The purpose of this study was to determine the fluoride levels in water, soil and tea, and to identify the major fluoride minerals in soil that supply water with fluoride ions. Another aim was to study the prevalence of dental fluorosis in permanent dentition of the school children of the Gaza Strip. Monitoring of fluoride levels in 73 groundwater wells and 20 topsoil samples for the last three years revealed a general trend of increasing from north to south of the Gaza Strip. A linear regression analysis found a correlation coefficient of r=0.93 between the fluoride concentrations in groundwater and soil for the same geographic areas. However, the X-ray diffraction technique (XRD) results showed that none of the four major fluoride minerals were detected in the tested soil samples; the PHREEQC model showed that fluorite (CaF2) was the main donating mineral of fluoride ions to groundwater.A high positive correlation was found between fluoride concentrations in groundwater and occurrence of dental fluorosis. Among 353 school children of the five geographic areas of the Gaza Strip the prevalence of dental fluorosis was 60%, and 40% had no signs of fluorosis in their permanent dentitions. The highest occurrence, 94%, was in Khan Yunis, followed by 82% in Rafah, 68% in the middle area, 29% in Gaza and the lowest occurrence of 9% was in the northern area. These percentages were directly proportional to the average content of fluoride in groundwater of each area: 2.6, 0.9, 1.7, 1.2, and 0.7 ppm, respectively. The exception was Rafah where people drank from new groundwater wells that have been dug in the last 10 years.The occurrence of the disease was due to intake of high amounts of fluorides in drinking water, tea and fish. Communication with population indicated a heavy intake of tea starting from a very young age; not uncommonly tea is put in nursing bottles. No significant correlation was found between prevalence figures and gender or age groups. This high prevalence indicates a need to examine other sources of F including diet.