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Factors influencing the relationship between fluoride in drinking water and dental fluorosis: a ten-year systematic review and meta-analysis

Akuno, M. H., Nocella, G., Milia, E. P., Gutierrez, L.·2019·Journal of Water and Health
DOI 10.2166/wh.2019.300
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Abstract

The relationship between naturally fluoridated groundwater and dental fluorosis has received large attention from researchers around the world. Despite recognition that several factors influence this relationship, there is a lack of systematic studies analyzing the heterogeneity of these results. To fill such a gap, this study performs a systematic review and meta-analysis to understand which factors influence this relationship and how. Selected studies were sampled between 2007 and 2017 from Web of Science, PubMed, Google Scholar and Scopus using keywords and Boolean operators. Results of the systematic review show that dental fluorosis affects individuals of all ages, with the highest prevalence below 11, while the impact of other factors (gender, environmental conditions, diet and dental caries) was inconclusive. Meta-regression analysis, based on information collected through systematic review, indicates that both fluoride in drinking water and temperature influence dental fluorosis significantly and that these studies might be affected by publication bias. Findings show that fluoride negatively affects people's health in less developed countries. The conclusions discuss policy tools and technological innovations that could reduce fluoride levels below that of the World Health Organization (WHO) (<1.5 mg/L).

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Crossref · 10.2166/wh.2019.300

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Figures

Figure 1 Flow diagram on the identi fi cation of eligible studies to fi nal inclusion.
Figure 1 Flow diagram on the identi fi cation of eligible studies to fi nal inclusion.CC-BY · From the PDF
Figure 2 Forest plot of the prevalence of dental fl uorosis for different levels of fl uoride in drinking water.
Figure 2 Forest plot of the prevalence of dental fl uorosis for different levels of fl uoride in drinking water.CC-BY · From the PDF
Figure 3 Forest plot of the prevalence of dental fl uorosis for different age groups.
Figure 3 Forest plot of the prevalence of dental fl uorosis for different age groups.CC-BY · From the PDF

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Citations

Cites

Research works printed but not linked: 60

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Metadata

Authors
Akuno, M. H., Nocella, G., Milia, E. P., & Gutierrez, L.
Affiliations
  • Department of Agricultural Sciences, University of Sassari, Viale Italia 39, 07100 Sassari, Italy
  • School of Agriculture, Policy and Development, University of Reading, Reading RG6 6BZ, UK
  • Department of Medicine, Surgery and Experimental Science, University of Sassari, Viale San Pietro, 07100 Sassari, Italy
Venue
Journal of Water and Health
Publisher
IWA Publishing
Published
2019-09-19
Volume
17
Issue
6
Pages
845-862
ISSN
  • 1477-8920
  • 1996-7829
DOI
10.2166/wh.2019.300
Cited by
65
References
5
Language
en
Licence
creativecommons.org/licenses/by/4.0/ (vor)
Funders
Horizon 2020 Framework Programme (690378)

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