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.”

We know from research extending back to the 1930s that very small amounts of fluoride in drinking water can significantly reduce dental caries (cavities) with no negative health effects. Fluoridated water is currently available to 70% of all Americans. However, we have also learned that excess fluoride from combined sources can result in staining of teeth called “fluorosis.”

What is the optimum fluoride concentration for healthy teeth?
A fluoride concentration of about 0.7-1.20 milligrams per liter (mg/L), or .7 to 1.2 ppm (parts per million), in the water supply seems to be optimum for dental health without causing negative effects. This concentration is about the same as a grain of salt in a gallon of water. An amount of 1 ppm was originally considered the safe standard, but since today Americans have access to more sources of fluoride than they did when water fluoridation was first introduced, the recommended amount has been reduced to .7 mg/L or .7 ppm.

The crucial amount to measure is the quantity of fluoride that is swallowed. Generally, the optimal level of fluoride per day from all sources is thought to be about .06 milligrams per kilogram of body weight, or about a sixth of the weight of a grain of salt for every two pounds of body weight.

It is probably not possible to calculate the precise amount of fluoride each person ingests per day, because the amount depends on more than just the amount of tapwater you drink. Bottled waters, soft drinks and juices also contain fluoride. Breast milk and cow's milk are very low in fluoride, but infant formulas may contain higher levels. Foods found to have high fluoride content include teas, dry infant cereals and processed chicken, fish and seafood products. Toothpaste can contribute to a child's total fluoride intake if the child swallows it.

What are the effects of too much fluoride?
Dental fluorosis produces a “mottling” of the outer coating of the tooth, the enamel. Mottling may show as staining ranging from small white striations to stained pitting and severe browning of the enamel surface.

The first six to eight years of life is the most risky time for development of dental fluorosis. Parents need to monitor their children to make sure they use small amounts of fluoride toothpaste (an amount the size of a pea on the brush is recommended). Watch for white spots on the enamel (hard outside coating) of your child's teeth. White spots from fluorosis mean it is time to pay attention to how much fluoride your child is getting from various sources, and to cut back on the total. You want fluoride's protection against cavities for your child's teeth, without the unsightliness of dental fluorosis from too much fluoride.

Contact us today to schedule an appointment to discuss your questions about fluoride. You can also learn more by reading the Dear Doctor magazine articles “Fluoride & Fluoridation in Dentistry” and “New Fluoride Recommendations.”