Fluoride in drinking water presents a paradoxical public health challenge; while essential in trace amounts for dental health, its excessive intake leads to debilitating fluorosis. A selected study region in the Gangetic plain of northern India, situated within the fluoride-endemic alluvial belt and host to significant industrial activity, is a critical area for investigating this geogenic and anthropogenic contaminant. This comprehensive review paper synthesizes existing data and hypotheses to assess the extent and sources of fluoride contamination in the region\\\'s drinking water, evaluate its health impacts on the local population, and propose integrated mitigation strategies. Analysis suggests widespread contamination exceeding the WHO (1.5 mg/L) and BIS (1.0 mg/L) permissible limits in groundwater, particularly in deeper aquifers. The primary source is geogenic, attributed to the dissolution of fluoride-bearing minerals (e.g., fluorite, apatite) in the subsurface geology under alkaline, high-bicarbonate, and low-calcium conditions. Anthropogenic contributions from local industrial clusters, especially leather tanneries and chemical units, may exacerbate the problem. The health impacts are severe and visible, with high prevalence rates of dental fluorosis among children and adolescents, and advanced cases of skeletal fluorosis leading to pain, stiffness, and crippling deformities in adults. Non-skeletal manifestations, including gastrointestinal, neurological, and endocrine disruptions, are also indicated. The review concludes that fluoride contamination is a silent, chronic public health emergency in the study region, disproportionately affecting rural and socio-economically disadvantaged communities reliant on untreated groundwater. Urgent, coordinated action encompassing alternative water sourcing, defluoridation technology deployment, robust monitoring, intensive public health campaigns, and supportive healthcare is recommended. This paper underscores the necessity of a \\\"One Health\\\" approach, integrating hydrogeology, public health, and social policy to address this multifaceted crisis.