Friday, January 14, 2011

Recommendations for Fluoride in Drinking Water Changed

Fluoride in drinking water has prevented dental disease for many years since it's introduction. Research supports an ideal amount of fluoride of 1 ppm (parts per million). There seems to be continued beneficial effect in caries prevention as the level rises. At amounts above 4 ppm developing teeth can be affected by Fluorisis or spots or blotches on the teeth, This is not the same as hypoplasia, but can look the same. It's mainly an appearance concern as the teeth are quite resistant to caries at these elevated levels. The U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency have decided to lower the maximun level allowed in the drinking water supplies to reduce the amount of fluorisis. They are recommending that the fluoride level in drinking water be set at 0.7 ppm, replacing the current range of 0.7 to 1.2.

I think it is a good idea as I have seen a slight rise in the amount of enamel hypoplasia and/or fluorosis over the last 20 years.
I suspect it is mainly because children get fluoride from other sources like prepackaged drinks that may have unknown fluoride levels. Also, a major factor is the amount of fluoridated toothpaste swallowed by children. I always advise very small amounts of toothpaste be used for children.

Article Links:
Wall Street Journal Article
Business Week Article
ADA commends new fluoride recommendations


Miami Dentist said...

Great article. Mind if we share this on our blog and link back to you?

Dr. Dean Brandon said...


Tom said...

I think there's a big halo effect when it comes to the amount of fluoride we get. When pre-packaged foods and drinks are made with fluoridated water, it gives the consumer a lot more fluoride than they bargained for.

If you're interested, here's an interesting list prepared by the U.S. Dept. of Agriculture that shows how much fluoride is in a variety of foods that we eat.

I think they key is finding the right concentration of fluoride in the water to reduce both caries and fluorosis.

Anonymous said...

I am a dental assistant in Edmonton, AB at Summerlea Dental. I think it is a very good idea to lower fluoride levels in drinking water. We have a lot of patients who opt out have having fluoride treatment when they come in for their cleanings as they are aware of the amount of fluoride they take in naturally through water, certain foods and toothpaste.

Stephanie said...

Thanks so much for the information. I didn't know that.

Anonymous said...

My family uses bottled water because our tap water has an unpleasant taste. My twins are almost 4 now and they had flouride drops for their first year. After that I have only given them flouride pills [.25 (.55) MG] sporadically because I'm unsure of the levels they are receiving from various sources. (Not to mention flouride levels that may not be disclosed on "spring water").

They do not use toothpaste with flouride yet either. I'm afraid of doing damage to their teeth, either with too much or too little flouride. The pills I have are to be given once a day. What would you suggest?
Thanks. -Jen

Dr. Dean Brandon said...

We only prescribe fluoride ( daily at home) doses after a water analysis. That way we know the fluoride level of the water. -What dosage we Rx or not depends on that. We also look at the age of the patient and ADA guidelines. Most of the time, if I Rx at all, I go one dose smaller than indicated by age and water fluoride content. Like you said, small amounts are good, large amounts or zero amounts are not.

Dr. Dean Brandon said...

Daily fluoride by prescription is different than that in the water added by the utility company, but it is supposed to substitute for that if it is missing in that drinking water.

Here are a couple more links:

ADA Chart

ADA article on supplements

Mom in Limbo said...

Not sure if you're checking this topic anymore, but if so:

I live in Wichita, KS. We have no fluoride in our water. My daughter has some problem where some of her teeth didn't develop enamel on the entire tooth. She's 3 and just had several fillings, sealants, etc. Ugh.

Anyway, her pediatrician (who is not a dentist) prescribed a low-dose fluoride supplement.

Her dentist (who is not a pediatric dentist, but works occasionally on children) is a little unsure, thinking it might stain.

What would you suggest for a child with an enamel deficiency in a town with no fluoridated water?

Dr. Dean Brandon said...


As you can see from the recommended ADA dosage schedules, systemic fluoride would be suggested for a three year old if there was no fluoride int he drinking water. Each case is different, however. Fluoride helps the developing teeth and to some degree the ones already in the mouth to develop properly and resist decay. Most topical and systemic fluorides do not stain or change the appearance of erupted teeth. Too much systemic fluoride can affect the developing teeth and make them look funny (fluorosis is what it's called). That is why dosage circumstances and patient selection is important.

Dr. Dean Brandon said...

Oh, usually most pediatricians would not prescribe fluoride supplements without knowing about the recommended dosage tables. So, I would feel pretty confident about their recommendation.

Dr. Dean Brandon said...

Here is ada table:

ADA dosage table

Mom in Limbo said...

Thank you!

Dental Implant said...

It is a well-written blog and very informative as well. There are some people who deny the fact that fluoride is harmful for our health and teeth. I read about this a couple of week ago in some article. So,it is still not clear if fluoride is good for our health and the teeth.