Fluoride and Infant Formula Frequently Asked Questions (FAQ)
What is fluoride?
Fluoride is nature’s cavity fighter with small amounts present in all water, including lakes and rivers. Some foods and beverages contain fluoride, and, to help protect teeth from cavities, fluoride is also added to some dental products such as toothpaste.
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How does fluoride protect teeth?
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 reverse early signs of tooth decay. When you brush your teeth with a fluoride toothpaste, or use other fluoride dental products, you are providing a “topical” benefit because the fluoride is applied to the surface of your teeth.
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.
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What is water fluoridation?
Community water fluoridation is simply the adjustment of the fluoride that occurs naturally in water to a level that helps prevent cavities. Approximately 70 percent of the U.S. population is served by fluoridated community water systems as of 2006.
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Why would communities want to fluoridate tap water?
Communities fluoridate their water supply as a cost-effective public health measure to help prevent cavities. A person can have a lifetime of fluoridated water for less than the cost of one dental filling.
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 supports community water fluoridation as the single most effective public health measure to prevent tooth decay. Studies show that water fluoridation reduces tooth decay by as much as 20 to 40% even with the widespread use of fluoride-containing products such as toothpaste.
The American Dental Association (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, simply by drinking fluoridated water, you are doing something good for your oral health.
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Is water fluoridation safe? How effective is it in preventing cavities?
Water fluoridation is safe, effective, and healthy. Specifically, more than six decades of research, thousands of studies and the experience of more than 184 million Americans tell us that water fluoridation is effective in preventing cavities and is safe for children and adults.
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What about mixing infant formula with fluoridated water?
The smaller size and weight of babies’ bodies mean they need less of certain things than older children and adults. By adding water with fluoride to powdered or liquid concentrate infant formula, babies under one year old may be getting more fluoride than they need. In some cases, getting more fluoride than is needed might lead to a condition called enamel fluorosis.
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What is dental enamel fluorosis? Does it harm teeth?
Enamel fluorosis is not a disease but rather affects the way that teeth look. In the vast majority of cases, enamel fluorosis appears as barely noticeable faint white lines or streaks on tooth enamel and does not affect the function or health of the teeth. In fact, in many cases, the effect is so subtle that, usually only a dental expert would notice it during an examination. Enamel fluorosis occurs only when baby and permanent teeth are forming under the gums. Once teeth break through the gums, they cannot develop enamel fluorosis.
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Will my baby get enamel fluorosis if I feed her formula that has been mixed with fluoridated water?
Children today are at no greater risk of developing enamel fluorosis from infant formula than children in previous generations. However, new research has indicated that fluoride exposure during the first year of life may play a greater role in developing enamel fluorosis than was previously thought. It's important to know that even if infants are fed formula mixed with water containing fluoride, it doesn't necessarily mean they will develop enamel fluorosis. It means they might.
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Are there ways to limit how much fluoride my baby gets during his first year of life?
Since fluoride levels in both tap and bottled water can vary, parents and caregivers should first consult with their pediatrician, family physician or dentist on the most appropriate water to use in their area to mix infant formula. Some children may have special medical needs, so be sure to ask your family physician or pediatrician whether water used for infant formula should be sterilized.
More research is needed before definitive recommendations can be made regarding fluoride intake for infants. While these studies are being conducted, the American Dental Association has posted this guidance for parents who wish to reduce their children’s fluoride intake from birth to age one:
Breast milk is widely acknowledged as the most complete form of nutrition for infants. The American Academy of Pediatrics recommends human milk for all infants (except for the few for whom breastfeeding is determined to be harmful). Babies who are breastfed do not appear to exceed the optimal amount of fluoride. Ready-to-feed formula is preferred over formula mixed with water containing fluoride to help ensure that infants do not get more fluoride than they need. Powdered or liquid concentrate infant formula can be mixed with water that is fluoride free or contains low levels of fluoride. These types of water are labeled as purified, demineralized, deionized, distilled or reverse osmosis filtered water. Many stores sell these types of drinking water for approximately $1 per gallon. Most other types of bottled water contain low fluoride concentrations but variations exist and some brands may contain optimal or higher levels. If you have questions about the fluoride content in the bottled water you use, check the label or contact the bottler. Some, but not all, home water treatment systems also remove fluoride from tap water, so check with the manufacturer.
Occasional use of fluoridated water should not greatly increase the chance of enamel fluorosis. After their first birthday, children can drink fluoridated water because they’ve grown and they weigh more. - Parents should consult with their physicians or dentists and weigh the balance between the chance of a child developing enamel fluorosis (which in the vast majority of cases simply results in barely noticeable faint white lines or streaks on tooth enamel) against the risk of not getting enough fluoride, which could result in cavities.
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What if I’m pregnant or nursing?
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.
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What about fluoride toothpaste, mouthrinse and supplements?
The ADA has long-standing recommendations concerning fluoride use. One of the most important things to remember is that if children are less than six years old, an adult should supervise their use of fluoride-containing dental products. Many children under age six have not yet fully developed their swallowing reflex, so they may be more likely to accidentally swallow fluoride toothpaste.
Fluoride Toothpaste
When children’s teeth start to appear, brush them with a child-size toothbrush. Do not use fluoride toothpaste until the child is two years old unless advised to do so by a dentist or other health professional.
For children age two and older, place only one pea-sized amount of fluoride toothpaste on the toothbrush at each brushing. Young children should always be supervised while brushing and taught to spit out, rather than swallow the toothpaste.
Fluoride Mouthrinse
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 under six years of age. Many children under age six have not yet fully developed their swallowing reflex and may be more likely to accidentally swallow fluoride mouthrinse.
Dietary Fluoride Supplements
Dietary fluoride supplements are available by prescription only from your dentist or physician for children living in areas without adequate fluoride in their water supply. If prescribed, the supplement dosage should follow the schedule approved jointly by the American Dental Association, the American Academy of Pediatrics and the American Academy of Pediatric Dentistry.
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Where can I find more information about fluoride?
You can find extensive information in “Fluoridation Facts,” the ADA’s comprehensive publication with facts from over 350 scientific references. Fluoridation Facts includes information from scientific research in an easy to use question and answer format on the topics of effectiveness, safety, practice and cost-effectiveness of fluoridation.
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Additional Resources
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to individual questions about fees, dental problems, conditions, diagnoses,
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