Distribution and Prevalence of Fluoride in Drinking Water Sources of Salem South Region: A Public Health Analysis
Abstract
Fluoride pollution in groundwater represents a major environmental issue and poses serious risks to public health, particularly in semi-arid regions with fluoride-bearing geological formations. This study comprehensively assessed fluoride levels in potable water across the southern region of Salem, Tamil Nadu, India, aiming to evaluate fluoride levels in drinking water and analyze the associated health impacts. A total of 200 water samples were gathered during both the pre- and post-monsoon periods from 39 villages across the south region of Salem district. Fluoride levels were measured using a high-fluoride checking device. Additionally, health surveys were conducted to assess the occurrence of dental fluorosis in affected groups. Results revealed that 42% of the sampled water sources exceeded the World Health Organization (WHO) recommended fluoride guideline of 1.5 mg/L, with concentrations varying between 0.8 and 15.2 mg/L. Notable hotspots of contamination were identified in Salem South, like Seeragadi, Veerapandi, Kondalampatti, and Aatayampatti regions, which are influenced by the existence of fluoride-rich minerals and high rates of evaporation during dry seasons. Health surveys showed that 68% of people in areas with high fluoride levels had dental fluorosis. This condition Children have been diagnosed with this condition, and 24% of adults report experiencing skeletal joint pain symptoms. in children, and 24% of adults have said they have symptoms of skeletal joint pain. The study points out the importance of sustainable interventions. At the same time, the public consuming Mettur water (issued by Salem Corporation) does not face this fluorosis issue; the fluoride level is low (0.3 PPM). Public awareness campaigns to mitigate Thirumanimuthar River pollution that affects the groundwater with fluoride exposure. Future research should focus on exploring advanced defluoridation technologies, pollution-free water, assessing the neurotoxic effects of fluoride and developing long-term solutions for safe drinking water.
Keywords:
Dental Fluorosis, Fluoride Contamination, Groundwater, Salem South Region
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References
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Hinton, R. G., Kalin, R. M., Banda, L. C., Kanjaye, M. B., Macleod, C. J., Troldborg, M., ... & Kamtukule, S. (2024). Mixed method analysis of anthropogenic groundwater contamination of drinking water sources in Malawi. Science of The Total Environment, 957, 177418.https://doi.org/10.1016/j.scitotenv.2024.177418
Jebaraj, B. S., Sushmitha, S., Vivekrabinson, K., & Arun Prathap, R. (2026). Groundwater quality appraisal and geospatial mapping in Tiruvallur district, Tamil Nadu, India: Insights from water quality index evaluation. Applied Water Science, 16, 79. https://doi.org/10.1007/s13201-026-02786-1
Jena, K. M., Patra, P. K., Behera, D., Goswami, S., & Jothimani, M. (2025). Geostatistical modelling of groundwater fluoride contamination in Western Odisha, India: insights for spatial prediction and risk management. Environmental Systems Research, 14, 24. https://doi.org/10.1186/s40068-025-00429-z
Medina-Solis, C. E., Pontigo-Loyola, A. P., Maupome, G., Lamadrid-Figueroa, H., Loyola-Rodríguez, J. P., Hernández-Romano, J., ... & Marquez-Corona, M. D. L. (2008). Dental fluorosis prevalence and severity using Dean’s index based on six teeth and on 28 teeth. Clinical Oral Investigations, 12(3), 197-202. https://doi.org/10.1007/s00784-007-0171-7
Moussa, H., & Abboud, M. (2024). The methodology of applying inverse distance weighting interpolation method in determining normal heights. Resourceedings, 4(1), 01-06.https://doi.org/10.21625/resourceedings.v4i1.1068
Nagaraj, S., & Masilamani, U. S. (2025). Simulation of fluoride transport in groundwater using visual MODFLOW flex and Human Health Risk Assessment. Applied Water Science, 15, 102. https://doi.org/10.1007/s13201-025-02454-w
Narsimha, A., & Sudarshan, V. J. A. W. S. (2017). Contamination of fluoride in groundwater and its effect on human health: A case study in hard rock aquifers of Siddipet, Telangana State, India. Applied Water Science, 7, 2501-2512. https://doi.org/10.1007/s13201-016-0441-0
