Assessing the risk of an excess fluoride intake among Swedish children in households with private wells--expanding static single-source methods to a probabilistic multi-exposure-pathway approach.

It is often assumed that water consumption is the major route of exposure for fluoride and analysis of water fluoride content is the most common approach for ensuring that the daily intake is not too high. In the present study, the risk of excess intake was characterized for children in households with private wells in Kalmar County, Sweden, where the natural geology shows local enrichments in fluorine. By comparing water concentrations with the WHO drinking water guideline (1.5 mg/L), it was found that 24% of the ca. 4800 sampled wells had a concentration above this limit, hence providing a figure for the number of children in the households concerned assessed to be at risk using this straightforward approach. The risk of an excess intake could, alternatively, also be characterized based on a tolerable daily intake (in this case the US EPA RfD of 0.06 mg/kg-day). The exposure to be evaluated was calculated using a probabilistic approach, where the variability in all exposure factors was considered, again for the same study population. The proportion of children assessed to be at risk after exposure from drinking water now increased to 48%, and when the probabilistic model was adjusted to also include other possible exposure pathways; beverages and food, ingestion of toothpaste, oral soil intake and dust inhalation, the number increased to 77%. Firstly, these results show how the risk characterization is affected by the basis of comparison. In this example, both of the reference values used are widely acknowledged. Secondly, it illustrates how much of the total exposure may be overlooked when only focusing on one exposure pathway, and thirdly, it shows the importance of considering the variability in all relevant pathways.