Fluoride Toxicity and Benefit: An Integrated Review of Mechanisms, Risks, and Public Health Impact

Fluoride has long been praised for its role in preventing dental caries, primarily through its effects on enamel remineralization and antibacterial effects. However, growing evidence from molecular and cellular studies suggests that excessive fluoride exposure, especially during tooth development, can lead to dental fluorosis and systemic toxicity. This paper examines the biological mechanisms underlying fluoride-induced dental fluorosis, with a focus on stress responses in ameloblasts, oxidative damage, impaired autophagy, and disrupted protein processing. It integrates data from in vitro, in vivo, and human studies to evaluate the cellular thresholds at which fluoride shifts from therapeutic to toxic. Systemic risks, including genotoxicity, neurotoxicity, and individual and population-level susceptibility were examined. While fluoride’s benefits in caries prevention are significant, the narrow margin of safety, cumulative exposure from various sources, and individual tolerance differences call for reconsidering current water fluoridation levels. Targeted fluoride delivery and risk-based guidelines may offer a more biologically sound strategy for preserving oral health while reducing unintended harm. A significant portion of the literature reviewed in this thesis is over a decade old. This underscores the need for updated research examining both the local effects of fluoride within the oral cavity and its broader systemic impacts. Future studies should aim to address these gaps using modern methodologies to reassess fluoride’s safety profile and therapeutic applications.