In 2006, both the American Dental Association and the Centers for Disease Control (CDC) released a warning that fluoridated water should not be used to mix concentrated baby formula for infants one year old and younger. The CDC stated the reason for the warning as “…there may be an increased chance of dental fluorosis.”
Dental fluorosis is a condition caused by prolonged overexposure to fluoride when teeth are forming during childhood—through about 8 years of age. Excess fluoride affects tooth mineralization causing white flecks or blotches in mild cases and larger chalky spots or brown discoloration in moderate cases. With severe fluorosis, the surfaces of the teeth are rough and pitted and susceptible to chipping and cracking.
The trouble with the ADA and CDC warnings was that many parents never heard the advisories. And, even if they did, many people have limited access to an alternative water source.
Now, six years later, a New Hampshire state legislature is taking steps to make sure their constituents receive the health notices by mandating that all fluoridated public water supplies in their state must include the warning on water bills.
Too Little, Too Late?
While New Hampshire’s efforts are to be commended, many believe that there’s still not enough public awareness of the problem of excessive fluoride exposure in children. The CDC estimates that dental fluorosis now affects 41% of American children between the ages of 12-15 and more than 60% of children in fluoridated communities.
Currently about 73% of the U.S. population receives water from fluoridated water systems. Fluoridated water together with processed beverages (e.g., soft drinks and fruit juices) made with fluoridated water provide approximately 75% of a person's fluoride intake. Inadvertent swallowing of toothpaste and other dental products containing fluoride account for the balance of fluoride exposure.
Reduce Your Child’s Risk of Fluorosis
- Know the fluoride concentration of your drinking water. If you live in a state that participates in CDC’s My Water's Fluoride, you can find out your water system’s fluoridation status online. If you are on a public water system, you can call the water utility company and request a copy of the utility’s most recent Consumer Confidence Report.
- Fluoride in Ground Water. Even well water can contain fluoride so you should have your water tested by an approved lab at least once every three years. A 2008 geological survey found that 4% of private wells sampled had natural fluoride levels above the EPA maximum contaminant level which is 4.0 milligrams per liter.
- Over the Limit - In some parts of the U.S., public water systems and private wells contain a natural fluoride concentration of more than 2 mg/L, and at this concentration, children 8 years and younger have a greater chance for developing dental fluorosis, including the moderate and severe forms. Use an alternative source of water for children aged 8 years and younger if your primary drinking water contains greater than 2 mg/L of fluoride.
- For very young children, less than 2 years old - Do not use fluoride toothpaste unless advised to do so by your doctor or dentist. You should clean your child’s teeth as soon as the first tooth appears by brushing without toothpaste with a small, soft-bristled toothbrush and plain water.
- For children aged 2 to 6 years - Apply no more than a pea-sized amount of fluoride toothpaste to the brush and supervise their toothbrushing, encouraging the child to spit out the toothpaste rather than swallow it. Children at this age have poor control of their swallowing reflex and frequently swallow most of the toothpaste placed on their brush.
- Mouth rinses - Fluoride mouth rinses provide only limited reductions in tooth decay among children. Children younger than 6 years should not use a fluoride mouth rinse without parents first consulting a dentist or physician because there is a possibility for dental fluorosis if these rinses are repeatedly swallowed.
Unfortunately, fluoride isn’t the only potentially toxic chemical in your water supply. Of the 60,000 chemicals in use in the U.S., the EPA only regulates about 90 contaminants in the water supply. Learn the Facts You Need to Know for Safe, Affordable Drinking Water.
CDC– Dental Fluorosis
CDC – Dental Fluorosis Prevalence
CDC – Water Fluoridation Statistics