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Why do we have fluoride in our water?

By Christian Nordqvist | Last updated Wed 21 February 2018
Reviewed by Karen Cross, FNP, MSN

RisksUsesSide EffectsBenefitsFactsControversy

Fluoride is found naturally in soil, water, and foods. It is also produced synthetically for use in drinking water, toothpaste, mouthwashes and various chemical products.

Water authorities add fluoride to the municipal water supply, because studies have shown that adding it in areas where fluoride levels in the water are low can reduce the prevalence of tooth decay in the local population.

Tooth decay is one of the most common health problems affecting children. Many people worldwide cannot afford the cost of regular dental checks, so adding fluoride can offer savings and benefits to those who need them.

However, concerns have arisen regarding fluoride's effect on health, including problems with bones, teeth, and neurological development.

Fast facts about fluoride

  • Fluoride comes from fluroine, which is a common, natural, and abundant element.
  • Adding fluoride to the water supply reduces the incidence of tooth decay.
  • Fluoride protects teeth from decay by demineralization and remineralization.
  • Too much fluoride can lead to dental fluorosis or skeletal fluorosis, which can damage bones and joints.


Excessive exposure to fluoride has been linked to a number of health issues.

Dental fluorosis

Water testing
A fluoride content of 0.7 ppm is now considered best for dental health. A concentration that is above 4.0 ppm could be hazardous.

Exposure to high concentrations of fluoride during childhood, when teeth are developing, can result in mild dental fluorosis. There will be tiny white streaks or specks in the enamel of the tooth.

This does not affect the health of the teeth, but the discoloration may be noticeable.

Breastfeeding infants or making up formula milk with fluoride-free water can help protect small children from fluorosis.

Children below the age of 6 years should not use a mouthwash that contains fluoride. Children should be supervised when brushing their teeth to ensure they do not swallow toothpaste.

Skeletal fluorosis

Excess exposure to fluoride can lead to a bone disease known as skeletal fluorosis. Over many years, this can result in pain and damage to bones and joints.

The bones may become hardened and less elastic, increasing the risk of fractures. If the bones thicken and bone tissue accumulates, this can contribute to impaired joint mobility.

Thyroid problems

In some cases, excess fluoride can damage the parathyroid gland. This can result in hyperparathyroidism, which involves uncontrolled secretion of parathyroid hormones.

This can result in a depletion of calcium in bone structures and higher-than-normal concentrations of calcium in the blood.

Lower calcium concentrations in bones make them more susceptible to fractures.

Neurological problems

In 2017, a report was published suggesting that exposure to fluoride before birth could lead to poorer cognitive outcomes in the future.

The researchers measured fluoride levels in 299 women during pregnancy and in their children between the ages of 6 and 12 years. They tested cognitive ability at the ages of 4 years and between 6 and 12 years. Higher levels of fluoride were associated with lower scores on IQ tests.

In 2014, fluoride was documented as a neurotoxin that could be hazardous to child development, along with 10 other industrial chemicals, including lead, arsenic, toluene, and methylmercury.


High fluoride levels in pregnancy may lower offspring IQ
Find out more about how fluoride may affect cognitive development


Other health problems

According to the International Association of Oral Medicine and Toxicology (IAOMT), an organization that campaigns against the use of added fluoride, it may also contribute to the following health problems:

  • acne and other skin problems
  • cardiovascular problems, including arteriosclerosis and arterial calcification, high blood pressure, myocardial damage, cardiac insufficiency, and heart failure
  • reproductive issues, such as lower fertility and early puberty in girls
  • thyroid dysfunction
  • conditions affecting the joints and bones, such as osteoarthritis, bone cancer, and temporomandibular joint disorder (TMJ)
  • neurological problems, possibly leading to ADHD

One review describes fluoride as an "extreme electron scavenger" with an "insatiable appetite for calcium." The researchers call for the balance of risks and benefits to be reconsidered.

Fluoride poisoning

Acute, high-level exposure to fluoride can lead to:

  • abdominal pain
  • excessive saliva
  • nausea and vomiting
  • seizures and muscle spasms

This will not result from drinking tap water. It is only likely to happen in cases of accidental contamination of drinking water, due, for example to an industrial fire or explosion.

It is worth remembering that many substances are harmful in large quantities but helpful in small amounts.


Flouride exists in many water supplies, and it is added to drinking water in many countries.

fluoride in dental products
Fluoride is added to many dental products.

It is also used in the following dental products:

  • toothpaste
  • cements and fillings
  • gels and mouthwashes
  • varnishes
  • some brands of floss
  • fluoride supplements, recommended in areas where water is not fluoridated

Non-dental sources of flouride include:

  • drugs containing perfluorinated compounds
  • food and beverages made with water that contains fluoride
  • pesticides
  • waterproof and stain-resistant items with PFCs

Excess fluoride exposure may come from:

  • public water fluoridation
  • high concentrations of fluoride in natural fresh water
  • fluoridated mouthrinse or toothpaste
  • untested bottled water
  • inappropriate use of fluoride supplements
  • some foods

Not all fluoride exposure is due to adding the chemical to water and dental products.

