Fluoride and Infant Formula: Frequently Asked Questions (FAQ)
- What is fluoride?
- How does fluoride protect teeth?
- What is water fluoridation?
- Why would communities want to fluoridate tap water?
- Is water fluoridation safe? How effective is it in preventing cavities?
- What is dental enamel fluorosis?
- If fluorosis occurs when teeth are developing, is it okay to use fluoridated water to reconstitute infant formula?
- What can I do to decrease the chances that my child’s teeth will develop fluorosis?
- How can I get the benefits of fluoride and minimize the risk of fluorosis for my child?
- What are the benefits of fluoridated water?
- What are the benefits of fluoride toothpaste?
- Should children use fluoride toothpaste?
- What are the benefits of fluoride mouthrinse?
- What are the benefits of dietary fluoride supplements?
- Where can I find more information about fluoride?
Fluoride is nature’s cavity fighter and occurs naturally in varying amounts in water sources such as rivers, lakes and even the oceans. Fluoride is naturally present to some extent in certain foods and beverages but the levels vary widely. To help protect teeth from cavities, fluoride is also added to some dental products such as toothpaste.
Fluoride benefits both children and adults. Here’s how:
Before teeth break through the gums, the fluoride taken in from foods, beverages and dietary supplements strengthens tooth enamel making it stronger and more resistant to cavities. This provides what is called a “systemic” benefit.
After teeth erupt, fluoride helps rebuild (remineralize) weakened tooth enamel and reverses early signs of tooth decay. When you brush your teeth with fluoride toothpaste, or use other fluoride dental products, the fluoride is applied to the surface of your teeth. This is provides what is called a “topical” benefit.
In addition, the fluoride you take in from foods and beverages continues to provide a topical benefit because it becomes part of your saliva, constantly bathing the teeth and helping to rebuild weakened tooth enamel.
Community water fluoridation is simply the addition of fluoride to drinking water to supplement what is already present naturally in order to bring the fluoride level up to the optimum level that helps prevent cavities. More than 72 percent of the U.S. population is served by fluoridated community water systems as of 2008.
Communities fluoridate their water supply as a cost-effective public health measure to help prevent cavities. The average annual cost of fluoridating the water of U.S. communities can range from $.50 per person for large communities to $3.00 per person for small communities.
Cavities are caused by a disease called “caries,” which is five times more common than asthma and seven times more common than hay fever in 5-to-17-year-olds. The pain from untreated cavities can cause people to lose sleep, have trouble eating, speaking and paying attention at school or work.
A report from the U.S. Surgeon General in 2000 estimated that 51 million school hours are lost per year because of dental-related illness. Without water fluoridation, that number would likely be much higher.
The American Dental Association (ADA) supports community water fluoridation as the single most effective public health measure to prevent tooth decay. Even with the widespread use of fluoride-containing products such as toothpaste, studies show that in communities having water fluoridation tooth decay is lower by as much as 20- 40% compared to communities without community water fluoridation.
The ADA, the American Medical Association, the World Health Organization and many others support fluoridation of community water supplies. The U.S. Centers for Disease Control and Prevention (CDC) has cited community water fluoridation as one of 10 great public health achievements of the 20th century (along with vaccinations, infectious disease control and motor vehicle safety).
So, by simply drinking fluoridated water, you are doing something good for your oral health.
Water fluoridation is safe, effective and healthy. Specifically, more than six decades of research, thousands of studies and the experience of more than 195.5 million Americans tell us that water fluoridation is effective in preventing cavities and is safe for children and adults.
Enamel fluorosis can result from ingesting greater than optimal amounts of fluoride in early childhood. Enamel fluorosis is a change in the appearance of the tooth’s enamel. In the United States, the majority of dental fluorosis is mild and appears as white spots that are barely noticeable and difficult for anyone except a dental health care professional to see. Tooth surface changes can be more extensive in the moderate and severe forms, which are less common. In the rare, severe form of dental fluorosis, pits may form on the tooth’s surface. Enamel fluorosis occurs only when permanent teeth are forming under the gums. Once teeth break through the gums, they cannot develop enamel fluorosis.
