1Asad Jahangir, 2Kamran Safdar, 3Dr Irtiza Memon, 4Marium Azfar, 5Faiza Maqsood, 6Zamin Abbas
Submission: 18 January 2026 | Acceptance: 19 February 2026 | Publication: 14 March 2026,
1Assistant professor, Dow University of Health Sciences, Karachi
2Associate Professor, Jinnah Hospital, Lahore
3Lecturer Department of Periodontology Sindh Institute of Oral Health Sciences Jinnah Sindh Medical University Karachi, Pakistan
4Associate Professor, Department of Community Dentistry, SIOHS JSMU.
5Assistant Professor, Bolan Medical College, Quetta
6Hayatabad Medical Complex, Peshawar
ABSTRACT:
Background: Dental fluorosis is a hypo mineralization of tooth enamel caused by excessive fluoride intake during enamel development. The fluoride concentration in drinking water is a major contributor to its prevalence, particularly in regions where fluoride levels are not consistently regulated. Differences between rural and urban water supplies may lead to varied exposure levels and, consequently, differences in fluorosis prevalence.
Aim: The aim of this study was to compare fluoride levels in drinking water sources and assess the prevalence of dental fluorosis among children residing in rural and urban areas.
Methods: This cross-sectional study was conducted at Jinnah Hospital, Lahore, from May 2024 to April 2025. A total of 100 children aged 6–12 years were enrolled, comprising 50 from rural areas and 50 from urban areas. Water samples from commonly used drinking sources in each locality were collected and analyzed for fluoride concentration using an ion-selective electrode method. Dental fluorosis was assessed through clinical examination using Dean’s Index.
Results: The mean fluoride concentration in rural drinking water sources was 2.3 ppm, significantly higher than the 0.8 ppm observed in urban water sources. Dental fluorosis was identified in 68% of rural children, compared to 32% of urban children. Moderate to severe fluorosis was more prevalent in rural participants, while urban children predominantly exhibited very mild to mild cases. A statistically significant correlation (p < 0.01) was found between high fluoride levels and increased severity of fluorosis.
Conclusion: The study concluded that children in rural areas were more exposed to higher fluoride levels in drinking water and had a significantly greater prevalence and severity of dental fluorosis compared to their urban counterparts. These findings highlight the need for targeted public health interventions to monitor and regulate fluoride levels in rural water supplies to prevent dental fluorosis.
Keywords: Dental fluorosis, fluoride concentration, drinking water, rural population, urban population, Dean’s Index, enamel hypo mineralization.