Fluoride Green Facts

Fluoride: Level 1 - Summary on Fluoride
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Fluoride Summary & Details:
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Questions on Fluoride
1. What are fluorides?

2. Where are fluorides found?
Context - Food and drinking water typically
3. How are humans exposed to fluorides?
contain at least small amounts of fluorides.
They occur in the environment both naturally 4. Can fluorides affect health?
and as a result of human activities. 5. What effects have actually been seen in humans?
6. To what extent can fluoride exposure be harmful
Fluorides are commonly added to dental to organisms in the environment?
products – and sometimes to tap water – to
7. What are the risks posed by fluorides?
prevent cavities.
8. What are the beneficial effects of fluoride on
teeth?
Under what conditions can fluoride exposure 9. Does water fluoridation pose risks?
be beneficial or detrimental to human health?
10. Conclusion
11. Other views
Level 1 Questions More in Details
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1.1 Fluorides are organic and inorganic compounds containing the fluorine element. Only inorganic fluorides are the
focus of this study, particularly those which are most present in the environment and may affect living organisms.
More...
1.2 Generally colourless, the different fluoride compounds are more or less soluble in water and can take the forms of
a solid, liquid, or gas. Fluorides are important industrial chemicals with a number of uses but the largest uses are for
aluminium production, drinking water fluoridation, and the manufacture of fluoridated dental preparations. More...
Conclusion Level 1 Questions More in Details
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2.1 In the environment, fluorides occur both naturally (e.g., rock weathering, volcanic emissions) and because of
human activities (e.g., phosphate rock mining and use, aluminium manufacturing, drinking water fluoridation).
More...
2.2 Fluorides can be present:
● in air, as gases or particulates;

● in water, mostly as fluoride ions or combined with aluminium;
● in soils, mainly combined with calcium or aluminium; and
● in living organisms.
More...
2.3 Fluoride levels in the environment depend on the proximity to both natural and human fluoride emission sources.
More...
2.4 Animals accumulate fluoride in their skeleton and plants in their leaves. More...
Next Question Top

3.1 In drinking water, fluoride can either be naturally present due to the specific geological environment from
which the water is obtained, or artificially added for the prevention of dental caries. More...
3.2 All foodstuffs contain at least small amounts of fluoride, but in some the concentrations can be higher. Fluoride
concentration in food can be increased by the presence of fluoride in water used for its preparation. More...
3.3 In dental products such as toothpaste, fluoride is present in significant amounts. More...
3.4 The consumption of foodstuffs and drinking water is the principal route of exposure to fluoride for adults, while
the ingestion of toothpaste by young children makes a significant contribution to their total intake of fluoride. More...
3.5 Humans retain 60 to 90% of the fluoride taken in and accumulate almost all of it in their bones and teeth. More...
Next Question Top
4. Can fluorides affect health?
4.1 Various harmful effects on the formation and hardening of bones and on delayed fracture healing were observed
in a series of animal laboratory studies. More...
4.2 Animal laboratory studies did not conclude that fluoride increases the frequency of any tumour. More...
4.3 Fluoride does not cause mutations but it has been shown to cause damage to chromosomes at high doses in
studies in cell cultures. This has not been shown in most studies on test animals fed with fluoride. More...
4.4 Drinking water containing fluoride has not affected reproduction or development of the foetus in most studies on
test animals. Microscopic changes in reproductive organs have been seen at high doses in some studies. More...
Next Question Top

5. What effects have actually been seen in humans?
5.1 The many studies on fluoride artificially added to drinking water have not found a link to cancer. Workers
exposed to high levels of fluoride in air showed an increased frequency of cancer but they were also exposed to other
known cancer-causing chemicals. More...
5.2 Fluoride can help prevent cavities, but as the amount taken in increases it can also harm teeth (dental fluorosis)
and bones (skeletal fluorosis). More...
5.3 Studies on human populations have not attributed any other health effects to fluoride exposure. More...
Next Question Top
6. To what extent can fluoride exposure be harmful to organisms in the environment?
6.1 Different organisms living in water are more or less sensitive to fluoride. It can affect their growth, activity, or
survival above certain concentrations. More...
6.2 In plants, high levels of fluoride can lead to the yellowing of leaves and slowed growth, as shown by studies
where fluoride was deposited on leaves. More...
6.3 In birds, laboratory tests showed high levels of fluoride could affect chick growth or survival. In deer, cattle, and
sheep it was observed that high fluoride intake affected weight, joints, teeth, and bones, milk production and
reproduction. More...
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7.1 The most serious effect of fluoride is its accumulation in bones from long-term excessive exposure, which can
lead to skeletal fluorosis and bone fractures. More...
7.2 Fluoride discharges from human activities can be toxic to aquatic organisms and pose a risk to local sensitive
plant species on land. High fluoride content in plants near emission sources or due to fertilizer use is a potential risk
to animals that eat them. More...
Next Question Top

8. What are the beneficial effects of fluoride on teeth?
An "optimum" level of fluoride in drinking water, associated with the maximum level of dental caries protection and
minimum level of dental fluorosis, has been determined. More...
8.1 Historically, populations benefiting from fluoridated drinking water have developed fewer cavities. Today, many
other fluoridated products are more extensively used and contribute to protecting a wider population. More...
8.2 There is a variety of fluoridated products: fluoridated drinking water, toothpaste, mouth solutions, gels or
varnishes, salt, milk, and supplements. More...
Next Question Top
9. Does water fluoridation pose risks?
9.1 The intake of excessive amounts of fluoride can lead to dental fluorosis, preventing the normal maturation of the
enamel, but only during the period of tooth development in children, up to 6–8 years old. More...
9.2 An increase in the frequency of dental fluorosis over the past 30 to 40 years is generally attributed to the
widespread use of fluoride products other than drinking water. Dental fluorosis is common in certain areas of the
world, such as China, where fluoride is naturally present at high levels in minerals and water. More...
9.3 The greater the amount of fluoride incorporated into bone, the more severe the skeletal fluorosis-associated
effects on bones. More...
9.4 In certain areas of the world where high levels of fluoride are naturally present, skeletal fluorosis is widespread,
mainly due to an increased intake of fluoride from foodstuffs and drinking water. However, other factors, such as
nutrition and climate, may also be important. More...
Next Question Top

