Fluoride in Water and Dental or Skeletal Fluorosis

There is no good evidence of any adverse medical effects associated with the consumption of water with fluoride naturally or artificially added at a concentration of 0.5 – 1.0 mg / litre other than the increase in dental fluorosis. US studies in areas with natural fluoride levels of up to 8 mg / litre found no clinical evidence of harm. However there is clear evidence from India and China that skeletal fluorosis and an increased risk of bone fractures occur as a result of long-term excessive exposure to fluoride (total intakes of 14 mg fluoride per day), and evidence suggestive of an increased risk of bone effects at total intakes above about 6 mg fluoride per day.