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Excess fluoride consumption has been studied as a factor in the following:
A weakening of bones, leading to an increase in hip and wrist fracture.[46] The National Research Council found the overall evidence "suggestive but inadequate for drawing firm conclusions about the risk or safety of exposures at [2 mg/L]", but states that fractures do seem to increase as fluoride is increased from 1 mg/L to 4 mg/L, suggesting a "continuous exposure-effect" dose-response relationship at these levels.[29]:170
Adverse effects on the kidney. Within the optimal dose, no effects are expected, but chronic ingestion in excess of 12 mg/day are expected to cause adverse effects, and an intake that high is possible when fluoride levels are around 4 mg/L.[29]:281 Those with impaired kidney function are more susceptible to adverse effects.[29]:292
Little research has been done on possible liver damage, although some studies suggest negative effects at chronic ingestion of 23 mg/day.[29]:292
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