10. Conclusion
Fluoride can help prevent cavities, but at high intakes it can harm tooth development (dental fluorosis) and bones
(skeletal fluorosis); there is a narrow range between intakes which are beneficial and those which are detrimental.
Populations consuming artificially fluoridated drinking water or other fluoridated products, such as fluoridated
toothpaste, develop fewer cavities.
In areas of the world with high levels of fluoride naturally present in minerals and water, skeletal fluorosis is
common. This crippling disability, which includes increased risk of bone fracture, affects millions of people in various
parts of Africa, China and India.
All organisms both on land and in water are exposed to fluoride released from natural sources and/or by human
activities. Excess exposure poses a risk to them.
There is a need to better characterize the biological effects of exposure to different levels of fluoride. More...
Top
11. Other views
This study is based on the latest International Programme on Chemical Safety (IPCS) review on Fluorides, EHC 227.
It is generally considered as a consensus document and some recent scientific assessments reach similar conclusions -
click here for some links
However, some people and organizations put forward different views:
● Positions suggesting that Fluorides pose more risk
● Positions suggesting that Fluorides pose less risk
Click here to see the GreenFacts factual Fluorides links page
More...
Conclusion Level 1 Questions
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Fluoride: Level 2 - Details on Fluoride

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Level 2 - Details on Fluoride

● 1. What are fluorides?
❍ 1.1 Which fluorides are most relevant?
❍ 1.2 What are fluorides used for in industry?
● 2. Where are fluorides found?

❍ 2.1 How are fluorides released into the environment?
❍ 2.2 Where in the environment can fluorides be found?
❍ 2.3 How much fluoride is there in environment?
❍ 2.4 How much fluoride can be found in living organisms?
● 3 . How are humans exposed to fluorides?

❍ 3.1 How much fluoride is there in drinking water?
❍ 3.2 How much fluoride is there in food?
❍ 3.3 How much fluoride is there in toothpaste?
❍ 3.4 How much fluoride are humans exposed to?
❍ 3.5 Does fluoride affect bones in test animals?
● 4. Can fluorides affect health?

❍ 4.1 Does fluoride affect bones in test animals?
❍ 4.2 Does fluoride cause cancer in test animals?
❍ 4.3 Does fluoride cause genetic mutations in cells or test animals?
❍ 4.4 Does fluoride affect reproduction or development in test animals?
● 5. What effects have actually been seen in humans?

❍ 5.1 Has fluoride exposure caused cancer?
❍ 5.2 What are the effects on teeth and bones?
❍ 5.3 Has fluoride caused other health problems?
● 6. To what extent can fluoride exposure be harmful to organisms in the environment?
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Fluoride: Level 2 - Details on Fluoride
❍ 6.1 What levels of fluoride exposure are harmful to aquatic organisms?

❍ 6.2 What levels of fluoride exposure are harmful to microbes and plants?
❍ 6.3 What levels of fluoride exposure are harmful to birds and mammals?
● 7. What are the risks posed by fluorides?

❍ 7.1 What are the risks to humans?
❍ 7.2 What are the risks to the environment?
● 8. What are the beneficial effects of fluoride on teeth?

❍ 8.1 Does fluoride protect teeth from cavities?
❍ 8.2 What fluoridated products have been used to prevent cavities?
● 9. Does water fluoridation pose risks?

❍ 9.1 When can teeth be affected by dental fluorosis?
❍ 9.2 Is water fluoridation causing dental fluorosis?
❍ 9.3 How can bones be affected by skeletal fluorosis?
❍ 9.4 At what intake levels does fluoride cause skeletal fluorosis?
● 10. Conclusion
● 11. Other views (Level 1 only)
Back to Summary Level 2 Questions More in the Source Document
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Fluoride: 1. What are fluorides?

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Level 1 Questions Next Question
1.1 Which fluorides are most relevant?

1.2 What are fluorides used for in industry?
1.1 Which fluorides are most relevant?
Fluorine (F) is an element of the halogen family, which also includes chlorine, bromine and iodine. It forms inorganic
and organic compounds called fluorides. Living organisms are mainly exposed to inorganic fluorides through food and
water. Based on quantities released and concentrations present naturally in the environment as well as the effects on
living organisms, the most relevant inorganic fluorides are hydrogen fluoride (HF), calcium fluoride (CaF2), sodium
fluoride (NaF), sulfur hexafluoride (SF6) and silicofluorides. They are the focus of this study. More...
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Fluoride: 1. What are fluorides?
1.2 What are fluorides used for in industry?
Fluorides are important industrial chemicals with a number of uses but the largest uses are for aluminium production,
drinking water fluoridation and the manufacture of fluoridated dental preparations.
● Hydrogen fluoride (HF) is a colourless, pungent liquid or gas that is highly soluble in organic solvents (e.g.,
benzene) and in water. It is mainly used in the production of synthetic cryolite (Na3AlF6), aluminium fluoride
(AlF3), motor gasoline alkylates and chlorofluorocarbons (CFCs). It is also used in etching semiconductor
devices, cleaning and etching glass, cleaning brick and aluminium and tanning leather, as well as in removing
rust.
● Calcium fluoride (CaF2) is a colourless solid that is relatively insoluble in water and dilute acids and bases. It
is used to produce steel, glass and enamel (because it lowers the melting temperature), hydrofluoric acid and
anhydrous hydrogen fluoride (as raw material), and aluminium (as electrolyte).
● Sodium fluoride (NaF) is a colourless to white solid that is moderately soluble in water. It is used in the
fluoridation of drinking water and in the manufacture of dental preparations such as toothpaste. It is also
used in the production of steel and aluminium (to lower the melting temperature), glass and enamel, or as an
insecticide and a preservative (for glues and wood).
● Sulfur hexafluoride (SF6) is a colourless, odourless, inert gas that is slightly soluble in water and readily
soluble in ethanol and bases. It is used extensively in various electronic components and in the production of
magnesium and aluminium.
● Silicofluorides such as fluorosilicic acid (H2SiF6) and sodium hexafluorosilicate (Na2SiF6) are also used for the
fluoridation of drinking water supplies More...
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Fluoride: 2. Where are fluorides found?

