PUBLIC HEALTH STATEMENT 

 FLUORIDES CAS#: Hydrogen Fluoride 7664-39-3 

 Fluorine 7782-41-4 

 Sodium Fluoride 7681-49-4

Division of Toxicology September 2003 

__________________________________________________________________________________________

DEPARTMENT of HEALTH AND HUMAN SERVICES, Public Health Service

Agency for Toxic Substances and Disease Registry 

www.atsdr.cdc.gov/ Telephone: 1-888-422-8737 Fax: 770-488-4178 E-Mail: atsdric@cdc.gov 

This Public Health Statement is the summary 

chapter from the Toxicological Profile for 

Fluorides, Hydrogen Fluoride, and Fluorine. It is 

one in a series of Public Health Statements about 

hazardous substances and their health effects. A 

shorter version, the ToxFAQsTM is also available. 

This information is important because this 

substance may harm you. The effects of exposure to 

any hazardous substance depend on the dose, the 

duration, how you are exposed, personal traits and 

habits, and whether other chemicals are present. For 

more information, call the ATSDR Information 

Center at 1-888-422-8737. 

_____________________________________ 

This public health statement tells you about 

fluorides, hydrogen fluoride, and fluorine and the 

effects of exposure presented in the toxicological 

profile. These profiles were specifically prepared by 

ATSDR for hazardous substances which are most 

commonly found at facilities on the CERCLA 

National Priorities List (Superfund sites) and are 

intended to describe the effects of exposure from 

chemicals at these sites. 

The Environmental Protection Agency (EPA) 

identifies the most serious hazardous waste sites in 

the nation. These sites make up the National 

Priorities List (NPL) and are the sites targeted for 

long-term federal cleanup activities. Fluorides, 

hydrogen fluoride, and fluorine have been found in 

at least 188 of the 1,636 current or former NPL 

sites. However, the total number of NPL sites 

evaluated for these substances is not known. As 

more sites are evaluated, the sites at which 

fluorides, hydrogen fluoride, and fluorine is found 

may increase. This information is important because 

exposure to these substances may harm you and 

because these sites may be sources of exposure. 

When a substance is released from a large area, 

such as an industrial plant, or from a container, such 

as a drum or bottle, it enters the environment. This 

release does not always lead to exposure. You are 

exposed to a substance only when you come in 

contact with it. You may be exposed by breathing, 

eating, or drinking the substance, or by skin contact. 

If you are exposed to fluorides, hydrogen fluoride, 

and fluorine, many factors determine whether you'll 

be harmed. These factors include the dose (how 

much), the duration (how long), and how you come 

in contact with it/them. You must also consider the 

other chemicals you're exposed to and your age, 

sex, diet, family traits, lifestyle, and state of health. 

 

 

1.1 WHAT ARE FLUORINE, HYDROGEN 

FLUORIDE, AND FLUORIDES? 

Fluorides are properly defined as binary compounds 

or salts of fluorine and another element. Examples 

of fluorides include sodium fluoride and calcium 

fluoride. Both are white solids. Sodium fluoride 

readily dissolves in water, but calcium fluoride does 

not. Sodium fluoride is often added to drinking 

water supplies and to a variety of dental products, 

including toothpastes and mouth rinses to prevent 

dental cavities. Other fluoride compounds that are 

commonly used for water fluoridation are 

fluorosilicic acid and sodium fluorosilicate. 

Calcium fluoride is the compound in the common 

minerals fluorite and fluorspar. Fluorspar is the 

mineral from which hydrogen fluoride is produced. 

It is also used in the production of glass and enamel 
 PUBLIC HEALTH STATEMENT 

 FLUORIDES CAS#: Hydrogen Fluoride 7664-39-3 

 Fluorine 7782-41-4 

 Sodium Fluoride 7681-49-4

Division of Toxicology September 2003 

__________________________________________________________________________________________

DEPARTMENT of HEALTH AND HUMAN SERVICES, Public Health Service

Agency for Toxic Substances and Disease Registry 

www.atsdr.cdc.gov/ Telephone: 1-888-422-8737 Fax: 770-488-4178 E-Mail: atsdric@cdc.gov 

and in the steel industry. In this profile, we will 

often use the term "fluoride" to include substances 

that contain the element fluorine. The reason for 

this is that we generally measure the amount of 

fluorine in a substance rather than the amount of a 

particular fluorine compound. 

