CDC and ADA Now Advise to Avoid Using Fluoride

A new study in the Journal of the American Dental Association finds once again that, contrary to what most people have been told, fluoride is actually bad for teeth.

Exposure to high levels of fluoride results in a condition known as fluorosis, in which tooth enamel becomes discolored. The condition can eventually lead to badly damaged teeth. The new study found that fluoride intake during a child's first few years of life is significantly associated with fluorosis, and warned against using fluoridated water in infant formula.

The Centers for Disease Control and Prevention (CDC) is of a similar opinion. According to their website:

"Recent evidence suggests that mixing powdered or liquid infant formula concentrate with fluoridated water on a regular basis may increase the chance of a child developing ... enamel fluorosis."

THE STUDY J Am Dent Assoc. 2010 Oct;141(10):1190-201.
Associations between fluorosis of permanent incisors and fluoride intake from infant formula, other dietary sources and dentifrice during early childhood.
Levy SM, Broffitt B, Marshall TA, Eichenberger-Gilmore JM, Warren JJ. Source Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa 52242-1010, USA. steven-levy@uiowa.edu
Abstract

OBJECTIVES: The authors describe associations between dental fluorosis and fluoride intakes, with an emphasis on intake from fluoride in infant formula.

METHODS: The authors administered periodic questionnaires to parents to assess children's early fluoride intake sources from beverages, selected foods, dentifrice and supplements. They later assessed relationships between fluorosis of the permanent maxillary incisors and fluoride intake from beverages and other sources, both for individual time points and cumulatively using area-under-the-curve (AUC) estimates. The authors determined effects associated with fluoride in reconstituted powdered infant formulas, along with risks associated with intake of fluoride from dentifrice and other sources.

RESULTS: Considering only fluoride intake from ages 3 to 9 months, the authors found that participants with fluorosis (97 percent of which was mild) had significantly greater cumulative fluoride intake (AUC) from reconstituted powdered infant formula and other beverages with added water than did those without fluorosis. Considering only intake from ages 16 to 36 months, participants with fluorosis had significantly higher fluoride intake from water by itself and dentifrice than did those without fluorosis. In a model combining both the 3- to 9-months and 16- to 36-months age groups, the significant variables were fluoride intake from reconstituted powder concentrate formula (by participants at ages 3-9 months), other beverages with added water (also by participants at ages 3-9 months) and dentifrice (by participants at ages 16-36 months).

CONCLUSIONS: Greater fluoride intakes from reconstituted powdered formulas (when participants were aged 3-9 months) and other water-added beverages (when participants were aged 3-9 months) increased fluorosis risk, as did higher dentifrice intake by participants when aged 16 to 36 months.

CLINICAL IMPLICATIONS: Results suggest that prevalence of mild dental fluorosis could be reduced by avoiding ingestion of large quantities of fluoride from reconstituted powdered concentrate infant formula and fluoridated dentifrice.

Overview: Infant Formula and Fluorosis

The proper amount of fluoride from infancy through old age helps prevent and control tooth decay. Community water fluoridation is a widely accepted practice for preventing and controlling tooth decay by adjusting the concentration of fluoride in the public water supply.

Fluoride intake from water and other fluoride sources, such as toothpaste and mouthrinses, during the ages when teeth are forming (from birth through age 8) also can result in changes in the appearance of the tooth’s surface called dental fluorosis. In the United States, the majority of dental fluorosis is mild and appears as white spots that are barely noticeable and difficult for anyone except a dental health care professional to see.

Recent evidence suggests that mixing powdered or liquid infant formula concentrate with fluoridated water on a regular basis may increase the chance of a child developing the faint, white markings of very mild or mild enamel fluorosis.

You can use fluoridated water for preparing infant formula. However, if your child is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance for mild dental fluorosis. To lessen this chance, parents can use low-fluoride bottled water some of the time to mix infant formula; these bottled waters are labeled as de-ionized, purified, demineralized, or distilled.

What is the best source of nutrition for infants?

Breastfeeding is ideal for infants. CDC is committed to increasing breastfeeding throughout the United States and promoting optimal breastfeeding practices. Both babies and mothers gain many benefits from breastfeeding. Breast milk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections. More can be learned about this subject at http://www.cdc.gov/breastfeeding/.

If breastfeeding is not possible, several types of formula are available for infant feeding. Parents and caregivers are encouraged to speak with their pediatrician about what type of infant formula is best suited for their child.

Why is there a focus on infant formula as a source of fluoride?

Infant formula manufacturers take steps to assure that infant formula contains low fluoride levels—the products themselves are not the issue. Although formula itself has low amounts of fluoride, if your child is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance for mild dental fluorosis.

Infants consume little other than breast milk or formula during the first 4 to 6 months of life, and continue to have a high intake of liquids during the entire first year. Therefore, proportional to body weight, fluoride intake may be higher for younger or smaller children than for older children, adolescents, or adults.

What types of infant formula may increase the chance of dental fluorosis?

There are three types of formula available in the United States for infant feeding. These are powdered formula, which comes in bulk or single-serve packets, concentrated liquid, and ready-to-feed formula. Ready-to-feed formula contains little fluoride and does not contribute to development of dental fluorosis. Those types of formula that require mixing with water—powdered or liquid concentrates—can be a child’s main source of fluoride intake (depending upon the fluoride content of the water source used) and may increase the chance of dental fluorosis.

Can I use optimally fluoridated tap water to mix infant formula?

Yes, you can use fluoridated water for preparing infant formula. However, if your child is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance for mild dental fluorosis. To lessen this chance, parents can use low-fluoride bottled water some of the time to mix infant formula; these bottled waters are labeled as de-ionized, purified, demineralized, or distilled.

How can I find out the level (concentration) of fluoride in my tap water?

The best source of information on fluoride levels in your water system is your local water utility. Other knowledgeable sources may be a local public health authority, dentist, dental hygienist, or physician. CDC’s Web site My Water’s Fluoride allows consumers in some states to learn the fluoridation status of their water system. Nearly all tap water contains some natural fluoride, but, depending on the water system, the concentration can range from very low (0.2 mg/L fluoride or less) to very high (2.0 mg/L fluoride or higher). Approximately 72% of all public water systems serving about 195 million people adjust the fluoride in their water to the level recommended to prevent tooth decay.

Will using only low fluoride water to mix formula eliminate my child’s risk for dental fluorosis?

Using only water with low fluoride levels to mix formula will reduce, but will not eliminate, the risk for dental fluorosis. Children can take in fluoride from other sources during the time that teeth are developing (birth through age 8). These sources include drinking water, foods and beverages processed with fluoridated water, and dental products, such as fluoride toothpaste, that can be swallowed by young children whose swallowing reflex is not fully developed.

Additional Resource

Dental Fluorosis – Learn more about simple steps to reduce your child’s risk for dental fluorosis.