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Help for sleepless parents


Fluoride is important for children's dental health, because the right amount of fluoride causes formation of enamel that is much more resistant to decay. Tooth decay results when tooth enamel is dissolved by the acids produced in the mouth by the breakdown of dietary sugars by tooth decay causing germs. Fluoride causes reduced demineralization of teeth in response to acid exposure, and enhanced remineralization and rebuilding of microscopically damaged areas. It is now known that fluoride also directly inhibits the acid forming metabolism of the decay producing bacterium (Streptococcus mutans).

Fluoridation of water supplies has reduced the incidence of children's dental caries by 40% to 50% in primary teeth, and 50% to 65% in permanent teeth. If you don't believe this, ask a dentist - he or she will tell you what happened to the cavity-filling business when fluoridation came!

Fluoride is now thought to chiefly effect its reduction in tooth decay by topical exposure to teeth already erupted, although systemic fluoride may still provide some additional protection.

There are no known adverse health effects to fluoride ingestion in low levels. It does not cause birth defects, gene mutations, or fertility problems, and it has no known effects on the digestive system, kidneys, or lungs. However, excessive fluoride exposure can be just as bad for the teeth as insufficient amounts. Fluorosis is the condition of mottling of the teeth caused by excess fluoride exposure. It produces a chalky, cloudy, or opaque appearance of the tooth enamel. In severe fluorosis, the enamel becomes soft, crumbly, and darkly stained. Some degree of fluorosis has now been noted at a rate of 50% or more in areas with fluoridated water. However, the degree of fluorosis is usually very mild and does not mean we should stop fluoridation of public water supplies.

Thus we need to balance the known great benefits of reduced tooth decay against the risks of fluorosis. Consumption of fluoridated municipal water is the best solution for most children to prevent excessive tooth decay while avoiding excessive fluoride ingestion. The optimal fluoride level in drinking water is 0.7 to 1.2 ppm (parts per million). Generally speaking, if the local water supply is fluoridated, no supplemental fluoride is needed beyond fluoridated toothpaste. Fluoride toothpaste should be used, but only tiny amounts for children under two or three. Until your child can be relied upon to spit out the toothpaste after brushing, use only a BB-sized blob of toothpaste on the brush. Teach your child to spit out the toothpaste after brushing.

Breast milk contains almost no fluoride, but because the beneficial effects of fluoride are mostly from topical exposure to the tooth enamel, breast babies do not need supplementation until the first teeth erupt at around 6 months.

For those children in areas with low fluoride well water, or whose municipal water supply is not fluoridated, use these guidelines:

  • Children who consume greater than half their daily fluid intake as bottled beverages and are prone to dental caries (cavities) should use fluoride supplementation.
  • Children who drink more than half their fluid intake from bottled beverages but seem to have a low disposition to caries can be watched without fluoride supplementation.
  • If the local water is not fluoridated, and more than half of daily fluid intake is from the local water supply, supplemental fluoride should be given.

Guidelines for fluoride supplementation levels based on fluoride levels in local water supplies appear in the table below:

Age less than
0.3 ppm
0.3-0.6 ppm greater
than 0.6 ppm
6 months-3 years 0.25 mg/day none none
3-6 years 0.50 mg/day 0.25 mg/day none
6-16 years 1.0 mg/day 0.50 mg/day none

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