Fluorine is a naturally occurring, widely distributed 

element and a member of the halogen family, which 

includes chlorine, bromine, and iodine. However, 

the elemental form of fluorine, a pale yellow-green, 

irritating gas with a sharp odor, is so chemically 

reactive that it rarely occurs naturally in the 

elemental state. Fluorine occurs in ionic forms, or 

combined with other chemicals in minerals like 

fluorspar, fluorapatite, and cryolite, and other 

compounds. (Ions are atoms, collections of atoms, 

or molecules containing a positive or negative 

electric charge.) Fluorine gas reacts with most 

organic and inorganic substances; with metals, it 

forms fluorides and with water, it forms 

hydrofluoric acid. Fluorine gas is primarily used to 

make certain chemical compounds, the most 

important of which is uranium hexafluoride, used in 

separating isotopes of uranium for use in nuclear 

reactors and nuclear weapons. 

Hydrogen fluoride is a colorless, corrosive gas or 

liquid (it boils at 19.5 °C) that is made up of a 

hydrogen atom and a fluorine atom. It fumes 

strongly, readily dissolves in water, and both the 

liquid and vapor will cause severe burns upon 

contact. The dissolved form is called hydrofluoric 

acid. It is known for its ability to etch glass. 

Commercially, hydrogen fluoride is the most 

important fluorine compound. Its largest use is in 

the manufacture of fluorocarbons, which are used as 

refrigerants, solvents, and aerosols. 

1.2 WHAT HAPPENS TO FLUORINE, 

HYDROGEN FLUORIDE, AND 

FLUORIDES WHEN THEY ENTER THE 

ENVIRONMENT? 

Fluorides occur naturally in the earth's crust where 

they are found in rocks, coal, clay, and soil. They 

are released into the air in wind-blown soil. 

Hydrogen fluoride is released to the air from 

fluoride-containing substances, including coal, 

minerals, and clays, when they are heated to high 

temperatures. This may occur in coal-fired power 

plants; aluminum smelters; phosphate fertilizer 

plants; glass, brick, and tile works; and plastics 

factories. These facilities may also release fluorides 

attached to particles. The biggest natural source of 

hydrogen fluoride and other fluorides released to 

the air is volcanic eruptions. 

Fluorine cannot be destroyed in the environment; it 

can only change its form. Fluorides released into the 

atmosphere from volcanoes, power plants, and other 

high temperature processes are usually hydrogen 

fluoride gas or attached to very small particles. 

Fluorides contained in wind-blown soil are 

generally found in larger particles. These particles 

settle to the ground or are washed out of the air by 

rain. Fluorides that are attached to very small 

particles may stay in the air for many days. 

Hydrogen fluoride gas will be absorbed by rain and 

into clouds and fog to form aqueous hydrofluoric 

acid, which will fall to the ground mainly in 

precipitation. The fluorides released into air will 

eventually fall on land or water. 

In water, fluorides associate with various elements 

present in the water, mainly with aluminum in 

freshwater and calcium and magnesium in seawater, 
 PUBLIC HEALTH STATEMENT 

 FLUORIDES CAS#: Hydrogen Fluoride 7664-39-3 

 Fluorine 7782-41-4 

 Sodium Fluoride 7681-49-4

Division of Toxicology September 2003 

__________________________________________________________________________________________

DEPARTMENT of HEALTH AND HUMAN SERVICES, Public Health Service

Agency for Toxic Substances and Disease Registry 

www.atsdr.cdc.gov/ Telephone: 1-888-422-8737 Fax: 770-488-4178 E-Mail: atsdric@cdc.gov 

and settle into the sediment where they are strongly 

attached to sediment particles. When deposited on 

land, fluorides are strongly retained by soil, forming 

strong associations with soil components. Leaching 

removes only a small amount of fluorides from 

soils. Fluorides may be taken up from soil and 

accumulate in plants, or they may be deposited on 

the upper parts of the plants in dust. The amount of 

fluoride taken up by plants depends on the type of 

plant, the nature of the soil, and the amount and 

form of fluoride in the soil. Tea plants are known to 

accumulate fluoride in their leaves. Animals that eat 

fluoride-containing plants may accumulate fluoride. 

