Journal of Investigative and Clinical Dentistry (2011), 2, 144–147

ORIGINAL ARTICLE
Community Dentistry and Oral Epidemiology

Fluoride content of commercially-available bottled water in

Bangkok, Thailand
Kittipong Dhanuthai & Malee Thangpisityotin
Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand

Keywords
Bangkok, bottled water, commercial, fluoride
content, Thailand.
Correspondence
Associate Professor Kittipong Dhanuthai,
Department of Oral Pathology, Faculty of
Dentistry, Chulalongkorn University, Henri
Dunant Road, Pathumwan, Bangkok 10330,
Thailand.
Tel: +66-2218-8798
Fax: +66-2218-8798
Email: fibroma123@yahoo.com
Received 28 July 2010; accepted 2 November
2010.
doi: 10.1111/j.2041-1626.2010.00045.x
Abstract
Aim: To determine the fluoride content of commercially-available bottled water
in Bangkok.
Methods: Thirty brands of bottled water (17 bottled plain water and 13 bottled
mineral water) were obtained from supermarkets in Bangkok. Two randomly-
selected samples of each brand were purchased 6 months apart. A 5-mL sample
was mixed with 5 mL of total ionic-strength adjusting buffer III. The fluoride
content of each sample was determined in triplicate by a fluoride ion-selective
electrode. Fluoride standards ranging in concentration from 0.01 to 1.00 ppm
were used to calibrate the measurements. Data were analyzed by Statistical
Package for the Social Sciences software, version 13.0.
Results: The fluoride content of bottled water in Bangkok ranged from 0.03 to
0.72 ppm, with a mean ± standard deviation of 0.17 ± 0.16 ppm. The mean
fluoride content of bottled mineral water was slightly higher than that of bot-
tled plain water, but the difference was not statistically significant.
Conclusions: Most commercially-available bottled water in Bangkok contains
negligible amounts of fluoride. This serves as baseline data for dentists pre-
scribing a fluoride supplement to make the utmost use of the fluoride caries
preventive effect, while avoiding adverse effects, such as dental fluorosis.

marketing campaigns that bottled water is cleaner and is

Introduction
In recent years, there has been a change in the water con-
sumption pattern, from the use of tap water to bottled
water in many parts of the world, including Thailand, as
seen by the dramatic increases in bottled-water consump-
tion.1 Some of the reasons behind this are that consum-
ers, especially in developing countries, fear that tap water
might not have high hygienic standards and might be
contaminated with chemicals used in water treatment,
such as chlorine. Tap water might have an unpleasant
smell and taste, similar to that of the pool water. How-
ever, people living in rural communities might change
their water consumption habit from the use of ground
water to bottled water because of fear of contamination
from sewage, hazardous waste, or naturally-occurring
minerals. In addition, consumers are bombarded with
part of a modern and healthy lifestyle.
Fluoride is an essential trace element for the healthy
development of bones and teeth. Because of its strong
electronegativity, fluoride has a tendency to be attracted
to positively-charged ions, such as calcium in bones and
teeth, and is deposited as calcium-fluorapatite crystals,
since fluorapatite is more stable than hydroxyl apatite.2,3
It is widely accepted that fluoride can exert an inhibitory
effect against tooth decay and promote the remineraliza-
tion of incipient caries.4 Water fluoridation has been
practiced for nearly six decades.5 As a consequence, there
has been a decline in the prevalence of caries in devel-
oped countries, especially in the USA. This decline in car-
ies prevalence is attributable to the widespread use of
water fluoridation and various forms of fluoride.5–7 How-
ever, information regarding the fluoride content on the

144 ª 2011 Blackwell Publishing Asia Pty Ltd

K. Dhanuthai and M. Thangpisityotin Fluoride content of bottled water

label of bottled water is either difficult to find or is inac- Table 1. Fluoride content of commercially-available bottled water in
curate. There have been several studies on the fluoride Bangkok
content of bottled water in many parts of the world,7–18 Mean fluoride concentration
but little is known about the fluoride content, especially (ppm)
in Bangkok, Thailand. The aim of the present study was
Average of
to determine the fluoride content of commercially-
the 1st and Labeled
available bottled water in Bangkok. 1st 2nd 2nd batches fluoride
Brand batch batch (mean ± SD) concentration

