317 children born and raised in two rural areas of Machakos District in Kenya were examined for enamel changes. All sources of drinking water were monitored for F–– over a period of 1 year. The children were grouped according to mean annual F–– concentrations in the drinking water: in area Al (0.10–0.46 mg/l) 78.0% of the children exhibited enamel changes as compared to 91.2% in area A2 (0.53–0.66 mg/l) and 93.8% in area B (0.54–0.93 mg/l). The prevalence and severity of enamel changes of each tooth type increased from the lowest to the highest F–– area. The bilateral symmetry of enamel changes was marked, indicating a systemic origin, and the intraoral distribution of severity scores corresponded to the pattern of fluoride-induced enamel changes reported by other investigators. The prevalence and severity of enamel changes, taking into account the low levels of F–– in drinking water, was surprisingly high.

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