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Scientific Panels Issue Evidence-Based Clinical Recommendations on Use of Fluoridated Water with Infant Formula, Prescribing Fluoride Supplements

ADA Council on Scientific Affairs convened separate expert panels for recommendations

January 10, 2011

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CHICAGO, Jan. 10, 2010 - Two multi-disciplinary expert panels, convened by the American Dental Association (ADA) Council on Scientific Affairs, issued reports containing clinical recommendations on children's fluoride intake from infant formula and prescription fluoride supplements.

The first report, focusing on prescription fluoride supplements, was published in the December Journal of the American Dental Association (JADA). The second report, focusing on fluoride intake from infant formula, appears in the January issue of JADA. Both reports are available on the ADA's Evidence-Based Dentistry (EBD) Web site. The clinical recommendations from the expert panel were reviewed and approved by the ADA's Council on Scientific Affairs.

Evidence-based clinical recommendations are intended to provide dentists and other health professionals with a review of the latest scientific evidence on particular topics and are not considered a standard of care. Rather, the health care professional can consider clinical recommendations, patient preference and his or her own clinical judgment when diagnosing and treating patients.

Fluoride Intake from Infant Formula

In a report published in the January JADA entitled, "Evidence-Based Clinical Recommendations Regarding Fluoride Intake from Reconstituted Infant Formula and Enamel Fluorosis," members of an ADA expert panel encourage clinicians to follow the American Academy of Pediatrics guidelines for infant nutrition, which advocate exclusive breastfeeding until the child is aged 6 months and continued breastfeeding until the child is at least 12 months of age, unless specifically contraindicated.

The panel offers the following suggestions to practitioners to use in advising parents and caregivers of infants who consume powdered or liquid concentrate infant formula as the main source of nutrition:

  • Suggest the continued use of powdered or liquid concentrate infant formulas reconstituted with optimally fluoridated drinking water while being aware of the potential for development of enamel fluorosis, which is mild in most children
  • Practitioners can also suggest ready-to-feed formula or powdered or liquid concentrate formula reconstituted with water that either is fluoride free or has low concentrations of fluoride to reduce the potential for developing enamel fluorosis

Mild enamel fluorosis appears as barely noticeable faint white lines or streaks on tooth enamel that may occur when children ingest excess fluoride while their teeth are developing. Mild enamel fluorosis does not harm the form or function of teeth.

"It is important for parents and caregivers to talk with their child's physician and dentist so they can make informed decisions regarding their child's health care," says Edmond Hewlett, D.D.S., an ADA consumer advisor spokesperson and professor at the University of California Los Angeles (UCLA) School of Dentistry. "The American Dental Association continues to strongly advocate for the use of fluoride as a proven method to prevent tooth decay. These new evidence-based clinical recommendations are a resource that dentists can consider along with their own clinical judgment and patient preference when diagnosing and treating patients."

The panel's recommendations are based on a review of evidence from two recently published clinical studies and one systematic review that addressed whether or not infant formula mixed with fluoridated water put infants from birth to 12 months at an increased risk for enamel fluorosis.

Dietary fluoride supplements

Dentists should continue prescribing dietary fluoride supplements to children who are at high risk of developing caries (tooth decay) and who live in areas without community water fluoridation, according to the expert panel issuing the report, "Evidence-Based Clinical Recommendations on the Prescription of Dietary Fluoride Supplements for Caries Prevention."

The ADA-commissioned report includes a full-text review of three systematic reviews and two recently published clinical studies that addressed the following clinical questions:

  • When and for whom should fluoride supplements be prescribed?
  • What should be the recommended dosage schedule for dietary fluoride supplements?

The panel acknowledged that fluoride supplements are effective in preventing tooth decay and that parents and caregivers should be aware of the potential for development of enamel fluorosis, that is mild in most children.

According to the report, "These recommendations emphasize the need for caries risk assessment and judicious prescription of dietary fluoride supplements with consideration to total fluoride intake."

ADA expert panels, Evidence-Based Dentistry

The clinical recommendations, developed by expert multidisciplinary panels convened by the ADA Council on Scientific Affairs, assessed available scientific evidence and developed practice-oriented recommendations through a comprehensive evidence-based process. The clinical recommendations serve as a resource for dentists to consider in addressing specific oral health needs of their patients along with the practitioner's professional judgment and the patient's needs and preferences.

Evidence-based clinical recommendations are a product of the Center for Evidence-Based Dentistry (EBD). The ADA created the Center for EBD to connect the latest research findings with the daily practice of dentistry. The EBD Web site provides on-demand access to systematic reviews, summaries and clinical recommendations that translate the latest scholarly findings into a user-friendly format that dentists can use with their patients.

Visit fluoride and fluoridation for more information

About the ADA

The not-for-profit ADA is the nation's largest dental association, representing 163,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA's consumer website