Groundwater Fluoride Concentration and Dental Fluorosis Status in School-Age Children Living in Areas Relying on Groundwater as the Primary Drinking Water Source: A Systematic Review
Arzy Kaneishya Azzahra1, Gilang Rasuna Sabdho Wening2*
Abstract
Groundwater is a major, often unmonitored, source of excess fluoride in many communities because its concentration depends on local geology rather than regulated fluoridation, and while the relationship between fluoride exposure and dental fluorosis is well established, evidence specifically addressing groundwater-dependent populations remains scattered across geographically diverse, small-scale studies. This systematic review aimed to synthesise evidence on groundwater fluoride concentration and dental fluorosis status among school-age children in areas relying on groundwater as the primary drinking water source. This review followed PRISMA 2020 guidelines, and a systematic search of PubMed, Scopus, and ScienceDirect (2021–2026) identified 419 records, of which 292 were screened, 15 assessed for full-text eligibility, and 12 met all inclusion criteria. Twelve cross-sectional, comparative, and surveillance-based studies from Indonesia, Libya, Jordan, Thailand, China (two studies), Mexico (three studies), India, Argentina, and Colombia met the inclusion criteria; most studies demonstrated a dose-related pattern between groundwater/well-water fluoride concentration and dental fluorosis severity, although two studies employing ecological or population-aggregated exposure designs (Argentina, Colombia) found inconsistent or non-significant direct associations at the locality level, attributable to confounding by altitude, temperature, and additional non-water fluoride sources, and several studies additionally linked fluorosis to caries risk, reduced quality of life, nutritional status, and intelligence quotient, while one study found an inverse relationship between fluorosis and Molar Incisor Hypomineralisation. Groundwater fluoride concentration is generally associated with dental fluorosis prevalence and severity in school-age children, though this relationship can be attenuated by geographic, nutritional, and multi-source exposure factors at the population level, and routine groundwater fluoride monitoring, individual-level exposure assessment, and context-specific preventive strategies are recommended in groundwater-dependent communities.
Keywords
dental fluorosis; groundwater; fluoride exposure; school-age children; systematic review
Cite This Article
Azzahra, A. K., Wening, G. R. S. (2026). Groundwater Fluoride Concentration and Dental Fluorosis Status in School-Age Children Living in Areas Relying on Groundwater as the Primary Drinking Water Source: A Systematic Review. International Journal of Scientific Advances (IJSCIA), Volume 7| Issue 5: Sep – Oct 2026, Pages 506-513 URL: https://www.ijscia.com/wp-content/uploads/2026/09/Volume7-Issue5-Sep-Oct-No.1070-506-513.pdf
Volume 7 | Issue 5: Sep – Oct 2026