Some geographical areas have drinking water that is naturally high in fluoride, for example, southern Asia, the eastern Mediterranean, and Africa.

Side effects

Possible side effects of excessive fluoride intake include:

  • discoloration of teeth
  • bone problems

Other possible side effects are listed under the "risks" section above.


The American Dental Association (ADA) says fluoride in water benefits communities because it:

dental check
Flouride has been linked to a reduction in tooth decay.
  • reduces tooth decay by 20 to 40 percent
  • protects against cavities
  • is safe and effective
  • saves money on dental treatment
  • is natural

Fluoride is present in natural water. Adding fluoride, says the ADA, is like fortifying milk with vitamin D, orange juice with calcium, or cereals with B vitamins and folic acid.

Studies continue to show that adding fluoride to water supports dental health.

A Cochrane review published in 2015 found that when fluoride was introduced to water:

  • Children had 35 percent fewer decayed, missing, or filled baby teeth.
  • There was a 15-percent increase in children with no decay in their baby teeth.
  • The proportion of children with no decay in their permanent teeth rose by 14 percent.

Applying fluoride on children's teeth can prevent or slow decay.

How does it work?

Fluoride prevents tooth decay by:

  • changing the structure of the developing enamel in children under the age of 7 years, so that it is more resistant to acid attack
  • eproviding an environment where better quality enamel is formed, which is more resistant to acid attack
  • reducing the ability of bacteria in plaque to produce acid

This involves the following processes:

Protection from demineralization: When bacteria in the mouth combine with sugars, they produce acid. This acid can erode tooth enamel and damage our teeth. Fluoride can protect teeth from demineralization that is caused by the acid.

Remineralization: If acid has already caused some damage to the teeth, fluoride accumulates in the demineralized areas and begins strengthening the enamel. This is remineralization.

Who benefits the most?

Everyone can benefit from added dental protection, but those who can benefit particularly are people who:

  • enjoy snacking
  • have poor dental hygiene
  • have little or no access to a dentist
  • follow diets that are high in sugars or carbohydrates
  • have had bridges, crowns, braces, and other restorative procedures
  • have a history of tooth decay or cavities

Most public health authorities and medical associations worldwide recommend that children and adults receive some fluoride, to protect their teeth from decay.


Here are some facts supporting the use of fluoride:

toothpaste and brush
Small amounts of fluoride are unlikely to be dangerous.
  • From 2000 to 2004, 125 communities in 36 states of the U.S. voted to adopt fluoridation.
  • In the right amounts, fluoride helps prevent dental decay.
  • It is similar to adding vitamins to foods.
  • Using fluoride in water to protect teeth reduces the need for costly dental procedures.
  • Over 100 national and international health and other organizations recognize the benefits of added fluoride.

Here are some arguments against its use, from the IAOMT:

  • Fluoride is a neurotoxin which, in high doses, can be harmful.
  • Excessive exposure can lead to tooth discoloration and bone problems.
  • There is enough fluoride in the water already, without adding more.
  • People have the right to choose whether or not they take medications.
  • Different people need different amounts of substances such as fluoride.
  • Current levels of fluoride in the water may not be safe.
  • It may be harmful for the environment.

A range of fluoride and fluoride-free dental products are available for purchase onlline.


The controversy continues over whether it is a good idea to add fluoride to water or not.

In 2000, German researchers reported that tooth decay fell in cities where fluoride ceased to be added to the water.

However, they called for further investigation into the reasons for this decline, which they said could be due to improved attitudes toward dental health and easier access to dental health products, compared with the years before fluoride was added.

They suggested that their findings might support the argument that caries can continue to fall if the concentration of fluoride is reduced from 1 part per million (ppm) to below 0.2 ppm.

How much fluoride is recommended?

The Department of Health and Human Services (DHHS) sets the optimal level of fluoride for preventing tooth decay at 0.7 ppm, or 0.7 milligrams (mg) in every liter of water.

The previous figure, in force from 1962 to 2015, was 0.7 to 1.2 ppm. In 2015, it was revised to the lower limit.

The aim of this optimal level is to promote public health.

What does the WHO say?

The World Health Organization (WHO) notes that long-term exposure to drinking water that contains more than 1.5 ppm fluoride can lead to health problems. The WHO's guideline limit is 1.5 ppm.

How much does the EPA allow?

The Environmental Protection Agency (EPA) aims to protect people from over-exposure to toxic chemicals.

It sets the maximum allowable level at 4 ppm, and a secondary maximum level at 2 ppm. People are asked to inform the EPA if levels are above 2 ppm. Levels above 4 ppm could be hazardous.

In areas where water naturally contains higher levels of fluoride, community water systems must ensure that the maximum level is no higher than 4 ppm.


As with any substance, excess intake or exposure can be harmful.

It is important not to use any fluoride supplements without first speaking to a dentist.

We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you. We partner with some of the companies that sell these products, which means Healthline UK and our partners may receive a portion of revenues if you make a purchase using a link(s) above.





