Health implications of chronic fluoride exposure in children and young adults: a systematic review

Abstract

Fluoride is widely recognized for its caries-preventive benefits; however, chronic exposure, particularly in children and young adults, raises significant public health concerns. The study assessed the health implications of prolonged fluoride exposure in individuals aged 0-30 years. A systematic search was conducted across major databases (PubMed, Scopus, Web of Science) following the PRISMA guidelines and CASP tools for quality assessment. Of the 1,020 articles, 34 studies were selected. Findings showed that while low fluoride concentrations (0.1-1.5 mg/L) effectively prevent dental caries, prolonged high-dose exposure is associated with adverse outcomes. Reported associations included dental fluorosis, reproductive disturbances, cognitive and neurodevelopmental impairments; mechanistic studies provided biological plausibility for several proposed toxicity pathways. Studies linked elevated levels with reduced IQ in children, raising concerns about long-term developmental health. Although impacts on bone and endocrine systems were inconsistent/inconclusive across different populations, potential systemic toxicity is not negligible. Chronic fluoride exposure is of human pathological importance. It highlights the importance of region-specific risk assessment, particularly in areas with fluoridated water or high fluoride levels. Further research, particularly using multi-omics approaches, is critical to uncover molecular mechanisms underlying fluoride toxicity. Balancing dental benefits with systemic risks requires urgent, evidence-based public health policies and exposure control strategies.