However, the fluoride accumulates primarily in the 

bones or shell rather than in edible meat. 

1.3 HOW MIGHT I BE EXPOSED TO 

FLUORINE, HYDROGEN FLUORIDE, 

AND FLUORIDES? 

Fluoride is a natural component of the earth's crust 

and soil. Small amounts of fluorides are present in 

water, air, plants, and animals. You may be exposed 

to small amounts of fluoride by breathing air, 

drinking water, and eating food. In particular, 

fluorides are frequently added to drinking water 

supplies at approximately 1 part of fluoride per 

million parts of water (ppm) and to toothpaste and 

mouth rinses to prevent dental decay. Analytical 

methods used by scientists to determine the levels 

of fluoride in the environment generally do not 

determine the specific form of fluoride present. 

Therefore, we do not always know the form of 

fluoride that a person may be exposed to. Similarly, 

we do not know what forms of fluoride are present 

at hazardous waste sites. Some forms of fluoride 

may be insoluble or so tightly attached to particles 

or embedded in minerals that they are not taken up 

by plants or animals. 

Fluorides are normally found in very small amounts 

in the air. Levels measured in areas around cities are 

usually less than 1 microgram (one millionth of a 

gram) of fluoride per cubic meter (μg/m3) of air. 

Rural areas have even lower levels. The amount of 

fluoride that you breathe in a day is much less than 

what you consume in food and water. You may 

breathe in higher levels of fluoride in areas near 

coal-fired power plants or fluoride-related industries 

(e.g., aluminum smelters, phosphorus fertilizer 

plants) or near hazardous waste sites. 

Levels of fluorides in surface water average about 

0.2 parts of fluoride per million parts of water 

(ppm). Levels of fluorides in well water generally 

range from 0.02 to 1.5 ppm, but often exceed 1.5 

ppm in parts of the southwest United States. Many 

communities fluoridate their water supplies; the 

recommended level of fluoride is around 1 ppm. In 

the United States, approximately 15,000 water 

systems serving about 162 million people are 

fluoridated in the optimal range of 0.7-1.2 ppm, 

either occurring naturally or through adjustment. 

Persons living in non-fluoridated areas may receive 

water exposure through beverages and foods 

processed in fluoridated areas. You will be exposed 

to fluorides in the water that you drink or in 

beverages prepared with fluoridated water. 

The concentration of fluorides in soils is usually 

between 200 and 300 ppm. However, levels may be 

higher in areas containing fluoride-containing 

mineral deposits. Higher levels may also occur 

where phosphate fertilizers are used, where coalfired power plants or fluoride-releasing industries 
 PUBLIC HEALTH STATEMENT 

 FLUORIDES CAS#: Hydrogen Fluoride 7664-39-3 

 Fluorine 7782-41-4 

 Sodium Fluoride 7681-49-4

Division of Toxicology September 2003 

__________________________________________________________________________________________

DEPARTMENT of HEALTH AND HUMAN SERVICES, Public Health Service

Agency for Toxic Substances and Disease Registry 

www.atsdr.cdc.gov/ Telephone: 1-888-422-8737 Fax: 770-488-4178 E-Mail: atsdric@cdc.gov 

are located, or in the vicinity of hazardous waste 

sites. You may be exposed to fluorides through 

dermal contact with these soils. 

You may also be exposed to fluorides in your diet. 

While food generally contains low levels of 

fluoride, food grown in areas where soils have high 

amounts of fluorides or where phosphate fertilizers 

are used may have higher levels of fluorides. Tea 

and some seafoods have been found to have high 

levels of fluorides. The average daily fluoride intake 

by adults from food and water is estimated to be 1 

milligram (mg) if you live in a community with 

<0.7 ppm in your water, and about 2.7 mg if you 

have fluoridated water. You can contact your local 

water system to determine the level of fluoride in 

your drinking water or refer to the annual Consumer 

Confidence Report furnished by your water system 

operators. You may also be exposed to fluoride in 

dental products, such as toothpastes, fluoride gels, 

and fluoride rinses. Dental products used in the 

home such as toothpastes, rinses, and topically 

applied gels contain high concentrations of fluoride 

(range 230-12,300 ppm) and are not intended to be 

ingested. The most commonly used dental products, 

toothpastes, contain 900-1,100 ppm fluoride (ca. 

