Overview

Fluoride intake has both beneficial effects – in reducing the incidence of dental caries – and
negative effects – in causing tooth enamel and skeletal fluorosis following prolonged exposure to
high concentrations. The intake ranges that produce these opposing effects are not far apart.
Public health actions are needed to provide sufficient fluoride intake in areas where this is
lacking, so as to minimize tooth decay. This can be done through drinking-water fluoridation or,
when this is not possible, through salt or milk fluoridation or use of dental care products
containing fluoride. Excessive fluoride intake usually occurs through the consumption of
groundwater naturally rich in fluoride, particularly in warm climates where water consumption is
greater, or where high-fluoride water is used in food preparation or irrigation of crops such as
rice. In these areas, means should be sought to manage intakes by providing drinking-water with
a moderate (i.e. safe) fluoride level or using alternative sources of water for drinking or cooking
or irrigation. Although removal of excessive fluoride from drinking-water may be difficult and
expensive, low-cost solutions that can be applied at a local level do exist. The preparation of
food using fluoride-rich coal also contributes to excess fluoride intake via ingestion and
inhalation.