title: Association of fluoride in water for consumption and chronic pain of body parts in residents of San Kamphaeng district, Chiang Mai, Thailand.
abstract: OBJECTIVE
  To assess the dose response of fluoride exposure from water and chronic pain.
  
  
  METHODS
  Using a retrospective cohort design, the study was conducted in two sub-districts of San Kamphaeng district, Poo-kha and On-tai. Five hundred and thirty-four residents aged ≥50 years of age were interviewed about their sources of drinking water and assessed for chronic pain. Each water source was sampled for fluoride measurement, from which the average daily fluoride dose was estimated. Binary logistic regression with forward stepwise (likelihood ratio) model selection technique was used to examine the association between the average daily fluoride dose and chronic pain.
  
  
  RESULTS
  We found associations between the average daily fluoride dose and lower back pain [odds ratio (OR) = 5.12; 95% confidence interval (CI), 1.59-16.98], and between the high fluoride area vs. the low fluoride area (OR = 1.58; 95% CI, 1.10-2.28; relative risk= 1.22 with 95% CI, 1.14-1.31) to lower back pain. Other risk factors, such as family history of body pain and a history of injury of the lower body, were also associated with lower back pain. However, there were no relationships between the average daily fluoride dose and leg and knee pains.
  
  
  CONCLUSIONS
  To prevent further lower back pain, we recommend that the water in this area be treated to reduce its fluoride content.
authors.affiliation: Department of Community Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Montakarn
authors.initials: M
authors.lastname: Namkaew
authors.forename: Phongtape
authors.initials: P
authors.lastname: Wiwatanadate
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000139:chemically induced / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D005457:Fluoridation / Q000009:adverse effects / Q000706:statistics & numerical data*; D005459:Fluorides / Q000009:adverse effects* / Q000032:analysis; D006801:Humans; D017116:Low Back Pain / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D018508:Water Purification / Q000706:statistics & numerical data
chemical_list: D060766:Drinking Water; D005459:Fluorides