The presence of excessive quantities of fluorine in drinking water is accompanied by a characteristic sequence of changes in teeth, bone and periarticular tissues. These changes lead to a variable degree of locomotor disability, ranging from simple mechanical back pain to severe, crippling, combined locomotor and neurological impairment. In endemic areas, a substantial proportion of the population may be affected, posing a severe public health problem. In some areas, the hazards to human health are not fully appreciated and are under-reported. The maximum impact is felt in those communities engaged in physically strenuous activities, either agricultural or industrial. The need of these often isolated communities in economically hard-pressed countries, for the provision of low-fluoride drinking water remains a hope rather than an expectation at the present time.