If fluorosis occurs when teeth are developing, is it okay to use fluoridated water to reconstitute infant formula?
Yes, it is safe to use fluoridated water to mix infant formula. If your baby is primarily fed infant formula, using fluoridated water might increase the chance for mild enamel fluorosis, but enamel fluorosis does not affect the health of your child or the health of your child’s teeth. Parents and caregivers are encouraged to talk to their dentists about what’s best for their child.
- You can breast feed. Breast milk is very low in fluoride. Nursing mothers or pregnant women who drink fluoridated water do not pass on significant amounts of fluoride to their child.
- You can use ready-to-feed formula.
- You can use powdered or liquid concentrate formula mixed with water that either is fluoride-free or has low concentrations of fluoride.
Getting the right amount of fluoride is best—not too much and not too little. Your dentist, pediatrician or family physician can help you determine how to optimize your child’s fluoride intake.
Fluoridated water helps prevent tooth decay in children and adults. Simply by drinking water, people can benefit from fluoridation’s cavity protection whether they are at home, work or school.Simply by drinking water, people can benefit from fluoridation’s cavity protection whether they are at home, work or school.
For optimal protection against tooth decay, children and adults need both systemic and topical fluoride. Community water fluoridation provides both topical and systemic benefits.
Drinking fluoridated water will help your child get the fluoride he or she needs to protect his or her teeth from decay. If your baby is primarily fed infant formula and you have questions about mixing it with fluoridated water, check with your dentist, pediatrician or family physician on the most appropriate water to use to mix with the formula.
Fluoridated water isn’t just for children. People in the United States are living longer and retaining more of their natural teeth than ever before. Adults are as likely as children to develop new cavities. A study published in 2007 found that fluoridation prevents about 27% of cavities in adults.
All toothpaste helps remove plaque, a film of bacteria that forms on teeth and gums every day. Plaque can cause gum disease and tooth decay. In addition to helping remove plaque, fluoride toothpaste provides an extra benefit in preventing tooth decay by strengthening tooth enamel.
Do not use fluoride toothpaste until the child is two years old unless advised to do so by a dentist or other health professional. When children’s teeth start to appear, brush them with a child-size toothbrush. For children age two and older, place one pea-sized amount of fluoride toothpaste on the toothbrush at each brushing. Young children should be supervised while brushing and taught to spit out, rather than swallow, the toothpaste.
A mouthrinse with fluoride helps reduce tooth decay on tooth enamel and makes teeth more resistant to decay. Unless you are advised to do so by a dentist or other health professional, the ADA does not recommend the use of fluoride mouthrinses for children younger than six years old. Many children younger than six have not yet fully developed their swallowing reflex and may be more likely to swallow fluoride mouthrinse rather than spitting it out.
Dietary fluoride supplements are ingested into the body and become incorporated into forming tooth structures which helps protect teeth from decay. They can also have a topical effect, strengthening teeth in the mouth and killing bacteria. Dietary fluoride supplements can be in the form of tablets, drops or lozenges, and they provide the same benefits as community water fluoridation.
Dietary fluoride supplements should be prescribed only for children living in areas without optimal levels of fluoride in their community drinking water and who are at high risk of developing cavities. Talk to your dentist, pediatrician or family physician about your child’s specific fluoride needs.
- Visit the American Dental Association’s Web site on fluoride and fluoridation.
- "Evidence-Based Clinical Recommendations on the Prescription of Dietary Fluoride Supplements for Caries Prevention" published in the December 2010 issue of The Journal of the American Dental Association.
- “Evidence-Based Clinical Recommendations Regarding Fluoride Intake from Reconstituted Infant Formula and Enamel Fluorosis” published in the January 2011 issue of The Journal of the American Dental Association.
- Evidence-Based Clinical Recommendations