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 young children the values are smaller, ranging from 0.7 mg/d to 2.2 mg/d for infants. Water and food sources of fluoride include community water fluoridation, seafood, tea, and gelatin.
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. The lethal dose for most adult humans is estimated at 5 to 10 g (which is equivalent to 32 to 64 mg elemental fluoride per kg body weight). A case of a fatal poisoning of an adult with 4 grams of sodium fluoride is documented, and a dose of 120 g sodium fluoride has been survived. For sodium fluorosilicate (NaSiF), the median lethal dose (LD) orally in rats is 125 mg/kg, corresponding to 12.5 g for a 100 kg adult.
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. 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.
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. 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. 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. 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.
A popular urban myth claims that the Nazis used fluoride in concentration camps, but there is no historical evidence to prove this claim.