Fluoride: From Birth to Adolescence
Tooth decay is one of the most common chronic diseases among children in the United States, and affects between 60-90% of school-aged children, particularly those in lower socioeconomic groups (Tham et al., 2015). In general, poor oral health can result in pain, infections, and tooth loss, which can negatively impact childhood quality of life (Chou, Cantor, Zakher, Mitchell, & Pappas, 2013). Fortunately, tooth decay is preventable! Fluoride is an essential mineral that helps strengthen tooth enamel and prevent cavities, especially in children (American Dental Association [ADA], 2014). In this article we will discuss the benefits of using fluoride, the most common concerns about fluoride intake in children, and recommendations from birth to adolescence.
Benefits of Fluoride
The most important benefit of fluoride is its association with improved dental health. More specifically, sufficient fluoride intake is associated with lower cavity rates in nearly every population, from infants to the elderly (ADA, 2014). Fluoride intake during the formative years of tooth development is linked to better overall tooth health as well as improved long-term tooth strength (ADA, 2014). The reduction in cavities will also reduce the need for fillings and tooth removal, which consequently reduces dental costs (Center for Disease Control [CDC], 2018). Studies show that preschool aged children who brushed their teeth with a standard fluoride toothpaste had a 24-29% reduced incidence of cavities (dos Santos, Nadanovsky, & de Oliveira, 2013). It is important to keep in mind that fluoride is a preventative measure and not a treatment for cavities, which is why it is important from a young age (Salas, Nascimento, Huysmans, & Demarco, 2015). If tooth decay or damage has occurred it will not be remedied with additional intake of fluoride (Salas et al., 2015).
Sources of Fluoride
Fluoride is found naturally in the environment in water and food sources, supplements, as well as in dental hygiene products (Kanduti, Sterbenk, & Artnik, 2016). Most freshwater has a small amount of naturally occurring fluoride with a concentration of 0.01-0.3 parts per million, which is not sufficient to provide protection against cavities. As of 2015, the U.S Public Health Service recommendation is that water has a fluoride concentration of 0.7 ppm or mg/L (U.S. Department of Health and Human Services [USDHHS], 2015). For this reason, many parts of the United States have introduced fluoride into the water supply in order to increase consumption; however, there are many areas in Utah that do not have fluoridated water despite the research and recommendations supporting the practice (CDC, 2018).
Current recommendations from the World Health Organization and Center for Disease Control are focused on providing fluoridated water and toothpaste to children (Petersen & Lennon, 2004; CDC, 2018). Fluoride needs vary with age and are different for children and adults (Wong et al., 2010). Table 1 includes the recommended concentrations of fluoride toothpaste to use with children of various ages. Before supplementing, it is beneficial to know the fluoride levels in the water you consume regularly. This can be done with home tests or, visit “My Water’s Fluoride” at https://nccd.cdc.gov/DOH_MWF/Default/Default.aspx on the CDC website. This can give you the best idea of the baseline amounts being ingested and whether additional supplementation is needed to reach the recommendations. Under the Affordable Care Act, insurance companies will cover preventative dental care for children, including fluoride treatments (HealthCare.gov, 2019). Talk with your child’s dentist or pediatrician if you have questions.
Table 1: Recommended Use of Fluoride Toothpaste
(Kanduti et al., 2016; Wright et al., 2014).
|6 months – 2 years||
||None up to 500 ppm|
|6 years and over||
Table 2. Extended Information on Recommendations of Fluoride and Dental Health
|Birth to 6 Months||
|6 Months to 2 Years Old||
|2 Years to 6 Years Old||
|6 Years up to 13 Years Old||
|13 Years up to 18 Years Old||
For more information on dental health in children and adolescents, talk with your pediatric dentist or visit the American Academy of Pediatric Dentistry and the American Dental Association websites.
Concerns with Excess Fluoride
The most common concern with excess fluoride is fluorosis, or visible damage and changes to the tooth enamel (USDHHS, 2015; Kanduti et al., 2017). Fluorosis occurs as a result of overexposure to fluoride in the first six years of life, when the process of tooth mineralization and enamel formation are occurring. Milder forms of fluorosis appear as lacy white marks on the teeth and discoloration, while more severe forms of fluorosis can result in pitting in the teeth (USDHHS 2015). Fluorosis can result from misuse of dental hygiene products and from drinking excessive amounts of fluoridated water in addition to supplementation (Kanduti et al., 2017). Using fluoride treatments as directed by a dentist or physician can prevent these issues from occurring. Fluoride poisoning can also occur if dental products are misused or overconsumed. The probable toxic dose level is defined as being 5 mg of fluoride per kilogram of bodyweight consumed (Kanduti et al., 2017).
- American Academy of Pediatric Dentists (AAPD). 2019. Fluoride Therapy. Retrieved from https://www.aapd.org/research/oral-health-policies--recommendations/fluoride-therapy/
- American Dental Association (ADA). 2014. Fluoride toothpaste use for young children.
- The Journal of the American Dental Association, 145(2), 190–191. doi.org/10.14219/jada.2013.47
- Center for Disease Control (CDC), Division of Oral Health. Community Water Fluoridation. November 5 2018. Retrieved June 22, 2019, from https://www.cdc.gov/fluoridation/index.html
- Chou, R., Cantor, A., Zakher, B., Mitchell, J. P., & Pappas, M. (2013). Preventing Dental Caries in Children <5 Years: Systematic Review Updating USPSTF Recommendation. Pediatrics, 132(2), 332–350. doi.org/10.1542/peds.2013-1469
- dos Santos, A. P. P., Nadanovsky, P., & de Oliveira, B. H. (2013). A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary dentition of preschool children. Community Dentistry and Oral Epidemiology, 41(1), 1–12. doi.org/10.1111/j.1600-0528.2012.00708.x
- Healthcare.gov. 2019. Preventative care benefits for children. Retrieved from https://www.healthcare.gov/preventive-care-children/
- Kanduti, D., Sterbenk, P., & Artnik B. (2016). Fluoride: A Review of Use and Effects on Health. Materia Socio Medica, 28(2), 133. doi.org/10.5455/msm.2016.28.133-137
- Petersen, P. E., & Lennon, M. A. (2004). Effective use of fluorides for the prevention of dental caries in the 21st century: The WHO approach. Community Dentistry and Oral Epidemiology, 32(5), 319–321. doi.org/10.1111/j.1600-0528.2004.00175.x
- Tham, R., Bowatte, G., Dharmage, S., Tan, D., Lau, M., Dai, X., … Lodge, C. (2015). Breastfeeding and the risk of dental caries: A systematic review and meta-analysis. Acta Paediatrica, 104, 62–84. https://doi.org/10.1111/apa.13118
- U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation (USDHHS). (2015). U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Reports, 130(4), 318–331. doi.org/10.1177/003335491513000408
- Wright, J. T., Hanson, N., Ristic, H., Whall, C. W., Estrich, C. G., & Zentz, R. R. (2014). Fluoride toothpaste efficacy and safety in children younger than 6 years. The Journal of the American Dental Association, 145(2), 182–189. doi.org/10.14219/jada.2013.37
- Wong, M., Glenny, A., Tsang, B., Lo, E., Worthington, H., & Marinho, V. (2010). Topical fluoride as a cause of dental fluorosis in children. Cochrane Library. doi.org/10.1002/14651858.CD007693.pub2
Ben Clark, Dietetics Student; Lydia Bangerter, Dietetics Student; Mateja R. Savoie-Roskos, PhD, MPH, RD; Casey Coombs, MS, RD; Carrie Durward, PhD, RD