by Amy Spangler
May 24, 2013
Updated June 3, 2015
Fluoride is often described as nature’s cavity fighter. By ensuring that your child gets the right amount of fluoride each day after her teeth start to erupt, usually between 6 and 12 months of age, you can help prevent tooth decay. But too much fluoride can discolor newly formed teeth, causing white or gray spots to appear—a condition known as fluorosis. Once teeth are completely visible in the mouth (around 8 years of age) there is no longer a risk for fluorosis. In the meantime, knowing how much fluoride to give and when can be challenging.
Most children and adults get their daily dose of fluoride from fluoridated toothpaste, mouthwash, and drinking water. Fluoride occurs naturally in water, but the level can be very low (less than 0.2 mg/L) or very high (more than 2.0 mg/L), so communities adjust the local water supply by adding or removing fluoride. The U.S. Department of Health and Human Services, in 2015, set the recommended level of fluoride for community drinking water at 0.7 mg/L, a decrease from the previous range (0.7–1.2 milligrams per liter) issued in 1962.
Infant formula manufacturers intentionally keep fluoride levels in infant formula low to guard against formula-fed babies getting too much fluoride when their formula is mixed with fluoridated water. According to the CDC, since 1979, U.S. infant formula manufacturers have voluntarily lowered the fluoride concentration of their products to less than 0.3 parts per million (ppm). However, when powdered or concentrated liquid infant formula is consistently mixed with fluoridated water, exclusively formula-fed babies can get too much fluoride. To prevent fluorosis in infants, parents are cautioned to use low-fluoride or fluoride-free bottled water (labeled as de-ionized, purified, demineralized, or distilled) when mixing infant formula for some of their child’s feedings each day. Parents can also use ready-to-feed formula that doesn’t require mixing with water. (Ready-to-feed formula, however, is much more costly than powdered or concentrated liquid formula.) The best way to prevent fluorosis is to monitor your child’s fluoride intake.
Fluoride supplements are not recommended for breastfed babies. Although some fluoride is delivered via breast milk, breastfed babies are not considered to be at risk for fluorosis unless they receive fluoride from other sources as well (supplements, formula mixed with fluoridated water, etc.).
How much fluoride toothpaste is recommended?
The latest recommendation from the American Dental Association (ADA) is for parents to use a “smear” of toothpaste (about the size of a grain of rice) for children under the age of 3 and a pea-sized amount for those 3 to 6 years of age. With the goal of simplifying fluoride guidance for parents, after an extensive review on the use of fluoride in children younger than 6 years of age, the ADA’s Council on Scientific Affairs reached two conclusions:
The recommendation is a change from the ADA’s previous guidance, which encouraged parents to brush with water only, consult with a dentist or health care provider before using fluoride or fluoride toothpaste in children younger than 2 years old, and to use a pea-sized amount beginning at age 2.
Tips for monitoring your child’s fluoride intake:
Although media reports can give the impression that fluoride is dangerous, such assertions are not supported by research. Parents simply need to know how much fluoride to give and when.
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