WATER FLUORIDATION IN SAN PEDRO, LAGUNA

CHAPTER 1
THE PROBLEM AND ITS SETTINGS

Introduction

Dental caries is one of the most widespread dental health issues all over the

world. It is characterized by softened enamel at the tooth surface. This is usually hidden

from sight and is located in between the fissures of the teeth. The affected area reaches

into the softer, sensitive part of the tooth underneath the enamel. Then the weakened

enamel will collapse forming a cavity. Later, the tooth is destroyed progressively. It is

more common in adults that caries also damage the roots of teeth if exposed by gum

recession.

Studies show that Philippines is one of the top countries affected by dental carries

with a 97.1% of six-year-old children suffering. More than four out of every five children

of this subgroup manifest symptoms of dentinogenic infection. In addition, 78.4% of

twelve-year-old children suffer from dental caries and 49.7% of the same age group

manifest symptoms of dentinogenic infections. Due to the increasing number of affected

communities, it is only appropriate to apply certain action. There are numerous

researches regarding prevention and treatment. One of these is Water Fluoridation.

Water Fluoridation is the addition of chemical grade fluoride to water network

system usually public ones. This process was first introduced by the Centers for Disease

Control and Prevention in the 1960’s. Since then, it was accepted by various health

sectors including the American Dental Association, American Academy of Pediatrics, US

Public Health Service, and World Health Organization. Preceding studies show that
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

communities using fluoridated water have fewer problems with dental carries than those

communities with unfluoridated water. It was reported by the CDC that fluoridation

ultimately reduces dental caries by about 25% in children and adults. Although there are

controversies about water fluoridation being the cause of dental fluorosis due to over

fluoridation, it is still recommended to use it but with a regulated amount.

The researchers will conduct a study pertaining to the levels of fluoride used in

different water network systems in San Pedro Laguna. It will be a contribution to those

health sectors in the Philippines to widen their grasp on Water Fluoridation in the

communities in San Pedro and further enhance this technology through increasing their

awareness.

Background of the Study

Water fluoridation is one of the greatest public health achievements of the 20th

century due to its low cost and effectiveness in dental health. Fluoridated water is still in

use for drinking in U.S because of its dental health benefits based from Division of Oral

Health (2018). For about 25% of the population, by fluoridated water, they have

prevented and reduced cavities in the length of 70 years.

Water fluoridation started through the curiosity of Dr. Frederick McKay, a dental

specialist. He studied about the brown stain in the teeth of native people in Colorado.

Together with Dr. D. V. Black, they found out that those affected by the stain were highly

resistant to tooth decay. Further studies were conducted and they discovered that it was

the concentration of fluoride that made them resistant.

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Cavity is one of the most common chronic diseases of childhood. Cavities can be

prevented by consuming fluoridated water. Usually, the prevention of dental caries comes

with products that are expensive so the most cost-effective way to provide fluoride in the

community is through water fluoridation. This shows how important it is to conduct

fluoridation in public water supplies.

In the Philippines, particularly in San Pedro, Laguna, there are different water

suppliers that are needed to be tested for fluoridation. These sources include the three

major water system namely La Beda, Calendola Water Station, and Prime Water

(formerly known as San Pedro Water District). Consumers are not aware how

fluoridation affects their teeth, whether it brings harmful or beneficial consequences.

Most people of San Pedro do not know the optimal amount of fluoride that must

considered for public use. According to Spencer AJ (2016), the best concentration of

fluoride must be 0.7 mg/l.

Fluoride might be present in natural sources such as water pumps, wells and other

freshwater sources. It is caused by the presence of fluoride in soil and rocks in the form

of fluorine. But the concentrations have a little possibility of preventing tooth decay. So

the private wells add little more amount of fluoride in water. But the add-on may be

harmful if too much, for it can cause white uneven spots in teeth or it also called

fluorosis. To get aware of this problem, authorities must focus on it.

The researchers aim to know the amount of fluoride that water suppliers deliver in

public due to water fluoridation. By the help of the authorities, the researchers will

measure the amount of fluoride used by public water suppliers in San Pedro, Laguna.
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Rationale

The safety and benefits of fluoride have been proven by many research studies.

