Water pollution with fluoride in the Republic of Moldova and its impact on oral health
Authors: Stepco Elena , Ferdohleb Alina , Ciobanu Elena , Patranac Maria 
Published: June 2024

Water quality, especially drinking water quality, is one of the most essential requirements for the survival of not only mankind but all terrestrial life on Earth. As a determining factor of health, the quality of drinking water must correspond to sanitary regulations, and the violation of the water protection regime results in pollution. Water pollution is one of the major threats to public health in the Republic of Moldova. According to data compiled by the Yale Center for Environmental Law and Policy, globally, the Republic of Moldova was placed 83rd out of 180 countries in terms of drinking water quality, the first place being occupied by the countries with the highest drinking water quality. The „age-standardized life-years lost per 100,000 people due to exposure to unsafe drinking water (Daily rate)” is a measure used to evaluate the quality of water. The Daly score for the Republic of Moldova in 2022 was 50.0. The Republic of Moldova is considered a biogeochemical zone with regard to some chemical elements in the environment, including the content of fluorine in groundwater, soil, and subsequently in food products. The analysis of water samples taken by the National Public Health Center of the Republic of Moldova demonstrated that in 90% of cases, water sources subjected to laboratory investigations for microbiological and chemical parameters (boron, fluorine, and nitrates) do not meet the requirements. The present study was a prospective, observational one, the main objective of which was to evaluate the epidemiological dental characteristics of children from the fluorosis-endemic area of the Republic of Moldova. The study targeted 520 12- and 15-year-old children from Fălești district, where the fluoride concentration in drinking water exceeds 16 times the permissible norm of 16.2 ppm/l. Thus, the prevalence of dental fluorosis in this locality (Dean index ≥1) was 98.7 for 12-year-old children and 100% for 15-year-old adolescents. The prevalence of dental caries was 51.2% with an intensity of 2.1 for 12-year-old children, and for 15-year-old children, the prevalence was 67.1% with an intensity of 3.5. Children’s age and severity of dental fluorosis were independent predictors of dental caries intensity. Thus, a positive correlation was established between the severity of dental fluorosis and the intensity of dental caries in both study groups and in all groups of teeth. The percentage of children with a COAD index (decayed, filled, or absent teeth) ≥1 was higher in those whose Dean index was ≥ 5 in the second molar compared to other groups of teeth. Conclusion. Dental fluorosis remains the most common dental disease in fluorosis-endemic areas, and the severity of fluorosis increases with increasing fluoride concentrations in drinking water. Contrary to the previously established opinion, tooth decay also develops in children from endemic areas of fluorosis, and its frequency and intensity are directly correlated with the concentration of fluoride in drinking water. The higher the concentration of fluoride, the higher the values of the prevalence indices and intensity of dental caries. Republic of Moldova performs suboptimally in the prevention of oral diseases in the pediatric population, and the implementation of dental disease prevention programs would have major implications for improving dental morbidity.