Fifteen benefits of drinking water

By James McIntosh | Last updated Mon 16 July 2018
Reviewed by Karen Cross, FNP, MSN

Fifteen benefitsKidney damageSourcesRecommended intakeFacts

Keeping hydrated is crucial for health and well-being, but many people do not consume enough fluids each day.

Around 60 percent of the body is made up of water, and around 71 percent of the planet's surface is covered by water.

Perhaps it is the ubiquitous nature of water that means drinking enough each day is not at the top of many people's lists of priorities.

Fast facts on drinking water

  • Adult humans are 60 percent water, and our blood is 90 percent water.
  • There is no universally agreed quantity of water that must be consumed daily.
  • Water is essential for the kidneys and other bodily functions.
  • When dehydrated, the skin can become more vulnerable to skin disorders and wrinkling.
  • Drinking water instead of soda can help with weight loss.

Fifteen benefits of drinking water

Benefits of drinking water
Possible benefits of drinking water range from keeping the kidneys healthy to losing weight.

To function properly, all the cells and organs of the body need water.

Here are some reasons our body needs water:

1. It lubricates the joints

Cartilage, found in joints and the disks of the spine, contains around 80 percent water. Long-term dehydration can reduce the joints' shock-absorbing ability, leading to joint pain.

2. It forms saliva and mucus

Saliva helps us digest our food and keeps the mouth, nose, and eyes moist. This prevents friction and damage. Drinking water also keeps the mouth clean. Consumed instead of sweetened beverages, it can also reduce tooth decay.

3. It delivers oxygen throughout the body

Blood is more than 90 percent water, and blood carries oxygen to different parts of the body.

4. It boosts skin health and beauty

With dehydration, the skin can become more vulnerable to skin disorders and premature wrinkling.

5. It cushions the brain, spinal cord, and other sensitive tissues

Dehydration can affect brain structure and function. It is also involved in the production of hormones and neurotransmitters. Prolonged dehydration can lead to problems with thinking and reasoning.

6. It regulates body temperature

Water that is stored in the middle layers of the skin comes to the skin's surface as sweat when the body heats up. As it evaporates, it cools the body. In sport.

Some scientists have suggested that when there is too little water in the body, heat storage increases and the individual is less able to tolerate heat strain.

Having a lot of water in the body may reduce physical strain if heat stress occurs during exercise. However, more research is needed into these effects.

7, The digestive system depends on it

The bowel needs water to work properly. Dehydration can lead to digestive problems, constipation, and an overly acidic stomach. This increases the risk of heartburn and stomach ulcers.

8. It flushes body waste

Water is needed in the processes of sweating and removal of urine and feces.

9. It helps maintain blood pressure

A lack of water can cause blood to become thicker, increasing blood pressure.

10. The airways need it

When dehydrated, airways are restricted by the body in an effort to minimize water loss. This can make asthma and allergies worse.

11. It makes minerals and nutrients accessible

These dissolve in water, which makes it possible for them to reach different parts of the body.

12. It prevents kidney damage

The kidneys regulate fluid in the body. Insufficient water can lead to kidney stones and other problems.

13. It boosts performance during exercise

Dehydration during exercise
Dehydration during exercise may hinder performance.

Some scientists have proposed that consuming more water might enhance performance during strenuous activity.

More research is needed to confirm this, but one review found that dehydration reduces performance in activities lasting longer than 30 minutes.

14. Weight loss

Water may also help with weight loss, if it is consumed instead of sweetened juices and sodas. "Preloading" with water before meals can help prevent overeating by creating a sense of fullness.

15. It reduces the chance of a hangover

When partying, unsweetened soda water with ice and lemon alternated with alcoholic drinks can help prevent overconsumption of alcohol.

Kidney damage

Water helps dissolve minerals and nutrients, making them more accessible to the body. It also helps remove waste products.

The kidneys
The kidneys play a key role in balancing fluid levels.

These two functions make water vital to the kidneys.

Every day, the kidneys filter around 120-150 quarts of fluid.

Of these, approximately 1-2 quarts are removed from the body in the form of urine, and the rest is recovered by the bloodstream.

Water is essential for the kidneys to function.

If the kidneys do not function properly, waste products and excess fluid can build up inside the body.

Untreated, chronic kidney disease can lead to kidney failure. The organs stop working, and either dialysis or kidney transplantation is required.

Urinary tract infections (UTIs) are the second most common type of infection in the body. They account for around 8.1 million visits to health care providers in the U.S. every year.

If infections spread to the upper urinary tract, including the kidneys, permanent damage can result. Sudden, or acute, kidney infections can be life-threatening, particularly if septicemia occurs.

Drinking plenty of water is a simple way to reduce the risk of developing a UTI and to help treat an existing UTI.

Kidney stones interfere with how the kidneys work. When present, can complicate UTIs. These complicated UTIs tend to require longer periods of antibiotics to treat them, typically lasting 7 to 14 days.

The leading cause of kidney stones is a lack of water. People who report them often do not drink the recommended daily amount of water. Kidney stones may also increase the risk of chronic kidney disease.

