Fluoride: a double-edged sword in public health and environmental toxicology.

Fluoride exposure has raised global concerns due to its potential neurodevelopmental, systemic, and ecological impacts. This review consolidates advancements in fluoride toxicity, highlighting molecular mechanisms like mitochondrial dysfunction, autophagy disruption, and epigenetic alterations. Prenatal exposure is linked to cognitive deficits, while systemic effects include renal, hepatic, and thyroid dysfunction. Novel therapeutic strategies, such as natural compounds and microbiota modulation, offer promise, but translational barriers persist. Real-world co-exposures amplify toxicity, underscoring the need for interdisciplinary research. Environmental contamination challenges demand innovative remediation and global policy reform. This review identifies key knowledge gaps, advocating for longitudinal studies, multi-omics integration, and sustainable interventions to mitigate fluoride's health burden and ecological risks. These findings lay a foundation for targeted public health strategies.

© 2025. The Author(s), under exclusive licence to Springer Nature Switzerland AG.