Fluoride in water helps the community people to prevent tooth decay and to protect

people from cavities. Water fluoridation is important to be implemented in a community

to reduce the risk of having dental problems, but having too much fluoride in water might

also lead to dental fluorosis. The researchers want to know if the San Pedro Water

System provides the community a right amount of fluoride in the community’s public

water.

Theoretical Framework

Chemo-Parasitic Theory. In 1890 Willoughby D. Miller formulated the chemo-

parasitic theory of caries. This theory states that caries is caused by acids that are

produced by oral bacteria after the fermentation of sugars. This particular work of Miller

at the University of Berlin is considered to be the most profound essence in the

comprehension of the etiology of dental caries and future researches.

Colorado Brown Stain. Frederick McKay discovered in 1901, while working as

an associate dentist in Colorado, that most patients had darkened and mottled teeth, now

considered as dental fluorosis. He then found out that the people suffering from such

condition were highly resistant to tooth decays. Later on, he found out that the group of

patients with this condition shared the same water source with high amounts of fluoride

and from then raised inquiries and studies regarding the effectivity of Fluoridation in

fighting dental caries.

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Skeletal Fluorosis. Yang Chen, Wang Yan, and Xu Hui (2017) stated that

Fluoride is soluble in water. It can accumulate in the bones when there is too much

absorption by the organism. Intake off excessive Fluoride can deteriorate the normal

processes of bone resorption and formation. This effect then may lead to bone turnover

disorders leading to skeletal fluorosis, a bone condition in which there is apparent lesions

including osteoporosis, osteosclerosis and degenerative joint changes. There can be a

substantial damage due to this condition. Patients can experience symptoms of fatigue,

loss of appetite and poor memory during the early stages. Over time, as the illness

continue to worsen and progress, accumulated fluoride in the bone may lead to dental

fluorosis as well as damage other organs including angiocarpy, endocrine organs, and the

nervous system. The incidence of skeletal fluorosis has increased worldwide in recent

years.

Conceptual Framework

Input Throughput Output

 Water Samples taken  Ion  ISE Test

from the three Water Selective Results
Supply Networks in San Electrode  Evaluation
Pedro Laguna (ISE) Test of Fluoride
 International Fluoride
Levels
Set Standard Limits and
Optimal Level

Figure 2 Conceptual Framework

Figure 1 shows the relationship between the input and the output of the study. The

input in the study includes the three water samples taken from the water network in San

Pedro Laguna and the International Fluoride Set Standard Limits that will be used as
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

basis for comparison. The throughput consists of the Ion Selective Electrode (ISE) test

while the output shows the results of the tests which will then be interpreted to develop

the evaluation of fluoride levels of each source.

Statement of the Problem

The addition of industrial-grade fluoride to public water system has been

considered an effective way to prevent and reduce cavities. Though it is accepted to be

beneficial to oral health, there is a recommended amount of fluoride to ensure efficacy

and avoid risks in public health. This study aims to evaluate the fluoride levels of

different water sources in San Pedro Laguna, whether or not the sources follow the

recommended fluoride levels and assess the health risks involved.

Specifically, this study will answer the following research questions:

General Problem:

 Do the three water suppliers of the water network system in San Pedro Laguna

follow the International and Regional Fluoride Set Standard Limit and Optimal

Level in preventing cavities?

Specific Problems:

 How much fluoride content does each water source include in their supply?

 Are there significant differences between the means of the sample from each
supplier and the control group?

 Which water source has the highest fluoride content?

 Which water source has the lowest fluoride content?

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Assumptions

1. The three water suppliers of the water network system in San Pedro do not follow

the International and Regional Fluoride Set Standard Limit and Optimal Level in

preventing cavities.

2. The levels of fluoride in the water samples have significant differences with that

of the control group following the set standards.

Significance of the Study

This study aims to increase the awareness and knowledge of the citizens of San

Pedro Laguna about the levels of fluoride which is known to prevent dental caries. The

levels depend on the different water fluoridation process in San Pedro public water

supply system.

Furthermore, the study could be of importance to the following:

Water Supply Networks. This study will benefit the Water Supply Networks in San

Pedro Laguna in increasing the knowledge about the right amount of fluoride in the water

systems. It could also help the water supply networks in maintaining the right amount of

fluoride in the water systems and ensure effectivity to prevent dental fluorosis.

