Fluoride levels in 745 groundwater samples from seven districts of Punjab ranged from 0.1–17.5 mg/L (mean 2.1 mg/L), with 49.7% exceeding the WHO/BIS limit of 1.5 mg/L. Bathinda, Muktsar, Faridkot, and Mansa showed the highest contamination, strongly linked to elevated TDS and EC, indicating geochemical and anthropogenic influences. Shallow aquifers were more polluted than deeper ones. Hazard quotient analysis showed HQ > 1 for most age groups in four districts, with children and teenagers facing the greatest non-carcinogenic risk. High fluoride exposure suggests increased likelihood of dental and skeletal fluorosis, especially in areas exceeding 10 mg/L. Industrial and agricultural activities contribute significantly to contamination. The study concludes that groundwater in the Malwa Belt is largely unsafe for drinking, requiring treatment and evaluation of alternative water sources.

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