Prevalence of bottled water usage by pediatric dental patients: implications for dental health

Drinking bottled water has become a popular substitute for tap water because of the concern over the contamination of municipal water supplies. The purpose of this study was to determine the percentage of pediatric dental patients drinking bottled water as their primary source of water. The fluoride content of these products was obtained from the distributors and the products were independently analyzed to ensure accuracy. Approximately 10 percent of 1,126 randomly selected patients from a private pediatric dental practice were routinely using bottled water from nine different sources. The fluoride content of these products varied from 0.04 ppm to 1.4 ppm. Independent analysis of the fluoride content of the different brands of bottled water using a microanalyzer with a fluoride-specific electrode indicated that the measured fluoride content was within +/- 0.1 ppm of the distributors' reported fluoride levels. The results of this study found that 16.9 percent of the pediatric patients were receiving less than the optimal level of fluoride and 72.4 percent were receiving greater than the recommended level of fluoride. Ten percent of the patients were being supplemented with additional fluoride tablets by their pediatrician, although the fluoride levels in the bottled water ranged from 0.9 to 1.4 ppm. In order for children to receive the optimal caries-preventive benefit from fluoride, the pediatric dentist needs to question the source of the patients' drinking water routinely. When bottled water is being used, the fluoride content should be obtained from the distributor or submitted for laboratory evaluation for fluoride content.