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Fluoride toxicity can occur in rare instances if fluoride is ingested in large amounts over a short period of time, most commonly due to accidental overdose of fluoride supplements. Fluoride toxicity can cause diarrhea, nausea, abdominal pain, vomiting, increased salivation, or increased thirst. These symptoms start half an hour after ingestion and may last up to 24 hours.
The EPA has set standards for public water supplies for fluoride at 4 milligrams per liter. Some individuals that consume water in excess of 4 milligrams per liter over many years could get bone disease, which can include pain and tenderness of the bones.