Camellia sinensis (tea plant) is a notable fluoride (F) accumulator, with mature leaves typically containing 2000–3000 mg F kg−1, significantly higher than common crops like rice and wheat. This accumulation links soil geochemistry with dietary F exposure and associated fluorosis risk. However, the processes governing F mobility in soils and its transfer to tea plants remain insufficiently explored. This review summarizes current knowledge on F accumulation in tea production systems, focusing on the geochemical forms and bioavailability of F in tea-growing soils. We examine the roles of soil acidity, mineral composition, and organic matter in regulating F mobility. Mechanisms of F uptake, translocation, and preferential accumulation in mature leaves are discussed based on recent physiological and molecular studies. Human exposure risks from tea consumption, particularly in high-F soil regions, are evaluated. We review integrated mitigation strategies, including soil amendments, nutrient management, low-F cultivars, and optimized processing techniques. Among these, nutrient-based management, especially using low-F phosphate fertilizers and optimized potassium supply, is a promising approach for reducing F accumulation in tea plants. Targeted nutrient regulation can effectively limit F mobility and uptake, offering a sustainable strategy for mitigating F exposure through tea consumption. These findings emphasize the importance of soil chemical conditions in controlling F transfer from soil to tea plants and provide a scientific foundation for developing effective strategies to reduce F accumulation in tea production systems.