public Health Rep, 2015, 130(4):318-331. https://doi.org/10.1177/003335491513000408
18. Nassar, Y.; Brizuela, M. The Role of Fluoride on Caries Prevention, in: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025, [online] https://www.ncbi.nlm.nih.gov/books/NBK587342/?utm_source=chatgpt.com (consultat: 12.11.2025).
19. Peres, M.A.; Macpherson, L.M.D.; Weyant, R.J. et al. Oral diseases: a global public health challenge, in: Lancet, 2019, 394(10194):249-260. https://doi.org/10.1016/S0140-6736(19)31146-8
20. Public Health England (2022). Water fluoridation: health monitoring report for England 2022, [online] https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2022 (consultat: 12.11.2025).
21. Watt, R.; Sheiham, A. Integrating the common risk factor approach into a social determinants framework, in: Community Dent Oral Epidemiol, 2012, 40(4):289-296. https://doi.org/10.1111/j.1600-0528.2012.00680.x
22. Srivastava, S.; Flora, S.J.S. Fluoride in Drinking Water and Skeletal Fluorosis: a Review of the Global Impact, in: Curr Environ Health Rep, 2020, 7(2):140-146. https://doi.org/10.1007/s40572-020-00270-9
23. Godoroja, P.; Spinei, A.; Spinei, I. Stomatologie terapeutică pediatrică. Chișinău: Centrul editorial-poligrafic Medicina; 2003, 87-101.
24. Stepco, E.; Ferdohleb, A.; Stratulat, S.; Tonofa, I.; Patranac, M. Aesthetic Perception of Dental Fluorosis and Quality of Life Related to Oral Health, in: IFMBE Proceedings: 7th International Conference on Nanotechnologies and Biomedical Engineering, ICNBME 2025, Ed. 6, 7-10.10.2025. https://doi.org/10.1007/978-3-032-06497-4_41
25. Stepco, E.; Ferdohleb, E. Particularitățile medico-sociale ale fluorozei dentare la copii din zona endemică. 2017, în: Arta Medica, 2017, 64(3):46-51.
26. Iheozor-Ejiofor, Z.; Worthington, H.V.; Walsh, T. et al. Water fluoridation for the prevention of dental caries, în: Cochrane Database Syst Rev. 2015;(6):CD010856. https://doi.org/10.1002/14651858.CD010856.pub2
