Editing Fluoride (section)

=== Ingestion ===
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&nbsp;mg/day for most people, corresponding to 10 L of fluoridated water with no risk. For young children the values are smaller, ranging from 0.7&nbsp;mg/d to 2.2&nbsp;mg/d for infants.<ref>{{cite web|title=Dietary Reference Intakes: EAR, RDA, AI, Acceptable Macronutrient Distribution Ranges, and UL |url=http://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables-and-application-reports|publisher=United States Department of Agriculture|access-date=9 September 2017}}</ref> Water and food sources of fluoride include community water fluoridation, seafood, tea, and gelatin.<ref>{{cite web|title=Fluoride in diet|url=https://www.nlm.nih.gov/medlineplus/ency/article/002420.htm|publisher=U.S. National Library of Medicine|access-date=10 March 2016}}</ref>

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 toxicity|acute poisoning]].<ref name=Aigueperse/> The lethal dose for most adult humans is estimated at 5 to 10&nbsp;g (which is equivalent to 32 to 64&nbsp;mg elemental fluoride per kg body weight).<ref>{{cite book | last = Gosselin | first = RE |author2=Smith RP |author3=Hodge HC | title = Clinical toxicology of commercial products | publisher = Williams & Wilkins| location = Baltimore (MD) | year = 1984 | pages =III–185–93| isbn =978-0-683-03632-9 }}</ref><ref>{{cite book |last=Baselt |first=RC |url=https://archive.org/details/dispositionoftox0000base_v7n5/page/636/mode/2up |title=Disposition of toxic drugs and chemicals in man |publisher=Biomedical Publications |year=2008 |isbn=978-0-9626523-7-0 |location=Foster City (CA) |pages=636–40 |url-access=registration}}</ref><ref>{{cite book | last = IPCS | title = Environmental health criteria 227 (Fluoride) | publisher = International Programme on Chemical Safety, World Health Organization| location = Geneva | year = 2002 | page =100| isbn =978-92-4-157227-9}}</ref> A case of a fatal poisoning of an adult with 4&nbsp;grams of sodium fluoride is documented,<ref name=acute/> and a dose of 120&nbsp;g sodium fluoride has been survived.<ref>{{cite journal |vauthors=Abukurah AR, ((Moser AM Jr)), Baird CL, ((Randall RE Jr)), Setter JG, Blanke RV | title=Acute sodium fluoride poisoning | journal=JAMA | year=1972 | pages=816–7 | volume=222 | issue=7 | pmid=4677934 | doi=10.1001/jama.1972.03210070046014}}</ref> For [[sodium fluorosilicate]] (Na<sub>2</sub>SiF<sub>6</sub>), the [[median lethal dose]] (LD<sub>50</sub>) orally in rats is 125&nbsp;mg/kg, corresponding to 12.5&nbsp;g for a 100&nbsp;kg adult.<ref name="merck">The Merck Index, 12th edition, Merck & Co., Inc., 1996</ref>

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.<ref name=acute>{{cite journal|pmid=20323400|pmc=1581810|year=1945|last1=Rabinowitch|first1=IM|title=Acute Fluoride Poisoning|volume=52|issue=4|pages=345–9|journal=Canadian Medical Association Journal}}</ref> [[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.<ref>{{cite journal |vauthors=Muriale L, Lee E, Genovese J, Trend S | year = 1996 | title = Fatality due to acute fluoride poisoning following dermal contact with hydrofluoric acid in a palynology laboratory | journal = Ann. Occup. Hyg. | volume = 40 | issue = 6| pages = 705–710 | pmid = 8958774 | doi = 10.1016/S0003-4878(96)00010-5 }}</ref>

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.<ref>{{cite journal |vauthors=Murray TM, Ste-Marie LG |title=Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 7. Fluoride therapy for osteoporosis |journal=CMAJ |volume=155 |issue=7 |pages=949–54 |year=1996 |pmid=8837545 |pmc=1335460}}</ref> 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 [[Human tooth development|tooth development]]; this is mostly mild and is unlikely to represent any real effect on aesthetic appearance or on public health.<ref>{{cite book |url=http://nhmrc.gov.au/_files_nhmrc/file/publications/synopses/Eh41_Flouridation_PART_A.pdf |year=2007 |title=A systematic review of the efficacy and safety of fluoridation |author=National Health and Medical Research Council (Australia) |isbn=978-1-86496-415-8 |access-date=2010-02-21 |archive-url=https://web.archive.org/web/20091014191758/http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/Eh41_Flouridation_PART_A.pdf |archive-date=2009-10-14 |url-status=dead }} Summary: {{cite journal |author= Yeung CA |title= A systematic review of the efficacy and safety of fluoridation |journal= Evid.-Based Dent. |volume=9 |issue=2 |pages=39–43 |year=2008 |pmid=18584000 |doi=10.1038/sj.ebd.6400578 |doi-access=free }}</ref> Fluoride was known to enhance bone mineral density at the lumbar spine, but it was not effective for vertebral fractures and provoked more nonvertebral fractures.<ref>{{cite journal|last=Haguenauer|first=D|author2=Welch, V |author3=Shea, B |author4=Tugwell, P |author5=Adachi, JD |author6= Wells, G |title=Fluoride for the treatment of postmenopausal osteoporotic fractures: a meta-analysis.|journal=Osteoporosis International |date=2000|volume=11|issue=9|pages=727–38|pmid=11148800 |doi=10.1007/s001980070051|s2cid=538666}}</ref> In areas that have naturally occurring high levels of fluoride in [[groundwater]] which is used for [[drinking water]], both [[dental fluorosis|dental]] and [[skeletal fluorosis]] can be prevalent and severe.<ref>{{cite web |author=World Health Organization |year=2004 |title=Fluoride in drinking-water |url=https://www.who.int/water_sanitation_health/dwq/chemicals/en/fluoride.pdf |url-status=dead |archive-url=https://web.archive.org/web/20160304082148/http://www.who.int/water_sanitation_health/dwq/chemicals/en/fluoride.pdf |archive-date=2016-03-04 |access-date=2014-02-13}}</ref>

==== Hazard maps for fluoride in groundwater ====

Around one-third of the human population drinks water from groundwater resources. Of this, about 10%, approximately 300 million people, obtain water from groundwater resources that are heavily contaminated with arsenic or fluoride.<ref>Eawag (2015) Geogenic Contamination Handbook – Addressing Arsenic and Fluoride in Drinking Water. C.A. Johnson, A. Bretzler (Eds.), Swiss Federal Institute of Aquatic Science and Technology (Eawag), Duebendorf, Switzerland. (download: www.eawag.ch/en/research/humanwelfare/drinkingwater/wrq/geogenic-contamination-handbook/)</ref>  These trace elements derive mainly from minerals.<ref>{{cite journal | last1 = Rodríguez-Lado | first1 = L. | last2 = Sun | first2 = G. | last3 = Berg | first3 = M. | last4 = Zhang | first4 = Q. | last5 = Xue | first5 = H. | last6 = Zheng | first6 = Q. | last7 = Johnson | first7 = C.A. | year = 2013 | title = Groundwater arsenic contamination throughout China | url = https://www.dora.lib4ri.ch/eawag/islandora/object/eawag%3A7346| journal = Science | volume = 341 | issue = 6148| pages = 866–868 | doi = 10.1126/science.1237484 | pmid = 23970694 | bibcode = 2013Sci...341..866R | s2cid = 206548777 }}</ref> Maps locating potential problematic wells are available.<ref>[http://www.gapmaps.org Groundwater Assessment Platform]</ref>