Fluorosis, a condition caused by the excessive intake of fluoride, results in toxic effects on the human body. It is a collective term for the various manifestations of this condition. Recent estimates indicate that approximately 200 million people across 25 nations worldwide are affected by the alarming consequences of fluorosis. In India, 20 states are facing the challenge of high fluoride levels impacting their population. Objectives: To determine the effect of black tea drinking and use of toothpaste in the development of dental fluorosis among children in the age group of 10-15 years in Kerala. Methodology: This study involved the selection of two districts with a high prevalence of fluorosis and two neighboring districts without fluorosis. A sample size of 980 school-going children werecalculated, and adequate sample size was selected. Data was collected using a pretested modified questionnaire. Dental specialists evaluated the fluorosis status, and information regarding the use of tooth paste and consumption of black tea along with other details.Subsequently, the collected data was entered and analyzed. The prevalence of fluorosis was calculated in percentage. Results: In the district of Alappuzha, the prevalence of dental fluorosis was found to be 38.9% among children who used toothpaste for dental cleaning and 30.6% among those who did not use tooth paste.However, in the other districts, no significant relationship was observed between the prevalence of dental fluorosis and the use of toothpaste. In the district of Alappuzha, the prevalence of dental fluorosis was 37.9% among individuals who consumed black tea, compared to 33.6% among those who did not consume black tea. Similarly, in Palakkad, the prevalence was 39.9% among black tea consumers and 35.2% among non-consumers. It was observed that a majority of students in both Alappuzha and Palakkad consumed black tea, and the prevalence of dental fluorosis was higher among students who consumed black tea in both districts. Conclusion: Dental fluorosis is a public health problem in the district of Alappuzha and Palakkad in Kerala, India. The main causative risk factor was the use of drinking water containing high fluoride level but the use of black tea and fluoridated toothpaste are the added risk factors in the development of fluorosis. Measures should be taken to avoid these added risk factors in these endemic areas in order to solve this public health problem.