Community. This study will benefit the community people to become aware of the water

they consume. It could also help the community by giving them information about the

water fluoridation in some parts of San Pedro Laguna.

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Public Health Workers. This study will benefit the public health workers in gaining

information about the water fluoridation in San Pedro Laguna.

Government. This study will contribute to the knowledge of the government health

sectors about the water fluoridation in San Pedro Laguna.

Future Researchers. Future researchers will have a basis on their studies about the water

fluoridation in San Pedro Laguna. This study can also serve as a guide whenever they

want to pursue or conduct a study regarding water fluoridation.

Scope and Delimitation

The general intent of this study is to determine if the major water supply network

in San Pedro Laguna is accurately fluoridated and follows the standard amount of

fluoride to prevent dental caries. It will also identify which source has the highest and

lowest levels of fluoride.

The study will focus on the three water sources in San Pedro namely Labeda,

Prime Water San Pedro and Calendola Water Station. The researchers will determine the

fluoride content of each source using the ISE test to be conducted by Mach Union Water

Laboratory. The results will then be interpreted based on the regulated level by the

various international health institutions.

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Definition of Terms

The following are terms that the researchers used throughout the study:

Dental Caries

—This is a scientific term for tooth decay or cavities. It is caused by specific types of

bacteria. They produce acid that destroys the tooth's enamel and the layer under it.

(conceptual)

—This is the problem of the research. It is the subject that is affected by water

fluoridation. (operational)

Dental Fluorosis

—The addition of fluoride to public water supplies and aims reduce the incidence of

tooth decay. (conceptual)

—This is the focus of the study. Fluoridation in public sources will be measured

through fluoride concentrations and standards. (operational)

Electroanalytical Sensor

—ISE is a transducer that converts the activity of a specific ion dissolved in a

solution into an electrical potential. (conceptual)

—This is the main feature of ISE instrument needed to produce accurate results of

the fluordide levels. (operational)

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Fluoridated Water

—It is a water containing the right amount of fluoride to prevent dental cavities.

(conceptual)

— This is what the researchers are trying to evaluate, whether or not the sources

are properly fluoridated and thus considered fluoridated water.

Fluoridation

—The addition of fluoride to public water supplies and aims reduce the incidence

of tooth decay. (conceptual)

—This is the focus of the study. Fluoridation in public sources will be measured

through fluoride concentrations and standards. (operational)

Ion Selective Electrode (ISE) Test

—ISE is a transducer that converts the activity of a specific ion dissolved in a

solution into an electrical potential. (operational)

—This is the instrument used in the study to identify fluoride levels. ISE test will

be conducted by Mach Union Water Laboratory.

Optimal Level

—It is the best level or state that something could achieve. (conceptual)

—It pertains to the fluoride levels needed to achieve the state of efficacy.

(operational)

San Pedronians

—These are citizens living in San Pedro Laguna. (conceptual)

—These are citizens of San Pedro Laguna who will be the major beneficiaries of

this study. (operational)

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Standard Level

—This is a level of quality that is considered acceptable or desirable. (conceptual)

—International and regional fluoride levels are used by the researchers to

compare data. (operational)

Water Supply Network (Major)

—It is a system of engineered hydrologic and hydraulic components which

provide water supply. (conceptual)

—It pertains to the three major water suppliers of San Pedro Laguna namely

Labeda, Prime Water San Pedro and Calendola Water Station where samples of

water will be taken from. (operational)

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

CHAPTER 2
REVIEW OF RELATED LITERATURE AND STUDIES

This chapter includes the concepts and ideas from different literature and studies

both foreign and local needed to clearly define the topic and provide support to the

study’s objective.

