day for 10 or more years. Therefore, a UL of 10 mg/day was established for children older than 8 years and for adults. Data from studies of fluoride exposure from dietary sources or work environments (Hodge and Smith, 1977) indicate that a UL of 10 mg/day for 10 or more years carries only a small risk for an individual to develop preclinical or stage 1 skeletal fluorosis.

UL for Children and Adults

> 8 years

10 mg/day

Pregnancy and Lactation

No data indicate an increased susceptibility to fluorosis during pregnancy. Therefore, the UL for adults of 10 mg/day was also established for pregnant women. A UL of 10 mg/day was established for lactation, because an extremely small proportion of fluoride in drinking water is transferred to the breast milk (Ekstrand et al., 1981, 1984; Esala et al., 1982; Spak et al., 1982).

UL for Pregnancy and Lactation

14 through 50 years

10 mg/day

Special Considerations

Reports of relatively marked osteofluorotic signs and symptoms have been associated with concentrations of fluoride in drinking water of approximately 3 mg/liter in tropical climates. This adverse effect has been attributed to poor nutrition, hard manual labor, and high levels of water intake (Krishnamachari, 1986; Singh and Jolly, 1970; WHO, 1984). Therefore, an increased risk of skeletal fluorosis from excess fluoride intake may exist for malnourished individuals living in hot climates or tropical areas.

Exposure Assessment

Prior to the 1960s, the diet, including water, was the only significant source of fluoride. Since then, fluoride ingestion resulting from the use of dental products and fluoride supplements has increased the risk of enamel fluorosis in children. The results of several studies (Kumar et al., 1989; Leverett, 1986; Pendrys and Stamm, 1990; Williams and Zwemer, 1990) have indicated that mild enamel fluorosis in communities with optimally fluoridated water (1.0 mg/liter) is now more than twice as prevalent as in the 1930s and 1940s; that is, the prevalence has increased from an average of about 10

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