To determine the extent of brick tea consumption fluorosis in children living at elevations of 2000 and 4300 m, 519 children aged 8-15 years living in Xiege'er Town at 4300 m and Zhangmu Town at 2000 m were examined for dental fluorosis, their urinary fluoride concentration was determined, their dietary structure investigated, and the fluoride concentrations of various foods, freshwaters, soils, and fuels determined. Fifteen Tibetan families living in these two areas of the nature reserve of Mount Qomolangma were studied according to UNEP, FAO, and WHO guidelines for the study of dietary intake of chemical contaminants, Horowitz's classification and examination of dental fluorosis, and Dean's dental fluorosis index. The results demonstrated that dental fluorosis in Tibetan children living at an elevation of 2000 m was significantly lower than that of children at 4300 m (P<0.01). Higher elevation can worsen the extent of fluorosis, leading to retention of fluoride in tissues as a result of hypoxia, but fluorosis can also be associated with the deterioration of the ecological environment at high elevation and a low-level economy. Beverages and foods mixed with brick tea water are responsible for the dental fluorosis in the children.