Materials and methods Plain water 0.16  0.16à 0.16 ± 0.183

Sun Night 0.10 0.17 0.14 ± 0.035 No
Thirty brands of drinking bottled water (17 bottled plain
Cooly 0.31 0.25 0.28 ± 0.029 No
water and 13 bottled mineral water) were obtained from Nestle 0.48 0.52 0.50 ± 0.021 No
supermarkets in Bangkok. Two randomly-selected samples Namthip 0.16 0.19 0.18 ± 0.014 No
from each brand were purchased 6 months apart. A 5-mL Sprinkle 0.05 0.03 0.04 ± 0.011 No
sample from each bottle was mixed with an equal volume Singha 0.68 0.72 0.70 ± 0.033 No
of total ionic-strength adjusting buffer III. The fluoride Crystal 0.05 0.04 0.04 ± 0.008 No
content of each sample was determined in triplicate by Jamjuree 0.15 0.19 0.17 ± 0.022 No
Le’cule 0.08 0.08 0.08 ± 0.002 No
a fluoride ion selective electrode (SL518; Select Systems,
Tesco 0.05 0.04 0.05 ± 0.007 No
Essex, UK). Fluoride standards ranging in concentration Thipsiam 0.04 0.04 0.04 ± 0.003 No
from 0.01 to 1.00 ppm were used to calibrate the Manobu 0.05 0.04 0.05 ± 0.004 No
measurement. Three measurements were carried out for BIO-C 0.15 0.16 0.16 ± 0.008 No
each sample, and the average of the three measurements Green 0.04 0.04 0.04 ± 0.005 No
was the average concentration of fluoride. All materials Home 0.07 0.07 0.07 ± 0.006 No
were rinsed with deionized water before use and after Jai 0.05 0.04 0.04 ± 0.008 No
Rainbow 0.16 0.15 0.15 ± 0.010 No
each use of the electrode to prevent contamination of the
Mineral water 0.19§ 0.20– 0.19 ± 0.126
samples. The final average concentration of fluoride was Minere 0.39 0.47 0.43 ± 0.047 Yes
calculated by averaging the concentration of fluoride of Fraiche 0.20 0.21 0.21 ± 0.014 Yes
the two batches of each brand of bottled drinking water. Aura 0.29 0.34 0.31 ± 0.026 Yes
Statistical analyses were performed using spss version Mont Fleur 0.40 0.41 0.41 ± 0.010 Yes
13.0 (Chicago, IL, USA). Data were analyzed by descrip- Evian 0.07 0.09 0.08 ± 0.008 No
tive statistics. Differences between study groups were Perrier 0.11 0.15 0.13 ± 0.021 No
Tesco 0.20 0.21 0.21 ± 0.010 Yes
determined by Student’s t-test. A P-value <0.05 was
Volvic 0.16 0.14 0.15 ± 0.010 No
considered statistically significant. Aquare 0.28 0.27 0.28 ± 0.008 Yes
Vittel 0.12 0.11 0.12 ± 0.005 No
San Benedetto 0.07 0.05 0.06 ± 0.010 No
Results
Aqua Penna 0.06 0.05 0.05 ± 0.008 Yes
Among the 30 brands of bottled water, 17 brands were Pi Water 0.08 0.06 0.07 ± 0.008 0.06
bottled plain water and 13 brands were bottled mineral  Average fluoride concentration of the plain water of the 1st batch.
water. The fluoride content in the 30 bottled water àAverage fluoride concentration of the plain water of the 2nd batch.
samples ranged from 0.03 to 0.72, with a mean fluoride §Average fluoride concentration of the mineral water of the 1st
concentration ± standard deviation of 0.17 ± 0.16. The batch.
Sigha brand contained the highest concentration of –Average fluoride concentration of the mineral water of the 2nd
fluoride among the 30 brands of bottled water tested batch.

(0.70 ppm). There was no significant difference in the

fluoride content between the two batches of the same
brand of bottled water. Most commercially-available bot-
tled water in Bangkok was found to have a negligible to
low concentration of fluoride: 13 brands (43.33%) had a
fluoride concentration <0.1 ppm, eight brands (26.67%)
had a fluoride concentration between 0.1 and 0.2 ppm,
four brands (13.33%) had a fluoride concentration
between 0.2 and 0.3 ppm, and only five brands
(16.67%) had a fluoride concentration above 0.3 ppm.
Mineral water had a higher fluoride concentration
than bottled plain water, but the difference was not
statistically significant (P = 0.586). Twenty-two brands
(73.33%) did not display the fluoride concentration on
the label, while seven brands (23.33%) listed fluoride as
one of the constituents of the bottled water, but did not
explicitly state how much fluoride the water actually
contained. Only one brand; Pi Water, explicitly

