Approved by the American Dental Association, American Academy of Pediatrics and American Academy of Pediatric Dentistry
| Age | Fluoride Ion Level in Drinking Water (ppm)* | ||
|---|---|---|---|
| <0.3 ppm | 0.3-0.6 ppm | >0.6 ppm | |
| Birth-6 months | None | None | None |
| 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 | 1.0 mg/day | None |
| * 1.0 ppm = 1 mg/liter ** 2.2 mg sodium fluoride contains 1 mg fluoride ion. |
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Borrowed from the American Dental Association, at http://www.ada.org/public/topics/fluoride/fluoride_article01.asp (accessed on May 3, 2005).
In the United States, the typical amount of fluoride in fluoride toothpaste is 1,000--1,100 ppm. In other words, about 1.0 gram of toothpaste contains about 1.0 milligram of fluoride.
Fluoride containing toothpaste should not be used until after age 2. After age 2, only a pea-size amount should be used. This is because ingesting toothpaste increases the risk of enamel fluorosis (See What is enamel fluorosis?).
In the mild form, enamel fluorosis is an opaque, white discoloring of the teeth. In the severe form, it can cause pitting of the teeth.
Generally child toothpastes and adult toothpastes contain the same amount of fluoride. About 1.0 gram of toothpaste contains about 1.0 milligram of fluoride. Children aged 2-6 years should use no more than a pea-sized amount of toothpaste or about .25 grams. However some adult toothpastes also contain anti-gingivitis or whitening ingredients.
Children younger than 2 may use just water when brushing their teeth. Alternatively there are some non-fluoridated infant gels available that have silica that gently helps clean teeth. Children younger than 2 should not use fluoridate toothpaste unless directed by a dentist or physician.
Generally this is not recommend for children under age 6 because they are likely to swallow some or all of the mouthwash. For children older than 6 it is acceptable -- but not necessary -- for your child to use a fluoridated mouthwash as long as none is swallowed.
Generally only children who live in areas without fluoridated water take fluoride supplements. The best form of fluoride supplement is a chewable tablet or lozenge. Calculating the exact the dosage of fluoride is complex. It involves knowing how much fluoride is in the drinking water at home as well as other locations (e.g., child care, school, bottled water). Also important is how much fluoride the child is exposed to through toothpaste or mouthwash. The best person to decide if your child needs a fluoride supplement is your dentist or pediatrician.
Yes, but it can also have too much fluoride. Contact your local department of health or a private laboratory to test your well water. If your well water has more than 2.0 ppm fluoride, your dentist or physician may recommend using bottled water. This is especially important for children younger than age 8 who are at risk for enamel fluorosis (See What is enamel fluorosis?).
Sometimes it is hard to know how much fluoride is in your drinking water, whether that be from a well, a public water source or bottled water. If you have public water source, your community public health office should be able to tell you how much fluoride is in your water. In fact the EPA requires all community water suppliers to publish an annual report on water quality that includes the amount of fluoride. If you have a well water, testing is usually offered by public health departments and private companies. With bottled water, fluoride content is not always listed on the label. If this is the case contact the production company directly to find out the fluoride content.
Today many people drink bottled water instead of tap water. Even thought the FDA regulates the amount of fluoride in bottled water, fluoride content is only listed on the label of bottled water if fluoride is added during processing. In general, most bottled water contains <0.3 ppm fluoride which is lower than the 0.4-1.4 ppm found in fluoridated public water sources. (To find the exact amount of fluoride you can always contact the bottler.) Thus, if you drink primarily bottled water, you may be missing out on the benefits of fluoridated water.
Topical treatments at the dentist office are generally offered to children 3 and older. However, they do not replace systemic sources of fluoride, such as fluoridated water or fluoride supplements. Systemic sources of fluoride are ones that are ingested by your body. The amount of fluoride that is optimal to ingest depends on your drinking water source. While too little fluoride can increase the risk of dental decay, too much fluoride can lead to enamel fluorosis (See What is enamel fluorosis?).
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