Related Literature

Foreign

Health organizations around the world have always been supportive of water

fluoridation. It has long been practiced for almost 70 years. An article Community Water

Fluoridation by the Centers for Disease Control and Prevention, Division of Oral

Health (2018), states that drinking fluoridated water helps in maintaining strong teeth

and effective in reducing cavities in children and adults by about 25%. It is recommended

by almost all public health, dental and medical organizations including the American

Academy of Pediatrics, American Dental Association, US Public Health Service, and

World Health Organization. Considering its contribution to the United States in terms of

the large decline in cavities since the 1960s, CDC declared that community water

fluoridation is one of the 10 great public health achievements of the 20th century. This

article serves as basis that water fluoridation is necessary. Although supported by facts,

some communities still lack knowledge and convincing to further practice fluoridation.
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

The Calgary city council has voted 10-3 to stop adding fluoride to public drinking

water. According to an interview conducted by Brandy Paynes (2016), Ward 6

Councilor Richard Pootmans stated that despite his colleagues’ majority decision of

removing fluoride from Calgary’s water network system, he is “up for the fight” to

pursue countering the action due to the strong evidence provided by Dental Health

Sectors that fluoridation is essential and necessary. In an article from the same source, the

other counsels reasoned that there was insufficient medical proof to attest that keeping it

would have any benefit. One of those in favor of removing it was Ward

7 Coun. Druh Farrell, who argued that it would be a better idea to help those families

who couldn't meet the expenses of fluoridated toothpaste instead of giving it to the entire

population. Furthermore, a journal in Community Dentistry and Oral Epidemiology

conducted a study comparing Grade 2 students in Calgary and Edmonton, which still

practice fluoridation to its drinking water. It showed that tooth decay in children in

Calgary has worsened since the city stopped adding fluoride to drinking water in 2011.

(CBC News, 2016)

Moreover, residents and politicians of New Jersey have a long history of resisting

such programs on fluoridation leaving the state to be among those who have the lowest

water fluoridation rates in the United States (Lauren Steussy, 2018). Only 14 percent of

the population receives fluoridated water instead of the national average of 72 percent of

individuals. According to Dr. Howard Pollick, director of the Dental Public Health

residency program at the School of Dentistry at the University of California San

Francisco, the lower rates projects that New Jersey residents are at much greater extent to
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

have a big disadvantage. According to him, without fluoride, the public would suffer

from an increasing incidence of tooth decay that will later result to banning sugar from

our diets.

On the other hand, to determine the concentration of fluoride in drinking water,

the researchers also focuses on the use of Ion Selective Electrode (ISE) test. According to

J. Koryta, An ion-selective electrode (ISE) is an electroanalytical sensor with a

membrane with a potential to indicate the activity of the ion to be determined. The

membranes of ISEs consist either of liquid electrolyte solutions or of solid or glassy

electrolytes that usually have negligible electron conductivity under the conditions of

measurement. ISE is used because of number of reasons. First, it does not affect the test

solution. Secondly, they are portable. They are suitable both for direct determinations

and as sensors for titrations and lastly, they are not expensive.

Local

Through carefully regulated amounts, fluoridation can be the best way of treating

dental caries, especially in third-world countries including the Philippines which has

increasing number of tooth decay among children and adults. An article by Suerte (2013)

suggests that there is a widespread occurrence of untreated dental caries in the

Philippines, therefore, it is deemed necessary that health sectors intervene. According to

the Philippine Dental Association (PDA), 78% of children under the age of 12 and 97%

of children aged six and below have different forms of tooth decay. This reveals that the

prevention of tooth decay and basic oral care must be given priority in various integrated
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

health promotion and feeding programs to enhance the welfare of Filipinos. This study

will be a tool to provide such programs.

Moreover, according to Ronda (2008), tooth decay and other dental health

problems have remained the number one health plague of millions of students in public

schools in the country. Fluorosis is one of them. It is defined as the mottling of the teeth

caused by too much fluorine or its compounds, which is the main concern of this

research, whether the amount of fluorine in each water supply tanks follows the standard

level to prevent tooth decay or not which in turn may harm teeth by means of fluorosis.

Related Studies

Foreign

According to a study Caution Needed in Altering the 'Optimum' Fluoride

Concentration in Drinking Water by A. John Spencer (2016), it is recommended that the

optimal concentration of fluoride is 0.7 mg/l based on their argument stating that this

concentration offers the best balance of protection from cavities while limiting the risk of

dental fluorosis. The researchers will be using this value of concentration to compare the

test results of different sources.

