Fluoride Contamination in Drinking Water and Its Pathological Impacts On Human Dental and Skeletal Systems: A Systematic Review

References

[1] Akuno MH, Nocella G, Milia EP, Gutierrez L (2019). Factors influencing the relationship between fluoride in drinking water and dental fluorosis: A ten-year systematic review and meta-analysis. Journal of Water and Health, 17(6), 845–862. https://doi.org/10.2166/wh.2019.300

[2] Ali S, Fakhri Y, Golbini M, Thakur SK, Alinejad A, Parseh I, Shekhar S, Bhattacharya P (2019). Concentration of fluoride in groundwater of India: A systematic review, meta-analysis and risk assessment. Groundwater for Sustainable Development, 9, Article 100224. https://doi.org/10.1016/j.gsd.2019.100224

[3] Ayoob S, Gupta AK (2006). Fluoride in drinking water: A review on the status and stress effects. Critical Reviews in Environmental Science and Technology, 36(6), 433–487. https://doi.org/10.1080/10643380600678112

[4] Bronckers ALJJ, Lyaruu DM, DenBesten PK (2009). The impact of fluoride on ameloblasts and the mechanisms of enamel fluorosis. Journal of Dental Research, 88(10), 877–893. https://doi.org/10.1177/0022034509343280

[5] Bureau of Indian Standards (BIS) (2012). Indian standard: Drinking water—Specification (IS 10500:2012). BIS, New Delhi.

[6] Dean HT (1942). The investigation of physiological effects by the epidemiological method. In: Moulton FR (ed), Fluorine and dental health. American Association for the Advancement of Science, Washington, DC, pp. 23–31.

[7] DenBesten PK, Li W (2011). Chronic fluoride toxicity: Dental fluorosis. Monographs in Oral Science, 22, 81–96. https://doi.org/10.1159/000327028

[8] DenBesten PK, Thariani H (1992). Biological mechanisms of fluorosis and level and timing of systemic exposure to fluoride with respect to fluorosis. Journal of Dental Research, 71(5), 1238–1243. https://doi.org/10.1177/00220345920710051701

[9] Directorate General of Health Services (2025). National Programme for Prevention and Control of Fluorosis (NPPCF). Ministry of Health and Family Welfare, Government of India. https://dghs.mohfw.gov.in/nppcf.php

[10] European Food Safety Authority (EFSA) Scientific Committee (2025). Updated consumer risk assessment of fluoride in food and drinking water including the contribution from other sources of oral exposure. EFSA Journal, 23(7), e9478. https://doi.org/10.2903/j.efsa.2025.9478

[11] Johnston NR, Strobel SA (2020). Principles of fluoride toxicity and the cellular response: A review. Archives of Toxicology, 94, 1051–1069. https://doi.org/10.1007/s00204-020-02687-5

[12] Ministry of Health and Family Welfare (2023). Tests to be conducted to confirm diagnosis of skeletal fluorosis. National Centre for Disease Control, Government of India.

[13] National Research Council (2006). Fluoride in drinking water: A scientific review of EPA’s standards. The National Academies Press, Washington, DC. https://doi.org/10.17226/11571

[14] Nawlakhe WG, Kulkarni DN, Pathak BN, Bulusu KR (1975). Defluoridation of water by Nalgonda technique. Indian Journal of Environmental Health, 17, 26–65.

[15] Padhan P, Maikap D (2022). Skeletal fluorosis mimicking spondyloarthritis: A rare presentation. Mediterranean Journal of Rheumatology, 33(2), 261–262. https://doi.org/10.31138/mjr.33.2.261

[16] Pal P, Jha NK, Pal D, Jha SK, Anand U, Gopalakrishnan AV, Dey A, Mukhopadhyay PK (2023). Molecular basis of fluoride toxicities: Beyond benefits and implications in human disorders. Genes & Diseases, 10(4), 1470–1493. https://doi.org/10.1016/j.gendis.2022.09.004

