Background: The present study was conducted to assess the relationship between drinking water fluoride (F) levels, dental fluorosis dental caries, and associated risk factors in the elderly population. Materials and Methods: A cross-sectional analytical study was conducted on 50 patients aged 25-60 years, selected by stratified random sampling from different areas with different levels of naturally occurring F in drinking water. The patients were assessed for dental fluorosis according to WHO basic survey guidelines. The overall oral health status of the patients was assessed by decayed missing filled teeth DMFT index and the bacterial count of saliva was calculated using the Caries Risk Test (CRT). Statistical analysis was done using mean, standard deviation, standard error, Z-Test, Mann-Whitney U Test, and Chi-square test. Results: The results of the present study revealed that the prevalence of fluorosis was 24%. The number of patients with dental fluorosis was highest in those who consumed water with high groundwater fluoride levels irrespective of the source of drinking water. Caries prevalence in the study population was about 5.56 ± 1.95. Conclusion: There was a moderate prevalence of fluorosis in patients, and caries prevalence is high in areas below optimal F areas. Caries prevalence and mean DMFT scores were least common in patients with optimal fluoride levels in drinking water and highest in those with below optimal fluoride in drinking water. © 2023 Elsevier B.V., All rights reserved.