Moreover, based on the study of Hausen (2007), in a fluoride level of 1 ppm of

water fluoridation (12.5%), the count of children with caries decreased, but dental

fluorosis was found a problem. It means that there is a high possibility of fluorosis if
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

water fluoridation is conducted with this amount. This study was related with 214 other

researches which also refer to the same objectives to determine the optimum amount of

fluoride needed in the fluoridation of water.

Despite these values as basis for water fluoridation, researchers are still somehow

limited to assessing water quality due to the high cost of equipments and sophisticated

research-related sensors and tools. A paper entitled “Open Source Colorimeter” provided

a methodology for applying the FOSS technique in software development to design a

powerful and effective open-source colorimeter. It is a methodology which enables to

eliminate the cost of such equipment as a barrier to the researcher’s progress and makes

the tool available to the broadest audience possible. The paper also had successfully

demonstrated an open-source 3-D printable solution for colorimetric determination of

COD and the said design is made freely available for reuse, derivation and modification

(Joshua Pearce, 2013).

On the other hand, due of the evidence of dental fluorosis, a downside of

fluoridation, researchers aim to determine why it happens with respect to different

amounts of application of fluoride as well how the community perceive it. According to

Cléa Adas Saliba Garbin, Lívia Bino Marques, Suzely Adas Saliba Moimaz, Nemre

Adas Saliba and Orlando Saliba (2015) in their study Dental fluorosis and its influence

on children’s life, the benefits of the reduction of caries are far greater than the risks of

fluorosis. This is why water fluoridation is widely accepted. The majority of the

participants in their study did not observe spots due to fluorosis signifying that their

quality of life was not affected by this occurrence. The researchers claimed that the spots
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

only demonstrated a “very mild” fluorosis and although represent an abnormality, are not

considered a public health problem. In addition, the researchers have pointed out that

there is also a possibility that the rate or levels of dental fluorosis is sometimes only self-

perceived by children. The researchers recommended that “subjective” or “self-

perception” oral health indicators should be considered only with objective indicators in

order to determine how the patients’ quality of life is affected by various oral health

problems while considering that the standard perception of the community can

miscalculate this factor.

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

CHAPTER 3

Research Methodology

This chapter describes and discusses how the researchers gathered the necessary

data and information that has been used in the entire study. This also shows

the type of research design, instrumentations and the research locale where the study

conducted.

Research Design

This study was conducted using the experimental research design in which the

researchers aim to investigate the current status of the fluoridation of the water network

system in San Pedro Laguna. Three water sources were analyzed and compared using the

three-group research design to assess if fluoridation meets its standards wherein the

International Fluoride Set Standard Limits and Optimal Level were the control group.

Sampling Technique

The researchers used the universal sampling technique since there are only three

total populations of the major water suppliers which compose the water network system

in San Pedro Laguna. This population can therefore serve as the sample size. Moreover,

the researchers also determined the number of households covered by each of the water

suppliers to quantify and describe the extent of the possible effects of the status of the

levels of fluoride in various parts of San Pedro Laguna.

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Research Instruments

35000

30000

25000

20000

15000

10000

5000

0
Prime Water San Pedro La Beda Water Calendola Water Station

Figure 3

Number of Households Covered by the San Pedro Water Network System

Figure 3 shows the approximate number of households covered by the San Pedro

Water Network System. The researchers were only given approximates by the water

network personnel because the said data were considered confidential and cannot be

disclosed with student researchers. Prime Water San Pedro supplies approximately

30,000 households, La Beda covers about 15,000 households while Calendola Water

Station provides water to 650 households in San Pedro. This helped the researchers plot

the extent of which households were affected by the results of the tests.
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Table 1 International Fluoride Set Standard Limits and Optimal Level

Fluoride (mg/L) References

U.S. EPA 2.0 and 4.0 U.S. EPA, 2014

EC/DWD 1.5 EC (1998)

WHO 1.5 WHO (2011)

HHS 0.7 CDC (2013)

GCC 0.6-1.7 Rizk (2009)

Table 1 shows the International and Regional Fluoride Set Standard Limits and

Optimal Level. The table presents the different fluoride standards of various health

organizations worldwide. These were used as references to compare the results of the ISE

test of fluoride levels and proceed with the evaluation.