Prasad, U. V., Vastrad, P., N, C., Barvaliya, M. J., Kirte, R., R, S., ... & Roy, S. (2023). A community-based study of dental fluorosis in rural children (6–12 years) from an aspirational district in Karnataka, India. Frontiers in Public Health, 11, 1110777. https://doi.org/10.3389/fpubh.2023.1110777
Reddy, D. V., Nagabhushanam, P., Sukhija, B. S., Reddy, A. G. S., & Smedley, P. L. (2010). Fluoride dynamics in the granitic aquifer of the Wailapally watershed, Nalgonda District, India. Chemical Geology, 269(3-4), 278-289. https://doi.org/10.1016/j.chemgeo.2009.10.003
Rehman, F., Ullah, Z., Azeem, T., Ahmad, S., Siddique, J., Riaz, O., ... & Rehman, F. (2026). Fluoride contamination and water quality fluctuations in Mianwali District Pakistan and its implications for human health and sustainable agriculture. Scientific Reports, 16(1), 9555. https://doi.org/10.1038/s41598-025-89321-5
Reshetnyak, V. Y., Nesterova, O. V., Admakin, O. I., Dobrokhotov, D. A., Avertseva, I. N., Dostdar, S. A., & Khakimova, D. F. (2019). Evaluation of free and total fluoride concentration in mouthwashes via measurement with ion-selective electrode. BMC Oral Health, 19, 251.https://doi.org/10.1186/s12903-019-0908-0
Rohde, M. M., Albano, C. M., Huggins, X., Klausmeyer, K. R., Morton, C., Sharman, A., ... & Stella, J. C. (2024). Groundwater-dependent ecosystem map exposes global dryland protection needs. Nature, 632(8023), 101-107. https://doi.org/10.1038/s41586-024-07702-8
Saxena, V., & Ahmed, S. (2001). Dissolution of fluoride in groundwater: a water-rock interaction study. Environmental Geology, 40(9), 1084-1087. https://doi.org/10.1007/s002540100290
Shaikh, M., & Birajdar, F. (2024). Groundwater and ecosystems: understanding the critical interplay for sustainability and conservation. EPRA International Journal of Multidisciplinary Research (IJMR),10, 198-210.https://doi.org/10.36713/epra16111
Shaji, E., Sarath, K. V., Santosh, M., Krishnaprasad, P. K., Arya, B. K., & Babu, M. S. (2024). Fluoride contamination in groundwater: A global review of the status, processes, challenges, and remedial measures. Geoscience Frontiers, 15(2), 101734. https://doi.org/10.1016/j.gsf.2023.101734
Singhal, R., Namdev, R., Kumar, A., Bhagol, A., & S, S. (2025). Correlation of fluoride intake with haemoglobin level and intelligence quotient in 8–12 year aged children: An observational study from India. BMC Public Health, 25(1), 788. https://doi.org/10.1186/s12889-025-21415-1
Speight, V. L., Kalsbeek, W. D., & DiGiano, F. A. (2004). Randomized stratified sampling methodology for water quality in distribution systems. Journal of Water Resources Planning and Management, 130(4), 330-338. https://doi.org/10.1061/(ASCE)0733-9496(2004)130:4(330)
Sulaiman, M.A., Divya, Zafar, M.M., Anjum, S., Kumari, A. (2023). Groundwater Contamination by Fluoride and Mitigation Measures for Sustainable Management of Groundwater in the Indo-Gangetic Plains of India. In: Ali, S., Armanuos, A.M. (eds) Groundwater in Arid and Semi-Arid Areas. Earth and Environmental Sciences Library. Springer, Cham. https://doi.org/10.1007/978-3-031-43348-1_12
World Health Organization (2011). Guidelines for Drinking-water Quality. 4th ed. Geneva: World Health Organization; 2011. 370–373 (Fluoride). Available at: https://www.liscr.com/getattachment/D6B3D46C-B1E2-4B09-A230-BE156212F35B/9789241548151_eng.pdf
Taylor, K., Rooney, A., & Bucher, J. (2020). Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects. Environmental Health Perspectives Supplements, 2020(1). https://doi.org/10.1289/isee.2020.virtual.o-sy-1323
Yang, L., Wang, Q., Meng, Z., Yan, F., Geng, X., & Wei, W. (2026). Optimal fluoride concentration in drinking water for balancing dental caries prevention and fluorosis control in Jinan, China. Scientific Reports, 16, 3661. https://doi.org/10.1038/s41598-025-33806-w
Ayoob, S., & Gupta, A. K. (2006). Fluoride in drinking water: a review on the status and stress effects. Critical Reviews in Environmental Science and Technology, 36(6), 433-487. https://doi.org/10.1080/10643380600678112
