Effects of water improvement and defluoridation on fluorosis-endemic areas in China: A meta-analysis

This meta-analysis systematically evaluated the effects of water improvement and defluoridation on fluorosis-endemic areas in North and South China. The study used PubMed, Embase, China National Knowledge Infrastructure, and Wanfang to retrieve relevant research studies published between January 2000 and October 2019. The data included water fluoride levels, dental fluorosis prevalence in children 8–15 years of age, urinary fluoride levels in children and adults, and skeletal fluorosis prevalence in adults. Fixed-effects and random-effects models were used in the meta-analysis. A total of 17 research articles met the inclusion criteria and had an average water improvement period of 15.8 years. With water improvement, water fluoride levels decreased from 2.72 mg/L to 0.54 mg/L (95% confidence intervals: −2.75, −1.58), which was below the standard for drinking water (1.5 mg/L). Additionally, after water improvement, the prevalence of dental fluorosis decreased from 54.5% to 36.2% (95% confidence intervals: 0.12, 0.31) in children, and the prevalence of skeletal fluorosis decreased from 13.7% to 4.2% (95% confidence intervals: 0.16, 0.40) in adults. Urinary fluoride levels decreased from 3.06 mg/L to 1.70 mg/L (OR = −2.03, 95% confidence intervals: −2.77, −1.30) in children and from 2.29 mg/L to 1.72 mg/L (OR = −0.57, 95% confidence intervals: 0.65, −0.49) in adults. The results showed that the prevalence of dental fluorosis and skeletal fluorosis and urinary fluoride levels were significantly reduced by water improvement. This study findings revealed that the effects of water improvement and defluoridation were greater in South China than in North China, and it is obviously related to the time of water improvement and reducing fluoride. [Display omitted] •The first analysis of the effect of improving water quality and reducing fluoride in China over 40 years.•Analysis of the effect of water improvement and fluoride reduction in different provinces of China.•We analyzed the effect of water improvement on dental fluorosis, skeletal fluorosis, and fluoride content in urine.