Table 2 Ion Selective Electrode Test Results

Water Sources Sample 1 Fluoride Sample 2 Fluoride Mean

(mg/L) (mean ± SD) (mg/L) (mean ± SD)

Prime Water

Labeda

Calendola
Water Station
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Table 2 shows the Ion Selective Electrode (ISE) result chart presenting the

different variables under study, each of which has two replicates. The mean was

computed for each water source and compared to the International and Regional Fluoride

Set Standard Limits and Optimal Level.

Data Collection Procedure

Acquisition of
water samples

Calendola Water La Beda

Station Prime Water

DOST International Limits

Ion Selective
Colorimetry Test and Optimal Level
Electrode
Results
(ISE)

Evaluation of Water
Fluoridation Status

Figure 3 Data Collection Procedure

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Figure 3 shows the data collection procedure. First, the researchers acquired 500

ml of water samples from each of the three sources; Prime Water, La Beda and Calendola

Water Station. These samples were replicated and tested using the Ion Selective

Electrode (ISE) that was conducted by Mach Union Water Laboratory located at 335

Alabang–Zapote Road, Las Pinas, Metro Manila. To ensure proper collection and

treatment of the water samples, the researchers followed the guidelines provided in the

handbook National Field Manual for the Collection of Water-Quality Data by the US

Geological Survey. The testing fee amounted to Php 450 per sample and will total Php

2700 including the two replicates of each water sample. The test results were then

analyzed and compared with the International Fluoride Set Standard Limits. Lastly, after

the comparisons, the researchers evaluated the water fluoridation status in San Pedro

Laguna.

Statistical Treatment
Mean and standard deviations of fluoride levels for all samples were calculated.

One way ANOVA followed by Tukey’s test were performed to see the significant

differences among the means of the three different water sources.

Where:

One Way ANOVA is

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

And Tukey’s Test is

Ethical Considerations

This study took into consideration the different suppliers of the water network

system in San Pedro, Laguna. The researchers sought approval to collect sample from

each suppliers and provide the suppliers background about the study, what the study is

for and how it will benefit the residents of San Pedro through evaluating whether water

fluoridation follows the standards. The suppliers were also given the right to know the

results of the tests and the conclusion of the study. The water suppliers were given notice

about any issues regarding the results before the public and provided unbiased

comparison with their system’s data.

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Chapter 4

Presentation, Analysis and Interpretation of Data

Table 2 Ion Selective Electrode Test Result

Water Sources Sample 1 Sample 2 Mean Rank

Fluoride (mg/L) Fluoride (mg/L)

Prime Water San Pedro 0.20 0.14 0.17 3

Labeda 0.33 0.34 0.34 2

Calendola Water 0.39 0.37 0.38 1

Station

Table 2 shows the ISE test result. The fluoride levels of the samples of each

supplier have small differences with the lowest of 0.1 mg/L and the highest of 0.6 mg/L.

Prime Water San Pedro has the lowest amount of fluoride with a mean of 0.17 mg/L,

followed by Labeda with a mean of 0.335 mg/L while the supplier with the highest

amount of fluoride is Calendola Water Station with a mean of 0.38 mg/L. It can be

observed that fluoride levels of all water suppliers fall below 0.6 mg/L which is the

minimum amount in fluoridation within the International Fluoride Set Standard Limits.
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

2.5

1.5

0.5

0
Control Prime Water San Pedro Labeda Calendola Water Station

Figure 4 Fluoride Level Comparisons

Table 3 shows the comparison of fluoride levels from the control group. The

control group consists of the GCC standard of 0.6 - 1.7 mg/L and the U.S. EPA standard

of 2.0 - 4.0 mg/L. The differences of the means of the three sources from the control

group are significant enough to be considered deficient with the lowest difference of 1.32

mg/L and the highest difference of 1.53 mg/L. In the graph, all three of the water

suppliers fall below the standards declared by both international organizations. Water

supply from the whole network of the three suppliers is not fluoridated in significant

amounts and therefore is not considered effective in preventing tooth decays among

consumers.
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

35000

30000

25000

20000

15000

10000

5000

0
Prime Water San Pedro La Beda Water Calendola Water Station

Figure 3
Approximate Number of Households

Based on figure 3, all households covered by Prime Water San Pedro (30,000),

Labeda (15, 000) and Calendola Water Station (650) are not receiving properly

fluoridated water with fluoride levels ranging from 0.6 mg/L to 1.7 mg/L. An estimated