[17] Saha R, Wankhede T, Majumdar R, Das IC (2024). Pan India fluoride hazard assessment in groundwater. Journal of Hazardous Materials, 478, Article 135543. https://doi.org/10.1016/j.jhazmat.2024.135543

[18] Srivastava S, Flora SJS (2020). Fluoride in drinking water and skeletal fluorosis: A review of the global impact. Current Environmental Health Reports, 7(2), 140–146. https://doi.org/10.1007/s40572-020-00270-9

[19] Taher MK, Momoli F, Go J, Hagiwara S, Ramoju S, Hu X, Jensen N, Terrell R, Hemmerich A, Krewski D (2024). Systematic review of epidemiological and toxicological evidence on health effects of fluoride in drinking water. Critical Reviews in Toxicology, 54(1), 2–34. https://doi.org/10.1080/10408444.2023.2295338

[20] Thylstrup A, Fejerskov O (1978). Clinical appearance of dental fluorosis in permanent teeth in relation to histologic changes. Community Dentistry and Oral Epidemiology, 6(6), 315–328. https://doi.org/10.1111/j.1600-0528.1978.tb01173.x

[21] Veneri F, Iamandii I, Vinceti M, Birnbaum LS, Generali L, Consolo U, Filippini T (2023). Fluoride exposure and skeletal fluorosis: A systematic review and dose-response meta-analysis. Current Environmental Health Reports, 10(4), 417–441. https://doi.org/10.1007/s40572-023-00412-9

[22] World Health Organization (WHO) (2017). Guidelines for drinking-water quality (4th ed., incorporating the 1st addendum). WHO, Geneva.

[23] World Health Organization (WHO) (2022). Guidelines for drinking-water quality: Fourth edition incorporating the first and second addenda. WHO, Geneva.

@article{1725102,
      author = {Dr. Amit Kumar Awasthi},
      title = {Fluoride Contamination in Drinking Water and Its Pathological Impacts On Human Dental and Skeletal Systems: A Systematic Review},
      journal = {Iconic Research And Engineering Journals},
      year = {2026},
      volume = {10},
      number = {5},
      pages = {2657-2669},
      issn = {2456-8880},
      url = {https://www.irejournals.com/formatedpaper/1725102.pdf},
      abstract = {Fluoride is a naturally-occurring mineral that can be found in drinking water sources, including groundwater. When present at the correct levels, fluoride contributes to the prevention of dental caries, but it can have harmful health impacts when present in high levels and for extended periods, especially on dental and skeletal tissues, when consumed in drinking water. A systematic review is intended to assess the scientific literature available on fluoride contamination in drinking water and its pathological effects to human dental and skeletal systems, with a critical evaluation. The review addresses the link between fluoride concentration, exposure time and health consequences. Dental fluorosis can occur: enamel discoloration, hypomineralization, mottling and, in severe cases, damage to the enamel surface may occur as a result of excessive fluoride intake during tooth development. Likewise, high levels of fluoride in the long-term may cause skeletal fluorosis that is linked to higher bone density, osteosclerosis, joint stiffness, chronic pain, limited mobility and skeletal deformities. The studies showed that the severity of the fluorosis is dependent on dose, age, nutritional status, climatic factors and susceptibility. Epidemiological data show positive correlations between high fluoride concentration of drinking water and dental and skeletal fluorosis, especially in communities relying on naturally occurring groundwater fluoride. The World Health Organization (WHO) has recommended a guideline fluoride level of 1.5 mg/L for drinking water, but the fluoride exposure conditions must also be taken into account, as well as the total fluoride intake. The study emphasizes the need for routine surveillance and mapping of fluoride polluted areas, and the application of successful defluoridation methods to reduce the health hazards associated with fluoride and ensure public health protection.},
      keywords = {Fluoride contamination, drinking water, dental fluorosis, skeletal fluorosis, enamel hypoplasia, osteosclerosis, fluoride toxicity, public health, review},
      month = {November},
  }