0.10%), most often as sodium fluoride. If you 

swallow these products, you will be exposed to 

higher levels of fluoride. Swallowing toothpaste can 

account for a large percentage of the fluoride to 

which a child <8 years of age might be exposed The 

Food and Drug Administration requires that 

toothpaste tubes be labeled with instructions to 

minimize ingestion of fluoride by children including 

the use of a "pea-sized" amount of paste and 

parental supervision of brushing. 

You may also be exposed to higher levels of 

fluoride if you work in industries where fluoridecontaining substances are used, most notably in the 

electronics industry where hydrogen fluoride may 

be used to etch glass in TV picture tubes or to clean 

silicon chips and in aluminum and phosphate 

fertilizer plants. Exposure will primarily result from 

breathing in hydrogen fluoride or fluoridecontaining dust. Exposure will be reduced if exhaust 

systems or protective masks are used in the 

workplace. 

1.4 HOW CAN FLUORINE, HYDROGEN 

FLUORIDE, AND FLUORIDES ENTER 

AND LEAVE MY BODY? 

Generally, most of the fluoride in food or water that 

you swallow enters your bloodstream quickly 

through the digestive tract. However, the amount 

that enters your bloodstream also depends on 

factors such as how much of the fluoride you 

swallowed, how well the fluoride dissolves in 

water, whether you ate or drank recently, and what 

you ate or drank. Factors such as age and health 

status affect what happens to the fluoride ion once it 

is in your body. After entering your body, about 

half of the fluoride leaves the body quickly in urine, 

usually within 24 hours unless large amounts (20 

mg or more, which is the amount in 20 or more 

liters of optimally fluoridated water) are ingested. 

Most of the fluoride ion that stays in your body is 

stored in your bones and teeth. 

When you breathe in air containing hydrogen 

fluoride or fluoride dusts, it enters your bloodstream 

quickly through your lungs. When hydrofluoric acid 

touches skin, most of it can quickly pass through the 

skin into the blood. How much of it enters your 
 PUBLIC HEALTH STATEMENT 

 FLUORIDES CAS#: Hydrogen Fluoride 7664-39-3 

 Fluorine 7782-41-4 

 Sodium Fluoride 7681-49-4

Division of Toxicology September 2003 

__________________________________________________________________________________________

DEPARTMENT of HEALTH AND HUMAN SERVICES, Public Health Service

Agency for Toxic Substances and Disease Registry 

www.atsdr.cdc.gov/ Telephone: 1-888-422-8737 Fax: 770-488-4178 E-Mail: atsdric@cdc.gov 

bloodstream depends on how concentrated the 

hydrofluoric acid is and how long it stays on your 

skin. Almost all of the fluoride that enters the body 

in these ways is quickly removed from the body in 

the urine, but some is stored in your bones and 

teeth. 

When you breathe in air containing fluorine, 

fluoride can enter your bloodstream through your 

lungs, but it is not known how quickly this happens. 

Much of the fluoride leaves your body in urine, but 

some is stored in your bones and teeth. Exposure to 

fluorine gas is uncommon, except in industrial 

settings. 

1.5 HOW CAN FLUORINE, HYDROGEN 

FLUORIDE, AND FLUORIDES AFFECT 

MY HEALTH? 

To protect the public from the harmful effects of 

toxic chemicals and to find ways to treat people 

who have been harmed, scientists use many tests. 

One way to see if a chemical will hurt people is to 

learn how the chemical is absorbed, used, and 

released by the body; for some chemicals, animal 

testing may be necessary. Animal testing may also 

be used to identify health effects such as cancer or 

birth defects. Without laboratory animals, scientists 

would lose a basic method to get information 

needed to make wise decisions to protect public 

health. Scientists have the responsibility to treat 

research animals with care and compassion. Laws 

today protect the welfare of research animals, and 

scientists must comply with strict animal care 

guidelines and must be recertified regularly with 

training in updated and new guidelines. 

