Occurrence of fluoride (F-) at elevated levels in groundwater (GW) has become a major concern as it is associated with serious health issues like dental-skeletal fluorosis, severe neurological disorders, and abnormal enzymatic activities. This study conducted, in Purulia district in West Bengal, India, to understand the factors influencing F- enrichment in GW in the context of hydroclimatic variability, its suitability for drinking water and irrigation purposes, and associated health risks. Results show that 37.5% of collected GW samples (n = 24) exceed the permissible limit of WHO (1.5 mg/L). The average and highest F- concentrations recorded at 1.4 mg/L and 2.2 mg/L, respectively. A positive correlation between F-, Ca-2(+), and Na+ indicates that rock weathering significantly contributes to F- mobilization. GW in this area is of Na-Mg-Cl type as indicated by the piper plot. The trend of rainfall and temperature shows an inverse relationship with F- content and GW level is one of the major aggravating hydroclimatic factors for mobilization of F- in GW. The study showed that, GW is suitable for irrigation based on geochemical indices, but elevated fluoride and moderate salinity have degraded its quality, raising concerns about increased F- exposure through dietary intake. Consequently, Dental fluorosis prevalence is notably higher among individuals aged 10-20, 21-30, and over 50, with males consuming more F--rich water than females across all age groups. So, it can be concluded that, hydroclimatic variability plays a key role in driving geochemical processes that mobilize fluoride in groundwater. Therefore, identifying safe aquifers while considering demographic and climatic factors is essential for managing fluoride contamination and mitigating health impacts.