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KeepanEyeonYourYoungChildrensFluorideIntake

We've known for a long time that fluoride strengthens tooth enamel against decay. We've also learned that fluoride consumption early in life pays later dividends with healthier teeth.

But while fluoride has generally proven safe, too much ingested by young children could cause enamel fluorosis. This condition produces a mottled or streaked appearance in teeth ranging from faint white patches to darker, pitted staining. Fluorosis doesn't harm teeth, but it does make them less attractive.

To prevent this, it may be necessary with your dentist's help to monitor your infant's or young child's fluoride intake and keep it in check. That will depend in large part on where you live, as well as your child's hygiene and eating habits.

Like three-quarters of public water systems, your local utility may be adding fluoride to your drinking water. The amount is governed by federal guidelines, which currently recommend fluoride amounts of no more than 0.70 parts per million of water. The fluoride levels in your water could have an impact on your child's total fluoride intake. You can find out for sure how much fluoride is present in your water by contacting your water utility company.

Another major fluoride source is toothpaste and other hygiene products. You can control your child's fluoride exposure by limiting the amount of toothpaste on their brush. Children under two only need a “smear,” while those between two and six need only a pea-sized amount.

Processed foods can contain fluoride if fluoridated water was used in their production. In this case, replace as much of the processed food items in your family's diet as you can with fresh fruits, vegetables and other foods.

Along this line, if you have an infant you want to pay particular attention to feeding formula, especially the powdered form you mix with water. If you're concerned about the amount of fluoride in your water consider other infant feeding options. Besides breast-feeding in lieu of formula, you can also use ready-to-feed pre-mixed with water (usually lower in fluoride) or mix powdered formula with bottled water specifically labeled “de-ionized,” “purified,” “demineralized,” or “distilled.”

This can be a lot to keep up with but your dentist can advise you. Fluoride is still a potent weapon against tooth decay and a safeguard on your child's current and future dental health.

If you would like more information on the relationship between fluoride and your child's dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Development and Infant Formula.”

KeepaCloseEyeonYourChildsFluorideIntake

Fluoride has been proven to strengthen tooth enamel against decay. That’s why it’s not only added to toothpaste and other dental products, but also to drinking water — in nearly three-quarters of U.S. water systems.

While research has eased most serious health questions about fluoride, there remains one moderate concern. Too much fluoride over time, especially in infants and young children, could lead to “enamel fluorosis,” an excess of fluoride in the tooth structure that can cause spotting or streaking in the enamel. While often barely noticeable, some cases of fluorosis can produce dark staining and a pitted appearance. Although not a symptom of disease, fluorosis can create a long-term cosmetic concern for the person.

To minimize its occurrence, children under the age of 9 shouldn’t regularly ingest fluoride above of the recommended level of 0.70 ppm (parts per million). In practical terms, you as a parent should monitor two primary sources of fluoride intake: toothpaste and drinking water.

Young children tend to swallow toothpaste rather than spit it out after brushing, which could result in too much fluoride ingestion if the amount is too great. The American Academy of Pediatric Dentistry therefore recommends a small “smear” of toothpaste for children under two, and a pea-sized amount for children up to age six. Brushing should also be limited to no more than two times a day.

Your child or infant could also take in too much fluoride through fluoridated drinking water, especially if you’re using it to mix infant formula. You should first find out the fluoride levels in your local water system by contacting the utility or the health department. If your system is part of the U.S. Centers for Disease Control and Prevention’s (CDC) “My Water’s Fluoride” program, you may be able to access that information on line at //apps.nccd.cdc.gov/MWF/Index.asp.

If the risk for developing fluorosis in your area is high, you can minimize your infant’s intake with a few recommendations: breastfeed rather than use formula; use “ready-to-feed” formula that doesn’t need mixing and contains lower fluoride levels; and use bottled water specifically labeled “de-ionized,” “purified,” “de-mineralized,” or “distilled.”

Fluoride can be a wonderful adjunct to dental care in reducing risk for tooth decay. Keeping an eye on how much fluoride your child takes in can also minimize the chance of future appearance problems.

If you would like more information on the possible effects of fluoride on young children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Development and Infant Formula.”