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2.1 How are fluorides released into the environment?

2.2 Where in the environment can fluorides be found?
2.3 How much fluoride is there in environment?
2.4 How much fluoride can be found in living organisms?
2.1 How are fluorides released into the environment?
Naturally, fluorides are released into the environment through the weathering of rocks and through atmospheric
emissions from volcanoes and seawater.
Human activities releasing fluorides into the environment are mainly the mining and processing of phosphate rock
and its use as agricultural fertilizer, as well as the manufacture of aluminium. Other fluoride sources include the
combustion of coal (containing fluoride impurities) and other manufacturing processes (steel, copper, nickel, glass,
brick, ceramic, glues and adhesives). In addition, the use of fluoride-containing pesticides in agriculture and fluoride
in drinking water supplies also contribute to the release of fluorides to the environment. More...
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2.2 Where in the environment can fluorides be found?
In air, fluorides can be present as gases or particulates. They can be transported by wind over large distances before
depositing on the earth’s surface or dissolving in water. In general, fluoride compounds do not remain in the
troposphere for long periods nor do they move up to the stratosphere. Only sulfur hexafluoride (SF6) can stay in the
atmosphere from 500 to several thousand years.
In water, when inorganic fluoride compounds dissolve they split up into ions although the speed at which they
dissolve depends on the type of compound and on factors such as the acidity of the water. The transport and
transformation of fluorides is influenced by pH, water hardness and the presence of materials such as clay, which
exchange ions. In water with a neutral pH and low fluoride concentrations, fluoride is predominantly present in the
form of fluoride ions (F-). As they travel through the water cycle fluorides usually combine with aluminium.
In soils, fluoride is predominantly combined with aluminium or calcium. When the soil is slightly acidic, fluoride
tends to adsorb more strongly to soil particles. Fluorides are very immobile in soil and are not easily leached from it.
In living organisms, the quantity of fluoride taken-up depends on the route of exposure, on how well the particular
fluorides are absorbed by the body and on how quickly they are both taken up and excreted. Fluoride released from
soluble fluorides tend to bioaccumulate in some aquatic and terrestrial plants or animals. However, there is no known
information on the biomagnification of fluoride, i.e. fluoride build-up in aquatic or terrestrial food-chains. More...
2.3 How much fluoride is there in environment?
In surface waters, such as rivers, fluoride levels depend on the proximity to human or natural emission sources; they
generally range from 0.01 to 0.3 mg/litre. In seawater fluoride concentrations are higher, i.e. 1.2 to 1.5 mg/litre. In
areas where the natural rock is rich in fluoride or where there is geothermal or volcanic activity, very high fluoride
levels, up to 50 mg/litre, may be found in groundwater or hot springs.
In air, fluoride emitted both naturally and from human activities in gaseous and particulate forms generally deposits
relatively near its emission source. In areas without nearby emission sources, the mean concentrations of fluoride in
ambient air are generally less than 0.1 µg/m3. Even near emission sources, the levels of airborne fluoride usually do
not exceed 2–3 µg/m3.
In most soils, fluoride is present at concentrations ranging from 20 to 1000 µg/g. This figure can reach several
thousand µg/g in mineral soils with natural phosphate or fluoride deposits. More...
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2.4 How much fluoride can be found in living organisms?
Aquatic organisms take up fluorides directly from water or to a lesser extent via food, and tend to accumulate
fluoride in their exoskeleton or bone tissue. Mean fluoride concentrations of more than 2000 mg/kg have been
measured in the exoskeleton of krill while mean bone fluoride concentrations in aquatic mammals, such as seals and
whales, ranged from 135 to 18 600 mg/kg dry weight.
Fluoride levels in terrestrial animals and plants are higher near natural and human fluoride emission sources.
Lichens, which have been used extensively as biomonitors for fluorides, generally contain less than 1 mg fluoride/kg
(background level), but at a distance of 2 to 3 km from fluoride emission sources mean concentrations range from
150 to 250 mg/kg.
Most of the fluoride in the soil is insoluble and, therefore, less available to plants. But the fluoride that is present in
soil solution is taken up through the root and accumulates in leaves.
Fluoride accumulates in the bone tissue of terrestrial vertebrates, depending on factors such as diet and the
proximity of fluoride emission sources. For example, mean fluoride concentrations of 7000 to 8000 mg/kg have been
measured in the bones of small mammals living near an aluminium smelter. More...

Fluoride: 3. How are humans exposed to fluorides?

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3.1 How much fluoride is there in drinking water?

