A number of researchers have pointed out both the importance of evaluating individual fluoride intake from all sources and the difficulties associated with doing so, given the variability of fluoride content in various foods and beverages and the variability of individual intakes of the specific items (Clovis and Hargreaves 1988; Nowak and Nowak 1989; Chan et al. 1990; Stannard et al. 1990, 1991; Weinberger 1991; Toumba et al. 1994; Duperon et al. 1995; Van Winkle et al. 1995; Chan and Koh 1996; Kiritsy et al. 1996; Warren et al. 1996; Heilman et al. 1997, 1999; Heller et al. 1999; Levy and Guha-Chowdhury 1999; Lalumandier and Ayers 2000). However, as shown in Figure 2-1, for typical individuals, the single most important contributor to fluoride exposures (approaching 50% or more) is fluoridated water and other beverages and foods prepared or manufactured with fluoridated water.
Fluoride should be included in nationwide biomonitoring surveys and nutritional studies (e.g., CDC’s National Health and Nutrition Examination Survey and affiliated studies). In particular, analysis of fluoride in blood and urine samples taken in these surveys would be valuable.
National data on fluoridation (e.g., CDC 1993) should be updated on a regular basis.
Probabilistic analysis should be performed for the uncertainty in estimates of individual and group exposures and for population distributions of exposure (e.g., variability with respect to long-term water consumption). This would permit estimation of the number of people exposed at various concentrations, identification of population subgroups at unusual risk for high exposures, identification or confirmation of those fluoride sources with the greatest impact on individual or population exposures, and identification or characterization of fluoride sources that are significant contributors to total exposure for certain population subgroups.
To assist in estimating individual fluoride exposure from ingestion, manufacturers and producers should provide information on the fluoride content of commercial foods and beverages.
To permit better characterization of current exposures from airborne fluorides, ambient concentrations of airborne hydrogen fluoride and particulates should be reported on national and regional scales, especially for areas of known air pollution or known sources of airborne fluorides. Additional information on fluoride concentrations in soils in residential and recreational areas near industrial fluoride sources also should be obtained.
Additional studies on the relationship between individual fluoride exposures and measurements of fluoride in tissues (especially bone and nails) and bodily fluids (especially serum and urine) should be conducted. Such