title: Effect of fluoride exposure on the intelligence of school children in Madhya Pradesh, India.
abstract: OBJECTIVE
  To assess the relationship between exposure to different drinking water fluoride levels and children's intelligence in Madhya Pradesh state, India.
  
  
  METHODS
  This cross-sectional study was conducted among 12-year-old school children of Madhya Pradesh state, India. The children were selected from low (< 1.5 parts per million) and high (≥1.5 parts per million) fluoride areas. A questionnaire was used to collect information on the children's personal characteristics, residential history, medical history, educational level of the head of the family, and socioeconomic status of the family. Levels of lead, arsenic, and iodine in the urine and the levels of fluoride in the water and urine were analyzed. The children's intelligence was measured using Raven's Standard Progressive Matrices. Data analysis was done using the chi-square, one way analysis of variance, simple linear regression, and multiple linear regression tests. P value <0.05 was considered statistically significant.
  
  
  RESULTS
  Differences in participant's sociodemographic characteristics, urinary iodine, urinary lead, and urinary arsenic levels were statistically not significant (P>0.05). However, a statistically significant difference was observed in the urinary fluoride levels (P 0.000). Reduction in intelligence was observed with an increased water fluoride level (P 0.000). The urinary fluoride level was a significant predictor for intelligence (P 0.000).
  
  
  CONCLUSIONS
  Children in endemic areas of fluorosis are at risk for impaired development of intelligence.
authors.affiliation: Department of Public Health Dentistry, People's College of Dental Sciences and Research Center, Bhopal, Madhya Pradesh, India.
authors.forename: Sudhanshu
authors.initials: S
authors.lastname: Saxena
authors.forename: Anjali
authors.initials: A
authors.lastname: Sahay
authors.forename: Pankaj
authors.initials: P
authors.lastname: Goel