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J. M. Brunkard, E. Ailes, V. A. Roberts, V. Hill, E. D. Hilborn, G. F. Craun, A. Rajasingham, A. Kahler, L. Garrison, L. Hicks, J. Carpenter, T. J. Wade, M. J. Beach and J. S. Yoder-Msw, “Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water, United States 2007-2008,” MMWR Surveillance Summaries, Vol. 60, No. 12, 2011, pp. 38-68.

has been cited by the following article:

• TITLE: Fluorosis and Dental Caries in the Hydrogeological Environments of Southeastern Communities in the State of Morelos, Mexico

  AUTHORS: Gricelda G. Varela-González, Alvaro García-Pérez, Rafael Huizar-Alvarez, Maria Esther Irigoyen-Camacho, Maria M. Espinoza-Jaramillo

  KEYWORDS: Fluoride; Drinking Water; Fluorosis; Dental Caries; México

  JOURNAL NAME: Journal of Environmental Protection, Vol.4 No.9, September 17, 2013

  ABSTRACT: Objectives: 1) To identify the hydrogeological characteristics and fluoride (F-) concentration in drinking water in the southeast of the state of Morelos, Mexico, and 2) to estimate the association between the prevalence and severity of fluorosis, dental caries, and water F-concentration. Methods: A hydrogeological model was developed to determine the vertical distribution of lithostratigraphic units, rocks’ hydraulic conductivities, and groundwater flow characteristics. A total of 649 schoolchildren from two communities received oral examinations. One community was located in an area with 0.75 mg F-/L in the water supply and the other in an area with 1.6 mg F-/L. Fluorosis was assessed using the Thylstrup & Fejerskov Index (TFI) and the dental caries were assessed with the decayed, missing, and filled teeth (DMFT) index. The region groundwater was extracted from an inter-granular aquifer consisting of volcano clasts of intermediate volcanic chemical composition. Results: Oral examinations showed that 32.35% of the children had severe forms of fluorosis (TFI ≥ 4) in the community with 1.60 mg F-/L and 7.8% in the 0.75 mg F-/L community (p -/L and 0.75 mg F-/L, respectively (p = 0.2259). Conclusions: The increasing extraction of underground water was associated with deeper water flows and higher F-concentration. In the community with high F-concentration, a third of the children showed objectionable levels of fluorosis. Adequate groundwater management actions are required to reduce fluorosis risk.