3.2 How much fluoride is there in food?
3.3 How much fluoride is there in toothpaste?
3.4 How much fluoride are humans exposed to?
3.5 Does fluoride affect bones in test animals?
3.1 How much fluoride is there in drinking water?
The amount of fluoride present naturally in drinking water is highly variable, depending on the specific geological
environment from which the water is obtained. In non-fluoridated drinking water (i.e., drinking water to which
fluoride has not been intentionally added for the prevention of dental caries) levels may reach up to about 2.0
mg/litre. However, some places can have fluoride levels in drinking water of up to 20 mg/litre. In areas in which
drinking water is fluoridated, the concentration of fluoride in drinking water generally ranges from 0.7 to 1.2 mg/litre.
More..
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3.2 How much fluoride is there in food?
Virtually all foodstuffs contain at least trace amounts of fluoride. Elevated levels are present in fish and in tea leaves,
which are particularly rich in fluoride. Although the concentration of fluoride in food products is not significantly
increased by the addition of superphosphate fertilizers (containing fluorides as impurities) to agricultural soil, a recent
study shows that plant uptake of fluoride could increase given certain conditions. The use of water containing
relatively low levels (less than about 3 mg/litre) of fluoride for crop irrigation generally does not increase fluoride
concentrations in foodstuffs, but this depends on plant species and fluoride concentrations in soil and water.
However, the level of fluoride in foods is significantly affected by the fluoride content of the water used in food
preparation or processing, particularly in beverages and dry foodstuffs to which water is added prior to consumption,
such as powdered baby formula. The concentrations of fluoride in unwashed or unprocessed foods grown near
industrial fluoride sources may be greater than the levels in the same foods grown in other non-industrially exposed
areas. Fluoride has been detected in breast milk at concentrations up to 100 µg/litre, with most measurements
ranging between 5 and 10 µg/litre. More...
3.3 How much fluoride is there in toothpaste?
Dental products such as toothpaste, mouthwash and fluoride supplements have been identified as significant sources
of fluoride. Toothpastes for adults that are commercially available generally contain fluoride at concentrations ranging
from 1000 to 1500 µg/g, whereas those designed for children contain 250 to 500 µg/g. The concentration of fluoride
in mouth rinses varies with the recommended frequency of use from 230 to 1000 mg/litre. More...
3.4 How much fluoride are humans exposed to?
Individual exposure to fluoride is highly variable depending on the levels of fluoride in foodstuffs and drinking water,
on the use of fluoridated dental preparations, and in certain cases on the levels of fluoride in indoor air.
For adults, the consumption of foodstuffs and drinking water is the principal route of exposure to fluoride.
Formula-fed infants receive 50–100 times more fluoride than exclusively breast-fed infants. The ingestion of
toothpaste by young children makes a significant contribution to their total intake of fluoride. In general, estimated
intakes of fluoride by children and adolescents do not exceed about 2 mg/day. Although adults may have a higher
absolute daily intake of fluoride in milligrams, the daily fluoride intake of children, expressed on a milligram per
kilogram body weight basis, may exceed that of adults. In geological areas rich in fluoride, drinking water obtained
from groundwater wells can be the principal source, leading to estimated intakes of fluorides in adults up to 27
mg/day.
The inhalation of airborne fluoride generally does not contribute much to the total intake of this substance, save in
areas of the world in which coal rich in fluoride is used indoors on open fires for heating and cooking or where certain
wood preservatives are used.
Workers in the aluminium, iron ore or phosphate ore processing industry may be exposed via inhalation or dermal

contact. More...
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When fluorides are ingested by humans or laboratory animals, they are absorbed in the stomach and/or the intestine.
Fluoride from soluble fluorides is almost completely absorbed (either as HF or F-, depending on stomach acidity).
However, when fluoride is bound to aluminium, calcium etc., its release and subsequent absorption may be reduced
because this combination is less soluble. When fluorides in gaseous or particulate form are breathed in, the
respiratory tract, they are partially or completely absorbed depending on how soluble they are or on how big the
fluoride-containing particles are.
Fluoride is then rapidly distributed in tissues. In humans and laboratory animals, fluorides mostly build up in bones
and teeth, which retain about 99% of the total fluoride body burden.
Fluoride is eliminated from the body primarily through the urine. Infants retain 80 to 90% of fluoride ingested, while
adults retain approximately 60%.
However, the balance of fluoride in the body (i.e. the difference between the amount of fluoride ingested and the
amount excreted) can be positive or negative. This physiological balance is determined by earlier fluoride exposure,
the degree of accumulation in bone, the rate at which it is released from bone and the efficiency of the kidneys in
excreting fluoride. When fluoride intakes are low excretion through urine can exceed intake.
Fluoride can be transferred from mother to foetus through the placenta. More...
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Fluoride: 4. Can fluorides affect health?

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4. Can fluorides affect health?

4.2 Does fluoride cause cancer in test animals?
4.3 Does fluoride cause genetic mutations in cells or test animals?
4.4 Does fluoride affect reproduction or development in test animals?
Various effects on bones were observed in a series of studies carried out on rats and mice fed with significant
amounts of fluoride for varying time periods. Effects included inhibition of bone formation and hardening, delayed
fracture healing, and reductions in bone volume and collagen synthesis. More...
4.2 Does fluoride cause cancer in test animals?
A series of studies carried out on various types of rats and mice fed with significant amounts of fluoride for long
periods showed no statistically significant increase in the incidence of any tumour. In one study there was a
significant trend for bone tumours in male rats only. However, the incidence of these tumours was not greater than
what had been observed in previous studies on rats that had not been exposed to fluoride (historical controls).
More...
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Fluoride: 4. Can fluorides affect health?
4.3 Does fluoride cause genetic mutations in cells or test animals?
In bacteria, fluoride generally does not cause mutations, i.e. permanent change to DNA. Although fluoride has been
shown to cause damage to DNA in a variety of cell types in in vitro tests, this appears to be due to an effect on the
synthesis of proteins involved in forming or repairing DNA and not to a direct interaction with DNA. In most studies
on test animals fed with fluoride, it had no effect on chromosomes, but chromosomal changes or effects on sperm
were reported when fluoride was injected into the abdominal cavity. More...
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4.4 Does fluoride affect reproduction or development in test animals?
In recent studies, animals exposed to fluoride via drinking water showed neither reproductive nor developmental
effects. However, changes in reproductive organs and reproductive function have been reported in test animals
administered significant doses of fluoride orally or via injections for varying periods of time. More...
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Fluoride: 5. What effects have actually been seen in humans?

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5. What effects have actually been seen in humans?
5.1 Has fluoride exposure caused cancer?

