Most of the body's fluorine (F) is contained in bones and teeth. Fluoride (the ionic form of fluorine) is widely distributed in nature. The main source of fluoride is fluoridated drinking water.

Deficiency

Fluorine deficiency can lead to dental caries and possibly osteoporosis. Fluoridation of water that contains < 1 ppm (the ideal) reduces the incidence of dental caries. If a child's drinking water is not fluoridated, oral fluoride supplements can be prescribed.

Toxicity

Excess fluorine can accumulate in teeth and bones, causing fluorosis. Drinking water containing > 10 ppm is a common cause. Permanent teeth that develop during high fluoride intake are most likely to be affected. Exposure must be much greater to affect deciduous teeth.

The earliest signs are chalky-white, irregularly distributed patches on the surface of the enamel; these patches become stained yellow or brown, producing a characteristic mottled appearance. Severe toxicity weakens the enamel, pitting its surface. Bony changes, including osteosclerosis, exostoses of the spine, and genu valgum, can develop but only in adults after prolonged high intake of fluoride.

No tests to diagnose toxicity are available.

Treatment involves reducing fluoride intake; eg, in areas with high fluoride water levels, patients should not drink fluoridated water or take fluoride supplements. Children should always be told not to swallow fluoridated toothpastes.

Last full review/revision August 2008 by Larry E. Johnson, MD, PhD