Fluorides. Several medicines that contain fluoride 

are used for treating skin diseases (e.g., flucytosine, 

an antifungal) and some cancers (e.g., fluorouracil, 

an antimetabolite). 

Small amounts of fluoride are added to toothpaste 

or drinking water to help prevent dental decay. 

However, exposure to higher levels of fluoride may 

harm your health. Skeletal fluorosis can be caused 

by eating, drinking, or breathing very large amounts 

of fluorides. This disease only occurs after longterm exposures and can cause denser bones, joint 

pain, and a limited range of joint movement. In the 

most severe cases, the spine is completely rigid. 

Skeletal fluorosis is extremely rare in the United 

States; it has occurred in some people consuming 

greater than 30 times the amount of fluoride 

typically found in fluoridated water. It is more 

common in places where people do not get proper 

nutrition. At fluoride levels 5 times greater than 

levels typically found in fluoridated water, fluoride 

can result in denser bones. However, these bones 

are often more brittle or fragile than normal bone 

and there is an increased risk of older men and 

women breaking a bone. Some studies have also 

found a higher risk of bone fractures in older men 

and women at fluoride levels typically found in 

fluoridated water. However, other studies have not 

found an effect at this fluoride dose. If you eat large 

amounts of sodium fluoride at one time, it can cause 

stomachaches, vomiting, and diarrhea. Extremely 

large amounts can cause death by affecting your 

heart. 

We do not know if eating, drinking, or breathing 

fluoride can cause reproductive effects in humans. 

Reproductive effects, such as decreased fertility and 

sperm and testes damage, have been seen in 
 PUBLIC HEALTH STATEMENT 

 FLUORIDES CAS#: Hydrogen Fluoride 7664-39-3 

 Fluorine 7782-41-4 

 Sodium Fluoride 7681-49-4

Division of Toxicology September 2003 

__________________________________________________________________________________________

DEPARTMENT of HEALTH AND HUMAN SERVICES, Public Health Service

Agency for Toxic Substances and Disease Registry 

www.atsdr.cdc.gov/ Telephone: 1-888-422-8737 Fax: 770-488-4178 E-Mail: atsdric@cdc.gov 

laboratory animals at extremely high doses (more 

than 100 times higher than levels found in 

fluoridated water). However, other studies have not 

found any reproductive effects in laboratory 

animals. 

A number of studies have been done to assess 

whether there is an association between fluoride and 

cancer in people who live in areas with fluoridated 

water or naturally high levels of fluoride in drinking 

water, or people who work in jobs where they may 

be exposed to fluorides. Most studies have not 

found any association between fluoride and cancer 

in people. A study in rats and mice found that a 

small number of male rats developed bone cancer 

after drinking water with high levels of fluoride in it 

throughout their lives. This was considered 

equivocal evidence that fluoride causes cancer in 

male rats. Fluoride did not cause cancer in mice or 

female rats. Another study found no evidence that 

even higher doses of fluoride caused cancer in rats. 

Both animal studies had problems that limited their 

usefulness in showing whether fluoride can cause 

cancer in humans. The International Agency for 

Research on Cancer (IARC) has determined that the 

carcinogenicity of fluoride to humans is not 

classifiable. 

Hydrogen Fluoride. Hydrogen fluoride is also a 

very irritating gas. Hydrogen fluoride is not as 

dangerous as fluorine, but large amounts of it can 

also cause death. People breathing hydrogen 

fluoride have complained of eye, nose, and skin 

irritation. Breathing in a large amount of hydrogen 

fluoride with air can also harm the lungs and heart. 

Kidney and testes damage have been observed in 

animals breathing hydrogen fluoride. 