5.2 What are the effects on teeth and bones?
5.3 Has fluoride caused other health problems?
5.1 Has fluoride exposure caused cancer?
Various studies of fluoride-exposed workers, primarily from the aluminium smelting industry, showed an increased
incidence of lung and bladder cancer and increased mortality due to cancer. However, no consistent pattern has been
observed and in certain cases the greater frequency of cancers can be attributed to substances other than fluoride.
The numerous studies carried out in many countries on populations consuming fluoridated drinking water did not
show any consistent evidence of an association between the consumption of controlled fluoridated drinking water and
increased frequency of cancer. More...
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Fluoride: 5. What effects have actually been seen in humans?
5.2 What are the effects on teeth and bones?
Fluoride can have both a positive and a negative impact on tooth enamel. Generally, the higher the concentrations of
fluoride in drinking water the smaller the likelihood to develop dental caries. However, the prevalence and severity of
dental fluorosis within the population increases with the concentration of fluoride in drinking water.
Bones can be negatively affected by fluoride. Cases of skeletal fluorosis are associated with high levels of fluoride in
drinking water or in ambient air at work or at home, for instance in areas of China in which coal rich in fluoride is
used indoors on open fires for heating and cooking. Although fluoride is the cause of skeletal fluorosis in these cases,
many other factors, including nutritional factors, can play a significant role in the severity of the health condition.
Evidence for an association between the consumption of fluoridated water and hip fractures is mixed; some studies
support the association, others do not, some even report protective effects of fluoride on bones. Two comparative
studies carried out on groups of people drinking water with different levels of fluoride showed greater risks of fracture
at higher fluoride levels. More...
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5.3 Has fluoride caused other health problems?
Studies on human populations did not show any association between the consumption of fluoridated drinking water
by mothers and increased risk of spontaneous abortion or congenital malformation. Studies on workers exposed to
airborne fluorides have provided no reasonable evidence of effects upon lungs, blood system, liver or kidneys
attributable to fluoride exposure alone. More...
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Fluoride: 6. To what extent can fluoride exposure be harmful to organisms in the environment?

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6. To what extent can fluoride exposure be harmful to organisms in the environment?
6.1 What levels of fluoride exposure are harmful to aquatic organisms?

6.2 What levels of fluoride exposure are harmful to microbes and plants?
6.3 What levels of fluoride exposure are harmful to birds and mammals?
6.1 What levels of fluoride exposure are harmful to aquatic organisms?
Fluoride can be toxic to aquatic life but some organisms are more sensitive to its effects than others. Its toxicity is
very low for bacteria involved in wastewater treatment and appears to be low for algae.
Fluoride toxicity is low for an aquatic floating plant, common duckweed, with a concentration giving a 50% reduction
in growth (EC50) greater than 60 mg fluoride/litre.
How easily invertebrates are affected depends on the species. The most sensitive appear to be caddisfly species
with calculated “safe concentrations” varying between 0.2 mg/litre and 1.79 mg/litre.
The data on fish are quite variable but fluoride toxicity to fish appears to be less in hard water than soft water and
greater at high temperatures than low temperatures. The concentration of fluoride lethal to 50% of groups of rainbow
trout (LC50) exposed for 20 days in laboratory experiments carried out in soft water, ranged from 2.7 to 4.7
mg/litre. However, for a wild fish population in a specific river with hard water, safe concentrations for rainbow and
brown trout were calculated to be 5.1 and 7.5 mg/l respectively. More...
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6.2 What levels of fluoride exposure are harmful to microbes and plants?
There is evidence that fluoride may be toxic to microbiological processes in soils at concentrations found in
moderately polluted areas.
Signs of harmful effects on plants include the yellowing of leaves and slowed growth. When plants take up fluoride
from soil its toxic effects depend on the ionic species of fluoride present and on the type of soil.
Many studies have assessed the effects of fluoride emissions on plants by exposing them to hydrogen fluoride (HF)
gas. Leave tissue starts to die (leaf necrosis) above certain concentrations in air, e.g. 0.17 and 0.27 µg/m3 in the
case of grapevines (for an exposure of 99 and 83 days). Airborne fluoride can also have an impact on the
development of plant diseases, but the type and magnitude of the effects depend on the specific plant and its
disease.
Evidence shows that the smaller the distance from great fluoride sources such as aluminium smelters or phosphorus
plants, the higher the fluoride levels in soils and hence the degree of damage to vegetation. Mean levels of fluoride in
vegetation near one of these large fluoride sources ranged from 281 mg/kg in severely damaged areas to 44 mg/kg
in slightly damaged areas. Near an aluminium smelter, differences in plant community composition and structure
were observed due partly to variations in fluoride tolerance, but other variables such as other atmospheric pollutants
must also be taken into account when interpreting the many field studies on fluoride pollution. More...
Top
6.3 What levels of fluoride exposure are harmful to birds and mammals?
In birds, laboratory tests were carried out on European starling chicks to determine at what levels fluoride would
affect their growth or be lethal. In the case of 1-day-old laboratory chicks, growth rates were significantly reduced at
13 mg fluoride/kg and half of the chicks died within the next 24h when administered a fluoride dose of 50 mg/kg
body weight. That figure dropped to 17 mg/kg body weight for 16-day-old nestlings.
In mammals, the lowest concentration of fluoride in food to cause dental fluorosis was 35 mg/kg food in wild white-
tailed deer. Fluorosis has also been observed in cattle and sheep, with dairy cattle having the lowest tolerance value
at 30 mg/kg feed or 2.5 mg/litre drinking water.
Symptoms of fluoride toxicity include emaciation, stiffness of joints and abnormal teeth and bones. Other effects
include lowered milk production and detrimental effects on reproduction. Near smelters, animal lameness has also
been observed. More...


Fluoride: 7. What are the risks posed by fluorides?

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IPCS (2002)
GreenFacts (2005)
About this study
7.1 What are the risks to humans?