In November 2014, the American College of Physicians issued new guidelines for people who have previously developed kidney stones. The guidelines state that increasing fluid intake to enable 2 liters of urination a day could decrease the risk of stone recurrence by at least half with no side effects.

Dehydration happens if we use and lose more water than the body takes in. It can lead to an imbalance in the body's electrolytes. Electrolytes, such as potassium, phosphate, and sodium, help carry electrical signals between cells. The kidneys keep the levels of electrolytes in the body stable when they function properly.

When the kidneys are unable to maintain a balance in the levels of electrolytes, these electrical signals become mixed up. This can lead to seizures, involving involuntary muscle movements and loss of consciousness.

In severe cases, dehydration can lead to kidney failure, which can be life-threatening. Possible complications of chronic kidney failure include anemia, damage to the central nervous system, heart failure, and a compromised immune system.


Is carbonated water bad for you?
Should I drink soda water? Find out more



Some of the water required by the body is obtained through foods with a high water content, such as soups, tomatoes, oranges, but most come through drinking water and other beverages.

During everyday functioning, water is lost by the body, and this needs to be replaced. We notice that we lose water through activities such as sweating and urination, but water is lost even when breathing.

Drinking water, whether from the tap or a bottle, is the best source of fluid for the body.

Milk and juices are also good sources of fluid, but beverages containing alcohol and caffeine, such as soft drinks, coffee, and beer, are not ideal because they often contain empty calories. Drinking water instead of soda can help with weight loss.

It was previously thought that caffeinated beverages had diuretic properties, meaning that they cause the body to release water. However, studies show that fluid loss because of caffeinated drinks is minimal.

Recommended intake

how much water
How much water we need to consume is influenced by the climate.

The amount of water needed each day varies from person to person, depending on how active they are, how much they sweat, and so on.

There is no fixed amount of water that must be consumed daily, but there is general agreement on what a healthy fluid intake is.

According to the U.S. National Academies of Sciences, Engineering, and Medicine, the average recommended daily intake of water from both food and drink is:

This would be around 15.5 cups for men and just over 11 cups for women. However, around 80 percent of this should come from drinks, including water, and the rest will be from food.

This means that:

  • Men should drink around 100 ounces, or 12.5 cups of fluid
  • Women should drink around 73 ounces, or just over 9 cups

Fresh fruits and vegetables and all non-alcoholic fluids count towards this recommendation.

Times when it is most important to drink plenty of water include:

  • when you have a fever
  • when the weather is hot
  • if you have diarrhea and vomiting
  • when you sweat a lot, for example, due to physical activity


Here are some facts about water:

  • Babies and children have a higher percentage of water than adults. When babies are born, they are about 78 percent water, but this falls to 65 percent by the age of 1 year.
  • Fatty tissue has less water than lean tissue.
  • Men have more water than women, as a percentage.

Do we drink enough water?

A study carried out by the Centers for Disease Control and Prevention (CDC) in 2013 analyzed data from the National Cancer Institute's 2007 Food Attitudes and Behaviors Survey.

Out of a sample of 3,397 adults, the researchers found:

  • 7 percent of adults reported no daily consumption of drinking water
  • 36 percent of adults reported drinking 1-3 cups of drinking water a day
  • 35 percent of adults reported drinking 4-7 cups of drinking water a day
  • 22 percent of adults reported drinking 8 cups or more a day

People were more likely to drink less than 4 cups of drinking water daily if they consumed 1 cup or less of fruits or vegetables a day.

The study only measured the intake of drinking water. Fluid can be gained from other beverages, but water is best because it is calorie-free, caffeine-free, and alcohol-free.

Seven percent of respondents reported drinking no water at all daily, and those who drank a low volume of water also consumed less fruit and vegetables. This suggests that a certain number of people are risking their health by not getting enough fluid.

Even if the respondents reporting low levels of water intake were obtaining enough fluid, it is likely that they would be obtaining it from sources that could potentially compromise their health in other ways.

"The biologic requirement for water may be met with plain water or via foods and other beverages," write the study authors. "Results from previous epidemiologic studies indicate that water intake may be inversely related to volume of calorically sweetened beverages and other fluid intake."





Water fluoridation 'does not lower IQ'

By David McNamee | Published Saturday 24 May 2014

Drinking fluoridated water does not lower IQ, according to a new study by researchers from the University of Otago in New Zealand.

Many popular theories cast suspicion on the role of water fluoridation, with some people claiming that fluoridated water is associated with a range of adverse health outcomes.

Fluoride is routinely added to drinking water in the US and other countries as a supplement to safeguard against tooth decay. However, some people object to the compulsory nature of water fluoridation.

Also, some of the concern around water fluoridation stems from conspiracy theories relating to the end of World War II. These include suggestions that the Nazi regime secretly fluoridated water supplies in an attempt to damage the pineal gland of their citizens, which some people think promotes docility in humans.

The proximity of conspiracy theories to the issue has made the debate over health risks of water fluoridation contentious. However, in 2012, researchers from Harvard University in Cambridge, MA, cast doubts on the health benefits of fluoride in water supplies.