Hydrofluoric acid is dangerous to humans because 

it can burn the eyes and skin. The initial exposure to 

hydrofluoric acid may not look like a typical acid 

burn. Skin may only appear red and may not be 

painful at first. Damage to skin may happen over 

several hours or days, and deep, painful wounds 

may develop. When not treated properly, serious 

skin damage and tissue loss can occur. In the worst 

cases, getting a large amount of hydrofluoric acid 

on your skin can lead to death caused by the 

fluoride affecting your lungs or heart. 

Fluorine. Fluorine gas is very irritating and very 

dangerous to the eyes, skin, and lungs. Fluorine gas 

at low concentrations makes your eyes and nose 

hurt. At higher concentrations, it becomes hard to 

breathe. Exposure to high concentrations of fluorine 

can cause death due to lung damage. 

1.6 HOW CAN FLUORINE, HYDROGEN 

FLUORIDE, AND FLUORIDES AFFECT 

CHILDREN? 

 

This section discusses potential health effects from 

exposures during the period from conception to 

maturity at 18 years of age in humans. 

When used appropriately, fluoride is effective in 

preventing and controlling dental caries. Drinking 

or eating excessive fluoride during the time teeth 

are being formed can cause visible changes in teeth. 

The condition is called dental fluorosis. The 

changes increase in severity with increasing levels 

of fluoride. Dental fluorosis develops only while the 

teeth are forming in the jaw and before they erupt 

into the mouth (age <8 years). After the teeth have 

developed and erupted, they cannot become 

fluorosed. Most enamel fluorosis seen today is of 
 PUBLIC HEALTH STATEMENT 

 FLUORIDES CAS#: Hydrogen Fluoride 7664-39-3 

 Fluorine 7782-41-4 

 Sodium Fluoride 7681-49-4

Division of Toxicology September 2003 

__________________________________________________________________________________________

DEPARTMENT of HEALTH AND HUMAN SERVICES, Public Health Service

Agency for Toxic Substances and Disease Registry 

www.atsdr.cdc.gov/ Telephone: 1-888-422-8737 Fax: 770-488-4178 E-Mail: atsdric@cdc.gov 

the mildest form, in which there are a few almost 

invisible white spots on the teeth. In moderate 

cases, there are large white spots on the teeth 

(mottled teeth), and some brown spots. In severe 

cases, the teeth are pitted and are fragile, and 

sometimes the teeth can break. The appearance of 

affected teeth is not identical for all children 

exposed to the same level of fluoride in the drinking 

water. Exposure to fluoride from other sources, 

such as fluoride tablets or rinses, may account for 

these differences. In general, some children who 

drink water with 1 ppm fluoride may get a few 

small spots or slight discolorations on their teeth. 

Some children who drink water with 4 ppm fluoride 

in it for long periods before their permanent teeth 

are in place may develop a more severe form of 

dental fluorosis. 

Fluoride can cross the placenta from the mother's 

blood to the developing fetus. Only a very small 

portion of fluoride ingested by women is transferred 

to a child through breast milk. Several human 

studies found an increase in birth defects or lower 

IQ scores in children living in areas with very high 

levels of fluoride in the drinking water. Those 

studies did not adequately access other factors that 

could have contributed to the effects. Another study 

did not find birth defects in children living in areas 

with low levels of fluoride. Birth defects have not 

been found in most studies of laboratory animals. 

 

1.7 HOW CAN FAMILIES REDUCE THE 

RISK OF EXPOSURE TO FLUORINE, 

HYDROGEN FLUORIDE, AND 

FLUORIDES? 

If your doctor finds that you have been exposed to 

significant amounts of fluorides, hydrogen fluoride, 

and fluorine, ask whether your children might also 

be exposed. Your doctor might need to ask your 

state health department to investigate. 

It is unlikely that the general population would be 

exposed to fluorine gas or hydrogen fluoride. 

Because fluorides are found naturally in the 

environment, we cannot avoid being exposed to 

them. Some areas of the United States, such as the 

Southwest, naturally have high levels of fluorides in 

well water. There has been an increase in the 

cosmetic condition of tooth enamel fluorosis in 

children in both fluoridated and non-fluoridated 

communities. Ask your health department whether 

your area has naturally high levels of fluorides in 

the drinking water. If you live in such an area, you 

should use bottled drinking water and consult your 

dentist for guidance on the need for appropriate 

alternative fluoride supplements. 