7.2 What are the risks to the environment?
7.1 What are the risks to humans?
Fluoride has both positive and negative effects on human health, but there is a narrow range between intakes which
are beneficial and those which are detrimental. It is important to take into account all sources of exposure to fluoride,
including through drinking water and foodstuffs.
It is difficult to determine dose-response relationships between fluoride exposure and different adverse effects. This
is due to the limited information available on total fluoride exposure, particularly with respect to fluoride intake and
absorption.
The most serious effect is the accumulation of fluoride in bones from long-term excessive exposure and the potential
for skeletal fluorosis and bone fractures. At total intakes of 14 mg fluoride/day, there is clear evidence of skeletal
fluorosis and an increased risk of bone fractures; at total intake levels above about 6 mg fluoride/day the evidence is
suggestive of an increased risk of adverse effects on bone. More...
Top
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Fluoride: 7. What are the risks posed by fluorides?
7.2 What are the risks to the environment?
Natural fluoride concentrations in freshwater are usually lower than those expected to cause toxicity in aquatic
organisms, which may, however, be adversely affected by nearby discharges from human activities.
The release of fluoride from human activities poses a risk to local sensitive plant species. However, damage to local
terrestrial plant communities is often difficult to attribute to the presence of fluoride alone as other atmospheric
pollutants also have an impact on vegetation.
Concentrations of fluoride in vegetation near fluoride emission sources, such as aluminium smelters, can be higher
than the lowest dietary effect concentration reported for mammals in laboratory experiments.
Fluorosis has been reported in domesticated animals and in livestock due to the uptake of fluoride from fluoride-rich
mineral supplements and drinking water. Furthermore, there is a potential risk from the ingestion of fluoride-
contaminated pasture after the long-term use of phosphate fertilizers containing high levels of fluoride. Fluoride-
induced effects, such as lameness and tooth damage, have also been reported in wild mammals close to fluoride
natural emission sources, such as volcanoes, and those linked to human activities. More...
http://www.greenfacts.org/fluoride/fluorides-2/07-risks.htm (2 of 2) [10/06/2005 16:23:14]

Fluoride: 8. What are the beneficial effects of fluoride on teeth?

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IPCS (2002)
GreenFacts (2005)
About this study
8. What are the beneficial effects of fluoride on teeth?
8.1 Does fluoride protect teeth from cavities?

8.2 What fluoridated products have been used to prevent cavities?
Fluoride can have both beneficial and potentially detrimental effects on dental health. While an increase in the
concentration of fluoride in drinking water means less chances of developing dental caries, it also means greater
chances of developing dental fluorosis. The "optimum" level of fluoride in drinking water, associated with the
maximum level of dental caries protection and minimum level of dental fluorosis, is considered to be approximately 1
mg/litre. More...
8.1 Does fluoride protect teeth from cavities?
Today, oral fluoride is still considered as an effective means of reducing dental caries. Historically, populations
consuming fluoridated drinking water have shown a much lower prevalence of dental caries than have those
consuming non-fluoridated drinking water, but the difference in caries prevalence between those two groups has
narrowed significantly over time. This apparent decrease in the protective virtue of fluoridated drinking water may be
explained by the fact that individuals who do not have access to fluoridated drinking water may consume other
fluoridated products in significant amounts, for example beverages prepared elsewhere with fluoridated drinking
water and dental products such as fluoridated toothpaste.
There is now ample evidence that fluoride inhibits the development of caries because of its direct action on the
enamel surface of teeth that have emerged from the gum. More...
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Fluoride: 8. What are the beneficial effects of fluoride on teeth?
Top
8.2 What fluoridated products have been used to prevent cavities?
There is a variety of fluoridated products:
● Fluoridated drinking water is one of the most cost-effective means of delivering fluoride to large numbers
of individuals. It requires a suitable community-wide drinking water delivery system along with a reasonable
level of technological development. About 210 million individuals throughout the world consume such water.
● Fluoridated toothpaste, which usually contains approximately 1000 mg fluoride/kg, is considered to be one
of the major factors responsible for the gradual decline in the prevalence of dental caries in most
industrialized countries. About 500 million individuals throughout the world use such toothpaste.
● Fluoridated mouth rinse is popular among public health care programmes for school aged children. Such
rinses contain 0.05 or 0.2% of fluoride depending on whether they are recommended for daily or weekly use.
It is not suitable for children below the age of six who might swallow significant amounts of the product.
● Fluoridated solutions, gels or varnishes , applied by dentists, may be effective for individuals with an
elevated risk of dental caries. Because of the high level of fluoride contained (up to 22 300 mg/kg), and to
avoid acute toxic effects in younger children who may swallow them, such materials are applied according to
strict protocols.
● Fluoridated salt is considered to act against the appearance of caries in a way similar to fluoridated drinking
water. According to the WHO, it should contain at least 200 mg fluoride/kg salt.
● Fluoridated milk was formerly considered to be a suitable means of increasing children’s intake of fluoride;
however, little information is available on the efficacy of this delivery method that requires close cooperation
with the dairy industry as well as a widespread system of distribution.
● Fluoride supplements in the form of tablets, liquid drops or lozenges are intended to provide a source of
fluoride when fluoridated drinking water is not available. There appears to be a growing consensus that
fluoride supplements have a limited public health role in improving dental health.
The effectiveness of interventions other than drinking water fluoridation depends on the compliance by all sections of
the population, particularly among socially and economically disadvantaged groups. More...
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Fluoride: 9. Does water fluoridation pose risks?

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IPCS (2002)
GreenFacts (2005)
About this study
9. Does water fluoridation pose risks?
9.1 When can teeth be affected by dental fluorosis?

