Fluoride Action Network



The prevalence and severity of endemic dental fluorosis were studied in 928 undernourished inhabitants who had resided since birth in two fluoride endemic areas in Italy (Compagnano di Roma and Quarto). The data were compared with the index of mottling in endemic areas in the United States with similar fluorine concentration in the water supply.

The relative nutritional status in Compagnano di Roma was fair, and in Quarto, poor, in comparison with that of American communities which was considered to be good.

1. The prevalence of mottling–that is, the number of individuals affected–was higher in the Italian communities than in comparable areas in the United States with similar fluorine content in the water supply.

2. The severity of mottling of the enamel as evidenced by the index of endemic dental fluorosis was noticeably higher in the Italian communities than in comparable areas in the United States.

3. The difference may be explained on the basis of the lower nutritional status of the group studied, the most important factor being probably a lower calcium intake. The children in Quarto and Compagnano di Roma were poorly nourished from birth in comparison with the children in the American communities. Rickets was prevalent.


1. The nutritional status of the population, especially the calcium intake, affects the prevalence and degree of mottling caused by the fluorine concentration in the water supply. The poorer the nutritional status and the lower the calcium intake, the more prevalent and more severe the mottling.

2. The degree of mottling in any given individual may be an indicator not only of the concentration of fluorine in the water ingested during the period of formation and calcification of the enamel but also of intercurrent systemic disturbances. When an individual or a population group shows mottling beyond the degree expected, the health and nutritional status of that group should be investigated.


The data from this and other investigations suggest that malnourished infants and children, especially if deficient in calcium intake, may suffer from the effects of water containing fluorine while healthy children would remain unaffected. . . . Thus low levels of fluoride ingestion which are generally considered to be safe for the general population may not be safe for malnourished infants and children. Therefore, the nutritional status must be carefully assessed and guarded in areas with endemic fluorosis. Nutritional studies should be included in any comprehensive program of fluoridation of water with special attention to chronically ailing infants and children.