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In the News (scroll down to view other articles)
Fluoride and Infant Formula
To whom does the interim guidance apply? The recommendations apply only to infants (ages birth to 12 months). What is the ADA’s interim guidance on infant formula and fluoride? The ADA’s interim guidance contains recommendations to simply and effectively reduce fluoride intake from infant formula:
Why was the interim guidance on infant formula and fluoride issued? Recent developments led the Association to offer interim guidance on infant formula and fluoride while more research is conducted. These developments include the U.S. Food and Drug Administration's health claim notification October 14 , 2006 allowing bottlers to claim that fluoridated water may reduce the risk of dental cavities or tooth decay, but not make the claim for bottled water products specifically marketed for use by infants, and the March 22 release of the National Research Council (NCR) Report: "Fluoride in Drinking Water: A Scientific Review of EPA's Standards." Studies cited in the NCR Report have raised the possibility that infants could receive a greater than optimal amount of fluoride through liquid concentrate or powdered baby formula that has been mixed with water containing fluoride during a time when their developing teeth may be susceptible to enamel fluorosis. Infants (ages birth to 12 months) need less fluoride than everyone else because of their size. While more research is needed before definitive recommendations can be made on fluoride intake and reconstituted formula, the American Dental Association issued interim guidance so parents, caregivers and health care professionals who are concerned have some simple and effective ways to reduce fluoride intake from reconstituted infant formula. The proper amount of fluoride throughout life helps prevent and control tooth decay. Some fluoride exposure to developing teeth also plays a long-term role in preventing tooth decay. The appropriate amount of fluoride throughout life is essential to prevent tooth decay. But it’s possible to get too much of a good thing. Fluoride intake above the recommended level for a child’s age creates a risk for enamel fluorosis, a condition that affects the way teeth look. In the vast majority of cases, fluorosis appears as barely noticeable faint white lines or streaks on tooth enamel and does not affect the function of the teeth. When are teeth at risk for developing enamel fluorosis? Enamel fluorosis occurs only when the teeth are under the gums and still developing. Does enamel fluorosis worsen after the teeth erupt? No. Once teeth are fully developed and erupt into the mouth they are no longer susceptible to enamel fluorosis. Can I use my tap water, which contains fluoride, to mix infant formula? Water can contain fluoride in varying amounts. Consult with your family physician or pediatrician to see if this is the most appropriate water to use. After their first birthday, children can drink infant formula mixed with water that contains fluoride because they weigh more and formula is no longer a primary part of their diet. What about “ready-to-feed” formula? Babies who drink “ready-to-feed” infant formula do not appear to exceed the optimal amount of fluoride. For infants who get most of their nutrition from formula during their first 12 months, ready-to-feed formula does not appear to increase the risk of enamel fluorosis. What if my child occasionally received formula mixed with water containing fluoride? If your infant was fed formula mixed with water containing fluoride, it doesn't necessarily mean that the child will develop enamel fluorosis. Occasional use of water containing optimal levels of fluoride should not appreciably increase a child’s risk for fluorosis. Is fluoride present in breast milk? Breast milk is very low in fluoride and does not appear to contribute to enamel fluorosis even if the mother uses oral care products that contain fluoride and drinks water containing fluoride. What if my pediatrician recommends bottled water? The U.S. Food and Drug Administration
Water labeled as purified, distilled, deionized, demineralized, or produced through reverse osmosis is known to be low in fluoride. 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. Because some children may have special medical needs, ask your family physician or pediatrician whether water used for infant formula should be sterilized. How can I help my children benefit from fluoride use while keeping an eye out so they won’t get too much? The ADA has long-standing recommendations concerning fluoride use. One of the most important things to remember is that if children are younger than six years old, an adult should supervise their use of fluoride-containing dental products. Fluoride Toothpaste When children’s teeth start to appear, brush them with a child’s 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. 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 Mouthrinse Unless 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 so they may be more likely to accidentally swallow fluoride mouthrinse. 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.
Contact Information: Please note: The ADA does not provide specific answers to individual questions about fees, dental problems, conditions, diagnoses, treatments or proposed treatments, or requests for research. Information about dental referrals, complaints and a variety of dental procedures may be found here. Please refer to our Frequently Asked Questions page before submitting an e-mail.
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(FDA) announced in October 2006 that it will allow bottlers to claim
that fluoridated water may reduce the risk of tooth decay. The ADA
agrees with the FDA that this health claim is not intended for use on
bottled water marketed to infants for whom lesser amounts of fluoride
are appropriate. The right amount of fluoride is essential to help
prevent tooth decay. But fluoride intake above optimal amounts
creates a risk for enamel fluorosis as teeth develop before they erupt
through the gums. The ADA’s