9.2 Is water fluoridation causing dental fluorosis?
9.3 How can bones be affected by skeletal fluorosis?
9.4 At what intake levels does fluoride cause skeletal fluorosis?
9.1 When can teeth be affected by dental fluorosis?
Dental fluorosis is a condition that results from the intake of excessive amounts of fluoride during the period of tooth
development, usually from birth to approximately 6–8 years of age. It is linked to the excessive incorporation of
fluoride into dental enamel and dentine which prevents the normal maturation of the enamel. The severity of this
condition ranges from very mild to severe, depending on the extent of fluoride exposure during the period of tooth
development. Mild dental fluorosis is usually characterized by the appearance of small white areas in the enamel;
individuals with severe dental fluorosis have teeth that appear stained and pitted ("mottled").
Dental fluorosis occurs during the period of enamel formation. Exposure to excessive levels of fluoride after tooth
development appears to have little influence on the extent of fluorosis.
Re-evaluation of past fluorosis data demonstrated a dose-response relationship and showed that even at low fluoride
intake levels from water, a certain level of dental fluorosis will be found. More...
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9.2 Is water fluoridation causing dental fluorosis?
Although there has been an increase in the prevalence of dental fluorosis over the past 30 to 40 years, it has
generally been attributed to the widespread intake of fluoride from sources other than drinking water, such as
toothpastes, mouth rinses, fluoride supplements fluoridated salt or milk, as well as locally applied dental gels,
solutions and varnishes on top of the possible exposure from drinking water.
An elevated prevalence of dental fluorosis is observed in certain areas of the world, such as China, where the intake
of fluoride may be extremely high, due in large part to the elevated fluoride content of the surrounding geological
environment. The consumption of drinking water containing naturally elevated levels of fluoride, the indoor burning of
coal rich in fluoride, the preparation of foodstuffs in water containing high fluoride levels and the consumption of
specific foodstuffs naturally rich in fluoride, such as tea, all contribute to the elevated intake of fluoride, with the
resultant development of dental fluorosis. More...
9.3 How can bones be affected by skeletal fluorosis?
Though the incorporation of fluoride into bone may increase the stability of the crystal lattice, it also delays or inhibits
bone hardening (mineralization), causing the bones to become brittle or less able to withstand pressure. The greater
the amount of fluoride incorporated into bone, the more severe are the effects associated with skeletal fluorosis.
In a preclinical phase of skeletal fluorosis, the patient may show no other symptoms than a slight increase in bone
mass, detected radiographically.
During the first and second clinical stages of skeletal fluorosis, the symptoms are: sporadic pain and stiffness of
the joints, chronic joint pain, osteosclerosis of cancellous bone and calcification of ligaments.
During the clinical phase III, associated with crippling skeletal fluorosis, symptoms are: limited movement of the
joints, skeletal deformities, intense calcification of ligaments, muscle wasting and neurological deficits.
Other effects of skeletal fluorosis arise when high fluoride intakes overly stimulate bone formation which can result in
calcium deficiency, osteomalacia, and secondary hyperparathyroidism.
The development of skeletal fluorosis depends on a number of factors, such as age, nutritional status, renal function
and calcium intake, in addition to the extent and duration of exposure to fluoride. Skeletal fluorosis may be reversible
to some degree. More...
Top

9.4 At what intake levels does fluoride cause skeletal fluorosis?
The occurrence of endemic skeletal fluorosis in certain areas of the world where the intake of fluoride may be
extremely high (e.g., India, China) has been well documented in case reports and surveys. An increased intake of
fluoride from foodstuffs and drinking water with high levels of fluoride of geological origin plays a major role. Yet it is
difficult to characterize the exposure-response relationship because many other factors may be important such as
nutrition and climate, which influence fluid intake, or the indoor burning of coal rich in fluoride (in China).
Indeed, the many studies on human skeletal fluorosis carried out around the world sometimes show significantly
different results from one area to another. In most of these studies, only fluoride intake from drinking water seems
to have been taken into account.
In the USA for instance, only five cases of crippling skeletal fluorosis were reported over the past 40 years. Their
total intake of fluoride over a 20-year period was estimated to be approximately 15–20 mg/day.
Studies in India, Senegal and China on populations exposed to drinking water naturally high in fluoride show
diverging results. In most studies, fluoride concentrations in drinking water ranging from 1 to 9.7 mg/litre were
associated with a varying prevalence of skeletal fluorosis within the range of 0 to 71%.
In India, a study on the dependence of skeletal fluorosis on duration of exposure and age showed that skeletal
fluorosis among individuals consuming water with an average fluoride concentration of 9.0 mg/litre started to appear
after 10 years of residence in the village and affected all individuals after 20 years.
Studies using bone-fracture as an indicator of increased bone brittleness due to skeletal fluorosis have shown an
increased risk of bone fractures at total fluoride intakes of 14 mg/day and evidence suggestive of an increased risk of
bone effects at total fluoride intakes above about 6 mg/day. More...

Fluoride: 10. Conclusion

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IPCS (2002)
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About this study
Previous Question Level 1 Questions Conclusion
10. Conclusion
All organisms are exposed to fluoride released from natural sources and/or by human activities.
Fluoride can help prevent cavities, but at high intakes it can harm teeth development (dental fluorosis) and at higher
intakes still, weaken and deform bones (skeletal fluorosis). There is a narrow range between intakes which are
beneficial and those which begin to be detrimental.
When drinking water is artificially fluoridated, the "optimum" level of fluoride, associated with the maximum level of
dental caries protection and minimum level of dental fluorosis, is considered to be approximately 1 mg/litre. Although
there has been an increase in the prevalence of dental fluorosis over the past 30 to 40 years, it has generally been
attributed to the widespread increased intake of fluoride from sources other than drinking water, such as
toothpastes, mouth rinses, fluoride supplements, fluoridated salt or milk, as well as locally applied dental gels,
solutions and varnishes.
Effects on the bone, such as skeletal fluorosis and fracture, are considered to be the most relevant outcomes in
assessing the adverse effects of long-term exposure of humans to fluoride.
In areas of the world with high levels of fluoride naturally present in minerals and water, intake of fluoride from
drinking water and foodstuffs is the primary cause for endemic skeletal fluorosis, a crippling disability that affects
millions of people in various parts of Africa, China and India. In some regions, the indoor burning of fluoride-rich coal
also serves as an important source of fluoride.
At total fluoride intakes of 14 mg/day, there is clear evidence of skeletal fluorosis and an increased risk of bone
fractures; at total intake levels above about 6 mg fluoride/day the evidence is suggestive of an increased risk of
effects on bone.
There is inadequate information for estimating total exposure to fluoride and the uptake into the body from different
sources which limits the conclusions on dose response that can be drawn from studies on adverse effects.
Excess exposure to fluoride in a form that can be absorbed by organisms poses a risk to aquatic and terrestrial
environments.
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Fluoride: 10. Conclusion
There is a need to improve the knowledge available on the accumulation of fluoride in organisms and how this can be
monitored and controlled.
The biological effects associated with different levels of fluoride exposure should be better characterised. More...
Previous Question Level 1 Questions Conclusion
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Factual Fluoride Links

