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Objective Fluoride, a naturally occurring mineral, is commonly found in drinking water. While low levels of fluoride are beneficial in preventing dental caries, chronic exposure to elevated levels has been linked to various health concerns, including potential neurotoxic effects. In developing countries like India, groundwater fluoride levels can exceed recommended limits, raising public health concerns. The aim was to assess the relationship between fluoride levels in drinking water and the intelligence of school-aged children in Tamil Nadu, India.Material and Methods This cross-sectional study included 100 school children aged 10 to 15 years from two distinct regions (one urban and one rural) in Chennai, Tamil Nadu. Fifty children were selected from areas with low fluoride concentration in drinking water (<2 ppm), and 50 from high fluoride areas (≥2 ppm). Data were collected using a pretested structured questionnaire capturing demographic details, residential history, parental education, socioeconomic status, and medical history. Children’s intelligence was assessed using a standardized IQ test, and the results were categorized based on conventional intelligence grading. Statistical analysis was performed using the chi-square test to evaluate the association between fluoride exposure and IQ levels.Results A statistically significant reduction in IQ scores was observed among children exposed to high fluoride levels in drinking water compared to those from low fluoride areas. The findings suggest an inverse relationship between fluoride concentration and cognitive performance.Conclusion Exposure to elevated fluoride levels in drinking water is associated with reduced intelligence among children in Tamil Nadu. These results highlight the need for public health interventions to monitor and control fluoride levels in drinking water sources, particularly in vulnerable populations such as school-aged children. Further research with larger sample sizes and longitudinal design is recommended to validate these findings and explore potential underlying mechanisms.