Guidelines for Canadian Drinking Water Quality: Guideline Technical Document – Fluoride

Table of Contents

• Part I. Overview and Application
  • 1.0 Guideline
  • 2.0 Executive summary
    • 2.1 Health effects
    • 2.2 Exposure
    • 2.3 Treatment
    • 2.4 Dental health benefits
  • 3.0 Application of the guideline
• Part II. Science and Technical Considerations
  • 4.0 Identity, use, sources and fate in the environment
  • 5.0 Exposure
    • 5.1 Water
    • 5.2 Food and beverages
    • 5.3 Dental products
    • 5.4 Soil
    • 5.5 Air
    • 5.6 Total daily intake
      • Table 1: Estimated daily intakes of fluoride
  • 6.0 Analytical methods
  • 7.0 Treatment technology
    • 7.1 Municipal scale
      • 7.1.1 Coagulation techniques
      • 7.1.2 Activated alumina
      • 7.1.3 Reverse osmosis and nanofiltration processes
      • 7.1.4 Lime softening
      • 7.1.5 Anion exchange
      • 7.1.6 Emerging treatment technologies
    • 7.2 Residential scale
  • 8.0 Kinetics and metabolism
    • 8.1 Absorption
    • 8.2 Distribution and metabolism
    • 8.3 Excretion
  • 9.0 Health effects
    • 9.1 Effects in humans
      • 9.1.1 Essentiality
      • 9.1.2 Acute effects
      • 9.1.3 Musculoskeletal effects
        • 9.1.3.1 Case reports
        • 9.1.3.2 Clinical studies
        • 9.1.3.3 Epidemiological studies - skeletal fluorosis
        • 9.1.3.4 Epidemiological studies - skeletal fractures
        • 9.1.3.5 Epidemiological studies - bone mineral density
      • 9.1.4 Cancer epidemiology
      • 9.1.5 Reproductive/developmental epidemiology
      • 9.1.6 Mutagenicity/genotoxicity
      • 9.1.7 Neurobehavioural effects
      • 9.1.8 Other health effects
    • 9.2 Effects on experimental animals and in vitro
      • 9.2.1 Acute toxicity
      • 9.2.2 Musculoskeletal effects
      • 9.2.3 Carcinogenicity
      • 9.2.4 Reproductive/developmental toxicity
      • 9.2.5 Mutagenicity/genotoxicity
      • 9.2.6 Neurotoxicity and neurobehavioural effects
      • 9.2.7 Other health effects
  • 10.0 Dental effects
    • 10.1 Dental fluorosis
      • Table 2: Fluorosis classification (Dean's Index)
    • 10.2 Effectiveness of water fluoridation
  • 11.0 Classification and assessment
    • 11.1 International considerations
  • 12.0 Rationale
  • 13.0 References
  • Appendix A: List of acronyms
  • Appendix B: Tables
    • Table B-1: Provincial/territorial estimates for community water fluoridation coverage
    • Table B-2: Estimated dietary intake of fluoride by children over 1 year of age and adults
    • Table B-3: Estimated dietary intake of fluoride by infants as a function of fluoride level
    • Table B-4: Estimated dietary intakes of infants living in the 1940s
    • Table B-5: Estimated dietary intakes of children 1 year of age and older and adults living in the 1940s
    • Table B-6: Estimated dose of fluoride ingested from fluoridated dentifrice per day in children