Knowledge, attitudes, behaviors, and consequences of geogenic fluoride exposure on oral and dental health in Nakuru, Kenya

Background: Although efforts to improve household water security have significantly advanced progress toward Sustainable Development Goal (SDG) 6, environmental hazards, such as geogenic fluoride contamination, continue to threaten the lives of billions of people who rely on unimproved water sources. While awareness of the harmful effects of high fluoride levels in drinking water exists, research on knowledge, attitudes, and behaviors related to fluoride and fluorosis remains limited, particularly among households in areas with naturally elevated fluoride levels. Methods: We therefore examined knowledge, attitudes, and behaviors related to fluoride in drinking water among families living in Nakuru County, Kenya, where geogenic fluoride occurs naturally. We conducted semi-structured surveys with 52 individuals living in Nakuru County, Kenya, where water samples exceeded the WHO acceptable levels for drinking water. Results: Most participants (81%) demonstrated a good understanding of fluoride and fluorosis, including their presence in water and their effects on health, such as dental and skeletal fluorosis. However, despite this knowledge, some participants (67%) exhibited negative attitudes, showing little to no concern. While some participants (35%) reported correct practices, such as using alternative sources, a majority (65%) engaged in incorrect practices, such as boiling and chemically treating their water, or persistently brushing their teeth to remove dental fluorosis. Conclusion: Environmental hazards, such as fluoride, continue to challenge water security and pose heightened health risks, including oral health risks. In resource-limited settings, implementing interventions to shift attitudes and behaviors will be necessary to effectively translate existing knowledge.