title: National and sub-national drinking water fluoride concentrations and prevalence of fluorosis and of decayed, missed, and filled teeth in Iran from 1990 to 2015: a systematic review.
abstract: Fluoride intake, fluorosis, and dental caries could affect quality of life and disease burden worldwide. As a part of the National and Sub-national Burden of Disease Study (NASBOD) in Iran, we conducted a systematic review to evaluate province-year-specific mean drinking water fluoride concentrations and prevalence of fluorosis and of decayed, missed, and filled teeth (DMFT) in Iran from 1990 to December 2015. We did electronic searches of all English and Persian publications on PubMed, ScienceDirect, Google Scholar, and Iranian databases. Results revealed that the weighted mean drinking water fluoride concentration in Iran from 1990 to 2015 has been about 0.65 ± 0.38 mg/l. However, based on the WHO guideline value (1.50 mg/l) and the maximum permissible Iranian national fluoride standard (1.40 to 2.40 mg/l depending on the region's climate), there have been some regions in Iran with non-optimum fluoride concentrations in their drinking water (up to 7.0 mg/l). Overall, concentrations have been higher in southern parts of Iran and in some areas of Azerbaijan-e-Gharbi Province in the northwest and lower in the rest of the northwest and central parts of Iran. In addition, some hotspots have been found in Bushehr Province, southwest of Iran. The highest prevalence of dental flourosis has been reported in normal index while the lowest prevalence has been expressed in severe index. The lowest DMFT (about 0.1) was in Arsanjan City in Fars Province, and the highest (about 6.7) was for Najaf Abad City in Isfahan Province. Prevalence of fluorosis has been rather high in studied areas of Iran (e.g. 100 % in Maku City in Azarbaijan-e-Gharbi Province), and there was discrepancy for DMFT, but a lack of studies renders the results inconclusive. Further studies, health education and promotion plans, and evidence-based nutrition programs are recommended.
authors: Department of Environmental Health Engineering, Faculty of Health, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
authors: Nader
authors: N
authors: Taghipour
authors: Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.|Unit of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
authors: Heresh
authors: H
authors: Amini
authors: Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. mmosaferi@yahoo.com.
authors: Mohammad
authors: M
authors: Mosaferi
authors: Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.
authors: Masud
authors: M
authors: Yunesian
authors: Department of Environmental Health Engineering, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors: Mojtaba
authors: M
authors: Pourakbar
authors: Department of Environmental Health Engineering, Tabriz University of Medical Sciences, Tabriz, Iran.
authors: Hassan
authors: H
authors: Taghipour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D005459:Fluorides / Q000032:analysis*; D009050:Fluorosis, Dental / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D014076:Tooth Diseases / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
chemical_list: D060766:Drinking Water; D005459:Fluorides
keywords: DMFT; Drinking water; Fluoride concentrations; Fluorosis; Iran