DontForgetHiddenFluorideSourcesYourFamilyCouldbeIngesting

In the last half century, fluoride has become an effective weapon against tooth decay. The naturally occurring mineral helps strengthen enamel, the teeth's hard, protective cover.

Although it's safe for consumption overall, too much during early tooth development can lead to fluorosis, a brownish, mottled staining in enamel. To avoid it, a child's daily consumption of fluoride should optimally be kept at around 0.05-0.07 milligrams per kilogram of body weight, or an amount equal to one-tenth of a grain of salt per two pounds of weight.

The two main therapeutic fluoride sources have limits to help maintain this balance: utilities that fluoridate drinking water are required to add no more than 4 parts fluoride per million (ppm) of water; toothpaste manufacturers likewise only add a small amount of fluoride compared to clinical gels and pastes dentists apply to teeth for added decay protection.

But drinking water and toothpaste aren't the only sources of fluoride your child may encounter. Even if you have a non-fluoridated water supply, you should still keep a close watch on the following items that could contain fluoride, and discuss with us if you should take any action in regard to them.

Infant formula. The powdered form especially if mixed with fluoridated water can result in fluoride concentrations 100 to 200 times higher than breast or cow's milk. If there's a concern, use fluoride-free distilled or bottled spring water to mix formula.

Beverages. Many manufacturers use fluoridated water preparing a number of packaged beverages including sodas (two-thirds of those manufactured exceed .6 ppm), soft drinks and reconstituted fruit juices. You may need to limit your family's consumption of these kinds of beverages.

Certain foods. Processed foods like cereals, soups or containing fish or mechanically separated chicken can have high fluoride concentrations, especially if fluoridated water was used in their processing. When combined with other fluoride sources, their consumption could put children at higher risk for fluorosis.

Toothpaste. Although mentioned previously as a moderate fluoride source, you should still pay attention to how much your child uses. It doesn't take much: in fact, a full brush of toothpaste is too much, even for an adult. For an infant, you only need a smear on the end of the brush; as they grow older you can increase it but to no more than a pea-sized amount.

If you would like more information on fluoride and how it strengthens teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Fluoride & Fluoridation in Dentistry.”

KeepingFluoridetoJusttheRightAmountProtectsYourFamilysSmiles

Since the 1950s fluoride has played an important role in the fight against tooth decay as an additive to hygiene products and many public water supplies. But although a proven cavity fighter, some have questioned its safety over the years.

To date, though, the only substantiated health risk from fluoride use is a condition known as enamel fluorosis, which occurs when too much fluoride is ingested during early tooth development as the mineral embeds in the tooth structure. Fluorosis can cause changes in the enamel’s appearance, ranging from barely noticeable white streaking to darker visible staining and a pitted texture.

Fluorosis is primarily a cosmetic problem and not a serious health issue. The staining on otherwise sound teeth, however, is permanent and more severe cases may require extensive bleaching treatment to improve appearance. The best strategy is to prevent fluorosis by monitoring and limiting your child’s fluoride intake, until about age 9.

Tooth decay is a more serious condition than fluorosis so we’re not advocating you eliminate fluoride but that you keep your family’s intake within safe levels. The first step is to determine just how much that intake is now, particularly if you drink fluoridated water. If you have public water, you may be able to find its fluoridation level online at apps.nccd.cdc.gov or call the utility directly.

You should also be careful about the amount of toothpaste your child uses to brush their teeth. Children under two need only a trace (a “smear”) on the brush, and children between the ages of 2 and 6 a pea-sized amount. And, they should brush no more than twice a day.

Another possible concern is infant formula, especially mixable powder. While the formula itself doesn’t contain fluoride, water mixed with it may. If you live in an area with increased fluorosis risk, consider breast-feeding (breast milk has little fluoride), using ready-to-feed formula, or mixing powdered formula with bottled water labeled “de-ionized,” “purified,” “demineralized” or “distilled.”

We’ll be glad to help assess your family’s current fluoride intake and advise you on making adjustments to bring it into normal ranges. Taking in the right amount of fluoride assures you and your children receive the most benefit and protection from it, while avoiding future smile problems.

If you would like more information on managing your family’s fluoride intake, please contact us today to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Development and Infant Formula.”