Ingestion of excess fluoride can cause fluorosis which affects the teeth and bones. Moderate amounts lead to dental effects, but long-term ingestion of large amounts can lead to potentially severe skeletal problems. The dental effects of fluorosis develop much earlier than the skeletal effects in people exposed to large amounts of fluoride. Clinically dental fluorosis is characterized by staining and pitting of the teeth. In more severe cases all the enamel may be damaged. Ingestion of fluoride after six years of age will not cause dental fluorosis. Chronic high-level exposure to fluoride can lead to skeletal fluorosis. In skeletal fluorosis, fluoride accumulates in the bone progressively over many years. The early symptoms of skeletal fluorosis include stiffness and pain in the joints. In severe cases, the bone structure may change and ligaments may calcify, with resulting impairment of muscles and pain. Acute high-level exposure to fluoride causes immediate effects of abdominal pain, excessive saliva, nausea and vomiting. Seizures and muscle spasms may also occur. Acute high-level exposure to fluoride is rare and usually due to accidental contamination of drinking water or due to fires or explosions. Moderate-level chronic exposure (above 1.5 mg/litter of water—the WHO guideline value for fluoride in water) is more common. People affected by fluorosis are often exposed to multiple sources of fluoride, such as in food, water, air (due to gaseous industrial waste), and excessive use of toothpaste. However, drinking water is typically the most significant source. A person’s diet, general state of health as well as the body’s ability to dispose of fluoride all affects how the exposure to fluoride manifests itself. Various sources of fluoride, features and management of acute and chronic fluoride toxicity are described in this chapter. It also highlights the bvarious methods of water defluoridation and prevention of dental fluorosis.