These areas may also contain high levels of 

fluorides in soil. A few hazardous waste sites may 

contain high levels of fluorides in soil. By limiting 

your contact with such soil (for example, reducing 

recreational activities that raise dust), you would 

reduce your family's exposure to fluoride. Some 

children eat a lot of dirt. You should prevent your 

children from eating dirt. You should discourage 

your children from putting their hands or objects in 

their mouths or engaging in other hand-to-mouth 

activity. Make sure they wash their hands frequently 

and always before eating. 

If you work in a phosphate fertilizer plant or other 

industry that uses minerals high in fluorides, it is 

sometimes possible to carry fluorides home from 

work on your clothing, skin, hair, tools, or other 

objects removed from the workplace. You may 
 PUBLIC HEALTH STATEMENT 

 FLUORIDES CAS#: Hydrogen Fluoride 7664-39-3 

 Fluorine 7782-41-4 

 Sodium Fluoride 7681-49-4

Division of Toxicology September 2003 

__________________________________________________________________________________________

DEPARTMENT of HEALTH AND HUMAN SERVICES, Public Health Service

Agency for Toxic Substances and Disease Registry 

www.atsdr.cdc.gov/ Telephone: 1-888-422-8737 Fax: 770-488-4178 E-Mail: atsdric@cdc.gov 

contaminate your car, home, or other locations 

outside work where children might be exposed to 

fluoride-containing dust. Your occupational health 

and safety officer at work can and should tell you 

whether the chemicals that you work with are likely 

to be carried home on your clothes, body, or tools as 

well as whether you should be showering and 

changing clothes before you leave work, storing 

your street clothes in a separate area of the 

workplace, or laundering your work clothes at home 

separately from other clothes. 

Children may be exposed to high levels of fluorides 

if they swallow dental products containing 

fluoridated toothpaste, gels, or rinses. Swallowing 

toothpaste can account for a large percentage of the 

fluoride to which a small child might be exposed. 

You should teach your children not to swallow 

these products. For children under age 8, parents 

should supervise brushing and place, at most, a 

small pea size dab of toothpaste on the brush. 

 

1.8 IS THERE A MEDICAL TEST TO 

DETERMINE WHETHER I HAVE BEEN 

EXPOSED TO FLUORINE, HYDROGEN 

FLUORIDE, AND FLUORIDES? 

Urine and blood samples can be analyzed to find 

out if you have been exposed to fluorides. The 

fluoride level in the sample is compared with the 

level of fluoride usually found in urine or blood. 

This will show if a person has been exposed 

recently to higher-than-normal levels of fluorides. 

However, this test cannot be used to predict any 

specific health effects that may occur after fluoride 

exposure. The test must be performed soon after 

exposure because fluoride that is not stored in the 

bones leaves the body within a few days. This test 

can be done at most laboratories that test for 

chemical exposure. Bone sampling can be done in 

special cases to measure long-term exposure to 

fluorides. Because fluorides, hydrogen fluoride, and 

fluorine all enter the body as fluoride, these tests 

cannot distinguish among exposure to these 

different chemicals. 

1.9 WHAT RECOMMENDATIONS HAS THE 

FEDERAL GOVERNMENT MADE TO 

PROTECT HUMAN HEALTH? 

The federal government develops regulations and 

recommendations to protect public health. 

Regulations can be enforced by law. Federal 

agencies that develop regulations for toxic 

substances include the Environmental Protection 

Agency (EPA), the Occupational Safety and Health 

Administration (OSHA), and the Food and Drug 

Administration (FDA). Recommendations provide 

valuable guidelines to protect public health but 

cannot be enforced by law. Federal organizations 

that develop recommendations for toxic substances 

include the Agency for Toxic Substances and 

Disease Registry (ATSDR) and the National 

Institute for Occupational Safety and Health 

(NIOSH). 

Regulations and recommendations can be expressed 

in not-to-exceed levels in air, water, soil, or food 

that are usually based on levels that affect animals; 

then they are adjusted to help protect people. 