They conducted a review of studies looking at the effects of water fluoridation on children and found that children living in high-fluoride areas "had significantly lower IQs than those who lived in low-fluoride areas."

Fluoride, the researchers said, is a chemical "with substantial evidence of developmental neurotoxicity."

THowever, these findings are challenged by a new study published in the American Journal of Public Health.

The Dunedin Multidisciplinary Study and water fluoridation

Drawing data from a large study of 1,000 people born in Dunedin in New Zealand during 1972-1973 - the Dunedin Multidisciplinary Study - researchers from the University of Otago compared the IQs of study participants who grew up in suburbs with and without fluoridated water. They also took into account to what extent the participants were exposed to fluoride toothpaste or tablets while growing up.

person filling a glass up with water from a tap
Dr. Broadbent suggests that studies finding an association between water fluoridation and reduced IQ tend to have used poor research methodology with a high risk of bias.

The IQ scores for 992 participants were examined between the ages of 7-13. Of these people, 942 were tested again at age 38. The scores of tests assessing verbal comprehension, perceptual reasoning, working memory and processing speed were also available to the Otago researchers.

The team controlled the results for factors that are known to influence IQ variation in childhood, such as the socioeconomic status of the parents, birth weight and breastfeeding, as well as achievement in secondary and tertiary education, which are thought to influence adult IQ.

Lead author Dr. Jonathan Broadbent describes the team's findings:

"Our analysis showed no significant differences in IQ by fluoride exposure, even before controlling for the other factors that might influence scores. In line with other studies, we found breastfeeding was associated with higher child IQ, and this was regardless of whether children grew up in fluoridated or non-fluoridated areas."

Dr. Broadbent suggests that studies finding an association between water fluoridation and reduced IQ tend to have used poor research methodology with a high risk of bias. Speaking to Medical News Today, he said of the Harvard study: "The authors stated that each of the articles reviewed had deficiencies, in some cases rather serious. It is a meta-analysis based on poor quality research."

He adds that the Dunedin Multidisciplinary Study, by comparison, is world-renowned for the quality of its data and rigor of its analysis.

In conclusion, Dr. Broadbent says:

"Our findings will hopefully help to put another nail in the coffin of the complete canard that fluoridating water is somehow harmful to children's development. In reality, the total opposite is true, as it helps reduce the tooth decay blighting the childhood of far too many New Zealanders."




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From Wikipedia, the free encyclopedia

This article is about the fluoride ion. For a review of fluorine compounds, see Compounds of fluorine. For the fluoride additive used in toothpasete, see Fluoride therapy. For the 2015 French film, see Floreide (film).

IUPAC name
CAS Number16984-48-8
3D model
Interactive image
PubChem CID28179
InChI          [show]
SMILES         [show]
Chemical formulaF-
Molar mass19.00 g・mol-1
Conjugate acidHydrogen fluoride
Std molar
145.58 J/mol K
Std enthalpy of

-333 kJ mol-1
Related compounds
Other anionsChloride
Except where otherwise noted, data are
giben for materials in their standard state
(at 25 ゚C[77 ゚F], 100 kPa).

Infobox references

Fluoride (/ˈflʊəraɪd, ˈflɔːr-/)[3] is an inorganic, monatomic anion with the chemical formula F- (also written [F]-), whose salts are typically white or colorless. Fluoride salts typically have distinctive bitter tastes, and are odorless. Its salts and minerals are important chemical reagents and industrial chemicals, mainly used in the production of hydrogen fluoride for fluorocarbons. Fluoride is classified as a weak base since it only partially associates in solution, but concentrated fluoride is corrosive and can attack the skin.

Fluoride is the simplest fluorine anion. In terms of charge and size, the fluoride ion resembles the hydroxide ion. Fluoride ions occur on earth in several minerals, particularly fluorite, but are only present in trace quantities in bodies of water in nature.


  1. Nomenclature
  2. Occurrence
  3. Chemical propreties
    1. 3.1 Basicity
    2. 3.2 Structure of fluoride salts
    3. 3.3 Inorganic chemistry
    4. 3.4 Naked fluoride
    5. 3.5 Biochemistry
  4. Applications
    1. 4.1 Cavity prevention
    2. 4.2 Biochemical reagent
  5. Dietary recommendations
  6. Estimated daily intake
  7. Safety
    1. 7.1 Ingestion
      1. 7.1.1 Hazard maps for fluoride in groundwater
    2. 7.2 Topical
  8. Other dericatives
  9. See also
  10. References
  11. External links


Fluorides include compounds that contain both ionic fluoride and those where fluoride does not dissociate. The nomenclature does not distinguish these situations. For example, sulfur hexafluoride and carbon tetrafluoride are not sources of fluoride ions under ordinary conditions.

