Inadequate or excess fluoride: a major public health concern

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.