Sometimes these not-to-exceed levels differ among 

federal organizations because of different exposure 

times (an 8-hour workday or a 24-hour day), the use 

of different animal studies, or other factors. 
 PUBLIC HEALTH STATEMENT 

 FLUORIDES CAS#: Hydrogen Fluoride 7664-39-3 

 Fluorine 7782-41-4 

 Sodium Fluoride 7681-49-4

Division of Toxicology September 2003 

__________________________________________________________________________________________

DEPARTMENT of HEALTH AND HUMAN SERVICES, Public Health Service

Agency for Toxic Substances and Disease Registry 

www.atsdr.cdc.gov/ Telephone: 1-888-422-8737 Fax: 770-488-4178 E-Mail: atsdric@cdc.gov 

Recommendations and regulations are also 

periodically updated as more information becomes 

available. For the most current information, check 

with the federal agency or organization that 

provides it. Some regulations and recommendations 

for fluorides, hydrogen fluoride, and fluorine 

include the following: 

Sodium fluoride, hydrogen fluoride, and fluorine 

have been named hazardous substances by the EPA. 

The federal government has set regulatory standards 

and guidelines to protect workers from the possible 

health effects of fluorides, hydrogen fluoride, and 

fluorine in air. OSHA has set a legally enforceable 

limit of 0.2 milligrams per cubic meter (mg/m3) for 

fluorine, 2.0 mg/m3 for hydrogen fluoride, and 2.5 

mg/m3 for fluoride in workroom air to protect 

workers during an 8-hour shift over a 40-hour work 

week. NIOSH recommends air levels of 0.2 mg/m3 

for fluorine, 2.5 mg/m3 for hydrogen fluoride, and 

2.5 mg/m3 for sodium fluoride in workroom air to 

protect workers during an 8-hour shift over a 40-

hour work week. 

The federal government has also set regulatory 

standards and guidelines to protect the public from 

the possible health effects of fluoride in drinking 

water. EPA determined that the maximum amount 

of fluoride allowed in drinking water is 4.0 

milligrams per liter (mg/L). 

For the prevention of dental decay, the Public 

Health Service (PHS) has, since 1962, 

recommended that public water supplies contain 

fluoride at concentrations between 0.7 and 1.2 

mg/L. PHS scientists representing the National 

Institutes of Health, the Centers for Disease Control 

and Prevention, the FDA, ATSDR, and other 

government agencies conducted an extensive 

examination of the worldwide biomedical literature 

on the public health risks and benefits of fluoride in 

1991. The PHS report stated that fluoride in the 

drinking water substantially reduces tooth decay. 

1.10 WHERE CAN I GET MORE 

INFORMATION? 

If you have any more questions or concerns, 

please contact your community or state health or 

environmental quality department or: 

Agency for Toxic Substances and Disease Registry 

Division of Toxicology 

1600 Clifton Road NE, Mailstop F-32 

Atlanta, GA 30333 

Information line and technical assistance: 

Phone: 888-422-8737 

FAX: (770)-488-4178 

ATSDR can also tell you the location of 

occupational and environmental health clinics. 

These clinics specialize in recognizing, evaluating, 

and treating illnesses resulting from exposure to 

hazardous substances. 

To order toxicological profiles, contact: 

National Technical Information Service 

5285 Port Royal Road 

Springfield, VA 22161 

Phone: 800-553-6847 or 703-605-6000 
 PUBLIC HEALTH STATEMENT 

 FLUORIDES CAS#: Hydrogen Fluoride 7664-39-3 

 Fluorine 7782-41-4 

 Sodium Fluoride 7681-49-4

Division of Toxicology September 2003 

__________________________________________________________________________________________

DEPARTMENT of HEALTH AND HUMAN SERVICES, Public Health Service

Agency for Toxic Substances and Disease Registry 

www.atsdr.cdc.gov/ Telephone: 1-888-422-8737 Fax: 770-488-4178 E-Mail: atsdric@cdc.gov 

Reference 

Agency for Toxic Substances and Disease Registry 

(ATSDR). 2003. Toxicological profile for fluorides, 

hydrogen fluoride, and fluorine. Atlanta, GA: U.S. 

Department of Health and Human Services, Public 

Health Service.