**6. Dietary practices of the children and fluorosis**

The hydrogeochemical characteristics of the groundwater in the study area indicated that the volcanic and plutonic rocks are the primary sources of fluoride whoever, the food could be the secondary sources.

Fluoride intake during infancy and early childhood is mirrored in dental fluorosis patterns. In most cases, the fluoride content of drinking water is considered sufficient for determining the level of fluoride exposure in a given area. There has been evidence that fluoride uptake from other sources such as food, dust, and beverages is many times higher than that from water [21]**.**

The percentage of children with fluorosis was found to be extremely high. Although high fluoride levels in drinking water may be to blame, various food habits (such as drinking black tea and chewing Gatof Catha edulis Forsk leaves (Khat)) indicated a high fluoride contribution to the diet. Some of the children used to chew Khat also, and the Khat is cultivated in the volcanic soil and irrigated by the high fluoride concentration water [22].

Cooking with fluoridated water raises fluoride levels significantly, particularly in dry foods such as maize flour, which absorbs a lot of water during cooking. It has been reported that the simultaneous intake of food and fluoride-containing compounds can affect fluoride availability in a positive or negative way, depending on the food type, mode of administration, and type of fluoride compound [21]**.**

The diet consumed by the children was not balanced and lacked quality. It is composed of maize flour with milk and a few rare vegetables. Intake of milk and milk products is said to diminish the fluoride availability by 20–50% in humans. Although the area under study had children taking whole milk (boiled or fermented).
