An Investigation of Bottled Water Use and Caries in the Mixed Dentition


  • This research was supported in part by National Institute of Health grants R01-DE09551, R01-DE12101, P30-DE10126, M01-RR00059, and the Wright-Bush-Shreves Endowed Research Professorship.

Ms. Barbara Broffitt, N339 DSB, University of Iowa, Iowa City, IA 52242. Tel.: 319-335-7186; Fax: 319-335-7187; e-mail:


Objectives: Bottled water consumption in the United States has greatly increased in the past decade. Because the majority of commercial bottled water is low in fluoride, there is the potential for an increase in dental caries. In these secondary data analyses, associations between bottled water use and dental caries were explored.

Methods: Subjects (n=413) are in the Iowa Fluoride Study, which included dental examinations of the primary (approximately aged 5) and early erupting permanent (approximately aged 9) dentitions by trained dentist examiners. Permanent tooth caries and primary second molar increments were related to bottled water use using logistic and negative binomial regression models. All models were adjusted for age and the frequency of toothbrushing.

Results: Bottled water use in this cohort was fairly limited (~10 percent). While bottled water users had significantly lower fluoride intakes, especially fluoride from water, there were no significant differences found in either permanent tooth caries (P=0.20 and 0.91 for prevalence and D2+FS, respectively) or primary second molar caries (P=0.94 and 0.74 for incidence and d2+fs increment, respectively). Results for smooth surfaces differed somewhat from those for pit and fissure surfaces, but neither showed significant differences related to bottled water use.

Conclusion: While bottled water users had significantly lower fluoride intakes, this study found no conclusive evidence of an association with increased caries. Further study is warranted, preferably using studies designed specifically to address this research question.