Balasubramaniyan, G., Murugesan, B., Swaminathan, B., Nandakumar, E., Kannan, P., Karuppannan, S., & Suresh, M. (2026). Fluoride contamination and its health implications in the groundwater using multivariate and geospatial analysis in Mettur Taluk, Tamil Nadu, India. Discover Environment, 4(1), 64.https://doi.org/10.1007/s44274-026-00563-0
Barbier, O., Arreola-Mendoza, L., & Del Razo, L. M. (2010). Molecular mechanisms of fluoride toxicity. Chemico-biological interactions, 188(2), 319-333. https://doi.10.1016/j.cbi.2010.07.011
Biswas, T., Pal, S. C., Saha, A., Ruidas, D., Pande, C. B., Islam, A. R. M. T., ... & Islam, M. K. (2025). Threats of arsenic and fluoride contamination in vulnerable Indo-Bangladesh coastal groundwater aquifers: issues, policy practice gap, and the way forward. Applied Water Science, 1, 166. https://doi.org/10.1007/s13201-025-02533-y
Choubisa, S. L. (2025). A brief review of fluoride exposure and its adverse health effects among tribal children in India. Journal of Clinical Medicine & Health Care, 2(2), 1-9. https://doi.org/10.61440/JCMHC.2025.v2.21
Das, K., Mondal, M., Mondal, N. K., Dey, U., Mukherjee, A., Aind, D. A., ... & Kumar, P. (2025). Integrated assessment of fluoride occurrence and groundwater usability: A critical concern for drinking water sustainability and irrigation in semi-arid region of West Bengal, India. Discover Sustainability, 6, 602.https://doi.org/10.1007/s43621-025-01498-x
de Sá, S. S., Tavella, R. A., Santos, J. E. K., Aick, C. D. M., de Oliveira Silveira, G., Machado, P. D. W., ... & da Silva Júnior, F. M. R. (2024). The Hidden Dangers in the Rain: Human Health Risk Assessment of Fluoride and Nitrate in Rainwater from a Medium-Sized Industrial City. Water Conservation Science and Engineering, 9, 51. https://doi.org/10.1007/s41101-024-00284-6
Fawell, J., Bailey, K., Chilton, J., Dahi, E., & Magara, Y. (2006). Fluoride in drinking-water. IWA publishing. https://iris.who.int/server/api/core/bitstreams/5c30b940-96c5-4467-ad45-dbe0b03b0dc5/content
Ghosh, S., & Jha, M. K. (2024). Evaluating trends in groundwater quality of coastal alluvial aquifers of Eastern India for sustainable groundwater management. Environmental Science and Pollution Research, 31(29), 42049-42074. https://doi.org/10.1007/s11356-024-33852-3
Grandjean, P., & Landrigan, P. J. (2014). Neurobehavioural effects of developmental toxicity. The Lancet Neurology, 13(3), 330-338. http://doi.org/10.1016/S1474-4422(13)70278-3
Hinton, R. G., Kalin, R. M., Banda, L. C., Kanjaye, M. B., Macleod, C. J., Troldborg, M., ... & Kamtukule, S. (2024). Mixed method analysis of anthropogenic groundwater contamination of drinking water sources in Malawi. Science of The Total Environment, 957, 177418.https://doi.org/10.1016/j.scitotenv.2024.177418
Jebaraj, B. S., Sushmitha, S., Vivekrabinson, K., & Arun Prathap, R. (2026). Groundwater quality appraisal and geospatial mapping in Tiruvallur district, Tamil Nadu, India: Insights from water quality index evaluation. Applied Water Science, 16, 79. https://doi.org/10.1007/s13201-026-02786-1
Jena, K. M., Patra, P. K., Behera, D., Goswami, S., & Jothimani, M. (2025). Geostatistical modelling of groundwater fluoride contamination in Western Odisha, India: insights for spatial prediction and risk management. Environmental Systems Research, 14, 24. https://doi.org/10.1186/s40068-025-00429-z
Medina-Solis, C. E., Pontigo-Loyola, A. P., Maupome, G., Lamadrid-Figueroa, H., Loyola-Rodríguez, J. P., Hernández-Romano, J., ... & Marquez-Corona, M. D. L. (2008). Dental fluorosis prevalence and severity using Dean’s index based on six teeth and on 28 teeth. Clinical Oral Investigations, 12(3), 197-202. https://doi.org/10.1007/s00784-007-0171-7
Moussa, H., & Abboud, M. (2024). The methodology of applying inverse distance weighting interpolation method in determining normal heights. Resourceedings, 4(1), 01-06.https://doi.org/10.21625/resourceedings.v4i1.1068
Nagaraj, S., & Masilamani, U. S. (2025). Simulation of fluoride transport in groundwater using visual MODFLOW flex and Human Health Risk Assessment. Applied Water Science, 15, 102. https://doi.org/10.1007/s13201-025-02454-w
Narsimha, A., & Sudarshan, V. J. A. W. S. (2017). Contamination of fluoride in groundwater and its effect on human health: A case study in hard rock aquifers of Siddipet, Telangana State, India. Applied Water Science, 7, 2501-2512. https://doi.org/10.1007/s13201-016-0441-0
