Fluoride intake from fluids and urinary fluoride excretion by young children in Kuwait: a non-fluoridated community

ObjectivesTo determine the pattern of fluid consumption, fluoride intake from the fluids and urinary fluoride excretion by children aged 1-9years in Kuwait, a nonfluoridated community. MethodsUsing the cluster sampling technique, children aged 1-9years were chosen from 2000 randomly selected households in Kuwait. Questionnaires were then administered to their mothers to determine the children's daily fluid intake. Fluoride concentrations in tap water as well as all brands of bottled water and beverages consumed by the children were measured, using the fluoride ion-specific electrode. Fluoride excretion was determined in 400 randomly selected children, based on fluoride/creatinine ratio. ResultsThe mean daily fluid consumption by the children was high, being 1115-1545ml. About 40% of the fluid intake was plain (tap and bottled) water and approximately 10% of the children drank bottled water exclusively. Fluoride concentration in tap water was low (0.04SD 0.02ppm), but was higher in bottled water (0.28 +/- SD 0.40ppm). Mean daily fluoride ingestion from fluids was 0.013-0.018mg/kg body weight (bw). Even after allowing for fluoride ingestion from other sources, mean daily fluoride ingestion was still below 0.1mg/kg bw set by the United States of America Institute of Medicine as the lowest-observed-adverse-effect level for moderate enamel fluorosis in children aged up to 8years. Furthermore, the mean daily urinary fluoride excretion of 128-220g was below the provisional standard of 360-480g for optimal fluoride usage by children aged 3-5years. ConclusionFluoride ingestion from fluids and urinary fluoride excretion by the children were below the recommendations for optimal fluoride usage. Thus, there is room for an upward adjustment of fluoride level in public drinking water supplies in Kuwait, as a caries preventive measure.