The systematic name fluoride, the valid IUPAC name, is determined according to the additive nomenclature. However, the name fluoride is also used in compositional IUPAC nomenclature which does not take the nature of bonding involved into account. Fluoride is also used non-systematically, to describe compounds which release fluoride upon dissolving. Hydrogen fluoride is itself an example of a non-systematic name of this nature. However, it is also a trivial name, and the preferred IUPAC name for fluorane.[citation needed]


Fluorite crystals

Fluorine is estimated to be the 13th most abundant element in the earth's crust and is widely dispersed in nature, almost entirely in the form of fluorides. Many minerals are known, but of paramount commercial importance is fluorite (CaF2), which is roughly 49% fluoride by mass.[4] The soft, colorful mineral is found worldwide.

In water

Fluoride is naturally present at low concentration in most fresh and saltwater sources and may also be present in rainwater. Seawater fluoride levels are usually in the range of 0.86 to 1.4 mg/L, and average 1.1 mg/L[5] (milligrams per litre). For comparison, chloride concentration in seawater is about 19 g/L. The low concentration of fluoride reflects the insolubility of the alkaline earth fluorides, e.g., CaF2.

Concentrations in fresh water vary more significantly. Surface water such as rivers or lakes generally contains between 0.01?0.3 ppm.[6] Groundwater (well water) concentrations vary even more, depending on the presence of local fluoride-containing minerals. For example, natural levels of under 0.05 mg/L have been detected in parts of Canada but up to 8mg/L in parts of China; in general levels rarely exceed 10 mg/litre[7]

  • In some locations, such as Tanzania, the drinking water contains dangerously high levels of fluoride, leading to serious health problems.
  • Worldwide 50 million people receive water from water supplies that naturally have close to the "optimal level".[8]
  • In other locations the level of fluoride is very low, sometimes leading to fluoridation of public water supplies to bring the level to around 0.7-1.2 ppm.

Fluoride can be present in rain, with its concentration increasing significantly upon exposure to volcanic activity or atmospheric pollution derived from burning fossil fuels or other sorts of industry.[9][10]

In plants

All vegetation contains some fluoride, which is absorbed from soil and water.[7] Some plants concentrate fluoride from their environment more than others. All tea leaves contain fluoride; however, mature leaves contain as much as 10 to 20 times the fluoride levels of young leaves from the same plant.[11][12][13]

Chemical properties


Fluoride can act as a base. It can combine with a proton ( H+):

  F- + H+ → HF                                   (1)

This neutralization reaction forms hydrogen fluoride (HF), the conjugate acid of fluoride.

In aqueous solution, fluoride has a pKb value of 10.8. It is therefore a weak base, and tends to remain as the fluoride ion rather than generating a substantial amount of hydrogen fluoride. That is, the following equilibrium favours the left-hand side in water:

   F- + H2O ⇄ HF + HO-                              (2)

However, upon prolonged contact with moisture, soluble fluoride salts will decompose to their respective hydroxides or oxides, as the hydrogen fluoride escapes. Fluoride is distinct in this regard among the halides. The identity of the solvent can have a dramatic effect on the equilibrium shifting it to the right-hand side, greatly increasing the rate of decomposition.

Structure of fluoride salts

Salts containing fluoride are numerous and adopt myriad structures. Typically the fluoride anion is surrounded by four or six cations, as is typical for other halides. Sodium fluoride and sodium chloride adopt the same structure. For compounds containing more than one fluoride per cation, the structures often deviate from those of the chlorides, as illustrated by the main fluoride mineral fluorite (CaF2) where the Ca2+ ions are surrounded by eight F- centers. In CaCl2, each Ca2+ ion is surrounded by six Cl- centers. The difluorides of the transition metals often adopt the rutile structure whereas the dichlorides have cadmium chloride structures.

Inorganic chemistry

Upon treatment with a standard acid, fluoride salts convert to hydrogen fluoride and metal salts. With strong acids, it can be doubly protonated to give H2F+. Oxidation of fluoride gives fluorine. Solutions of inorganic fluorides in water contain F- and bifluoride HF-2.[14] Few inorganic fluorides are soluble in water without undergoing significant hydrolysis. In terms of its reactivity, fluoride differs significantly from chloride and other halides, and is more strongly solvated in protic solvents due to its smaller radius/charge ratio. Its closest chemical relative is hydroxide, since both have similar geometries.

Naked fluoride

When relatively unsolvated, for example in nonprotic solvents, fluoride anions are called "naked". Naked fluoride is a very strong Lewis base,[15] it is easily reacted with Lewis acids, forming strong adducts. Naked fluoride salts have been prepared as tetramethylammonium fluoride, tetramethylphosphonium fluoride, and tetrabutylammonium fluoride has been reported.[16] Many so-called naked fluoride sources are in fact bifluoride salts.


