Is Fluoride Safe for Children? | MouthHealthy - Oral Health Information from the ADA

A Mom's Guide to Fluoride

Dr. Brittany Seymour

By Dr. Brittany Seymour
Assistant Professor, Harvard School of Dental Medicine

It was my first year out of dental school, and I was treating a two-and-a-half-year-old girl who grew up in a community without fluoride in the water. Her four front teeth were so badly decayed, painful and infected that I had to remove them completely. For a tiny toddler, the lights and sounds of the dental chair can feel terrifying. Although she was scared and crying, she held perfectly still while I treated her. I was so proud of her.

After the procedure, we were standing in the hallway with her mom and I was explaining how to care for her at home while she was healing from her dental infection. The little girl was calm now, positioned on her mother’s hip and watched me as I talked. Suddenly, in the middle of my sentence, this tiny girl reached out, threw her arms around my neck and hugged me.  Her mother and I both gasped in surprise. The little girl didn’t say anything at all, just hugged me for the longest time. I knew instantly why, and I hugged her right back.  She was finally free from her pain.

That was 11 years ago. I will never forget her or the pain my tiniest patient had been living with for so long because of cavities. Now, as the mom of a young daughter myself, this story has taken on new personal meaning. Our children deserve the healthiest start to their lives, and a healthy smile is one of the best gifts we can give them.

Treating cavities is important, but preventing cavities is best. That’s where fluoride comes in. Millions of children in the United States and around the world have been spared thanks to fluoride in tap water, toothpaste and routine dental checkups starting no later than a child’s first birthday.

Questions? Let’s talk mom-to-mom.

What’s a kid-friendly way to explain why fluoride is so important?

Use some of your child’s favorite things to describe fluoride in a way he or she can understand. Here’s what worked for me: My three-year-old daughter loves super heroes and pretending she has super powers! I explained to her that the fluoride in her water and in her toothpaste is like a superpower to fight sugar bugs on her teeth that cause cavities.  She seems to know what this means and is really good about taking care of her teeth. She is also (I’m proud to say) an excellent patient in the dental chair.

Why is fluoride important?

Did you know dental cavities are the most common disease in children and adults worldwide? Fluoride is one of the best and safest ways we can prevent cavities for children and adults alike.

Here’s how fluoride works. Your mouth contains bacteria that feed on the sugars in the foods we eat and the beverages we drink. This produces acid that can wear away the hard, outer shell of your tooth (enamel). This can lead to cavities. Fluoride protects teeth by making the your teeth stronger and more resistant to acid. It not only reduces the risk of cavities, it can even help reverse early signs of decay. Due to its success in preventing cavities, fluoride in water was named a top public health achievement in the 20th century.

Do I need to be worried about my child drinking water with fluoride?

No. Fluoridated water is easy, inexpensive and one of the best beverage choices for kids.  Sweetened drinks like fruit juice (even those labeled 100% natural), soda and sports drinks contribute to tooth decay. Fluoridated water protects teeth. Sugary drinks also contribute to weight gain, where water with fluoride is calorie-free.

Something else to keep in mind is that fluoride is natural. It is an element found at some level in all natural water sources. If you’re drinking tap water in communities that add fluoride to the public water supply, you’re getting just the right amount of fluoride to help your teeth thanks to strict standards set by the EPA. Not all bottled water has fluoride, so check the label or contact the bottler to be sure you’re getting the fluoride your teeth need. While most water filters used at home (in a pitcher or attached to the tap) do not remove fluoride, home water treatment systems such as reverse osmosis (RO) and distillation do remove significant amounts of fluoride from the water. Check with the manufacturer to learn if what you are using at home removes fluoride.

If my family uses a toothpaste with fluoride, do we also need to drink fluoridated water?

Yes! Drinking water with fluoride bathes your teeth in small amounts of fluoride throughout the day and has been found to add to the benefits of brushing with fluoride toothpaste. Drinking water with fluoride helps prevent cavities before they start.

When should I start brushing my child’s teeth, and how much fluoride toothpaste should I use?

To keep your baby’s mouth as clean as possible, use a soft cloth to wipe his or her gums clean from the start. Once those first teeth start coming through the gums, begin brushing them with a soft, child-sized toothbrush (my daughter loved her Elmo toothbrush) and a tiny smear of fluoride toothpaste about the size of a grain of rice and minimizes the amount your child swallows. This will help spread the fluoride onto teeth without your child swallowing too much, since he or she can’t really spit yet. Once your child becomes better at spitting (about age 3), use a pea-sized amount of toothpaste and have your child spit after brushing. Keep helping your child brush until at least age five or six. It may be a team effort until then (it is at our home!), but keep doing the final brushing just to be sure all the “sugar bugs” are gone. Stickers help!

Do I need to worry if my child swallows toothpaste with fluoride?

Not if you are using the recommended amount of toothpaste for your child’s age and supervising their brushing to prevent unnecessary swallowing. Fluoride toothpaste is recommended for babies and toddlers by the American Academy of Pediatrics, the American Association of Pediatric Dentistry, and the American Dental Association.  For more information, see Toothbrushing Tips for Young Children.

How common is dental fluorosis, and how can I prevent it?

Dental fluorosis happens before age 8 and is caused by getting too much fluoride when teeth are forming below the gums and before they appear in the mouth. It is mostly a cosmetic issue with no negative health effects.

It is estimated that less than 1 in 4 people between the ages of 6-49 have fluorosis, which most often can only be seen by a dental professional. Less than 2% of people are categorized as having anything more than mild fluorosis, which looks like small white spots on the teeth. To minimize the risk of visible fluorosis, teach your children to spit, not swallow toothpaste or mouthwash/rinse after use. Talk to your dentist about any questions or concerns you may have and about which dental products are right for your child.

What should I know about mixing formula in fluoridated water?

According to both the American Academy of Pediatrics and the American Dental Association, it is absolutely safe to mix infant formula with fluoridated water. Babies who are exclusively formula fed might have an increased risk for mild dental fluorosis, so discussing your baby’s needs with your dentist and pediatrician is important.

When should I start taking my child to the dentist?

Schedule your child first dental visit no later than his or her first birthday. If your baby has teeth, he or she can get cavities! This early start is important for you and your child to begin good habits and develop a positive relationship with your dentist.

My child’s dentist has recommended he or she receive a fluoride treatment. How will it help, and what can I expect during the visit?

Fluoride treatments prevent cavities by strengthening the hard, outer shell of teeth, and they may even reverse very early cavities that have just started forming. A fluoride treatment is quick and painless. Your dentist will paint a thin layer of fluoride varnish on your child’s teeth. Fluoride varnish is a sticky yellow or orange substance that often has a pleasant taste. The varnish application is fast and sets quickly. Your child may be advised to avoid eating of drinking for a short period of time (maybe 30 minutes) after the treatment.