6. What further investigations are needed to improve assessment of exposure and of the health effects of fluoride?
Exposure assessment is the most important element of additional research. In particular, information about health effects of fluoride beyond fluorosis, such as bone cancer and neurological and reproductive effects, is poor quality, with inaccurate exposure measurements and observed effects only at very high exposure levels.
Improving risk assessment requires:
1. Development and validation of new biomarkers for direct measurement of long-term fluoride exposure.
2. Development of standardized methods for exposure assessment, integrating all routes of exposure.
3. Better information on fluoride in food.
4. Epidemiological studies to refine data on fluoride, dental fluorosis and dental health.