At physiological pHs, hydrogen fluoride is usually fully ionised to fluoride. In biochemistry, fluoride and hydrogen fluoride are equivalent. Fluorine, in the form of fluoride, is considered to be a micronutrient for human health, necessary to prevent dental cavities, and to promote healthy bone growth.[17] The tea plant (Camellia sinensis L.) is a known accumulator of fluorine compounds, released upon forming infusions such as the common beverage. The fluorine compounds decompose into products including fluoride ions.
Fluoride is the most bioavailable form of fluorine, and as such, tea is potentially a vehicle for fluoride dosing.[18] Approximately, 50% of absorbed fluoride is excreted renally with a twenty-four-hour period. The remainder can be retained in the oral cavity, and lower digestive tract. Fasting dramatically increases the rate of fluoride absorption to near 100%, from a 60% to 80% when taken with food.[18] Per a 2013 study, it was found that consumption of one litre of tea a day, can potentially supply the daily recommended intake of 4 mg per day. Some lower quality brands can supply up to a 120% of this amount. Fasting can increase this to 150%. The study indicates that tea drinking communities are at an increased risk of dental and skeletal fluorosis, in the case where water fluoridation is in effect.[18] Fluoride ion in low doses in the mouth reduces tooth decay.[19] For this reason, it is used in toothpaste and water fluoridation. At much higher doses and frequent exposure, fluoride causes health complications and can be toxic.


 See also: Flurochemical industry, Biological aspects of fluorine, and Fluorine

Fluoride salts and hydrofluoric acid are the main fluorides of industrial value. Compounds with C-F bonds fall into the realm of organofluorine chemistry. The main uses of fluoride, in terms of volume, are in the production of cryolite, Na3AlF6. It is used in aluminium smelting. Formerly, it was mined, but now it is derived from hydrogen fluoride. Fluorite is used on a large scale to separate slag in steel-making. Mined fluorite (CaF2) is a commodity chemical used in steel-making.

Hydrofluoric acid and its anhydrous form, hydrogen fluoride, is also used in the production of fluorocarbons. Hydrofluoric acid has a variety of specialized applications, including its ability to dissolve glass.[4]

Cavity prevention

 Main articles: Fluoride therapy and Water fluoridation

Fluoride is sold in tablets for
cavity prevention.

Fluoride-containing compounds, such as sodium fluoride or sodium monofluorophosphate are used in topical and systemic fluoride therapy for preventing tooth decay. They are used for water fluoridation and in many products associated with oral hygiene.[20] Originally, sodium fluoride was used to fluoridate water; hexafluorosilicic acid (H2SiF6) and its salt sodium hexafluorosilicate (Na2SiF6) are more commonly used additives, especially in the United States. The fluoridation of water is known to prevent tooth decay[21][22] and is considered by the U.S. Centers for Disease Control and Prevention as "one of 10 great public health achievements of the 20th century".[23][24] In some countries where large, centralized water systems are uncommon, fluoride is delivered to the populace by fluoridating table salt. For the method of action for cavity prevention, see Fluoride therapy. Fluoridation of water has its critics (see Water fluoridation controversy).[25] Fluoridated toothpaste is in common use, but is only effective at concentrations above 1,000 ppm, as is common in North America and Europe. [26]

Biochemical reagent

Fluoride salts are commonly used in biological assay processing to inhibit the activity of phosphatases, such as serine/threonine phosphatases.[27] Fluoride mimics the nucleophilic hydroxide ion in these enzymes' active sites.[28] Beryllium fluoride and aluminium fluoride are also used as phosphatase inhibitors, since these compounds are structural mimics of the phosphate group and can act as analogues of the transition state of the reaction.[29][30]

Dietary recommendations

The U.S. Institute of Medicine (IOM) updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for some minerals in 1997. Where there was not sufficient information to establish EARs and RDAs, an estimate designated Adequate Intake (AI) was used instead. AIs are typically matched to actual average consumption, with the assumption that there appears to be a need, and that need is met by what people consume. The current AI for women 19 years and older is 3.0 mg/day (includes pregnancy and lactation). The AI for men is 4.0 mg/day. The AI for children ages 1-18 increases from 0.7 to 3.0 mg/day. The major known risk of fluoride deficiency appears to be an increased risk of bacteria-caused tooth cavities. As for safety, the IOM sets Tolerable upper intake levels (ULs) for vitamins and minerals when evidence is sufficient. In the case of fluoride the UL is 10 mg/day. Collectively the EARs, RDAs, AIs and ULs are referred to as Dietary Reference Intakes (DRIs).[31]

The European Food Safety Authority (EFSA) refers to the collective set of information as Dietary Reference Values, with Population Reference Intake (PRI) instead of RDA, and Average Requirement instead of EAR. AI and UL defined the same as in United States. For women ages 18 and older the AI is set at 2.9 mg/day (includes pregnancy and lactation). For men the value is 3.4 mg/day. For children ages 1-17 years the AIs increase with age from 0.6 to 3.2 mg/day. These AIs are comparable to the U.S. AIs.[32] The EFSA reviewed safety evidence and set an adult UL at 7.0 mg/day (lower for children).[33]

For U.S. food and dietary supplement labeling purposes the amount of a vitamin or mineral in a serving is expressed as a percent of Daily Value (%DV). Although there is information to set Adequate Intake, fluoride does not have a Daily Value and is not required to be shown on food labels.[34]

