The purpose of this study was to assess exposure to drinking water fluoride and evaluate the risk of dental fluorosis among the Estonian population. The study covered all 15 counties in Estonia and 93.7% of population that has access to public water supplies. In Estonia groundwater is the main source for public water supply systems in most towns and rural settlements. The content of natural fluoride in water ranges from 0.01 to 7.20 mg/L. The exposure to different fluoride levels was assessed by linking data from previous studies on drinking water quality with databases of the Health Protection Inspectorate on water suppliers and the number of water consumers in water supply systems. Exposure assessment showed that 4% of the study population had excessive exposure to fluoride, mainly in small public water supplies in western and central Estonia, where the Silurian-Ordovician aquifer system is the only source of drinking water. There is a strong correlation between natural fluoride levels and the prevalence of dental fluorosis. Risk of dental fluorosis was calculated to different fluoride exposure levels over 1.5 mg/L.

No abstract

Judging from our results and the EU structural indicators on health, the prevalence of activity limitations derived from chronic conditions is comparatively high in Estonia. The measures to prevent activity limitations and disability should receive a higher priority in Estonia.

Fluoride is a naturally occurring contaminant in groundwater in Estonia. There are several regions in Estonia with fluoride contents in public water supplies as high as 7 mg/L. Long-term exposure to high-fluoride drinking water may have several adverse health effects, primarily dental fluorosis. The opportunities for exposure reduction rely highly on water treatment technologies. Since 2004 public water suppliers in Estonia have made efforts to diminish fluoride content in drinking water systems. A follow-up study on a country level was carried out in 2004–2012 to analyze the changes in population exposure to excessive (over 1.5 mg/L) fluoride in drinking water and to get information about the reduction methods applied by public water supplies (PWS) to optimize the fluoride levels in public water system. The results showed that bigger PWS have been more effective in fluoride reduction measures than small PWS. The main methods used to lower the fluoride content were reverse osmosis technology and replacement of water sources with new ones (new drilled wells). As a result of all the measures taken the overall high-fluoride exposure has been reduced substantially (82%).