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IPCS (2002)
GreenFacts (2005)
About this study
Create a link to our Fluoride study
Fluoride Links
Factual Fluoride Links - endorsed by the GreenFacts Scientific Board
Some of the websites providing reliable scientific information on fluoride:
1. Some Q&As & FAQs on Fluoride

2. More Info for the non-specialist
3. Information on fluoride in drinking water
Other Links - not necessarily endorsed by the GreenFacts Scientific Board
● Other views suggesting that fluorides pose either more or less risks

Top
1. Some Q&As & FAQs on Fluoride
● The ATSDR (Agency for Toxic Substances and Disease Registry) proposes a "Toxicological Profile for Fluorides,
Hydrogen Fluoride, and Fluorine" and a link to its "ToxFAQs™ for Fluorine, Hydrogen Fluoride, and Fluorides" on
www.atsdr.cdc.gov/tfacts11.html
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Factual Fluoride Links

Top
2. Some More Information for the Non-specialist
● The Eurofluor website developed by the CTEF (representing the fluorine industry) provides information on the various
uses of fluorine in the industry: www.eurofluor.org
● The Commission on Life Sciences (CLS) has published a book entitled "Health Effects of ingested Fluorides" (1993)
available for free online reading at the NAP (National Academies Press)
http://stills.nap.edu/books/030904975X/htm
● The GSDOM (German Society of Dental, Oral and Craniomandibular Sciences) provides information on Fluoride as a tool
against tooth decay on www.dgzmk.de/set15.htm [DE]

Top
3. Information on fluoride in drinking water
● The WHO proposes a guideline value for fluoride in drinking water in its 2004 "Fluoride in drinking water" document:
www.who.int/water_sanitation_health/dwq/chemicals/en/fluoride.pdf
● The WSH (Water, Sanitation and Health) unit of WHO proposes several links addressing Fluoride as part of the Drinking
Water Quality issue:
www.who.int/water_sanitation_health/dwq/chemicals/fluoride/en/
● Local information:
Contact your local water supplier if you wish to find out if fluoridation is practiced in your region and/or how much
fluoride is naturally present in your drinking water.
http://www.greenfacts.org/fluoride/links/index.htm (2 of 3) [10/06/2005 16:23:35]

GreenFacts : Sources for the Fluoride study

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IPCS (2002)
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GreenFacts Copyright Policy
About this Fluoride study

1. Sources for this Study
2. Current Status
3. Study Publication History
1. Sources for this Fluoride Study
The material content of the texts on Level 3 are directly sourced from the
Executive Summary (Chapter 1) of the "Environmental Health Criteria for Fluorides" (EHC 227) of the IPCS
(International Programme on Chemical Safety), a leading scientific report produced in 2002 by a large international
panel of scientists.
The Levels 1 & 2 were written by John Fawell in collaboration with the GreenFacts editorial team.
2. Current Status
Approved for publication by the GreenFacts Scientific Board.
3. Fluorides Study Publication History
The GreenFacts publication process is designed to ensure as high a degree of objectivity as possible.
First draft
http://www.greenfacts.org/fluoride/about-fluoride.htm (1 of 2) [10/06/2005 16:23:38]

GreenFacts : Sources for the Fluoride study
The first draft of this study was produced by John Fawell in September 2004 on the basis of a canvas prepared by the
GreenFacts Editorial Team.
Second draft
The second draft of this study was produced in October 2004 by John Fawell after review by the GreenFacts Editorial
Team.
Preliminary and Peer review
The final draft of this study was produced in January 2005 by John Fawell after pre-review by experts from
environmental organizations (see our pre review form) and peer review by 3 independent scientists selected by
the GreenFacts Scientific Board (see our peer review form). Final corrections were added under the
supervision of the GreenFacts Scientific Board in March 2004.
Publication
Final publication was authorized by the President of the GreenFacts Scientific Board the 20th April 2005.
Updates or subsequent post-publication revisions
No update or revision at present.
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Fluoride: Level 1 - Summary on Fluoride

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Home > Studies > Fluoride > Level 1

Scientific Facts on Source document:

Info on our studies structure

1. What are fluorides?

Level 1 Questions More in Details

Next Question Top

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1. What are fluorides?

Conclusion Level 1 Questions More in Details

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2. Where are fluorides found?

2.2 Fluorides can be present:

● in air, as gases or particulates;

Conclusion Level 1 Questions More in Details

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3. How are humans exposed to fluorides?

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4. Can fluorides affect health?

Conclusion Level 1 Questions More in Details

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5. What effects have actually been seen in humans?

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6. To what extent can fluoride exposure be harmful to organisms in the environment?

Conclusion Level 1 Questions More in Details

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7. What are the risks posed by fluorides?

Conclusion Level 1 Questions More in Details

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8. What are the beneficial effects of fluoride on teeth?

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9. Does water fluoridation pose risks?

Conclusion Level 1 Questions More in Details

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Conclusion Level 1 Questions More in Details

11. Other views

However, some people and organizations put forward different views:

● Positions suggesting that Fluorides pose more risk

● Positions suggesting that Fluorides pose less risk

Click here to see the GreenFacts factual Fluorides links page

Conclusion Level 1 Questions

Send this page Feedback Download this study

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Level 2 - Details on Fluoride

● 2. Where are fluorides found?

● 3 . How are humans exposed to fluorides?

● 4. Can fluorides affect health?

● 5. What effects have actually been seen in humans?

● 6. To what extent can fluoride exposure be harmful to organisms in the environment?