Prasad, U. V., Vastrad, P., N, C., Barvaliya, M. J., Kirte, R., R, S., ... & Roy, S. (2023). A community-based study of dental fluorosis in rural children (6–12 years) from an aspirational district in Karnataka, India. Frontiers in Public Health, 11, 1110777. https://doi.org/10.3389/fpubh.2023.1110777
Reddy, D. V., Nagabhushanam, P., Sukhija, B. S., Reddy, A. G. S., & Smedley, P. L. (2010). Fluoride dynamics in the granitic aquifer of the Wailapally watershed, Nalgonda District, India. Chemical Geology, 269(3-4), 278-289. https://doi.org/10.1016/j.chemgeo.2009.10.003
Rehman, F., Ullah, Z., Azeem, T., Ahmad, S., Siddique, J., Riaz, O., ... & Rehman, F. (2026). Fluoride contamination and water quality fluctuations in Mianwali District Pakistan and its implications for human health and sustainable agriculture. Scientific Reports, 16(1), 9555. https://doi.org/10.1038/s41598-025-89321-5
Reshetnyak, V. Y., Nesterova, O. V., Admakin, O. I., Dobrokhotov, D. A., Avertseva, I. N., Dostdar, S. A., & Khakimova, D. F. (2019). Evaluation of free and total fluoride concentration in mouthwashes via measurement with ion-selective electrode. BMC Oral Health, 19, 251.https://doi.org/10.1186/s12903-019-0908-0
Rohde, M. M., Albano, C. M., Huggins, X., Klausmeyer, K. R., Morton, C., Sharman, A., ... & Stella, J. C. (2024). Groundwater-dependent ecosystem map exposes global dryland protection needs. Nature, 632(8023), 101-107. https://doi.org/10.1038/s41586-024-07702-8
Saxena, V., & Ahmed, S. (2001). Dissolution of fluoride in groundwater: a water-rock interaction study. Environmental Geology, 40(9), 1084-1087. https://doi.org/10.1007/s002540100290
Shaikh, M., & Birajdar, F. (2024). Groundwater and ecosystems: understanding the critical interplay for sustainability and conservation. EPRA International Journal of Multidisciplinary Research (IJMR),10, 198-210.https://doi.org/10.36713/epra16111
Shaji, E., Sarath, K. V., Santosh, M., Krishnaprasad, P. K., Arya, B. K., & Babu, M. S. (2024). Fluoride contamination in groundwater: A global review of the status, processes, challenges, and remedial measures. Geoscience Frontiers, 15(2), 101734. https://doi.org/10.1016/j.gsf.2023.101734
Singhal, R., Namdev, R., Kumar, A., Bhagol, A., & S, S. (2025). Correlation of fluoride intake with haemoglobin level and intelligence quotient in 8–12 year aged children: An observational study from India. BMC Public Health, 25(1), 788. https://doi.org/10.1186/s12889-025-21415-1
Speight, V. L., Kalsbeek, W. D., & DiGiano, F. A. (2004). Randomized stratified sampling methodology for water quality in distribution systems. Journal of Water Resources Planning and Management, 130(4), 330-338. https://doi.org/10.1061/(ASCE)0733-9496(2004)130:4(330)
Sulaiman, M.A., Divya, Zafar, M.M., Anjum, S., Kumari, A. (2023). Groundwater Contamination by Fluoride and Mitigation Measures for Sustainable Management of Groundwater in the Indo-Gangetic Plains of India. In: Ali, S., Armanuos, A.M. (eds) Groundwater in Arid and Semi-Arid Areas. Earth and Environmental Sciences Library. Springer, Cham. https://doi.org/10.1007/978-3-031-43348-1_12
World Health Organization (2011). Guidelines for Drinking-water Quality. 4th ed. Geneva: World Health Organization; 2011. 370–373 (Fluoride). Available at: https://www.liscr.com/getattachment/D6B3D46C-B1E2-4B09-A230-BE156212F35B/9789241548151_eng.pdf
Taylor, K., Rooney, A., & Bucher, J. (2020). Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects. Environmental Health Perspectives Supplements, 2020(1). https://doi.org/10.1289/isee.2020.virtual.o-sy-1323
Yang, L., Wang, Q., Meng, Z., Yan, F., Geng, X., & Wei, W. (2026). Optimal fluoride concentration in drinking water for balancing dental caries prevention and fluorosis control in Jinan, China. Scientific Reports, 16, 3661. https://doi.org/10.1038/s41598-025-33806-w
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Babu, S., Muththamizh, A., Gurusamy, R., Muthusamy, R. and Kalaimamani, E. (2026) “Distribution and Prevalence of Fluoride in Drinking Water Sources of Salem South Region: A Public Health Analysis”, International Journal of Advancement in Life Sciences Research, 9(3), pp. 136-150. doi: https://doi.org/10.31632/ijalsr.2026.v09i03.011.
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