ª 2011 Blackwell Publishing Asia Pty Ltd 145

Fluoride content of bottled water
displayed the amount of fluoride the water contained
(0.06 ppm) (Table 1).
Discussion
In the present study, the fluoride content of commer-
cially-available bottled water in Bangkok varied substan-
tially from 0.03 to 0.72 ppm. This result is consistent
with those of previous studies.8–11 Most brands of bottled
water in Bangkok contained small amounts of fluoride.
Twenty-five brands (83.33%) had a fluoride content
<0.3 ppm, while only five brands (16.67%) had a fluoride
content above 0.3 ppm. When water is treated before it is
bottled, fluoride might be lost. Water purification
systems, such as reverse osmosis or distillation, might
remove substantial amounts of fluoride from bottled
water to the extent that a fluoride supplement might be
necessary.19 Although bottled mineral water contains a
higher fluoride concentration than the bottled plain
water, bottled mineral water is more expensive than
bottled plain water. When only fluoride is taken into
account, consumers can alternatively use tap water with
fluoridation to obtain an optimal level of fluoride at a
much lower cost.
With regard to the fluoride content on the label, seven
brands (23.33%) listed fluoride as one of their constitu-
ents, and only one brand (3.33%) explicitly displayed
the amount of fluoride on the label, which was close to
what was measured in the laboratory. Studies from the
USA,12,13 Australia,14 Britain,15,16 Greece,17 and Thai-
land18 showed that the majority of bottled water did not
display the fluoride concentration on the label. Surpris-
ingly, studies by Weinberger20 in Canada revealed that all
brands of commercially-available bottled water displayed
the fluoride concentration on the label. Although some
brands of bottled water displayed the fluoride concentra-
tion on the label, there were discrepancies between
the actual fluoride concentration and those listed on the
label. These discrepancies might be accounted for by the
fact that fluoride binds to glass bottles. For this reason,
the fluoride concentration of glass-bottled water might be
lower than the original fluoride concentration from the
manufacturer.20 In addition, multiple sites of production
for a single company and the seasonal fluctuation in fluo-
ride of the water sources might also contribute to this
discrepancy.14,21 The regulatory authorities should ensure
the accuracy of the information displayed on the bottled
water labels. The improved reliability of labeling will
increase consumer confidence and better enable clinicians
to estimate the total fluoride intake.22
The US Public Health Service established that the opti-
mal concentration of fluoride in water for the USA should
be in the range of 0.7–1.2 ppm, depending on the annual
146
K. Dhanuthai and M. Thangpisityotin
average maximum temperature of the area.23 This range
was based on the investigation by Dean et al. who found
that a fluoride concentration close to 1.0 ppm effectively
reduced dental caries, while minimizing the occurrence of
dental fluorosis.24,25 Similarly, Galagan et al.26 reported
varying levels of fluorosis in different temperature zones,
despite the same concentration of fluoride in water.
Akpata et al.27 recommended that the level of fluoride in
water for tropical countries should be in the range of
0.6–0.7 ppm. In addition, Warnakulasuriya et al.28 recom-
mended that the level of fluoride in the drinking water for
Sri Lanka be in the range of 0.6–0.8 ppm, since people in
tropical countries consume larger amounts of water than
their temperate counterparts.
Fluoride might be viewed as a double-edged sword. An
optimal amount of fluoride helps strengthen tooth struc-
tures and reduce the incidence of dental caries, as has
been documented in several studies; however, excessive
amounts of fluoride is detrimental to the body. Excessive
fluoride intake can have detrimental effects to not only
bones and teeth, but to soft tissues, such as the thyroid,
reproductive organs, brain, liver, and kidney.3 Dental
fluorosis from excessive fluoride intake is manifested as
opaque white, yellowish brown, or black stains to pitting
of the tooth surface in severe cases.2 It is therefore essen-
tial that both consumers and pedodontists/physicians
know the amount of fluoride in bottled water. Consumers
should be aware of the presence or absence of fluoride in
their drinking water, so that they know the amount of
fluoride they consume, and can make an informed
decision regarding the choice of their drinking water.14
Pedodontists and physicians prescribing a fluoride
supplement for children need to know how much total
fluoride children are getting. Although fluoride in drink-
ing water constitutes the principal source of fluoride, cli-
nicians prescribing a fluoride supplement should take
into account other fluoride sources, such as fluoride den-
tifrice, beverages, fluoridated flavored milk, and high
fluoride foods, when estimating the total fluoride intake
in order to ensure the utmost caries preventive effect,
while minimizing the risk of fluorosis.
In conclusion, most brands of bottled water in Bang-
kok contain a low concentration of fluoride, and there-
fore, do not pose a risk for dental fluorosis; drinking only
bottled water in Bangkok might not provide sufficient
fluoride to attain the caries preventive effect. Most bottled
water in Bangkok do not display the fluoride concentra-
tion on the label.
Acknowledgments
This study was supported by the research fund, Faculty of
Dentistry, Chulalongkorn University, Bangkok, Thailand.
ª 2011 Blackwell Publishing Asia Pty Ltd
K. Dhanuthai and M. Thangpisityotin
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