ADA Recommendation for Fluoride in Infant Diets

By Roberta C. Barbalace

[Jan. 4, 2007]

Minimizing the concentration of fluoride in infants' diets is not a new concept. In 1995 the Committee on Nutrition of the American Academy of Pediatrics recommended that infants up to the age of 6 months who are fed powdered formula should not receive supplemental fluoride unless the water supply contains less than 0.3ppm fluoride. The committee also recommended that babies 6 months to three years should not receive dietary supplements unless the water supply contains less than 0.6ppm.

In November of 2006 the American Dental Association instituted an interim policy and advised that parents and caregivers using an infant formula that needs to be reconstituted should consider using water that has no or low levels of fluoride (<0.3ppm). The fluoride content in many American cities is much higher than would be considered safe for infants. In Boston, MA, the fluoride concentration consumed in a day by infants would average 60% above the safe level of 0.7 mg/day for formula fed babies. While in Philadelphia, New York City and San Francisco over exposure for formula fed babies would average 44.6%. In Los Angeles the over exposure of formula fed babies would average only 15.5%.

You are probably wondering what health hazards have been attributed to fluoride ingestion by infants. There is increasing evidence that excessive ingestion of fluoride during infancy and early childhood may damage the tooth-forming cells and leading to defective enamel referred to as "dental fluorosis." This condition is typified by white spotting, yellow, brown and/or pitted permanent teeth. At the same time there is little indication that there is any benefit from ingesting fluoride before teeth erupt. Interestingly enough, skeletal fluorosis has also been reported in individuals exposed to increased fluoride levels during early childhood.

Several studies from the USA and China have shown that young children who drink water with fluoride levels >1.0 mg/L have a significantly lower IQ than children who are exposed to low concentrations of fluoride during early childhood. Other learning disabilities including increased reaction time, visuospacial organization were also noted in some research and suspected of affecting reading and writing abilities.

A study led by Dr. Elise Bassin, Harvard Center for Cancer Prevention, supports studies by the New Jersey Health Department and National Institute of Health indicating that boys who drink water containing fluoride levels considered to be safe by federal guidelines are 5 times more likely to have osteocarcoma (a rare bone cancer) than boys who drank unfluoridated water as young children. This is in contrast to the results reported by Bassin's dissertation adviser Chester Douglass, the chair of the Oral Health Policy and Epidemiology Department at the Harvard School of Dental Medicine. It appears that Douglass lied about the results of Bassin's work when he cited the research in his federally funded research report to the National Institute of Environmental Health Sciences (NIEHS). Douglass is on the payroll of the Colgate toothpaste company, where he is the editor of their dentists' newsletter. When a reporter from Fox News pressed Douglass for an explanation of the discrepancy, the researcher recanted what he had reported to NIEHS concerning Bassin's research, and defended the actual results and interpretations that she reported in her paper. "She did a good job there's nothing wrong with her analysis."

Research worldwide strongly suggests that fluoride is responsible for other diseases including those associated with kidney, liver, thyroid gland, and reproductive organs. How these findings relate to the ingestion of fluorinated drinking water by infants is still under investigation.

Since recent studies indicate that oral contact with fluoride and not the ingestion of fluoride is responsible for reduction in cavities, we should question why drinking water should be fortified with fluoride at all. The American Dental Association (ADA) recommends that parents not use fluoridated toothpaste for children two years and younger. Older children should be supervised to ensure that they only use a pea size amount of fluoride toothpaste at each brushing. They should also be taught to spit out rather than swallow toothpaste. Children under six years of age may not have completely developed their swallowing reflexes and may accidentally swallow fluoride toothpaste or fluoride rinse. Children under six years of age should not be given fluoride mouthwash unless recommended by a dentist or other health professional.

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Related Resources


  1. American Dental Association; Your Oral Health; Fluoride & Fluoridation; Updated 3/14/05 Accessed 12/31/06
  2. Connett, Michael; Kidney & Liver Damage found in Fluoride-Exposed Children; FAN Science Watch; July 19, 2006, Issue #30 Access 1/2/07
  3. Eden, Alvin, MD; Fluoride for Babies; The Parenting Resource Center on the Web; Last modified: Oct 24, 1995. Accessed 12/31/06
  4. Environmental Working Group; National Academy Calls for Lowering Fluoride Limits in Tap Water; Released 3/22/2006 Accessed 1/2/07
  5. Environmental Working Group, Public Affairs; Strong Link Between Fluoridated Water and Bone Cancer in Boys Department Chair With Industry Ties Misrepresented Results to Federal Authorities ; April 05, 2006 Accessed 12/31/06
  6. Hernandez, Doris A.; Fluoride May Cause Cancer Dental Health student's study contradicts her adviser's findings; The Harvard Crimson; 4/10/2006. Accessed 1/2/07
  7. More Communities Throw Out Fluoridation Fluoride Action Network; December 21, 2006 Accessed 1/2/07
  8. Organic Consumer's Association; Infants Should Not Have Fluoridated Tap Water Warns American Dental Association; 11/13/06 Accessed 1/2/07
  9. Sanchez, Olga M. D.M.D., M.S., and Noel K. Childers, D.D.S., M.S., PH.D.; Anticipatory Guidance in Infant Oral Health: Rationale and Recommendations; American Family Physicians; 12/2000 Accessed 12/31/06

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