Estimated daily intake

Daily intakes of fluoride can vary significantly according to the various sources of exposure. Values ranging from 0.46 to 3.6-5.4 mg/day have been reported in several studies (IPCS, 1984).[17] In areas where water is fluoridated this can be expected to be a significant source of fluoride, however fluoride is also naturally present in virtually all foods and beverages at wide range of concentrations.[35] The maximum safe daily consumption of fluoride is 10 mg/day for an adult (U.S.) or 7 mg/day (European Union).[31][33]

The upper limit of fluoride intake from all sources (fluoridated water, food, beverages, fluoride dental products and dietary fluoride supplements) is set at 0.10 mg/kg/day for infants, toddlers, and children through to 8 years old. For older children and adults, who are no longer at risk for dental fluorosis, the upper limit of fluoride is set at 10 mg/day regardless of weight. [36]

Examples of fluoride content
(mg per 1000g / ppm)
(mg per portion)
Black tea (brewed)3.731 cup, 240 g (8 fl oz)0.884
Raisins, seedless2.34small box, 43 g (1.5 oz)0.101
Table wine1.53Bottle, 750 ml (26.4 fl oz)1.150
Municipal tap-water,
0.81Recommended daily intake,
3 litres (0.79 US gal)
Baked potatoes, Russet0.45Medium potato, 140 g (0.3 lb)0.078
Lamb0.32Chop, 170 g (6 oz)0.054
Carrots0.031 large carrot, 72 g (2.5 oz)0.002

Data taken from United States Department of Agriculture, National Nutrient Database


 Main article: Fluoride toxicity


According to the U.S. Department of Agriculture, the Dietary Reference Intakes, which is the "highest level of daily nutrient intake that is likely to pose no risk of adverse health effects" specify 10 mg/day for most people, corresponding to 10 L of fluoridated water with no risk. For infants and young children the values are smaller, ranging from 0.7 mg/d for infants to 2.2 mg/d.[37] Water and food sources of fluoride include community water fluoridation, seafood, tea, and gelatin.[38]

Soluble fluoride salts, of which sodium fluoride is the most common, are toxic, and have resulted in both accidental and self-inflicted deaths from acute poisoning.[4] The lethal dose for most adult humans is estimated at 5 to 10 g (which is equivalent to 32 to 64 mg/kg elemental fluoride/kg body weight).[39][40][41] A case of a fatal poisoning of an adult with 4 grams of sodium fluoride is documented,[42] and a dose of 120 g sodium fluoride has been survived.[43] For sodium fluorosilicate (Na2SiF6), the median lethal dose (LD50) orally in rats is 0.125 g/kg, corresponding to 12.5 g for a 100 kg adult.[44]

Treatment may involve oral administration of dilute calcium hydroxide or calcium chloride to prevent further absorption, and injection of calcium gluconate to increase the calcium levels in the blood.[42] Hydrogen fluoride is more dangerous than salts such as NaF because it is corrosive and volatile, and can result in fatal exposure through inhalation or upon contact with the skin; calcium gluconate gel is the usual antidote.[45]

In the higher doses used to treat osteoporosis, sodium fluoride can cause pain in the legs and incomplete stress fractures when the doses are too high; it also irritates the stomach, sometimes so severely as to cause ulcers. Slow-release and enteric-coated versions of sodium fluoride do not have gastric side effects in any significant way, and have milder and less frequent complications in the bones.[46] In the lower doses used for water fluoridation, the only clear adverse effect is dental fluorosis, which can alter the appearance of children's teeth during tooth development; this is mostly mild and is unlikely to represent any real effect on aesthetic appearance or on public health.[47] Fluoride was known to enhance the measurement of bone mineral density at the lumbar spine, but it was not effective for vertebral fractures and provoked more non vertebral fractures.[48]

A popular urban myth claims that the Nazis used fluoride in concentration camps, but there is no historical evidence to prove this claim.[49]

In areas that have naturally occurring high levels of fluoride in groundwater which is used for drinking water, both dental and skeletal fluorosis can be prevalent and severe.[50]

Hazard maps for fluoride in groundwater

Around one-third of the human population drinks water from groundwater resources. Of this, about 10%, approximately three hundred million people, obtains water from groundwater resources that are heavily contaminated with arsenic or fluoride.[51] These trace elements derive mainly from minerals.[52] Maps are available of locations of potential problematic wells.[53]


Concentrated fluoride solutions are corrosive.[54] Gloves made of nitrile rubber are worn when handling fluoride compounds. The hazards of solutions of fluoride salts depend on the concentration. In the presence of strong acids, fluoride salts release hydrogen fluoride, which is corrosive, especially toward glass.[4]

Other derivatives

Organic and inorganic anions are produced from fluoride, including:

See also


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  4. Aigueperse, Jean; Mollard, Paul; Devilliers, Didier; Chemla, Marius; Faron, Robert; Romano, Rene; Cuer, Jean Pierre (2000). "Fluorine Compounds, Inorganic". Fluorine Compounds, Inorganic. Ullmann's Encyclopedia of Industrial Chemistry. doi:10.1002/14356007.a11_307. ISBN 3527306730.
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