45, 600 total number of households covered by the water network system receive water

supplies with below the minimum amount of fluoride to prevent tooth decay. Considering

the large number of residents depending on the suppliers, the extent of the deficiency of

fluoride for fluoridation may result to more consumers with less protection from decays,

especially children.
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

One Way Anova

MST= ∑ (x – gm) ^2 = 3.67195 = 1.224

k -1 3
MSE= ∑ (x - x̅) ^2 = 0.04705 = 0.012
N–k 4
F= 1.224__
0.012
= 102 > 16.69 (FCRIT)

Differences between the means are significant, therefore a post hoc test (Tuckey’s

Test) is conducted.

Tukey’s Test

HSD = q √MSE = 9.173 √0.012 where 9.173 came from q table with dfw of 4
. nk 2 (horizontal) and k of 4 (vertical).
HSD = 0. 71
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

x̅1 = 0.335 x̅3 = 0.38

x̅4 = 1.85 x̅2 = 0.17

Table 3 Absolute Difference (Tukey’s Test)

x̅1 x̅2 x̅3 x̅4

x̅1

x̅2 0.045

x̅3 0.165 0.21

x̅4 0.515 1.47 1.68

The table shows the absolute difference between the means of the four groups.

Using the HSD result, which is 0.71, we can determine if the following differences did

scope the significance of their differences. There are only 3 differences reached the HSD

standard, all of those minuend/subtrahend, x̅4. That means that the three groups has

signi8ficant difference with the group control/standard.

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Chapter 5

Findings, Conclusions and Recommendations

Summary of Findings

Based on the test results of ISE for fluoride content, Prime Water San Pedro

contains 0.17 mg/L of fluoride in their supply, Labeda contains 0.34 mg/L while

Calendola Water Station include 0.38 mg/L of fluoride. These numbers do not fall within

the average water fluoridation standards with a limit of 1.7-2.0 mg/L to be considered as

preventive in tooth decays while also deterrent to dental fluorosis. All water suppliers

have significant differences from that of the control group according to the Tukey test

with an Honestly Significant Difference (HSD) of 0.71 mg/L.

Furthermore, the test result shows that Prime Water San Pedro contains the least

amount of fluoride while Calendola Water Station has the highest, though is still deficient

according to standards. In comparison with the control group regarding the HSD value of

0.71 mg/L, it can be observed that Prime Water has a 1.53 mg/L significant difference;

Labeda has 1.36 mg/L significant difference while Calendola Water Station has 1.32

mg/L significant difference. All of which differences are higher that the HSD value.
WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Conclusion

After the course of experimentation, the researchers formulated the following

conclusions.

1. All three water supply networks, Prime Water San Pedro, Labeda and Calendola

Water Network system, do not follow the International Fluoride Set Standard

Limit and Optimal Level required in water fluoridation. The water network

contains fluoride levels below minimum.

2. There are significant differences between the means of the sample from each

supplier and the control group. All sources have a difference of greater than 0.7

mg/L which is the significant value according to Tukey’s Test.

3. Prime Water San Pedro has a mean of 0.17 mg/L of fluoride; Labeda has 0.34

mg/L of fluoride while Calendola Water Station has a mean of 0.38 mg/L of

fluoride included in their supply.

4. The supplier with the highest level of fluoride is Calendola Water Sation while

the lowest value is contained by Prime Water San Pedro.

WATER FLUORIDATION IN SAN PEDRO, LAGUNA

Recommendation

After the findings and conclusions of the study, the researchers recommend the

following:

For future researchers:

1. Include more cities within the region other than San Pedro to widen the scope of

the results.

2. Provide more replicates for testing to come up with more accurate results.

3. Work on a health risk assessment of tooth decay among consumers to address

and connect the issue concerning the need of fluoridated water.

For the water suppliers:

1. Consider the benefit of water fluoridation which exceeds its detriment according

to research.

2. Observe fluoridation guidelines from trusted health organizations such as GCC

(1.7 mg/L) and U.S. EPA (2.0 mg/L).

3. Conduct a survey or further study pertaining the development of supplying water

having the standard level of fluoride in your area.